Although the cure rate is high for Hodgkin lymphoma, it’s easily mistaken for other diseases, like glandular fever. Finding a simple way to diagnose it earlier would help children avoid unnecessary illness, and maybe mean less intensive treatment.
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CCL17 and the early diagnosis of classical Hodgkin lymphoma – a feasibility study in the primary care setting
Professor Ruth Jarrett
University of Glasgow
Glasgow, G61 1QH
1 June 2019
Hodgkin lymphoma is one of the most common cancers in young people but diagnosis is often delayed because signs and symptoms are attributed to diseases that are more common in this age group. This may lead to avoidable illness and anxiety. Diagnostic delays may also result in spread of the disease and the need for more treatment, although are unlikely to affect overall outcome. Blood samples from almost all untreated Hodgkin lymphoma patients contain high levels of a molecule called CCL17, and we have shown that a raised CCL17 level is a good predictor of Hodgkin lymphoma, particularly in young people.
This data suggests that a simple and cheap blood test could be used to identify Hodgkin lymphoma patients among those presenting enlarged lymph glands to their GP, or other symptoms associated with Hodgkin lymphoma. A high CCL17 level would lead to immediate referral to an appropriate hospital clinic for further investigation. The research on CCL17 as an early diagnostic marker of Hodgkin lymphoma has, thus far, been carried out in the hospital setting, and the team now want to evaluate this test in primary care. This presents challenges and so, before planning a large study, we need to gather more information about the best methods of recruiting participants, and the number of participants we will need to definitively evaluate our test.
CCL17 is a known marker of active Hodgkin lymphoma but we are not aware of any other research testing this, or other markers, for use in early diagnosis.
The study will inform the design of a larger study evaluating the value of CCL17 testing for the early diagnosis of Hodgkin lymphoma in the primary care setting. It is hoped that this large study will lead to the introduction of CCL17 testing into routine healthcare. Through earlier diagnosis of Hodgkin lymphoma in young people, the team hope to avoid unnecessary illness and anxiety before reaching the diagnosis and to streamline the diagnostic process. In some cases, earlier diagnosis may also lead to initiation of treatment at an earlier disease stage, when less intensive treatment is required. This, in turn, could lead to a reduction in late side-effects, which continue to be an important consideration in Hodgkin lymphoma treatment.
The research team has had a longstanding interest in the use of CCL17 as a marker of disease activity in Hodgkin lymphoma. During these investigations, a member of the team was found to have a high level of serum CCL17 and this subsequently led to a diagnosis of Hodgkin lymphoma. We are therefore highly motivated to carry out this study. We have analysed CCL17 in thousands of samples and have introduced very strict quality control measures for performing this laboratory test.
The Jarrett laboratory has worked closely with Dr Pam McKay, a consultant haematologist with a special interest in lymphoma, throughout these studies. Mr Iain Nixon, a consultant ENT surgeon, has played an invaluable role in our on-going study of CCL17 as an early diagnostic marker of Hodgkin lymphoma through recruitment of patients attending his neck lump clinic. Together, they have the necessary expertise, enthusiasm and motivation to carry out this study.