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LINFOMA DI HODGKIN
Epidemiologia
Negli Stati Uniti vengono diagnosticati ogni anno all’incirca 7500 nuovi casi di morbo di Hodgkin. Mentre nei linfomi non Hodgkin l’incidenza aumenta linearmente con l’età, nel caso dei linfomi di Hodgkin la curva di incidenza ha un caratteristico andamento bimodale con un primo picco fra i 15 ed i 35 anni ed un secondo dopo i 50 anni; è più frequente nei maschi, soprattutto nei giovani adulti e la predominanza maschile è ancora più sorprendente nei bambini (più dell’80% dei casi infantili riguardano bambini maschi).
Eziologia
Ancora del tutto sconosciuti sono i fattori causali di questa malattia, nonostante siano stati segnalati gruppi di pazienti con un aumentato rischio di ammalarsi: questo rischio è stato correlato a fattori tra i quali l’ipotesi di un’infezione virale è quella più accreditata. Un virus che possiede un oncogene a bassa potenzialità infettando un individuo predisposto geneticamente (associazione con determinati tipi di HLA) e interagendo con fattori ambientali sarebbe in grado di causare la malattia, soprattutto con l’aumentare dell’età in cui avviene l’infezione.
Biologia
Una cellula neoplastica gigante conosciuta come cellula di Reed-Sternberg è considerata l’elemento neoplastico essenziale in tutte le forme di linfoma di Hodgkin, e la sua individuazione nel reperto bioptico della neoplasia è fondamentale per la formulazione della diagnosi. La malattia origina, nella maggioranza dei casi, in un linfonodo o in più linfonodi della stessa stazione linfatica e si propaga successivamente, attraverso la via linfatica, alle stazioni linfatiche più vicine fino ad invadere tutto il sistema linfatico. Più tardivamente poi il tessuto neoplastico può invadere, diffondendosi per via ematica, gli organi viscerali.
Aspetti clinici
Il LH si presenta in genere come una massa o un gruppo di linfonodi duri, liberamente mobili e spesso non dolenti, appartenenti alla rete linfatica superficiale o profonda. Le stazioni superficiali più frequentemente interessate sono le stazioni cervicali (60-80%) e quelle ascellari (10-20%); più raro all’esordio è il coinvolgimento dei linfonodi inguinali (5-10%) e rarissimo è il coinvolgimento dei linfonodi dell’ anello di Waldeyer (< 2%). Le stazioni profonde, all’esordio, sono colpite nel 30-50% dei casi e possono essere isolate o associate al coinvolgimento di stazioni superficiali: le stazioni ilo-mediastiniche (frequenti e riscontrate spesso con RX di routine del torace), lombo-aortiche, iliache, del tripode celiaco, dell’ilo epatico e splenico sono le più frequentemente interessate. Il 25-30% dei pazienti ha sintomi aspecifici, di cui il più comune è senz’altro la febbricola associata a sudorazione notturna ricorrente; in un piccolo numero di pazienti si può osservare febbre elevata intermittente accompagnata da abbondantissima sudorazione notturna (febbre di Pel-Epstein). Questi due sintomi sono più frequenti in pazienti anziani e con malattia di stadio avanzato. Un altro sintomo molto importante è la perdita di peso superiore al 10%, avvenuta in 6 mesi o meno senza causa apparente. Affaticabilità, malessere generale, debolezza sono altri sintomi piuttosto frequenti ed il prurito è presente in circa il 10% dei casi: spesso è generalizzato e può essere associato ad arrossamento cutaneo.
