Grant: CIHR Fellowship

Hodgkin lymphoma is the most common form of malignant lymphoma affecting young people in the Western World. Despite advances in treatment over the last half century, 25% of patients will relapse after initial treatment. Most of these people are then treated with high intensity chemotherapy and bone marrow transplant with 50% subsequently being cured. Currently, we lack reliable tools to predict which patients will be cured by this second line treatment and in whom the disease will progress or relapse. In this proposal we plan to develop tools to predict outcome of second line treatment by examining the lymph node biopsies of patients taken at the time that the lymphoma returns. In Hodgkin lymphoma, the cancer cells make up only ~1% of the cells present in these biopsies, with the remainder being normal cells attracted by the cancer cells - the so-called "tumor microenvironment". We have recently shown that the cells present in this microenvironment are important predictors of response to the initial treatment. We will determine whether the mix of cells in the relapse biopsies predict outcome of the second treatment. We will also use recently described special techniques to measure the expression of genes in the relapse biopsies. A predictor will then be produced using information about how the patients responded to the second line treatment. This tool will ultimately inform patients and doctors about the likely outcome of the high intensity chemotherapy and bone marrow transplant and will allow us to identify people who may be better served by new treatment options.