Hodgkin lymphoma (HL) Treatment in Malaysia

What is Hodgkin lymphoma (HL)?

Hodgkin lymphoma is a lymphatic malignancy. The lymphatic system is part of the body's immune system, which fights germs and diseases. Hodgkin lymphoma develops when healthy cells in the lymphatic system mutate and expand out of control.

The lymphatic system contains lymph nodes. They are located throughout the body. Most lymph nodes are in the abdomen, groin, pelvis, chest, underarms, and neck.

The lymphatic system contains the spleen, thymus, tonsils, and bone marrow. Hodgkin lymphoma can affect all these locations and other organs in the body.

Hodgkin lymphoma, formerly known as Hodgkin disease, is one of two primary forms of lymphomas. The other is non-Hodgkin's lymphoma.

What is the Importance of Timely Treatment?

• Timely treatment of Hodgkin Lymphoma (HL) is essential for improving outcomes and increasing the likelihood of a cure. Early detection and action considerably boost the possibility of complete remission, as HL responds favourably to early-stage treatments such as chemotherapy and radiation.
• Delaying treatment can allow cancer to spread, resulting in serious problems such as organ damage and an increased chance of subsequent cancers. As a result, beginning treatment early increases survival chances and reduces long-term health risks.

What are the Common Symptoms of Hodgkin lymphoma (HL)?

The most frequent initial symptom of Hodgkin lymphoma is painless enlarged lymph nodes in the neck, underarm, or groin. Additional symptoms include:

• Persistent fatigue: This refers to feeling substantially more fatigued than usual for numerous days.
• Unexplained fever: A high temperature that persists for two or more hours after home therapy or lasts more than two days may indicate a dangerous condition.
• Drenching night sweats: Occurrence of excessive sweating
• Unexplained weight loss: This refers to losing body weight without trying. Losing 10% or more of your body weight in six months indicates unexplained weight loss.
• Itchy skin (pruritis): Some persons with Hodgkin lymphoma experience extremely itchy skin
• Abdominal discomfort or edema: Not every abdominal pain indicates a serious illness. Contact a healthcare specialist if you are experiencing significant discomfort that is not going away.
• Chest discomfort: It could be a symptom of Hodgkin lymphoma in your lung tissues or lymph nodes within your chest.
• Shortness of breath: This could indicate Hodgkin lymphoma in your lungs or a massive lump in your chest.

Types of Hodgkin Lymphoma

There are four classical Hodgkin lymphoma subtypes:

• Nodular Sclerosis Hodgkin lymphoma: This is the most prevalent classical Hodgkin lymphoma subtype. It frequently affects young adults. It often affects lymph nodes in the centre of the chest.
• Mixed cellularity Hodgkin lymphoma: This subtype primarily affects persons in their sixties. It can sometimes develop in your abdomen.
• Lymphocyte-rich, classic Hodgkin lymphoma: This subtype affects around 6% of all Hodgkin lymphoma patients.
• Lymphocyte-depleted Hodgkin lymphoma: This subtype affects around 1% of Hodgkin lymphoma patients. It is particularly common among those over the age of 60 and those living with HIV/AIDS.

Stages of Hodgkin Lymphoma

Disease staging assists healthcare providers in determining how advanced the disease is, how quickly it may spread, and which treatments may be most effective. Here are the phases of Hodgkin lymphoma.

• Stage I: Cancer cells are present in a single lymph node or lymphoid organ. Alternatively, lymphoma can develop in a specific location of an organ other than your lymph system.
• Stage II: Cancer cells are found in two or more groups of lymph nodes on the same side of the diaphragm (additional lymph nodes nearby may also be affected).
• Stage III: Lymph node sections on both sides of your diaphragm contain lymphoma cells, or cancer cells are found in lymph nodes above your diaphragm and Spleen.
• Stage IV: There is lymphoma in at least one organ other than your lymph system, such as your liver, lung, or bone marrow.

Causes, Risk Factors and Complications of Hodgkin lymphoma (HL)

Causes

• Healthcare professionals are unsure what causes Hodgkin lymphoma. It starts with modifications to the DNA of a lymphocyte, a type of disease-fighting blood cell. A cell's DNA includes instructions that teach it what to do.
• The DNA modifications instruct the cells to grow rapidly and survive when other cells usually die. Hodgkin lymphoma cells attract many healthy immune system cells, safeguarding and assisting them to grow. Extra cells flock into lymph nodes, causing swelling and other symptoms.

Risk Factors

The following factors can raise the risk of Hodgkin lymphoma:

• Your age: Hodgkin lymphoma is most commonly diagnosed in persons in their 20s and 30s, as well as those over the age of 65.
• Family history of Hodgkin lymphoma: Having a blood relative with Hodgkin lymphoma enhances one's risk of developing the disease.
• Being male: Men are somewhat more likely than women to get Hodgkin lymphoma.
• People who have previously been infected with the Epstein-Barr virus are more likely to develop Hodgkin lymphoma than those who have not. One example is contagious mononucleosis.
• HIV infection: People with HIV are more likely to develop Hodgkin lymphoma.

Complications

Complications of Hodgkin lymphoma (HL) can include:

• Infections
• Infertility
• Cardiac complications
• Pulmonary complications
• Thyroid dysfunction
• Second cancers
• Blood abnormalities

Latest Research and Technologies in the Treatment of Hodgkin Lymphoma (HL) in Malaysia

Recent developments in Malaysian Hodgkin lymphoma (HL) care centre on incorporating innovative treatments and enhancing patient outcomes:

• Antibody-Drug Conjugates (ADCs) Adoption: ADCs like brentuximab vedotin are being used in clinical settings in Malaysia. By delivering strong chemotherapy straight to cancer cells, these tailored medicines reduce harm to healthy tissue and improve the effectiveness of treatment.
• Investigation of Immunotherapies in Combinations: For relapsed or refractory classical HL, clinical trials are examining the combination of anti-PD-1 antibody (pembrolizumab) with anti-LAG-3 antibody (favezelimab). Promising results from early trials suggest that patients not responding to conventional treatments may have options.

Hodgkin Lymphoma (HL) Prevention Tips

Here are some preventative tips for Hodgkin Lymphoma (HL):

• Avoid Infections: To avoid infections, practice proper cleanliness and limit exposure to the Epstein-Barr virus (EBV).
• Healthy Lifestyle: A healthy lifestyle includes eating a balanced diet, exercising regularly, and managing stress.
• Limit Your Tobacco and Alcohol Consumption: Avoid smoking and drinking excessively.
• Early Detection: Regular check-ups and awareness of uncommon symptoms will help in early diagnosis.

While these strategies may not ensure prevention, they promote general health and early intervention.