Stadiazione e Diagnosi
La stadiazione del linfomi di Hodgkin è quella di Ann Arbor già riportata per i LNH, e tutti gli stadi sono ulteriormente suddivisi in base all’assenza (A) o alla presenza (B) dei seguenti sintomi sistemici: febbre significativa, sudorazione notturna, perdita di peso superiore al 10% in 6 mesi o meno senza causa apparente. L’iter diagnostico vede in primo luogo l’anamnesi con particolare attenzione ai segni sistemici, l’esame obiettivo per evidenziare l’interessamento linfonodali e la splenomegalia, la documentazione anatomo-patologica del reperto bioptico e la valutazione di parametri di laboratorio (emocromo, VES, funzionalità epatica e renale); questi esami però non danno informazioni riguardo l’estensione del morbo di Hodgkin o riguardo l’interessamento di specifici organi, e gli esami di laboratorio presentano una scarsa specificità. L’RX del torace e la TC dell’addome e della pelvi ha un ruolo importante nella stadiazione del LH .
Terapia
Attualmente il linfoma di Hodgkin deve essere considerato una malattia potenzialmente guaribile. La radioterapia può guarire più dell’80% dei pazienti con linfoma localizzato e la chemioterapia più del 50% di pazienti con malattia disseminata.
TerapieAlso see: Categorized Resources | WebCasts
Antibodies such as Rituxan
Bexxar / Zevalin / other - Radio-immunotherapy
Biologics such as Interferon, Neupogen, Leukine ...
Bone marrow (stem cell) transplants
Allogeneic | Autologous |
Comparing Auto and Allo SCT | Cord blood |
HLA-typing | Mini | Background | Harvesting stem cells |
Graft vs Host Disease | Patient stories | Resources
Chemotherapy
Alphabetical index | agents by mechanism
Chemoprotective | CHOP | Combinations
Fish oil and? | Liposomal | Low dose (metronomic) PEP-C | Outcome abstracts - Frontline | Treatment support for
Clinical Trials - Lymphoma-specific searches by:
Lymphoma subtype | Treatment type
State or Country | Other criteria - age, complementary, stage, phase, refractory
Clinical Trials of Interest for Lymphoma
Complementary and Alternative Medicine
Chemoprotective & Radioprotective strategies
Elderly patients - treatment protocols and resources
Emerging Therapies & Targets index of investigative therapies & treatment targets, containing brief explanations.
Evaluating medical claims - recognizing bias; limits of abstracts, what makes information credible.
Immune-based therapies
Low toxic treatments (NEW)
Nanotechnology
Photopheresis
Progress Review Group Progress Review Group (PRG) research objectives
Quality of life - interventions that may improve
Radiotherapy - basics and resources
Treatment support for
Refractory lymphomas - resistant to treatment
Protocols for | Clinical Trials for
Remissions & Response - background
Also see Spontaneous regressions
Rituxan details, links to resources
Rituxan - categorized abstracts
Rituxan check list what to expect, bring, do.
Side effects - common to treatments
Splenectomy as treatment
Therapy-Related Risks
(Balancing Risks and Benefits)
Treatment Decisions - Factors that Influence
About treatment: goals | types |
outcomes | interventions
Considerations at relapse
Factors that determine treatment and timing
Strategy for treating indolent lymphomas -
FDA Flow chart
Treatment goals, types, outcomes and interventions - overview from patients
Time to Progression comparing protocols for first line treatment of indolent NHL | Frontline
Treatment settings - frontline, relapse, survival.
Watch & Wait background and treatment consideration. Rationale for w&w
Transformation - background
Vaccines - about investigational patient-specific therapeutic vaccines
Categorized abstracts | Outcome Data
Also see: Categorized Resources | WebCasts
Antibodies such as Rituxan
Bexxar / Zevalin / other - Radio-immunotherapy
Biologics such as Interferon, Neupogen, Leukine ...
