Research in recent decades has led to significant improvements in pediatric lymphoma care, with the latest treatments now curing up to 95% of certain subtypes and stages of lymphoma.1 Despite this success, more work needs to be done.
“Our goal is 100% cure,” said Elizabeth Robbins, MD, a pediatric hematologist-oncologist at UCSF Benioff Children’s Hospitals. “We aim to increase the cure rate and simultaneously decrease the risk of long-term side effects for an increased number of cured individuals.”
To that end, the pediatric oncology team at UCSF Benioff Children’s Hospitals continually adopts new best practices as soon as they are identified. Through bench research and clinical trials, the team also helps advance the field – to the benefit of patients treated locally, nationally and worldwide.
Lymphoma clinical trials now enrolling participants
As a complement to comprehensive lymphoma care that includes chemotherapy, immunotherapy, stem cell transplantation and a robust CAR T-cell therapy program, the team actively pursues therapeutic improvements through clinical trials.
Many physicians at UCSF Benioff Children’s Hospitals hold committee seats with the Children’s Oncology Group (COG), giving patients with Hodgkin lymphoma or non-Hodgkin lymphoma a direct link to novel therapies. Thanks to this connection, multiple lymphoma studies are ongoing at UCSF Benioff Children’s Hospitals.
Here are some that are currently open or will be open for enrollment:
- NYMC-598: A Phase 1 Trial of Targeted Immunotherapy with Daratumumab Following Myeloablative Total Body Irradiation (TBI)-Based Conditioning and Allogeneic Hematopoietic Cell Transplantation in Children, Adolescents and Young Adults with High-Risk T-Cell Acute Lymphoblastic Leukemia and Lymphoma (T-ALL/T-LLy) (ALLO-T-DART) (NCT04972942)
- E4412: A Phase II Study of the Combinations of Ipilimumab, Nivolumab and Brentuximab Vedotin in Patients with Relapsed/Refractory Hodgkin Lymphoma
- A High-Intensity Electronic Health Intervention for the Reduction of Learning Disparities in Childhood Cancer Survivors. This trial offers videoconferencing and a custom website designed to improve learning for children age 6 and older who have received leukemia or lymphoblastic lymphoma therapies, which have the potential to cause neurological damage.
Research strategies in relapsed lymphoma
A particularly exciting area of investigation is the use of immunotherapy to improve outcomes in newly diagnosed and relapsed lymphoma. Researchers are eagerly seeking answers to various questions, including:
- Can immunotherapy drugs negate the need for stem cell transplants and other aggressive treatments for recurrent Hodgkin lymphoma?
- Are there new ways to manipulate medications that can improve outcomes in new and recurrent cases?
- Might combining multiple immunotherapy products during initial therapy cure more patients?
- What lasting, currently unknown side effects might immunotherapy have?
As physician-scientists at UCSF Benioff Children’s Hospitals seek answers to these and other questions, they continue using established best practices to maximize outcomes and quality of life for their patients.
“Even when a therapy doesn’t work the first time, we’re able to offer other treatments that give new hope to families,” said Rohini Jain, MD, a pediatric hematologist-oncologist at UCSF Benioff Children’s Hospitals. “Our mission is to get patients to the end of their cancer journey – when their cancer is cured – and onto living their best lives.”
Removing radiation from the regimen
Dr. Robbins’ early efforts to improve outcomes and reduce complication risk began with eliminating radiation therapy from the standard Hodgkin lymphoma treatment regimen. This approach, used at UCSF Benioff Children’s Hospitals since 2011, relies on the chemotherapy drugs doxorubicin hydrochloride (Adriamycin), bleomycin sulfate, vinblastine sulfate and dacarbazine (ABVD), with interim imaging studies to assess response.2 The practice continues today, though the backbone therapy is modified with the addition of new immunotherapy drugs.
“By avoiding radiation, our Hodgkin lymphoma patients are able to achieve a similarly high rate of cure,” Jain said. “They also experience a far lower incidence of harmful late effects.”
Clinicians at UCSF Benioff Children’s Hospitals have practiced this radiation-free approach for nearly 15 years. The team’s dedicated oncology nurses and social workers have many years of shared experience, empowering them to anticipate potential side effects, prepare patients and their families for treatment, and guide them through the therapeutic process.
The Children’s Oncology Group recently completed a nationwide Hodgkin lymphoma study with treatment regimens similar to those at UCSF. Results were outstanding, and very few patients required radiation therapy. The team at UCSF Benioff Children’s Hospitals continues to forge ahead with successful treatment regimens, evaluating novel therapies to further improve outcomes.
Adding targeted immunotherapy
Targeted immunotherapy is the most encouraging recent modification to lymphoma treatment. Within the last five years, this approach has proven effective in pediatric patients with Hodgkin lymphoma and in some patients with non-Hodgkin lymphoma.
“We’re hopeful that combining immunotherapy with chemotherapy will result in an increased cure rate. Immunotherapy can also be helpful in patients whose lymphoma has recurred,” Robbins said.
Refer a patient online or by calling the Pediatric Access Center at (877) 822-4453 (877-UC-CHILD).
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References:
1 Interviews with Drs. Robbins and Jain
2 https://www.cancer.gov/publications/dictionaries/cancer-terms/def/abvd-regimen
