How I treat advanced classical Hodgkin lymphoma

Abstract

The development of curative systemic treatment of Hodgkin lymphoma was recently voted one of the top 5 achievements of oncology in the last 50 years (http://cancerprogress.net/top-5-advances-modern-oncology). The high expectation of cure (above 80%) with initial therapy, even for advanced disease, is tempered by the recognition of some important limitations: not all patients are cured, especially those in older age groups, and patients have suffered debilitating or, in some cases, fatal long-term side effects. The challenge for modern treatment approaches is to improve the cure rate and, at the same time, minimize the long-term damage resulting from treatment. After several decades during which we have tested a variety of different ways to combine conventional cytotoxic treatments with or without radiotherapy but have identified no effective new approaches, the field is once again moving forward. The developments that hold the greatest promise in this respect are the application of functional imaging with 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) to make an early judgment of the success of treatment and the introduction of some highly active new agents such as antibody-drug conjugates.

Hodgkin lymphoma: A complex metabolic ecosystem with glycolytic reprogramming of the tumor microenvironment

“…The most commonly used treatment for cHL in the United States is combination therapy with adriamycin, bleomycin, vinblastine and dacarbazine (ABVD) with or without subsequent radiation therapy and approximately 80% of patients are cured with this approach 2 . However, 20% of patients have aggressive cHL, which is defined as relapsed disease or disease which is refractory to initial therapy 2 .…”

“…The most commonly used treatment for cHL in the United States is combination therapy with adriamycin, bleomycin, vinblastine and dacarbazine (ABVD) with or without subsequent radiation therapy and approximately 80% of patients are cured with this approach 2 . However, 20% of patients have aggressive cHL, which is defined as relapsed disease or disease which is refractory to initial therapy 2 . In addition, the toxicity of treatment is significant with high rates of heart and lung disease, secondary malignancies and compromised fertility, which not only impact quality of life but increase mortality 3 .…”

Pleiotropic effects of spongean alkaloids on mechanisms of cell death, cell cycle progression and DNA damage response (DDR) of acute myeloid leukemia (AML) cells

“…Hence, we conclude that Aa and Ap as well as daunorubicin disturb normal cell cycle progression through S-and G2/M-phase. It is feasible that part of the cell cycle-related effects of the spongean alkaloids are related to a stimulation of differentiation processes, as described for instance for retinoic acid derivatives in the context of APL therapy [44]. Yet, to our knowledge, effects of Aa or Ap on the differentiation status of AML cells have not been reported so far.…”

Hodgkin’s lymphoma associated with hemophagocytic lymphohistiocytosis: A challenging combination

“…Based on institutional experience, the "Adriamycin, Bleomycin, Vinblastine, and Dacarbazine" (ABVD), escalated BEACOPP, or Stanford V regimens are typically used [9,10] . The exact management of HLH in the case of lymphoma is not well-defined.…”