Bone marrow (stem cell) transplants
Allogeneic | Autologous |
Comparing Auto and Allo SCT | Cord blood |
HLA-typing | Mini | Background | Harvesting stem cells |
Graft vs Host Disease | Patient stories | Resources
Chemotherapy
Alphabetical index | agents by mechanism
Chemoprotective | CHOP | Combinations
Fish oil and? | Liposomal | Low dose (metronomic) PEP-C | Outcome abstracts - Frontline | Treatment support for
Clinical Trials - Lymphoma-specific searches by:
Lymphoma subtype | Treatment type
State or Country | Other criteria - age, complementary, stage, phase, refractory
Clinical Trials of Interest for Lymphoma
Complementary and Alternative Medicine
Chemoprotective & Radioprotective strategies
Elderly patients - treatment protocols and resources
Emerging Therapies & Targets index of investigative therapies & treatment targets, containing brief explanations.
Evaluating medical claims - recognizing bias; limits of abstracts, what makes information credible.
Immune-based therapies
Low toxic treatments (NEW)
Nanotechnology
Photopheresis
Progress Review Group Progress Review Group (PRG) research objectives
Quality of life - interventions that may improve
Radiotherapy - basics and resources
Treatment support for
Refractory lymphomas - resistant to treatment
Protocols for | Clinical Trials for
Remissions & Response - background
Also see Spontaneous regressions
Rituxan details, links to resources
Rituxan - categorized abstracts
Rituxan check list what to expect, bring, do.
Side effects - common to treatments
Splenectomy as treatment
Therapy-Related Risks
(Balancing Risks and Benefits)
Treatment Decisions - Factors that Influence
About treatment: goals | types |
outcomes | interventions
Considerations at relapse
Factors that determine treatment and timing
Strategy for treating indolent lymphomas -
FDA Flow chart
Treatment goals, types, outcomes and interventions - overview from patients
Time to Progression comparing protocols for first line treatment of indolent NHL | Frontline
Treatment settings - frontline, relapse, survival.
Watch & Wait background and treatment consideration. Rationale for w&w
Transformation - background
Vaccines - about investigational patient-specific therapeutic vaccines
Categorized abstracts | Outcome Data
COMMON CHEMOTHERAPY DRUGS
(common brand names are in parentheses)
DNA-ALTERING DRUGS These drugs change DNA, the building block of cells, to prevent cell growth:
Carboplatin (Paraplatin®)
Carmustine (BCNU®) Chlorambucil (Leukeran®) Cisplatin (Platinol®) Cyclophosphamide (Cytoxan®) Dacarbazine (DTIC®) Ifosfamide (Ifex®) Mechlorethamine (nitrogen mustard, Mustargen®) Melphalan (Alkeran®) Procarbazine (Matulane®)
ANTI-TUMOR ANTIBIOTICS
These drugs interact with DNA and decrease cell survival. Drugs that
come from natural sources, such as plants or yeast, include: Bleomycin (Blenoxane®) Doxorubicin (Adriamycin®, Rubex®) Idarubicin (Idamycin®)
Synthetic drugs that act like doxorubicin, include: Mitoxantrone (Novantrone®)
ANTIMETABOLITES
These drugs interfere with normal cell growth. Cladribine (Leustat®) Cytarabine (cytosine arabinoside, Ara-C, Cytosar®) Fludarabine (Fludara®) 6-mercaptopurine (Purinethol®) Methotrexate (Rheumatrex®) 6-thioguanine (Thioguanine®) Pentostatin (Nipent®) Etoposide (VP- 1 6, VePesid®)
Gemcitabine (Gemzar®)
HORMONES These drugs also affect cell growth:
Prednisone, dexamethasone (Decadron®, Dexasone®)
DRUGS THAT PREVENT CELLS FROM DIVIDING BY BLOCKING CELL DUPLICATION
These drugs damage cell structures that are required for a cell to divide:
Vinblastine (Velban®)
Vincristine (Oncovin®)
Vinorelbine (Navelbine®)
COMBINING CHEMOTHERAPY DRUGS
Chemotherapy for Hodgkin’s lymphoma often consists of several drugs given together, combination therapy. Combinations are used because different drugs damage or kill cancer cells in different ways making them more vulnerable. This provides a more effective way to kill tumor cells because using drugs together, rather than individually, greatly augments the impact the drug would accomplish, if used individually or additively. This is called synergism. In addition, drugs added together in lower doses helps reduce the likelihood of side effects without reducing the overall amount of effective chemotherapy. For example, the combination ABVD is currently considered standard therapy and uses drugs with smaller amounts of toxicity while sustaining a full capacity to destroy Hodgkin’s lymphoma.
