Hodgkin Lymphoma Patients Adequately Treated With Chemotherapy Without Radiotherapy

Hodgkin Lymphoma Patients Adequately Treated With Chemotherapy Without Radiotherapy

An ongoing clinical trial from University College London in collaboration with Christie Hospital NHS Foundation Trust found that patients with Stage IA or Stage IIA Hodgkin Lymphoma may be adequately treated with chemotherapy alone and do not need to undergo radiotherapy to be free from disease. The findings of the trial, “PET Scan in Planning Treatment in Patients Undergoing Combination Chemotherapy For Stage IA or Stage IIA Hodgkin Lymphoma (RAPID),” were reported for 571 patients who have already undergone three cycles of doxorubicin hydrochloride IV, bleomycin sulfate IV, vinblastine IV, and dacarbazine IV (ABVD) and positron-emission tomography (PET) scanning. Results are showing that a majority of patients may not need to undergo radiotherapy in addition to combination chemotherapy to remain disease-free three years later.

The goal of the Phase 3 study is to learn how combination chemotherapy can adequately treat Hodgkin Lymphoma patients without further treatment with radiotherapy. Radiotherapy can cause long-term side effects, including heart disease and second cancers, motivating the interest in limiting patient exposure to radiation treatment.

Three groups of patients were formed from the 602 Stage IA or Stage IIA Hodgkin Lymphoma patients enrolled in the trial. All groups received the same ABVD treatment and underwent PET scanning. For those patients who had a positive result that indicated remaining cancerous growth, 30 Gy of involved field radiotherapy (IFRT) were delivered in daily fractions of 1.8 – 2.0 Gy. Anyone in the group who had a negative PET finding after undergoing chemotherapy and PET was assigned to one of two groups. One group received IFRT and the other group received no radiation therapy for their cancer.

As reported in the writeup for the clinical trial, which was entitled “Results of a Trial of PET-Directed Therapy for Early-Stage Hodgkin’s Lymphoma” and published in the journal New England Journal of Medicine, the survival rate of all patients was over 90%. For the non-IFRT patients, 90.8% survived without seeing worsening of their lymphoma, while 94.6% of IFRT-receiving patients saw no disease worsening. However, overall survival for the non-radiotherapy group was 99%, and for the IFRT group, 97.1%. The authors attribute the higher survival in non-IFRT patients to less damage in healthy tissues.

“This research is an important step forward,” said Professor John Radford, leader of the trial in The University of Manchester, in a news report from Leukaemia & Lymphoma Research. “The results of RAPID show that in early stage Hodgkin lymphoma radiotherapy after initial chemotherapy marginally reduces the recurrence rate, but this is bought at the expense of exposing to radiation all patients with negative PET findings, most of whom are already cured.” In other words, a personalized approach to treating blood cancers can be safely deployed by determining an individual’s risk of disease progression and adjusting treatment accordingly.

One patient is particularly excited about the results of the trial. “When my end of chemo PET scan came back clean I cannot tell you the relief and joy I felt,” said Shiv Meaker, who was diagnosed with Hodgkin Lymphoma in 2012 when she was 33. “It meant my chemo had worked and the possibility of radiotherapy, more uncertainty, yet more pressing hold on my life, was lifted.”

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Maureen Newman is a researcher by trade, and brings her knowledge of the lab to her reporting. Currently, she is serving as a PhD student at University of Rochester, and working towards a career of research in biomaterials for drug delivery and regenerative medicine. She is an integral part of Dr. Danielle Benoit’s laboratory, where she is investigating bone-homing therapeutics for osteoporosis treatment.

One comment

  1. florie fryer says:

    I can not mention his name,but this guy has a defuse large Bcell NHL for almost 2 years,diagnose in April 2015.He had his treatment in Springfield,an hour away from his home and also sometimes in Jacksonville IL 36 hrs away.
    Then on his last 6 cycles of treatment,he had a Petscan,etc.. then his result was seen on Dec 10th,2015 His lymphoma is now in his lungs or ribs.So he went to Specialist on March 17th,2016 at BarnesJewish in St louis the Dr recommend a stem cell trans but he was not elligible,chemo did not work.So he started Clinical trials for Cart tcell on June7th for 2 weeks and he had to stay for another week to make sure hes fine.
    Then on July7th,he didn’t get his complete remission.And 3 weeks was his follow up,his NHL came back and on his back and ribs.It started on his pancreas,when he was first diagnose.
    On Thursday and Friday,hes having his 2nd Chemos for the study med and after 5-6 months he’ll have a stem cell transplant if he gets a complete remission.
    Last week,he’s Chemo wS DELAYED for another week due to Low platelets,the DR says it has to be at least 75 to receive a treatment.So he’ll receive it this coming Thursday n Friday.
    Those platelets are those the healthy cells,that was affected with Chemo? Thanks in advance for responding.

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