Hodgkin's lymphoma research

All treatments have to be fully researched before they can be adopted as standard treatment for everyone. This is so that

• We can be sure they work
• We can be sure they work better than the treatments that are available at the moment
• They are known to be safe

First, treatments are developed and tested in laboratories. For ethical and safety reasons, experimental treatments must be tested in the laboratory before they can be tried in patients. If a treatment described here is said to be at the laboratory stage of research, it is not ready for patients and is not available either within or outside the NHS.

Tests in patients are called clinical trials. The trials and research section has information about what trials are including information about the 4 phases of clinical trials. If you are interested in taking part in a clinical trial, visit our searchable clinical trials database. If there is a trial you are interested in, print it off and take it to your own specialist. If the trial is suitable for you, your doctor will need to make the referral to the research team. The database also has information about closed trials and trial results.

We don’t know exactly what causes Hodgkin’s lymphoma. There is a study looking at the possible causes in children as well as adults. The researchers are looking at tissue and blood samples taken from people with Hodgkin’s lymphoma. They use the samples to look at DNA and find out about any viruses the person may have had. They are especially interested in a virus called Epstein Barr, which we know can be linked to Hodgkin’s lymphoma. The researchers hope that they will also find out why treatment for Hodgkin’s lymphoma works better for some people than others.

All the new approaches covered here are the subject of ongoing research. Until studies are completed and new effective treatments are found, these treatments cannot be used as standard therapy for Hodgkin’s lymphoma.

Some trials are using newer chemotherapy drugs and combinations of drugs to treat people whose lymphoma has come back since it was first treated. A trial has been comparing the standard chemotherapy of ABVD with another combination called Stanford V. Stanford V is a combination of 6 chemotherapy drugs and steroids. The drugs are mustine, doxorubicin (Adriamycin), vinblastine, vincristine, bleomycin, and etoposide. The treatment is more intensive than ABVD but it is a shorter course. You usually have ABVD over about 6 months. This trial found that there was no difference between the two treatments.

One trial is looking at giving a higher dose of doxorubicin in ABVD chemotherapy. Researchers want to work out the highest dose of doxorubicin that can be given safely. Doctors hope that for more people this treatment might be able to get rid of the lymphoma completely. They also want to see if certain substances in the body (biomarkers) can show how well the treatment is working. This trial is now closed and we are waiting for the results. 

The EORTC 20012 trial is trying to find out whether ABVD or BEACOPP chemotherapy is better for advanced Hodgkin’s lymphoma. BEACOPP is bleomycin, etoposide, Adriamycin (doxorubicin), cyclophosphamide, Oncovin (vincristine), procarbazine and the steroid prednisolone. BEACOPP is a more intensive treatment than ABVD so it is likely to cause more severe side effects. This trial has closed and we are waiting for the results.

The 18 to 30 study is investigating whether young adults with Hodgkin's lymphoma might do better with chemotherapy that is usually given to children. The chemotherapy drugs used include some of those mentioned above, as well as cyclophosphamide and procarbazine.

Only about 1 in 4 cases of Hodgkin's lymphoma are in people over 60. But it is more difficult to treat Hodgkin’s lymphoma in this age group. This is mainly because it is harder to cope with the side effects of intensive treatment. The SHIELD trial showed that doctors could treat people over 60 with a new combination of chemotherapy called VEPEMB, instead of the more intensive ABVD treatment.

Researchers are looking into whether using a PET scan can help them to make decisions about treatment for Hodgkin's lymphoma. ABVD is a common treatment for Hodgkin's lymphoma. Most people are cured with it but some people need more treatment and others may need less. The RATHL trial aims to find out whether a PET scan early in the treatment can tell how well the treatment is working and whether they can stop the bleomycin for people whose scan shows there is no active lymphoma. ABVD includes a drug called bleomycin. It can cause lung damage and doctors want to see if some people can safely have less of it. For people whose lymphoma is still active on the PET scan the trial also aims to find out if changing to a more intensive chemotherapy helps.

The EuroNet PHL-LP1 study is looking at treatment for children and young people (under the age of 18) with nodular lymphocyte predominant type Hodgkin's lymphoma. Doctors think that children with this type of lymphoma may be able to have less chemotherapy than people with classical types of Hodgkin's lymphoma. And some may be able to have surgery alone and not need any chemotherapy at all. In this study, the researchers want to find out whether this group of patients need to have any further treatment after surgery to remove their lymphoma.

You can click on the drug name links above to find out more about the specific side effects of each drug. You can find details of trials for Hodgkin's lymphoma on our clinical trials database. Pick 'Hodgkin's lymphoma' from the dropdown list.

Platelet transfusions are often given during treatment for Hodgkin's lymphoma to prevent bleeding. Chemotherapy can slow the production of platelets by the bone marrow so there are less in the blood. If the level of platelets gets very low, you may bruise easily, have nosebleeds, or bleed more than usual from cuts or grazes. Doctors check your level of platelets and if they are very low you are normally given platelets through a drip.

Doctors don't really know if these platelet transfusions are needed to prevent bleeding. There are small risks associated with platelet transfusions. Some people have a reaction to the platelets and sometimes this can be serious. Also, there is a small risk of getting an infection from transfusions.

The TOPPS trial in the UK is finding out if platelet transfusions are really needed for people who have a low platelet count, but no signs of bleeding. The aim is to compare different ways of using platelet transfusions. This may affect the way doctors use them in the future.

Scans are being used to assess the need for treatment or how well treatment has worked. There are trials looking at 

• PET scans
• MRI scans

PET scans

A scan called a PET scan can show up areas of active cancer in the body. This may help doctors know how well treatment for Hodgkin's lymphoma has worked. Early stage Hodgkin's lymphoma is usually treated with chemotherapy and radiotherapy. At the moment there is no way of knowing how well chemotherapy has worked. So all patients go on to have radiotherapy. Doctors think that some patients may be having radiotherapy without really needing it. 