Another reason for combination chemotherapy is to prevent drug resistance. A chemotherapy regimen is a combination of anticancer drugs given at a certain dose in specific sequence according to a strict schedule. This schedule should be maintained whenever possible. Clinical investigators often use the first initials of the drugs in a particular treatment regimen (an acronym) to communicate among themselves as a shorthand reference to the treatment. Some of the most common regimens used for Hodgkin’s lymphoma are outlined below. Many other combinations are being tested in clinical trials.
COMMON DRUG REGIMENS USED TO TREAT HODGKIN’S LYMPHOMA
(common brand names are in parentheses)
Regimen Abbreviation Drugs
ABVD Doxorubicin (Adriamycin®, Rubex®) Bleomycin (Blenoxane®) Vinblastine (Velban®, Velsar®) Dacarbazine (DTIC®)
Stanford V
Mechlorethamine (Mustargen®) Doxorubicin (Adriamycin®, Rubex®) Vinblastine (Velban®, Velsar®) Bleomycin (Blenoxane®) Etoposide (VP-16) Prednisone (Deltasone®) Local radiation
continued on next page
Regimen Abbreviation
BEACOPP
MOPP
MOPP-ABV
Drugs
Bleomycin (Blenoxane®) Etoposide (VP-16) Doxorubicin (Adriamycin®, Rubex®) Cyclophosphamide (Cytoxan®) Vincristine (Oncovin®) Procarbazine (Matulane®) Prednisone (Deltasone®)
Mechlorethamine (Mustargen®) Vincristine (Oncovin®) Procarbazine (Matulane®) Prednisone (Deltasone®)
Mechlorethamine (Mustargen®) Vincristine (Oncovin®) Procarbazine (Matulane®) Prednisone (Deltasone®) Doxorubicin (Adriamycin®, Rubex®) Bleomycin (Blenoxane®) Vinblastine (Velban®, Velsar®)
CHEMOTHERAPY CYCLES
A single dose of chemotherapy kills only a percentage of the cancer cells, and multiple doses are therefore necessary to try to kill all of the cancer cells. Chemotherapy is scheduled as frequently as possible to minimize tumor growth, prevent the development of resistant cancer cells, and achieve the best outcome.
Chemotherapy is usually given in cycles, that is, each treatment is followed by several weeks of rest and recovery during which no treatment is given. Together, each period of treatment and non-treatment is called a chemotherapy cycle The medicines are usually given according to a schedule, with a defined number of days passing between each time the drugs are given.
Clinical trials have determined how often chemotherapy should be given to kill the most tumor cells while minimizing side effects. The number of cycles will depend on factors such as the stage of the disease, the type of disease, the type of drugs administered, the level of response achieved, and the nature and severity of the side effects.
HOW CHEMOTHERAPY IS GIVEN
Depending on the chemotherapy regimen, you may receive drugs in pill form, as an injection, or as an intravenous drip. If you are going to receive intravenous drugs (ones that are given through a vein) for multiple cycles, sometimes your doctor may recommend having a Catheter inserted. An intravenous catheter is a device that is put into a vein to make it easier to give drugs. Catheters may be left in place temporarily or permanently.
