Research Impact


Treating patients with Hodgkin lymphoma when the standard treatment does not work

12 December 2014


UCL research over the last 30 years has developed new treatments for Hodgkin lymphoma and has improved outcomes for patients who do not respond to conventional therapy.

Each year in the UK, around 1,600 people are diagnosed with Hodgkin lymphoma. Treatment is usually very successful, and most people can be cured, or the lymphoma can be controlled for many years. However, for around a quarter of patients, this is not the case.

From the late 1980s until the present day, UCL researchers have continuously worked on new and improved treatments, developing new treatment strategies and improving outcomes for those patients for whom conventional therapy had failed.

Hodgkin Lymphoma remains a 'poster child' amongst cancers for the development of novel and effective therapies. New immunomodulatory drugs have recently shown great promise for patients who have not responded to other treatments and will undoubtedly be incorporated into transplant strategies in coming years. - Dr Karl Peggs

Firstly, they demonstrated the advantages of autologous stem cell transplantation (ASCT), where the patient receives a transplant of stem cells previously harvested from his or her own blood. Their clinical research developed a regime of two parts: initially high dose chemotherapy (the 'BEAM' regime) followed by ASCT. They undertook trials which showed that this approach was effective, and it became the global standard treatment for all patients where conventional chemo/radiotherapy has failed. Further work refined this technique by establishing the correct dose range for the infused stem cells. Despite these major advances, the use of BEAM plus ASCT still only 'rescued' about 45% of patients; for the remainder, the prognosis was dismal. The researchers began to investigate the use of allogeneic transplantation, where the stem cells are from a donor rather than the patient's own. This had previously been shown to have a positive effect on treatment of the lymphoma, but the procedure was very toxic in its own right, with high mortality rates from side effects. The team developed reduced-intensity transplants which greatly reduced the toxicity and mortality of the treatment, allowing it to be used.

With these improvements in treatment, relapse of the patients' lymphoma became the primary cause for treatment failure. In response, the researchers pioneered the development of donor lymphocyte infusions, where increasing doses of immune cells from the donor are administered following the allogeneic transplantation. These were combined with a novel strategy for monitoring patients for early signs of relapse following transplantation utilising positron emission tomography (PET) scanning. This combined approach delivered results that were significantly better than those seen in other countries, and has become standard practice throughout the UK.

High dose therapy and autologous transplantation, as developed at UCL, are currently the standard treatment for relapsed and resistant Hodgkin lymphoma. This recommendation was confirmed in 2012 in the updated clinical practice guidelines of the National Comprehensive Cancer Network (USA), and remains the standard throughout Europe. It is estimated that in the last five years alone, almost 5,000 patients in Europe have been cured through use of the treatments developed.