Hodgkin’s Disease Treatment in Israel – Advanced Therapies & High Recovery Rates

Hodgkin’s lymphoma is one of the most treatable blood cancers, primarily affecting lymphocytes. It accounts for 30% of all lymphatic system cancers, making early diagnosis and treatment crucial for successful outcomes. The disease almost always develops in the lymph nodes and causes them to enlarge. Initially, it is limited to one lymph node or group, and over time it spreads to other lymph nodes. The chances of recovery from this disease are among the highest of other common cancers. Hodgkin’s disease is a disease of young people (average age 32) and 40% of patients have the Epstein-Barr virus. Therefore, patients with infectious mononucleosis are at higher risk of developing Hodgkin’s disease than others. In a biopsy examined under a laboratory microscope, a very unique picture can be seen that is specific to Hodgkin’s disease. 

Unusually, the malignant cells are the minority and all the other cells are inflammatory cells. In recent years, the disease has been classified into two types: Nodular lymphocytic predominance and classical, which accounts for 95% of cases. In both types, the malignant cell is a B lymphocyte. In the first type, it is a distinct B lymphocyte, meaning that it contains genes responsible for creating antibodies and the envelope surrounding it contains markers typical of B cells. The chances of recovery are excellent even without treatment, but the disease may recur and in rare cases become a more malignant disease. In the second type, the typical cell is the Reed-Sternberg cell, which contains a nucleus with at least two lobes, a kind of mirror image with large nucleoli. The origin of these cells is also a B lymphocyte, but it is abnormal and does not contain the normal properties.

Most of the cells lack the markers typical of B lymphocytes and instead have different markers. Although these cells are abnormal, they have a mechanism that prevents their natural death (Apoptosis) and therefore they thrive and cause the development of the disease.

Hodgkin’s cells contain an excessive amount of abnormal “cytokines,” that is, substances responsible for the special features of the disease, including the enormous accumulation of inflammatory cells.

In light of the diverse activity of the “cytokines,” the classic disease is classified into four types that express different microscopic, clinical, and prognostic features in each type:

• Nodular sclerosing
• Mixed cellularity, specifically associated with the EBV virus
• Lymphocytic rich
• Lymphocytic depleted, which, unlike the others, in this type of disease, malignant cells are the majority.

The chances of recovery from Hodgkin’s disease after innovative treatments that have been developed in recent years are significantly higher, especially when the spread of the disease in the body (Stage) is limited. Therefore, it is very important to undergo diagnosis and treatment in best hospitals for Hodgkin’s lymphoma like Tel Aviv Medical Clinic.

Hodgkin’s disease symptoms

The main symptoms of Hodgkin’s disease are:

• Swelling of the lymph nodes in the neck, armpits, or groin
• High fever
• Night sweats
• A general feeling of fatigue and lack of energy
• Abdominal pain
• Unexplained weight loss
• Local irritation and itching of the skin
• Rash
• Difficulty swallowing (due to the swelling of the lymph nodes in the neck)

Lymph nodes can swell for a long time before any clinical signs appear, and fever and other symptoms related to lymph node diseases may appear and disappear for several weeks before the patient feels the need to see a doctor. Even drastic weight loss can be explained with alternative diagnoses. Therefore, it is very important to be especially sensitive to all the signs listed above and seek medical help if necessary.

Diagnosis and Testing

If your doctor suspects that you have Hodgkin’s disease based on your medical history and description of your symptoms, he or she will perform a complete physical examination to look for swollen lymph nodes. In addition, blood tests and a lymph node biopsy will be performed. During the biopsy, the doctor injects a local anesthetic into the area of ​​the swollen lymph nodes and uses a sterile needle to remove a small piece of tissue for laboratory testing. Sometimes the surgeon will remove a larger portion of the lymph node for a more definitive diagnosis. In cases where the cancer is suspected of spreading to the bone marrow, this tissue may also be evaluated to determine for sure that it is Hodgkin’s disease.

Additional tests may also include an X-ray of the chest, bones, liver, and spleen. If you have been diagnosed with Hodgkin’s lymphoma, the next step is to determine the stage of cell division, the stage at which the cancer is in. To do this, your doctor will need to consider whether you are exhibiting symptoms known as B symptoms, which include fever, weight loss, and night sweats. The stages of the disease are classified from stage 1, where the cancer is confined to one tissue, to stage 4, where the cancer has spread widely outside the lymphatic system to the bone marrow or other organs.

Hodgkin’s lymphoma treatment 

Hodgkin’s disease is a type of cancer of the lymphatic system, characterized by the presence of Reed-Sternberg cells. Treatment is personalized for each patient depending on the stage of the disease, type, general health status, and other risk factors.

Main treatments for Hodgkin’s disease are:

Chemotherapy for Hodgkin’s disease – The main treatment for Hodgkin’s disease, given in combination with several drugs: Common protocols:

• ABVD (Adriamycin, Bleomycin, Vinblastine, Dacarbazine) – first line.
• BEACOPP (Bleomycin, Etoposide, Adriamycin, Cyclophosphamide, Oncovin, Procarbazine, Prednisone) – for advanced conditions.

Radiation therapy for lymphomas – is given mainly after chemotherapy to complete the treatment. Radiation is targeted at the affected lymph nodes and prevents the disease from recurring. Radiation is usually appropriate for early stages.

Targeted Therapy – Biological drugs that act against specific mechanisms in cancer cells. Common drugs:

• Brentuximab vedotin (Adcetris) – an antibody against CD30, intended for patients with relapsed disease.
• Nivolumab (Opdivo) / Pembrolizumab (Keytruda) – PD-1 inhibitors used for advanced or recurrent treatment.

Stem Cell Transplant for Hodgkin’s lymphoma – The treatment is suitable for patients with resistant or recurrent disease (Relapsed/Refractory Hodgkin’s Lymphoma). It is performed after high doses of chemotherapy. Types of transplants:

• Autologous SCT – stem cell transplantation from the patient himself.
• Allogeneic SCT – cells donated from a suitable relative or a donor pool.

Experimental and Innovative Therapies

• CAR-T therapy for Hodgkin’s – A gene therapy in which the patient’s immune system cells are genetically modified to recognize and destroy the cancer.
• Advanced Immunotherapies – Studies are examining new combinations of drugs to improve survival and reduce side effects.

Related diseases that can cause Hodgkin’s disease

Hodgkin’s lymphoma is a malignant disease affecting the lymphatic system, but in some cases, it may develop in conjunction with or as a result of other medical conditions. Certain cancers and tumors, particularly those affecting the uterus, thyroid, blood vessels, and skull base, have been linked to an increased risk of developing Hodgkin’s lymphoma. Additionally, tumors in the thoracic isthmus or previous surgeries in this region may contribute to lymphatic system alterations, potentially triggering malignancies.

Understanding the relationship between Hodgkin’s disease and these associated conditions is crucial for early detection, effective treatment, and improved patient outcomes. In this article, we explore the possible connections between Hodgkin’s lymphoma and related diseases, along with their implications for diagnosis and management.

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