Can a simple blood test speed up diagnosis of Hodgkin lymphoma?

18 October 2016

Professor Ruth Jarrett, University of Glasgow

Hodgkin lymphoma is one of the most common cancers to occur in children and young adults. Although the cure rate is high, symptoms are often attributed to other diseases such as glandular fever, delaying diagnosis and resulting in unnecessary illness and anxiety, and possibly more intensive treatment than would otherwise be necessary. This project will explore the value of a new blood test in facilitating early diagnosis of Hodgkin lymphoma.

Amount of grant: £149,968 | Date of award: July 2016

Overview

Lymphoma is a form of blood cancer. It affects the same cells that become cancerous in leukaemia but develops in the lymph nodes rather than the bone marrow. Cancerous cells cluster in the lymph nodes and form solid tumours. These cells can also spill into the blood stream and spread the cancer around the body, including to other lymph nodes.

There are two main types of lymphoma: Hodgkin and non-Hodgkin. Hodgkin lymphoma tends to affect the lymph nodes in the head and neck whereas non-Hodgkin lymphoma can affect any lymph node or related tissue in the body.

Lymphoma is one of the most common cancers in children, teenagers and young adults. There are around 340 cases of Hodgkin lymphoma every year in the UK in the 0 to 24 age group. Most cases occur after the age of 10 years.

Hodgkin lymphoma usually presents with enlarged lymph glands in the neck and more general symptoms such as tiredness and night sweats. Since cancers are rare in young people, these signs and symptoms are often attributed to more common diseases such as glandular fever. The cancer diagnosis is therefore often delayed, leading to unnecessary illness and anxiety and often resulting in distrust of doctors.

Blood samples from people with untreated Hodgkin lymphoma usually contain high levels of a molecule called CCL17. This opens up the possibility that a simple blood test could be used to screen people seeing their GP with signs and symptoms of Hodgkin lymphoma. A positive result would lead to immediate hospital referral for confirmation of the diagnosis.

Although it is clear that people with Hodgkin lymphoma have higher circulating levels of CCL17 than healthy people, there are limited data on CCL17 levels in other diseases. Before we can use this test to screen for Hodgkin lymphoma, we therefore need to know more about CCL17 levels in young people with other diseases. We also need to know whether the test can correctly identify people with Hodgkin lymphoma from others referred to hospital with similar symptoms.

During this project, the team will measure CCL17 levels in samples from three groups of young people using an established test that has been extensively used in the Jarrett laboratory. First, they will test samples from people referred to hospital with signs and symptoms that could be caused by Hodgkin lymphoma and will determine whether the CCL17 test can correctly identify those who actually have the disease. They expect to recruit 100 to 150 patients from across Scotland to this part of the study.

Secondly, they will test a random selection of around 1,000 blood samples from children and adolescents submitted for testing for a broad range of other conditions. They will link their results with diagnoses and determine whether similarly raised CCL17 levels are found in other diseases.

Finally, they will test 1,000 samples submitted for diagnosis of glandular fever, since it is possible that some of these samples will actually come from (undiagnosed) Hodgkin lymphoma patients. If they identify people with Hodgkin lymphoma through this route, then that may make a case for performing CCL17 at the same time as glandular fever testing.

About the research team

Professor Jarrett is a world-leader in this field.
External reviewer
Ruth Jarrett is Professor of Molecular Pathology at the University of Glasgow and an Honorary Consultant NHS Pathologist. She is a leading expert in lymphoma in children and young people and she and her group have a longstanding interest in the cause of Hodgkin lymphoma and believe that CCL17 testing has a role at several points in the care pathway. During the analysis of samples from healthy controls, the group identified someone with early stage Hodgkin lymphoma who did not have obvious symptoms and this provided the motivation for this study.

In this study, Professor Jarrett brings together research groups and clinicians with complementary expertise. Collaborators Professor Frank Sullivan and Professor Bruce Guthrie have a wealth of experience of research in the primary care setting and translating research from the laboratory into clinical practice. They have been closely involved in the design of the study and will play a key role in deciding whether to take this test forward into general practice.

Mr Omar Hilmi is an ENT surgeon who is a proponent of neck lump clinics and actively involved in improving the pathway for investigating neck lumps. He will recruit patients and inform others in the field about the study as well as advising on the implementation of the test.

The study also involves a large number of other physicians and surgeons involved in the diagnosis and care of Hodgkin lymphoma patients, who have given their enthusiastic support for this study.

What difference will this project make?

If successful, this work could lead to shortening of the time to diagnosis of Hodgkin lymphoma for many individuals.
External reviewer
The study will potentially lead to a blood test that could be used in the early detection of Hodgkin lymphoma, one of the commonest cancers in children and young adults. People with Hodgkin lymphoma often consult their GP with enlarged lymph glands or non-specific symptoms like fatigue and are initially diagnosed with less serious conditions, such as glandular fever, which are more common than cancer in young people.

Many people with Hodgkin lymphoma will therefore have tests for glandular fever and other simple blood tests. It is only if symptoms persist that hospital referral is arranged and ultrasound is usually the first line of investigation.

The introduction of a simple blood test that could be performed as soon as a Hodgkin lymphoma diagnosis is considered, or at the same time as glandular fever testing, would speed up and streamline the referral process. A positive test would lead to immediate referral to an appropriate clinic to confirm the diagnosis. This would lead to faster diagnosis and reduce the time from symptoms to treatment. Although earlier diagnosis wouldn’t usually change the chance of a cure in Hodgkin lymphoma, which has a high cure rate, delays to diagnosis result in unnecessary illness and anxiety and frequently to distrust of doctors and the healthcare system. It is possible that earlier diagnosis could lead to detection of the disease at an earlier stage, i.e. when the disease has spread less and thus lead to a reduction in treatment intensity, an important consideration in this group of patients.

Read more: Hodgkin lymphoma in children

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