Circulating Biomarkers in Hodgkin Lymphoma

Abstract

Although the long-term disease control of classical Hodgkin lymphoma (cHL) is relatively high, significant treatment-related morbidities are common. These include secondary cancers, cardiopulmonary complications, stroke, peripheral neuropathy, and infertility. In the 20 % of patients who do not respond to first-line agents, prolonged exposure to suboptimal therapy can induce chemoresistance. Patients with a rapid response may be overtreated and might benefit from a truncated treatment regimen. Accurate risk stratification is needed in order to optimally treat cHL. However, this requires defined predictive and treatment response markers. Existing clinical parameters have limited prognostic value prior to therapy, and the only established marker of value once treatment has commenced is 18-fluorodeoxyglucose positron emission tomography (FDG-PET) combined with computerized tomography (CT). Although PET/CT is currently the most important tool used, interpretation is imperfect with low false-negative rates countered by high false positives. Furthermore, PET/CT is unavailable in many rural or underprivileged centers and, even in the most advantaged centers, is impractical for frequent testing. In order to risk-stratify patients once therapy has commenced, clinicians need an accurate marker of treatment response that can be performed throughout the therapy, prior to each follow-up visit. This chapter focuses on two newly identified serum disease response biomarkers, CD163 and TARC, for cHL that have the potential to greatly assist clinical decision making and aid interpretation of PET/CT.