My Brother has Hodgkin lymphoma stage IV-B please Help

[god_help_me]

Dear All,

My Brother has final diagnosis  " Hodgkin lymphoma stage IV-B with bone marrow involvment on third line chemotherpy (IGEV)"
He is 27 year old , he started  ABVD without response , shifted to ESHAP and still diasease was progressing, he was started  on IGEV for 3 cycle and was admitted electivety for the 3rd cycle. he was asymptomatic. No shortness of breath , no cough , no dyspnea, no abdominal pain , no nausea or vomiting , no fever.

He has a cervical lymphadenopathy in the left side and  left supraclavicular 3 lymph nodes. the largest was 2x1 cm round , mobile , not tender and no skin changes and left axillary , 3 lymph nodes ,the larget was 3X4 cm and not mobile  , not tender and no skin changes.

the final report was " Patiant was seen after IGEV chemotherapy X3.CT scan and PET scan showed same disease , no response, actually minimal increase in the size of lymph. patient is not a candidte for any further chemo or salvage or high dose chemo and transplant . currently there is no standard treatment option"

Currently he is in government hospital in Saudi Arabia ,   please any advice :(    .  is there any solution any good hospital in world that can deal with this situation .  PLEASE help .


Thank you for ALL

[Ken_PA]

Ahlan. There are two ways to proceed for his "refractory" (meaning that it didn't respond to treatment) Hodgkin's Lymphoma, and what you choose is ultimately just a matter of guesswork.

The first thing I'd do is to look here:
http://clinicaltrials.gov/ct2/results?term=refractory+hodgkin+lymphoma

People for whom standard treatment is no longer an option look to whatever new drugs are being tested. They might not turn out to be effective, they might not turn out to be safe - but typically they are the only chance left.

You'll notice that some are currently recruiting, others are not. In either case, that page tells you what drugs are being looked into for refractory HL.

For example, the first one that I see is for Bexxar. That is an approach that uses "antibodies" that individually bind onto cancer cells and deliver a radioactive molecule there to try and kill the cancer cells (rather than shooting a beam of radiation). This approach has been used with some limited success for Non-Hodgkin's Lymphoma, so it's not a new drug - instead they are looking into whether this known drug can be used for HL whereas it has not been used for HL before. Notice that there are eligibility criteria, such as "Must be at least 4 weeks out from their most recent chemotherapy".

That is a mild treatment, as compared to the very harsh standard chemo regimens he has been receiving.

Lenalidomide is another drug that been used in NHL. It is less harsh but still can wipe out the immune system so that the patient dies from infections.

Some drugs on that list such as PLX3397 are so new that they don't have a proper name yet.

Some like bendamustine are harsh drugs, and your brother might not be able to take any more of those kinds.

Rituxan (aka Mabthera is Europe) is typically the mildest, I'm surprised he wasn't given any - though it's not standard treatment. It is an antibody which hopefully gets the patients' own system to kill the cancer cells. However, it only works in certain subtypes of HL:
http://www.ncbi.nlm.nih.gov/pubmed/21183282  Can you find out what subtype of HL he has? If it is lymphocyte predominant HL, then that treatment would be what I'd go for.


I presume all this mist be confusing, so I'm trying to give an overview to you as an intro.


A whole different approach would be to go with alternative types of treatments, which I'd never recommend except if there is no other reasonable option.

One example is Dr. Burzynski from Texas, USA. You can decide if he is a pioneer or a quack:
http://www.google.com/search?q=texas+doctor+fda+cance

Another approach uses "Coley toxins" to make a fever that fights the cancer. Once again, you'd have to decide on how credible that is. Here is one man's story:
http://www.youtube.com/watch?v=Upc1ZaD6aTA

I suppose there are other alternative treatments, but if they center on "detoxing" I'd avoid those as presumably being completely ineffective.


Good luck to your brother and to you. I'll check later today to see if you have any followup questions.

The important question for you to answer: Can you find out what subtype of HL he has? Is "lymphocyte predominant HL"? Or alternatively if he has "classic HL" then is it CD20+?

(The CD20 is what the Rituxan antibodies need to attach to.)

[god_help_me]

Dear  Dr

Thank yo so much for your reply,  I really appreciate .

I just talked with him actually he has " Nodular Sclerosing"

any advice  please .

thank you so much

Best Regards,

[Ken_PA]

Hi, I am not a doctor and there are no doctors who answer questions on this forum.

However, it does look like Rituxan wouldn't work with your brother. I'd also personally guess that Bexxar wouldn't work, either. So you'd have to look at one of the other treatments.

What to do at this point? All advanced cancer treatment centers in the world would likely have the same options. So I'd think it is a matter of deciding what country you want to take him to: most likely France, England, or US and then choose any large center there.

This might help, it's the "American Cancer Society Clinical Trials Matching Service":
http://www.cancer.org/treatment/treatmentsandsideeffects/clinicaltrials/app/clinical-trials-matching-service.aspx

Good luck

[god_help_me]

Thanks Mr.  Ken   god bless you