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Hodgkin Lymphoma: Improved Healing Through Shorter Therapy?


Physicians are studying the impact of shortened therapy for Hodgkin lymphoma

The so-called advanced Hodgkin lymphoma is treated with the help of chemotherapy. While such treatment works effectively, it often has very severe acute and long-term side effects. Eight cycles of chemotherapy lead to a survival rate of approximately 90 percent after five years. Researchers have now managed to reduce the therapy to just four cycles if those affected respond positively to the treatment after just two cycles.

In their investigation, the scientists at Cologne University Hospital found that the chemotherapy used in advanced Hodgkin lymphoma can be significantly reduced if those affected respond well to the first two cycles of treatment. The doctors published the results of their study in the English-language journal "The Lancet".

Therapy should become shorter without losing effectiveness

Hodgkin's lymphoma is treated with very intensive chemotherapy. Such treatment takes eight cycles to lead to a 90 percent survival rate. Doctors were looking for ways to possibly reduce the duration of previous therapy. The aim of the German Hodgkin Study Group (DHSG) is to reduce the intensity of the therapy and also to improve tolerability. However, the effectiveness of the treatment must not be lost, the scientists explain.

Significant therapy reduction on just four cycles is possible

"The results of the current HD18 study by the DHSG have now shown that a significant reduction in therapy to only four cycles is possible if they (the patients) have already responded well to treatment after two cycles," said Professor Dr. Peter Borchmann, senior physician in Clinic I for internal medicine at the university hospital.

Experts examine over 2,000 subjects

A total of 300 centers in five European countries (Germany, Austria, Switzerland, the Netherlands and the Czech Republic) were involved in the current study. For their study, the doctors examined 2,001 patients between the ages of 18 and 60. The subjects had previously received an initial diagnosis of advanced Hodgkin lymphoma. At the beginning of treatment, the participants received two cycles of the current standard therapy (escalated BEACOPP). This was followed by a so-called nuclear medical examination (positron emission tomography, PET). In addition, classic computer tomography (CT) was carried out by the doctors. Computer tomography makes it possible to visualize the metabolism in tissues. Not only can the size be determined by PET and CT, but the vitality of a tumor can also be checked and assessed, the doctors explain.

Participants were divided into two groups

If the participants responded positively to the early therapy (PET negative), they were then randomly divided into two therapy groups. These received either six further cycles or a greatly reduced number of only two cycles of therapy. The scientists found that therapy with only four cycles is just as effective for patients as therapy that is normally administered and that runs over eight cycles. When chemotherapy was complete, all patients were examined for the remains of tumors. If tumor remains were discovered, the radiation had to be continued, the authors say.

Fewer cycles of treatment reduce side effects

Fewer cycles also reduced the acute and long-term side effects of the treatment. The survival of the participants also improved significantly, the authors say. After five years, the survival rate was 98 percent. The entire therapy was also reduced from 24 weeks to just 12 weeks. "Patients can therefore use rehabilitation therapy earlier and find their way back to life, which contributes significantly to the quality of life," explains Professor Borchmann in a press release.

Conventional chemotherapy works reliably and ensures patient survival

If the participating patients were still PET-positive after two cycles of chemotherapy, the doctors examined in their study an intensification of the treatment by taking a so-called targeted antibody (rituximab), in addition to the classic chemotherapy regimen. The results of the investigation showed that controlling tumors with the help of conventional chemotherapy works so well that another drug would not bring any additional benefit. This is good news for those affected. Even if the patient does not respond early to treatment, with the help of proven chemotherapy, they have a very good chance of surviving. The cure rate is 96 percent after five years.

Adaptation of the current therapy is possible

Based on the current results, an adjustment of the overall therapy intensity can now be sought if patients respond to chemotherapy early. The researchers hope that this could become a new standard treatment. Because such an adaptation of the current therapy could really be decisive for a more tolerable, individualized, shorter and yet highly effective treatment for cancer. (as)

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