The Dutch treatment guideline for advanced-stage Hodgkin lymphoma has been revised on the basis of the international HD21 study, meaning that the new standard of care is now implemented in hospitals across the Netherlands. The Dutch contribution to this practice-changing research was led by CCA researcher Prof. Josée Zijlstra, Professor of Hematology. The new regimen is more effective and causes less permanent damage than the previous standard of care. Zijlstra: "That makes a real difference, especially for young patients. Can they resume their lives after treatment? Will they retain the ability to have children later on?"
Hodgkin lymphoma is a cancer of the lymphatic system that predominantly affects young adults. In advanced-stage disease, multiple lymph node regions and organs are involved. Although the existing treatment is effective, it is highly toxic. Patients may experience severe side effects, including infections, anemia, nerve damage, and reduced fertility, with a major impact on the rest of their lives.
A new combination with less harmful agents
The guideline change is directly based on the results of the international HD21 study, published in July 2024. In this trial, researchers compared the existing treatment with a new combination of chemotherapy and immunotherapy: BrECADD. This regimen omits three agents known to cause pulmonary damage, nerve damage, and infertility. These have been replaced by drugs associated with fewer permanent adverse effects, including an immunotherapeutic agent that targets cancer cells more specifically.
Fewer side effects, better outcomes
Of key importance to patients is the reduction in long-term impact. Ovarian and testicular function recovers more frequently after treatment with BrECADD, giving patients a greater chance of conceiving naturally later in life. Fewer blood transfusions are required, and patients less frequently suffer from neuropathy, such as sensory disturbances. Zijlstra: "This is precisely why these results are so important: the new treatment is both more effective and better tolerated." In addition, most patients now require only four cycles; treatment is shorter than before, as it is guided by interim PET scans.
New standard across the Netherlands
BrECADD is now the preferred treatment in the Netherlands for patients up to 60 years of age with advanced-stage Hodgkin lymphoma. The treatment is available as standard of care in all hospitals and is reimbursed by all Dutch health insurers.
The research was made possible in part by a contribution from KWF Kankerbestrijding (the Dutch Cancer Society), funded entirely by proceeds from Alpe d'HuZes.