Novel therapeutics for Hodgkin\'s lymphoma

Abstract

Hodgkins LymphomaHL) was first described by Thomas Hodgkin in 1832., is a malignant disorder, a rare B cell lymphoma (mutant lymphocytes) with reasonable outcome due to the fair cure rates achieved by modern chemotherapy and/or radiotherapy. The incidence of HL is 2.6 cases per 100,000 people, accounts for 10% lymphoma cases. The Epstein–Barr virus (EBV) is detected in nearly 45% of HL patients Most of the affected patients are between ages 20 to 40 years. HL is uncommon in children < 5 years of age. The Reed-Sternberg (RS), large cells 50 micrometers in diameter which secrete cytokines to recruit reactive cells that include IL-5 and transforming growth factor-beta (TGF-beta). The RS cells are positive for CD 30 and CD15 & sometimes for CD 20. They are negative for CD 45. The 5-year overall survival (OS) in stage 1 or stage IIa is approximately 90%;, the stage 4 disease has a 5-year OS of approximately 60%. More than 80 percent of all patients diagnosed with Hodgkin lymphoma can be cured by current treatment approaches. The cure rate is higher, approaching 90 percent, in younger patients and those with early-stage Hodgkins lymphoma (ESHL).  Pragmatic therapeutic approach includes brief chemotherapy (ABVD- Adriamycin), bleomycin, vinblastine sulfate, and dacarbazine. For 3–4 cycles), For advanced-stage classic (CD30-positive) Hodgkin lymphoma, the combination of doxorubicin, vinblastine, dacarbazine, and brentuximab has emerged as a more effective, Patients with recurrent Hodgkin lymphoma would require high-dose chemotherapy followed by ASCT. Hodgkin lymphoma that recurs after ASCT would be managed by the checkpoint inhibitors nivolumab and pembrolizumab. Radiotherapy plays a role as a single modality in early stage lymphocyte-predominant HL. The role of autologous transplant was established decades ago by two randomized controlled trials demonstrating an improvement in PFS but not OS in patients with relapsed/refractory HL.