There are several types of catheters. One type, called a Hickman-Broviac catheter, consists of one to three small tubes inserted through the chest wall into a vein. Six to twelve inches of tubing remain outside the skin. The main advantage of this type of catheter is that blood tests can be drawn and drugs given without having to pierce the skin. Disadvantages include: (a) the possibility of infection if the catheter is not cared for properly and (b) the tubes on the outside of the body make it more obvious that a catheter is in place. If you have this type of catheter, your health care team will show you what needs to be done daily to care for it and make sure it stays clean. This type of catheter is occasionally, but not commonly used for patients for lymphoma.
A second type of intravenous catheter, called an Infusa-Port or Portacath catheter, is placed under the skin and appears only as a bump on the chest. The advantage of this catheter is that its care is easier for patients because it only needs to be maintained by a nurse (called "flushing") once a month. However, it also has disadvantages. Each time this type of device is used, an injection through the skin is required, and it is therefore not convenient to draw blood samples. These devices may also occasionally clot.
If you need a catheter, discuss the pros and cons of the different types with your doctor. Your situation and personal preferences will be considered in making this decision.
THE IMPORTANCE OF MAINTAINING THE DOSE AND SCHEDULE OF CHEMOTHERAPY
Dose Intensitiy is a term used to describe giving the highest possible doses of drug over a specific period of time, while maintaining acceptable side effects. This approach has been shown to be very effective in curing some cancers, including Hodgkin’s lymphoma. Some studies have suggested that reducing the dose or delaying chemotherapy may decrease both the chance for a cure and long-term survival in some types of lymphomas.
It is important that patients know that changing the regimen to reduce short-term side effects may actually be harmful in the long run. Some side effects may be unpleasant, but tolerable. Others may be serious but can often be anticipated and prevented. It is very important that chemotherapy schedules be maintained to the greatest extent possible.
Bone Marrow and Stem Cell Transplantation
Bone marrow, the spongy material found inside our bones, contains immature, "stem" cells. Stem cells develop into three types of cellular elements found in the blood: red blood cells that deliver oxygen to all parts of the body and take away the waste product carbon dioxide; white blood cells that protect the body from infection; and platelets that help blood clot.
When Hodgkin's lymphoma cells not totally destroyed by standard doses of chemotherapy return (relapsed disease), it may still be possible to eliminate the cancer cells by using very high doses of chemotherapy. During this treatment, normal bone marrow is destroyed. A transplant of bone marrow or stem cells can then be used to restore healthy bone marrow.
THE SOURCES OF BONE MARROW OR STEM CELLS
A key to the success of a transplant is the availability of stem cells. There are two sources of stem cells: allogeneic sources, in which patients receive bone marrow or stem cells donated by another person, and autologous sources, in which patients receive their own cells. Autologous bone marrow transplantation is far more common than allogeneic because it is much less toxic.
ALLOGENEIC TRANSPLANT:
Finding a suitable donor is important because your body will reject stem cells if they are too unlike your own. Several different blood tests may be used to see if someone is a suitable transplant donor. The best candidates are siblings (brothers or sisters).
AUTOLOGOUS TRANSPLANT:
In this case, patients receive their own stem cells. The advantage to this type of transplant is that there is no danger that the body will reject the bone marrow or stem cells, or that the stem cells will react against the body, a condition called graft versus host disease(GVHD)
Harvesting is the procedure in which stem cells are obtained either from the bone marrow or peripheral blood for use in repopulating the body's cells after high-dose chemotherapy. A bone marrow harvest involves removing bone marrow, which is a thick red liquid, from the hip bone with a needle. This procedure is done in an operating room and requires general anesthesia for comfort. Once the bone marrow is harvested, it is purified and stored until the day of the transplant. Multiple needle insertions are required to harvest enough bone marrow. This procedure is performed less commonly now, but was frequently performed in the past.
Although the greatest number of stem cells are found in the bone marrow, these cells are also present in the peripheral blood. Another way to collect cells for a transplant is by harvesting them from the blood. This outpatient procedure is commonly employed and usually preferred. It involves the withdrawl of blood in a process called apheresis(which means to remove or take away). In this instance, stem cells are removed, and the rest of the blood is returned to the patient.
