A simple change to the chemotherapy regimen for Hodgkin lymphoma patients could reduce the long-term health impacts from treatment, say Cambridge researchers.
The findings could lead to national guidance being revised.
Hodgkin lymphoma cells under the microscope
A study by Cambridge University Hospitals NHS Foundation Trust and the Wellcome Sanger Institute compared the lasting effects of two chemotherapy regimens.
Hodgkin lymphoma is often diagnosed in younger people – aged 20-40 – so kinder treatments could cut hospital time and increase the likelihood of recovering fertility.
Data previously collected from 1,945 patients treated with the existing chemotherapy regime (eBEACOPP) was compared to 312 patients treated with a similar regimen, called eBEACOPDac.
Both use combinations of drugs, with the change replacing one of these, procarbazine, with another called dacarbazine. Both chemotherapies achieved the same success in treating cancer (93.3 per cent in remission three years after treatment), but comparison showed that patients treated with eBEACOPDac generally experienced fewer, less severe side effects. They spent less time in hospital, required fewer blood transfusions and signs of recovering fertility sooner.
Prof George Follows, consultant haematologist at Addenbrooke’s Hospital and the Department of Haematology, University of Cambridge, and co-lead author on the study, said: “Our findings highlight the potential to make the short and long-term side effects of chemotherapy much kinder for Hodgkin lymphoma patients without compromising the effectiveness of treatment. By making a small change to how patients are managed, we can greatly reduce the lasting impacts that this disease, and its treatment, has on their lives giving many more patients the opportunity to go on to raise families.”
Dr Raheleh Rahbari, Wellcome Sanger Institute and co-lead author on the study, added: “This is an example of how genomics can impact lives and help change healthcare. Through the use of genome sequencing we’ve gained a deeper insight into the lasting effects of chemotherapies, allowing us to learn more about their role in long-term health, and make progress towards effective treatments that minimise side effects as much as possible.”
Louisa, a patient in her 30s from Peterborough, was treated with eBEACOPDac as part of the study and three years later, she has had her second child.
She said: “When I was told I had lymphoma, it was the start of the Covid pandemic and we had a new baby in the house. It was a challenging time and instinctively, what I wanted most was to get the best treatment that would allow me to be there for my new family and do the things I love. Undergoing treatment was still difficult but I received excellent care and support throughout.
“Regaining my fertility was the most unexpected and incredible experience. I knew my chances of fertility after chemotherapy treatment would be somewhat compromised, so to have another child last year was wonderful and I am eternally grateful to be able to experience motherhood for a second time.”
Dr Cathy Burton, chair of the UK Hodgkin lymphoma study group, and haematology consultant at Leeds Teaching Hospitals NHS Trust, said: “This excellent work provides strong evidence of the benefits of using eBEACOPDac for treatment of Hodgkin lymphoma. This approach of switching procarbazine to dacarbazine is preferable due to its reduced side effects and improvements in fertility recovery. Crucially, these findings are of international significance and should be used to inform treatment guidelines globally to ensure patients are receiving the best treatments.”