Lymphoma clinical trials

Clinical trials are research studies that evaluate whether a new drug, treatment, or combination of treatments is safe, effective and possibly better than the current standard-of-care.  Clinical trials are the way that new treatments are tested for safety and efficacy—and the only route to regulatory approval.

As a patient with cancer, it is important to investigate all of your treatment options, especially when the cancer has not responded to standard treatments.

Lymphomas are referred to as “blood” cancer or “liquid” tumors

Lymphoma 

Lymphomas are cancers that develop in the blood and lymphatic system. They are commonly referred to as “blood” cancer or “liquid tumors” rather than solid tumors like breast, prostate, colon, etc. There are  two main types of lymphomas— Hodgkin lymphoma and non-Hodgkin lymphoma (NHL).

Hodgkin lymphoma occurs in the blood and bone marrow. It is distinctive from other lymphomas largely due to the presence of large cancerous cells called Reed-Sternberg cells.  Hodgkin lymphoma is one of the most curable forms of cancer.

Non-Hodgkin lymphoma (NHL) is a group of over 30 cancers that affect the lymphatic system and  generally develop in the lymph nodes and lymphatic tissues, though sometimes NHL also develops in the blood and bone marrow. NHL develops when there is an abnormal change in a white cell in a lymph node or lymphoid tissue called a lymphocyte. The abnormal cell grows uncontrollably and reproduces other abnormal cells, resulting in tumors.  These abnormal cells overwhelm the normal white cells that defend the body against infection, and spread to other parts of the body via the lymphatic system.  There are three3 types of lymphocytes which give rise to the NHL subtypes: B lymphocytes (B cells) produce antibodies to help combat infections. About  85% of NHL diagnoses are related to B cell cancers.

The most common types of NHL in adults are diffuse large B-cell lymphoma (a more aggressive form) and follicular lymphoma (a slower or “indolent” form). There are more rare types of NHL,  including  mycosis fungoides and Sézary syndrome, which  start in the blood cells in the skin. There are also  other forms of NHL that start in white blood cells in the brain, spinal cord, or eye. Learn more from the Leukemia & Lymphoma Society

History of Lymphoma Research

Hodgkin and NHL are named after Thomas Hodgkin, who in 1832, recognized abnormalities in the lymphatic system, although other scientists had described NHL as early as 1666.  Hodgkin studied seven patients who had enlarged but painless lymph nodes and presented his findings to the Medical and Chirurgical Society in London in 1832. His findings were subsequently published.  In 1856, Samuel Wilks reported on another set of patients with the same disease described by Hodgkin. Wilks later published a paper, in 1965, in which he coined the term “Hodgkin’s disease,” in honor of Hodgkin. In 1872, Hodgkin’s lymphoma was seen at the microscopic level, and the significance of Reed-Sternberg cells were discovered in 1898.

The first known treatment for Hodgkin’s lymphoma was a medicine containing arsenic in 1894. In 1932, radiation therapy was starting to be utilized, but mainly for palliative purposes. Two pharmacologists noticed that mustard gas used in WW1 lowered blood counts and destroyed lymph nodes in soldiers who were exposed to the gas, and began looking at mustard gas as a possible treatment for lymphoma. Two decades after the war, a thoracic surgeon named Gustav Lindskog used nitrogen mustard to successfully treat a patient with NHL, giving rise to the first “chemotherapy” agents.

In 1963, a combination regimen of chemotherapy agents was developed, which consisted of cyclophosphamide, vincristine, methotrexate, and prednisone. Another drug regimen was introduced in 1987 called EBVP (epirubicin, bleomycin, vinblastine, prednisone).  In 1992, the German Hodgkin’s Study Group designed the BEACOPP regimen which involved the use of seven chemotherapy agents, including bleomycin, etoposide, adriamycin, cyclophosphamide, oncovin, procarbazine and prednisone.

In the mid-1950s, the first bone marrow transplants were performed in patients with lymphoma; however, despite its ability to improve outcomes, bone marrow transplants are sometimes associated with complications. Another problem is gaining access to this procedure.  Patients now have a number of therapeutic options that include different forms of chemotherapy, radiotherapy, bone marrow transplant, stem-cell treatment, and newer targeted drugs. Learn more from News Medical

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Current Lymphoma Research

Scientists have been working to advance their understanding of how normal lymphocytes develop into lymphoma cells and the role of DNA mutations. These mutations may allow the cells to grow rapidly, resist cell death, and resist maturation into cells that take part in normal immune reactions. Drugs can be targeted to these growth processes once the mechanisms for abnormal growth are identified.

Genetic tests have been developed to identify DNA changes that can cause disease. These tests can identify lymphoma cells based on changes, such as chromosome translocations or rearrangements, or specific gene mutations. These tests can detect lymphoma in biopsies and determine the specific lymphoma type so that treatments can be more targeted. These tests also help predict how quickly the cancer is growing and spreading, while also being able to measure treatment success and the chance of relapse. Learn More from the National Cancer Institute

Progress is being made in bone marrow and peripheral blood stem-cell transplant methods, both for donor and autologous (self) transplants. Researchers are working on new ways to collect these cells before the transplant to reduce risk of reintroducing the cancer after treatment. They are also investigating ways to remove the last traces of cancerous cells from the stem- cells before they are returned to the patient.

This procedure may have better outcomes with use of some of the newer drugs for treating lymphoma, such as monoclonal antibody therapies. Eliminating graft-versus-host disease (GVHD) is currently a major research goal.  In GVHD, transplanted T-cells attack the body, so the goal is to ensure that transplanted T-cells kill the lymphoma cells, without attacking the immune system.

As researchers gain more insight into lymphoma cells, they are developing drugs that target specific parts of these cells, with the goal of creating a treatment with fewer side effects and another treatment option when chemotherapy fails. Monocolonal antibodies are a type of immunotherapy that targets specific proteins on the lymphoma cell surface or use antibodies to direct drugs into the cancer cells to destroy them while causing little damage to normal body tissues. Other potential treatments for lymphoma include antibiotics, vaccines, and chemotherapy combinations. There are many current clinical trials that are testing these newer therapies, providing new hope for lymphoma patients. Learn more from the American Society of Clinical Oncology

Genetic tests can detect lymphoma in biopsies and determine the type.

This can help make treatments more targeted and growth rates more predictable.

Why Cure Forward?

Finding information about lymphoma clinical trials or other relevant studies can be difficult and frustrating.

When you get started with Cure Forward, your personal Clinical Trial Navigator with help you and you care team build a robust profile inclusive of your full medical history, personal preferences and molecular profile (when applicable), all at no cost. We are able to provide this free service as we focus on building robust profiles so we can match patients with relevant and active clinical trial options, opening the door to advanced treatments and accelerating medical innovation. We work directly with clinical trial recruiters and update the trials available often to bring current, active studies directly to you.