THE PROCEDURE FOR A BONE MARROW OR STEM CELL TRANSPLANT
Bone marrow and stem cell transplants are performed in four steps:
STEP 1: HARVESTING STEM CELLS OR BONE MARROW
Stem cells are usually filtered from the blood in a process called apheresis; the other components of the blood are then returned immediately to the patient. Bone marrow (which contains stem cells) is usually harvested from bones in the hip.
STEP 2: PROCESSING OR PRESERVING THE STEM CELLS OR BONE MARROW
Machines are used to purge any malignant cells, filter out unwanted substances, and freeze and store the pure transplant material, including cells.
STEP 3: ADMINISTERING THERAPY
High-dose chemotherapy is then administered, with or without radiation, to eliminate the cancer cells. This high-dose treatment also wipes out healthy blood and immune cells. The type of chemotherapy will depend on the stage and type of disease, whether it is a recurrence, the condition of the patient, and the treatment facility's preferences and experiences.
STEP 4: REINFUSING HARVESTED STEM CELLS OR BONE MARROW
As the harvested stem cells or marrow are returned to your body (transplanted), they travel through the circulatory system to your bone marrow, where they implant themselves (like seeds in a garden) and slowly begin to make healthy new cells. Over time, the bone marrow produces enough healthy cells to completely repopulate the blood and immune systems. In the period before these new cells are created, patients are more susceptible to infection.
MINI-BONE MARROW OR MINI-STEM (NON-MYELOABLATIVE) CELL TRANSPLANT
Unlike the usual bone marrow or stem cell transplant in which high-dose chemotherapy is administered, in this procedure the patient receives low or normal dose chemotherapy, just enough to allow the body to accept new stem cells from an allogeneic donor. This procedure is quite new and is therefore still considered investigational. It takes advantage of the graft-ver-sus-disease effect, in which the transplanted cells recognize the tumor as a foreign entity and activate T-cells to destroy the cancer. Patients who experience a graft-versus-disease effect may remain in remission for a longer period. Also, because patients receive lower doses of chemotherapy, they may avoid some of the toxicities seen with higher dose chemotherapy. Graft-versus-host disease, however, is a frequent and sometimes serious side effect (toxicity). GVHD is a potentially serious complication of allogeneic bone marrow transplantation.
HOW RADIATION THERAPY WORKS
Radiation therapyalso called radiotherapy) uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation is a local therapy, which means it only affects cancer cells in the treated area. Depending on the circumstances, radiation can be used alone or in combination with chemotherapy.
A Radiation field is the term used to describe the part of the body selected to receive radiation therapy. Hodgkin’s lymphoma generally spreads predictably from one lymph node to another. Radiation may be given in a limited or regional field (a small area) or maybe given more broadly to common areas. When used with chemotherapy, radiation fields are generally limited (called "involved" fields).
Pelvic Common areas that are irradiated are the mantle field, the abdominal field and the pelvic field. The mantle field delivers radiation to the lymph nodes in the neck, chest, and armpit. The upper abdominal field includes lymph nodes in the para-aortic area and possibly the spleen. Irradiating the pelvic field treats lymph nodes in the pelvis and groin and also irradiates large areas of bone marrow. In certain circumstances, an extended field (mantle and upper abdominal fields), or occasionally total body radiation, may be recommended.
To prepare for radiation therapy, the skin will be marked with tiny ink dots (called “tattoos”) so the exact same area will be treated every time. Before the first treatment, the health care team will devote a substantial amount of time marking your body to make sure that specific areas receive radiation. Normal tissues around the radiation field are shielded by lead, which blocks the path of stray radiation beams. You will lie on a table beneath a large machine that delivers the radiation. You must remain still during the treatment: props and supports with plastic forms, pillows, and rolled blankets will help keep you in the proper position. Once the proper preparations have been made, it takes only a few minutes to deliver the prescribed dose. The total dose of radiation is usually divided and administered over one to six weeks.
