The study, published today (11 December) in [_The Lancet Oncology_](https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(24)00598-9/fulltext) was led by researchers at the Wellcome Sanger Institute and Cambridge University Hospitals NHS Foundation Trust (CUH). It compares the lasting effects of two chemotherapy regimens used to treat Hodgkin lymphoma in younger adults.
Both chemotherapy regimens achieved the same success in treating cancer but one led to fewer, less severe side effects.
Hodgkin lymphoma is often diagnosed in younger people aged 20 to 40, and finding effective treatments with less severe side effects could reduce hospital time and give patients a greater likelihood of recovering fertility.
In the new study, researchers suggest that making the newer chemotherapy regimen, known as eBEACOPDac, the recommended treatment for Hodgkin lymphoma in adults could improve the long-term health of patients and enable more of them to go on to have children.
Hodgkin lymphoma is a type of blood cancer, with around 2,000 people diagnosed in the UK each year1. The occurrence of Hodgkin lymphoma in younger people means there is a significant need to reduce the long-term health and fertility impacts of treatment.
Chemotherapy is a well-established approach for treating various cancers, including Hodgkin lymphoma. There are many different chemotherapies consisting of several different drugs used in combination. Chemotherapies are highly effective for treating cancer but also have well-known side effects such as nausea and hair loss, and can have lasting effects following treatment, including anaemia and infertility.
A commonly used standard first-line treatment for people with advanced Hodgkin lymphoma involves chemotherapy known as eBEACOPP. This research compared the impact of eBEACOPP against a similar regimen, called eBEACOPDac. Both treatments use combinations of drugs, but in eBEACOPDac a drug called procarbazine is replaced with another called dacarbazine. The new eBEACOPDac regimen does not increase the cost of treatment and is administered to patients in the same way.
A similar drug substitution is already approved for use in children with Hodgkin’s Lymphoma and is increasingly widely used for the treatment of adults, but this is the first study to rigorously examine its impact in adult patients.
The team looked at health data previously collected from 1,945 patients treated with the existing chemotherapy regimen, eBEACOPP, and compared it to data from 312 patients treated with eBEACOPDAC.
Both chemotherapies achieved the same success in treating cancer. 93.3 per cent of patients were in remission three years after treatment, but a comparison of data from the two groups showed that patients treated with eBEACOPDac generally experienced fewer, less severe side effects.
Patients treated with the new regimen spent less time in hospital, required fewer blood transfusions following treatment, and more patients showed signs of recovering fertility sooner. This also has the potential to reduce hospital admissions and demand for hospital appointments.
The team also used whole genome sequencing at the Sanger Institute to look at the effects of both treatments and showed that eBEACOPDac has a greatly reduced impact on patient genes. They found more DNA changes in the tissues of those treated with eBEACOPP, along with two mutational signatures that were not seen in those who received eBEACOPDac.
This work is illustrative of the benefits that can be delivered through the effective translation of research into clinical practice. The next steps for this research will include more long-term follow-up of patients treated with eBEACOPDac, in the hopes that it will inform a global change in the guidance for treating adults with Hodgkin lymphoma.
> “Our findings highlight the potential to make the short and long-term side effects of chemotherapy much kinder for Hodgkin lymphoma patients without compromising the effectiveness of treatment. By making a small change to how patients are managed, we can greatly reduce the lasting impacts that this disease, and its treatment, has on their lives giving many more patients the opportunity to go on to raise families.”
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> **Professor George Follows,** co-lead author from Addenbrooke’s Hospital and the Department of Haematology, University of Cambridge
> “This work provides strong evidence of the benefits of using eBEACOPDac for treatment of Hodgkin lymphoma. This approach is preferable due to its reduced side effects and improvements in fertility recovery. Crucially, these findings are of international significance and should be used to inform treatment guidelines to deliver the best treatment for patients in the UK and around the world.”
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> **Dr Cathy Burton,** Chair of the UK Hodgkin lymphoma study group, and Haematology Consultant at Leeds Teaching Hospitals NHS Trust
> “This is an example of how genomics can impact lives and help change healthcare. Through the use of genome sequencing, we’ve gained a deeper insight into the lasting effects of chemotherapies, allowing us to learn more about their role in long-term health, and make progress towards effective treatments that minimise side effects as much as possible.”
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> [**Dr Raheleh Rahbari,**](/person/rahbari-raheleh/) co-lead author from the Wellcome Sanger Institute
#### **Louisa’s story**
Louisa, a patient in her 30’s from Peterborough, was treated with eBEACOPDac as part of the study. Three years later, she has gone on to have her second child.
> “When I was told I had lymphoma, it was the start of the COVID pandemic and we had a new baby in the house. It was a challenging time and instinctively, what I wanted most was to get the best treatment, that would allow me to be there for my new family and do the things I love. Undergoing treatment was still difficult but I received excellent care and support throughout.”
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> Regaining my fertility was the most unexpected and incredible experience. I knew my chances of fertility after chemotherapy treatment would be somewhat compromised, so to have another child last year was wonderful and I am eternally grateful to be able to experience motherhood for a second time”.
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> **Louisa**