The RAPID trial is looking to see if PET scans can help doctors decide which patients need radiotherapy. The trial has closed and we are waiting for the results. The RATHL trial is looking at how PET scans might help to decide treatment for people with more advanced Hodgkin's lymphoma (stage 2B, 3 or 4). After 2 cycles of ABVD chemotherapy, you have a PET scan. Doctors hope that this scan will tell them who can then safely be given less chemotherapy, and who needs more intensive chemotherapy, and possibly radiotherapy.

MRI scans

Cancer Research UK is funding the MELT study. The study is looking at a new type of magnetic resonance imaging (MRI) scan. It wants to find out how good the scan is at assessing Hodgkin’s lymphoma and its response to treatment in children and young people.

These trials are listed on our clinical trials database. Choose 'Hodgkin's lymphoma' from the dropdown list of cancer types.

Researchers are testing some biological therapy drugs for some types of Hodgkin's lymphoma. These include monoclonal antibodies and drugs that block cell growth. 

Monoclonal antibodies

Monoclonal antibodies target proteins called receptors found on some Hodgkin's lymphoma cells. Sometimes monoclonal antibodies are attached to chemotherapy drugs or radioactive molecules so that this anti cancer treatment can be delivered straight to the cancer cells. This is called targeted treatment. CHT25 is a monoclonal antibody that targets the CD25 receptor found on some lymphoma cells. I stands for Iodine-131. So I-CHT25 is the CHT25 antibody attached to a radioactive iodine molecule. The aim of the treatment is that the CHT25 binds to the CD25 receptors on the lymphoma cells and the radioactivity kills the cells. An early phase 1 trial found a safe dose of I-CHT25 that didn’t cause serious side effects. They also found that the drug helped about two thirds of the people in this trial. The researchers are now planning a phase 2 trial.

Another monoclonal antibody researchers are looking into is brentuximab. It is a monoclonal antibody that targets CD30 that is found on most Hodgkin's lymphoma cells. Brentuximab has a chemotherapy attached to it called vedotin. So, brentuximab attaches to the CD30 receptor delivering the chemotherapy directly to the cell. 

Drugs that block cell growth

Doctors are using a new type of biological therapy called panobinostat. Panobinostat is also known as LBH589 and it aims to stop cancer growing by blocking enzymes called deacetylases (pronounced dee-as-et-isle-azes). It is a type of deacetylase inhibitor. Cells need these enzymes to grow and divide. Blocking them may stop cancer growing. A phase 2 trial has been looking into how well it works for people whose Hodgkin's lymphoma has come back after a stem cell transplant and to find out more about the side effects. The trial is no longer recruiting patients and it will be some time before we know the results.

Most stem cell transplants for Hodgkin's lymphoma are autologous. This means that your own stem cells are collected and then you have them back after high dose chemotherapy. But doctors are also looking at using allogeneic stem cell transplants, where the cells come from a donor. Patients have high dose chemotherapy and radiotherapy which kills off all of their stem cells. Then they have a drip of the donor's stem cells which starts making blood cells again. For some people this can get rid of their Hodgkin's disease. But the donor cells can also attack normal body cells and cause a reaction called graft versus host disease (GVHD). GVHD can make people very ill. Sadly, some patients die from it. 

Doctors are looking at mini transplants to try to reduce the side effects of treatment. You have much lower doses of chemotherapy before the transplant, with no radiotherapy. Doctors call this a reduced intensity allogeneic stem cell transplant. Doctors now sometimes use mini stem cell transplants for people with Hodgkin's disease that has come back or where treatment did not get rid of it. 

The RIC UCBT trial is looking at using stem cells collected from the umbilical cords of newborn babies. The umbilical cord stem cells are given to people after a mini transplant. These cord blood transplants are for people who don't have a relative who can be their stem cell donor. Doctors hope that the umbilical cord stem cells will cause fewer side effects than adult stem cells.

Doctors try to use drugs that do not cause infertility if the person they are treating has not had children or would like to have more in the future. But this isn't always possible. Having high dose chemotherapy with bone marrow or stem cell transplant will almost certainly mean you will be infertile.

The possibility of becoming infertile is one of the major worries for younger people being treated for Hodgkin’s lymphoma. It is possible for men to have sperm banking before they have chemotherapy so they can still have children. For women, the situation can be more difficult. Sometimes treatment needs to start quickly. And there may not be time beforehand to stimulate and collect eggs and then freeze them as eggs or as embryos. This process takes a couple of weeks at least and can take longer, depending on when your next period is due.

Researchers have been looking into the possibility of removing some ovarian tissue before chemotherapy and then freezing it. The aim is to be able to reimplant the ovarian tissue after treatment is over. Researchers are satisfied that ovarian tissue can be frozen and thawed safely. They are now working on reimplanting it into the body and getting it to work again. There have been at least 2 reports of women giving birth after this treatment. But this is still early research. It will be some time before we know whether ovarian tissue reimplantation works well enough to be made more widely available.

The EuroNet-PHL-C1 trial is looking at the treatment given to children with Hodgkin's lymphoma. The researchers want to see if we can reduce the chance of the children becoming infertile.The children taking part will have chemotherapy, but the doctors will try to avoid giving radiotherapy afterwards, unless you really need it. They also want to find out if using the chemotherapy drug dacarbazine instead of procarbazine will work as well against the Hodgkin's lymphoma, but be less likely to make you infertile.

There is more information about sex and fertility in the section about living with Hodgkin’s lymphoma.