Hodgkin lymphoma (HL) is the most common form of lymphoma affecting people under the age of 30 in the Western world, making up approximately 11 per cent of all cancers among patients between the ages of 15 and 29 in Canada. In Canada, approximately 1,000 patients are diagnosed with HL each year with a peak incidence in the second and third decade of life.
Although treatment of HL is widely regarded as a model of success, with chemotherapy having greatly improved patient survival, approximately 20 per cent of patients experience progression or relapse of their lymphoma during or after treatment. If relapse occurs, high-dose chemotherapy and autologous stem-cell transplantation (ASCT) is the usual course of action for patients, who are fit enough to handle this intensified treatment. Unfortunately, approximately fifty per cent of these patients will still die as a result of persisting disease.
New research, spearheaded by BC Cancer Agency scientists and published in the Journal of Clinical Oncology, demonstrates dynamic molecular changes between the tumours from HL patients at the point of initial diagnosis compared to relapse. Specifically, the results of the research show that the tumour microenvironment surrounding the cancer cells can significantly change over time.
The full article is available from JCO, here.
"Our study directly addresses the unmet need of providing a clinically useful assay at the time point of relapse when multiple treatment alternatives are available," says Dr. Christian Steidl, senior author for the study and Head of Lymphoid Cancer Research at BC Cancer Agency. "Our findings will be of significant translational relevance for future clinical trials and patient management."
Using this information, the research team has developed a novel, clinically ready test, using tissue biopsies obtained at lymphoma relapse. The test is called RHL30 and can identify the subset of relapsed HL patients at highest risk of subsequent treatment failure. This provides a foundation for informed clinical decision making, supporting the use of high dose chemotherapy and ASCT as a second-line regimen in low risk patients or suggesting alternative therapeutic approaches, such as targeted or immunotherapy, for high-risk patients.
The prognostic significance of the RHL30 assay has been successfully validated in two independent external studies from the University Medical Center Groningen, Netherlands, and the Aarhus University Hospital, Denmark.