Hodgkin’s Lymphoma and its Treatment
Hodgkin’s lymphoma is a type of cancer that arises in the lymphatic or reticuloendothelial system, a part of the immune system of the body. Lymphocytes are white cells that are produced in the bone marrow and home to the reticulo-endothelium. They help fight infections and some other diseases. The two types are T lymphocytes and the B lymphocytes.
Hodgkin’s lymphoma starts in the B lymphocytes whose main function is to make proteins called antibodies to help protect the body from harmful bacteria and viruses. Hodgkin’s lymphoma is named after Thomas Hodgkin an English pathologist who first identified this discrete disease entity in 1932.
Chemotherapy and radiation therapy are the main treatments for Hodgkin’s lymphoma. Till 1950s many patients lost their lives to Hodgkin’s Lymphoma.Dr Henry Seymour Kaplan,a Radiation Oncologist at Stanford University studied the progression of Hodgkin’s lymphoma and gave the concept of treating the adjacent lymph node stations rather than “Chasing Field Technique” followed for treatment with radiation therapy prevalent in his days. He was the co-inventor of the first Linear Accelerator with Edward Ginzton, a 6 million volt machine at Stanford Medical Centre in 1955.
He gave the concept of extended field treatments using the Linear accelerator and coined terms like “Mantle Field treatment” Inverted Field treatment.400 of his Hodgkin’s Lymphoma patients and their families attended a re-union in 1982 at Stanford to mark 20 years of successful clinical trials against this once dreaded disease.
Mustine hydrochloride is a nerve gas that was used in the World War II in chemical warfare. The other names for this drug are Nitrogen mustard or Mustragen. Nitrogen mustard can cause DNA breaks and cell cycle arrest and is labeled as an alkylator. It was one of the first drugs used for cancer treatment and the cancer was Hodgkin’s lymphoma. After the discovery of Nitrogen mustard, vinka alkaloids and Endoxan, various combination chemotherapy protocols were derived and multi agent chemotherapy was started for treatment of Hodgkin’s Lymphoma.
In late 1990s the doctors started trials to combine lesser doses of radiation and reduced cycles of chemotherapy to reduce the side effects of treatment as they were getting long term survivors of >20 years who had started manifesting late side effects of either treatment although cured of their primary cancer.This reduction of one treatment led to synergistic effect of two treatments ,shortening of treatment time and minimizing toxicity of either .This was the origin of Multi-Modality treatment and a proper sequencing ,number of cycles and doses was defined over the next two decades.
At present Hodgkin’s lymphoma is curable in >90 % of patients with proper staging and sequencing of chemotherapy, radiation and or radiation alone. Hodgkin’s lymphoma is an important disease that defined the staging and curative treatment for a disease believed to be lethal till 1950s.It si the success story of undying quest of human mind to overcome adversity through persistent application of science.