Treatment strategies to improve outcomes in aggressive lymphomas

Abstract

© 2016 Dr. Eliza Anne HawkesLymphoma is the 5th most common cancer subtype, comprising 5% of all cancers. There are over 40 different subtypes of lymphoma. Those considered indolent are generally slowly progressive, and most are deemed incurable yet confer median survivals of approximately 10 years. Aggressive lymphomas, by contrast, have a short natural history, often with survival of weeks to months if left untreated. The majority of aggressive lymphomas, including diffuse large B-cell non-Hodgkin lymphoma and Hodgkin lymphoma, are cured with upfront combination chemotherapy, however up to 30% eventually die from disease. The aim of the research projects presented here has been to contribute to the developments and improvements in management of aggressive lymphomas with a focus on diffuse large B cell lymphoma and Hodgkin lymphoma. The topics covered within this thesis explore several strategies for improving outcomes in aggressive lymphomas including dose intensification of firstline combination chemotherapy in diffuse large B-cell lymphoma, incorporating novel targeted therapies into standard treatment regimens, comparing outcomes from firstline chemotherapy in clinical trial Hodgkin lymphoma patients to those treated in routine standard practice, evaluating novel chemotherapy regimens in relapsed lymphoma as well as biomarker-driven identification of high risk groups and adequate follow up of aggressive lymphomas. The findings of the research in the thesis have confirmed the quality of local standards of care in Australia, contributed to global changes in management in aggressive lymphomas and provided a platform for further investigation in improving outcomes from aggressive lymphomas