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Hodgkin’s disease marks one of the earliest successes in the war against cancer. A chemotherapy regimen, known as MOPP, developed in the 1970s and sometimes accompanied by radiation therapy, cures most patients.
Hodgkin’s disease is a lymphoma, a cancer that attacks the lymph cells (lymphocytes) of the immune system. It is a relatively rare cancer that primarily affects adolescents and young adults with another spike in incidence occurring in adults over age 55. Researchers believe the disease originates from an abnormal immune system B cell called the Reed-Sternberg cell.
While experts don’t know exactly what causes Hodgkin’s disease, infections with certain viruses, particularly the Epstein-Barr virus, increase a person’s risk of developing the cancer.
Swollen lymph nodes, usually in the neck, underarms, or groin, weight loss, night sweats, itchy skin, persistent low grade fever, coughing, and fatigue, are the most common symptoms of Hodgkin’s disease. Since the lymphatic system runs through the entire body, symptoms can impact many different tissues and organs. It is diagnosed through biopsy of affected lymph nodes.
Hodgkin's disease is diagnosed by taking a small sample of an enlarged lymph node and examining it under a microscope -- a procedure called a biopsy. Examining lymph nodes for lymphoma is best done by experienced hematopathologists -- pathologists who focus primarily on this type of disease using specialized techniques.
Methods of treatment for Hodgkin's Disease usually include radiation therapy or chemotherapy (drug treatment). While the cure rate is among the highest of all cancers, between 80 percent and 90 percent, that this still means 10 percent to 20 percent will not be cured with standard therapy.
For these patients, blood stem cell transplants are an option. In the 1990s, Johns Hopkins Kimmel Cancer Center investigators developed the technology to isolate blood stem cells, the rare cells that give rise to all other blood and immune cells. To kill relentless cancer cells, doctors can give patients very high doses of anticancer drugs—so high that they are toxic to the bone marrow—and rescue them from these toxic affects by giving patients an infusion of their own purified stems cells or those from a matching donor. These cells will then repopulate healthy blood and immune cells. The same method can be used to treat Hodgkin’s disease that has spread to the bone marrow.
In the laboratory, research focusing on B cells, found to be cancer stem cells for other blood and immune cancers, is underway. Cancer stem cells are a minute population within cancers but believed to be the driving force behind the growth and spread of certain cancers. Investigators believe these less understood cells may be at play in recurrent cancers. Standard chemotherapy kills the bulk of tumor cells but often leaves cancer stem cells unharmed. Over time, these cancer cells replicate leading to a relapse. The researchers liken it to weeding a garden. If the gardener removes just the part of the weed that shows above ground, it will look, for a time, like the weed is gone. If the root remains intact, however, eventually the weed will grow back. Cancer stems cells can be likened to the root and the bulk of the tumor to the part of the weed that shows above the ground. For some patients, curative therapies for resistant cancers may require treatments that target both.
Experts also are working on a new therapy that exploits the presence of the Epstein-Barr virus in Hodgkin’s disease. While the virus is present in the cancers cells, it is latent or dormant. Their new therapy uses a drug to wake up the virus and turn on a gene that enables binding of a radioactive compound that kills the tumor cells. When coupled with the radioactive compound, the chemotherapy kills more tumor cells. Since the virus is only in the cancer cells, the therapy targets the cancer, leaving normal cells unharmed.
Investigators and clinicians are hopeful that standard therapy along with these new discoveries will bring us closer to our goal of curing all patients with Hodgkin’s disease.