Biologic Treatments
(including immunotherapy) is a treatment that uses the body's own disease-fighting capabilities to treat cancer or to lessen the side effects caused by cancer treatments. These therapies can boost, direct, or restore the natural defenses against disease. Examples of biologic therapies include monoclonal antibodies and vaccines. Biologic therapy, however, is only being used in experimental settings at this time.
MONOCLONAL ANTIBODIES AND HOW THEY WORK
Plasma cells, the most mature B-cells in the body, are white blood cells that specialize in making antibodies. Each plasma cell is responsible for one antibody, otherwise known as a monoclonal antibody (MAb). Each MAb acts specifically against a particular antigen, which is sort of like a beacon that attracts antibodies and immune cells (such as lymphocytes). Using new technologies, scientists can now produce large amounts of antibodies that can be directed to a single antigen on the cell's surface. A MAb is similar to a guided missile that homes in on a target cell and kills it.
A number of strategies involving the use of MAbs to treat cancer are being studied, including: (a) MAbs that react with specific types of cancer cells, thereby enhancing a patient's immune response to cancer, (b) MAbs that are combined with other anticancer drugs, toxins, or radioisotopes, allowing the delivery of these drugs directly to the tumor and bypassing toxicity to most normal cells, and (c) MAbs that are used to help purge and destroy cancer cells before a patient is re-infused in an autologous bone marrow transplant.
MONOCLONAL ANTIBODIES AS POSSIBLE TREATMENT FOR HODGKIN'S LYMPHOMA
Rituximab (Rituxan®) was the first monoclonal antibody approved for the treatment of relapsed or refractory low-grade or follicular, CD-20 positive, B-cell non-Hodgkin's lymphoma. Rituxan is also currently being tested in combination with other treatments as a potential therapy for certain forms of Hodgkin's lymphoma, particularly lymphocyte predominate, which has the CD20 antigen.
Rituxan targets the CD-20 antigen found on almost all B-cells, killing both cancerous and normal B-cells. All other cells and tissues are spared by Rituxan. Researchers believe that this therapy works via the body's immune system response triggered by the MAb's attachment to cancer cells. Because the youngest B-cells in the body (precursor cells that will become B-cells) do not yet have the CD-20 antigen, they are not affected. Thus, after treatment the body can replenish its B-cell supply from these young cells.
Another antibody currently being evaluated for Hodgkin's lymphoma therapy is the MAb Alemtuzumab (Campath®). This MAb targets a different lymphocyte antigen named CD52.
CD30 antibodies are currently being explored in Hodgkin’s lymphoma. The CD30 antigen is found in most classical Hodgkin’s lymphoma tissues.
The results of ongoing clinical trials with Rituxan, Campath, and other MAbs in earlier phases of development will determine whether MAbs will ultimately become an intergral part of Hodgkin's lymphoma treatment.
VACCINES
Vaccines are not yet available as standard treatments, but various vaccines are being evaluated in clinical trials. Lymphoma vaccines enhance the patient's own natural defenses to fight his or her disease.
Infection with the Epstein-Barr virus (EBV) has been associated with some Hodgkin's lymphoma patients. Some researchers believe that targeting EBV in Hodgkin's lymphoma tumor cells with a vaccine may be effective in this disease. In this still experimental strategy, a sample of an EBV patient's immune cells are collected, selected (for the presence of EBV), then re-infused into the patient in an effort to kill the cancer cells.
It is not yet known how effective this or other vaccines will be in treating Hodgkin's lymphoma, but the results of clinical trials will provide the answer to that question.
The hope is that vaccine therapy, like antibody therapy, will be less toxic than traditional therapies such as chemotherapy and radiation. Unlike antibody therapy which uses “passive” immunity, vaccines are designed to stimulate “active” immunity. |
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