Research in Hodgkin lymphoma

We are always learning more about cancer. Researchers and healthcare professionals use what they learn from research studies to develop better practices that will help prevent, find and treat Hodgkin lymphoma (HL). The following is a selection of research showing promise for treating HL.

We've included information from the following sources. Each item has an identity number that links to a brief overview (abstract).

• PubMed, US National Library of Medicine (PMID)
• American Society of Clinical Oncology (ASCO)
• Canadian Cancer Trials and ClinicalTrials.gov (NCT)

Researchers are looking for ways to improve chemotherapy as a treatment for HL.

PET-guided treatment uses PET scans to find out how well HL is responding to treatment after 2 cycles of chemotherapy. If HL responds well to chemotherapy, then the person doesn't need to have as many treatments. People with HL that does not respond as well to 2 cycles of chemotherapy are still given the full number of treatments. While both groups had the same survival, the group having less chemotherapy had fewer side effects (The Lancet, PMID 29061295).

Intensive chemotherapy treatment with radiation therapy improves overall survival in people with advanced HL. An evaluation of the long-term survival data from 2 clinical trials found that the most effective chemotherapy combination was escalated BEACOPP. BEACOPP is bleomycin (Blenoxane), etoposide (Vepesid, VP-16), doxorubicin (Adriamycin), cyclophosphamide (Cytoxan, Procytox), vincristine (Oncovin), procarbazine (Natulan) and prednisone. Escalated BEACOPP means that this combination is given over a shorter period of time (every 14 days rather than every 21 days). The researchers also noted that less toxic but equally effective treatments are needed for HL because of the long-term side effects of current treatments, such as second cancers (Lancet Haematology, PMID 30290903).

A stem cell transplant uses high-dose chemotherapy to kill all the cells in the bone marrow. This includes both healthy cells and lymphoma cells. After high-dose chemotherapy, healthy stem cells are given to replace the ones in the bone marrow that were destroyed. Researchers are looking for the best ways to treat HL using stem cell transplant.

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare type of HL. An autologous stem cell transplant stores stem cells from a person's own body and gives them back to them after high-dose chemotherapy. While this type of treatment has been used for the most common types of HL, it isn't known if it will be an effective treatment for NLPHL that comes back after treatment (relapses) or doesn't respond to treatment (refractory). Research shows that NLPHL responded well to autologous stem cell transplant and that this treatment led to good long-term survival (American Journal of Hematology, PMID 277531149).

Stem cell transplant after high-dose chemotherapy may be a safe treatment option for HL in some carefully selected healthy people who are older than 70 years of age. A study concluded that doctors should not use a person's age to rule out stem cell transplant as a treatment option (ASCO, Abstract e19003).

People with Hodgkin lymphoma and HIV may be able to have an allogeneic stem cell transplant, where stem cells are taken from a donor. In the past doctors preferred not to offer an allogeneic transplant because it can lead to a life-threatening infection. But a study of people with HIV infection and a blood cancer or HL found that carefully selected people treated with an allogeneic transplant and intensive anti-HIV therapy did not have a relapse causing death at 100 days after the transplant or infections that caused death at 1 year after the transplant. The study concluded that doctors should consider an allogeneic transplant as a treatment option for people in this group if they meet the eligibility criteria (ASCO, Abstract 7006).

Targeted therapy uses drugs or other substances to target specific molecules (usually proteins) involved in cancer cell growth while limiting harm to normal cells. A key area of research is looking at better ways to treat HL with targeted therapy.

Brentuximab vedotin (Adcetris) is a targeted therapy drug used to treat advanced HL that has come back after treatment (relapsed) or has stopped responding during treatment (refractory). Studies are being done to see if it can be used as the first treatment for people with newly diagnosed Hodgkin lymphoma. One study compared A+AVD with AVBD. A+AVD is brentuximab vedotin, doxorubicin, vinblastine (Velbe) and dacarbazine (DTIC). AVBD is doxorubicin, bleomycin, vinblastine and dacarbazine. Results show that A+AVD was the better treatment with lower rates of progression and death (New England Journal of Medicine, PMID 29224502; ASCO, Abstract 7541).

Bendamustine (Treanda) and brentuximab vedotin were combined in a study in people with HL that was no longer responding to chemotherapy. Bendamustine is a chemotherapy drug used for some types of leukemia and non-Hodgkin lymphoma. Researchers hoped that the combination of the 2 drugs would achieve a complete response, which means that there is no evidence of cancer after treatment. Having a complete response to treatment is needed before having a stem cell transplant. Results of the study show that a high number of people had a complete response after treatment with bendamustine and brentuximab vedotin, and they were able to have a stem cell transplant as part of their treatment (British Journal of Haematology, PMID 27984643).

Immunotherapy uses the immune system to help destroy cancer cells. It is sometimes called biological therapy. Researchers are looking for the best ways to treat HL using immunotherapy.

Nivolumab (Opdivo) is a PD-1 checkpoint inhibitor. PD-1 is an immune checkpoint protein that stops T cells from attacking other cells in the body. It does this by attaching to PD-L1, a protein found on some normal cells and some cancer cells. Some cancer cells have a lot of PD-L1, which helps protect them from being attacked by T cells. Research suggests that the cancers with higher PD-L1 may respond better to PD-1 checkpoint blockade immunotherapy. Some studies show that nivolumab may be an effective treatment for people who have relapsed or refractory HL (Cochrane Database of Systematic Reviews, PMID 30001476; Journal of Blood Medicine, PMID 28546779). Clinical trials are continuing to look at the role of nivolumab, in combination with targeted therapy drugs, as a treatment for HL (ClinicalTrials.gov, NCT 02304458, NCT 03712202).

Sintilimab (IBI308) is another type of PD-1 checkpoint inhibitor. A small trial looked at using sintilimab in people with relapsed or refractory HL. While the trial looked mostly at the side effects of the drug, it found that the drug produced responses, including complete responses (ASCO, Abstract 7536).

CAR T-cell therapy takes millions of T cells from a person with cancer. In the lab, they are changed so they have chimeric antigen receptors (CARs) on their surface. These receptors recognize a specific antigen (protein) found on the type of cancer cell being treated. The T cells are then given back to the person where they multiply, attack and destroy the cancer cells. Researchers are exploring CAR T-cell therapy as a treatment for HL that has come back after stem cell transplant (Nature Reviews: Clinical Oncology, PMID 28857075; ClinicalTrials.gov, NCT 02690545).

Researchers continue to try to find out more about cancer. Clinical trials are research studies that test new ways to treat cancer. They also look at ways to prevent, find and manage cancer. Clinical trials provide information about the safety and effectiveness of new approaches to see if they should become widely available. Most of the standard treatments for cancer were first shown to be effective through clinical trials.

Learn more about clinical trials.