Abstract
Hodgkin lymphoma (HL) is a unique hematopoietic neoplasm characterized by cancerous Reed-Sternberg cells in an inflammatory background. Patients are commonly diagnosed with HL in their 20s and 30s, and they present with supradiaphragmatic lymphadenopathy, often with systemic B symptoms. Even in advanced-stage disease, HL is highly curable with combination chemotherapy, radiation, or combined-modality treatment. Although the same doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapeutic regimen has been the mainstay of therapy over the last 30 years, risk-adapted approaches have helped de-escalate therapy in low-risk patients while intensifying treatment for higher risk patients. Even patients who are not cured with initial therapy can often be salvaged with alternate chemotherapy combinations, the novel antibody-drug conjugate brentuximab, or high-dose autologous or allogeneic hematopoietic stem cell transplantation. The programmed death-1 inhibitors nivolumab and pembrolizumab have both demonstrated high response rates and durable remissions in patients with relapsed/refractory HL. Alternate donor sources and reduced-intensity conditioning have made allogeneic hematopoietic stem cell transplantation a viable option for more patients. Future research will look to integrate novel strategies into earlier lines of therapy to improve the HL cure rate and minimize long-term treatment toxicities. CA Cancer J Clin 2018;68:116-132. © 2017 American Cancer Society.
Overview
- The study focuses on Hodgkin lymphoma (HL), a cancerous hematopoietic neoplasm characterized by Reed-Sternberg cells in an inflammatory background. The hypothesis being tested is the effectiveness of different treatment options for HL, including risk-adapted approaches, salvage therapy, and novel immunotherapies. The methodology used for the experiment includes a review of the literature and analysis of clinical trials. The primary objective of the study is to provide an overview of the current treatment options for HL and their effectiveness in improving the cure rate and minimizing long-term treatment toxicities.
Comparative Analysis & Findings
- The study compares the outcomes observed under different experimental conditions or interventions for HL, including risk-adapted approaches, salvage therapy, and novel immunotherapies. The results show that risk-adapted approaches have helped de-escalate therapy in low-risk patients while intensifying treatment for higher risk patients. Patients who are not cured with initial therapy can often be salvaged with alternate chemotherapy combinations, the novel antibody-drug conjugate brentuximab, or high-dose autologous or allogeneic hematopoietic stem cell transplantation. The programmed death-1 inhibitors nivolumab and pembrolizumab have demonstrated high response rates and durable remissions in patients with relapsed/refractory HL. The study highlights the key findings of the study and how they relate to the initial hypothesis, which is that different treatment options have varying effectiveness in improving the cure rate and minimizing long-term treatment toxicities.
Implications and Future Directions
- The study's findings have significant implications for the field of research and clinical practice, as they provide insights into the effectiveness of different treatment options for HL. The study identifies limitations, such as the need for more research on the long-term effects of these treatments. Future research directions include integrating novel strategies into earlier lines of therapy to improve the HL cure rate and minimize long-term treatment toxicities. The study suggests that allogeneic hematopoietic stem cell transplantation is a viable option for more patients, and alternate donor sources and reduced-intensity conditioning have made it possible.