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Grand Slam

St. Jude hits one out of the park, helping children with Hodgkin lymphoma avoid treatment-related health problems.

Grand Slam

To a competitive baseball player, the flashy silver ring on Hunter Taylor’s slim hand symbolizes grit, determination, victory. “It’s a finals ring,” explains the young shortstop, who aspires to a professional baseball career. For an agile teen with a strong throwing arm, anything is possible. After all, Hunter has already beat Hodgkin lymphoma, a cancer of the lymph system. How difficult can it be to make it to the major leagues?

Thanks to his team at St. Jude Children’s Research Hospital, not only has Hunter reached home plate, but he has done so without undergoing radiation therapy or harsh chemotherapy.

Strike one

When a knot arose on Hunter’s upper leg in the fall of 2010, he assumed he had been hit with a baseball — a common occurrence for a boy who played the game for hours on end. But the nodule persisted, prompting a visit to the pediatrician and then to the hospital. A biopsy indicated that Hunter had Hodgkin lymphoma, a cancer originating in immune-system cells called lymphocytes. The disease generally moves from one group of lymph nodes to the next. Fortunately, Hunter’s cancer was discovered before it could spread beyond the primary location.

When he arrived at St. Jude, physicians confirmed that Hunter had a low-risk form of Hodgkin lymphoma. The boy enrolled in a clinical trial designed to minimize his risk of developing serious health problems later in life.

Since St. Jude opened its doors in 1962, the survival rate for children like Hunter has increased from 50 percent to about 95 percent. But for many of those children, survival has come at a high cost. The chemotherapy and radiation treatments required to eradicate the cancer can cause problems years — even decades — later. Many patients have developed heart problems, infertility or second cancers.

The consequences for females have been especially daunting. “For girls with Hodgkin who received chest radiation, the risk of secondary breast cancers in the future was extremely high,” says Monika Metzger, MD, of St. Jude Oncology. “We could cure most children with Hodgkin lymphoma. But at what price?”

A novel game plan

St. Jude researchers were determined to maintain or improve Hodgkin’s excellent survival rates while reducing the long-term side effects of treatment. As a result, Hunter and 87 other children enrolled in a multicenter trial aimed at tailoring treatment. The patients in this study all had a favorable-risk form of Hodgkin in which the cancer had spread to less than three lymph node groups. None of the participants had experienced the weight loss, fatigue and night sweats that are often associated with a worse outcome.

The children received four chemotherapy drugs for 16 weeks. St. Jude investigators chose drugs that would not place survivors at significant risk for health problems later in life. If a patient’s tumor shrank at least 75 percent following the first eight weeks of treatment, that child did not receive radiation therapy. Children whose cancer did not respond favorably to the chemotherapy received low-dose irradiation. More than half of the patients in the study were able to avoid radiation altogether.

“I didn’t feel bad during my treatment,” Hunter recalls. “It was fun to come to St. Jude. I got to be homeschooled for six months, and I didn’t miss a single baseball game.”

Home run

All of the study participants who avoided irradiation were still alive five years after their initial treatment. Results of the study recently appeared in the Journal of the American Medical Association (JAMA). Metzger and her colleagues are working feverishly to further improve outcomes. St. Jude has continued to tweak the chemotherapy regimen, replacing the four-drug, 16-week treatment with a seven-drug, eight-week treatment.

“Instead of having 50 percent of low-risk patients who do not get radiation, our aim is to have 60 or 70 percent of them avoid radiation,” Metzger explains. “We’re also looking at our intermediate-risk patients and trying to help them avoid radiation. We’re using a strategy similar to the one we used in the low-risk study. We think we’ll be able to safely omit radiation altogether for those who are in complete remission after two cycles of chemotherapy. It looks very promising.”

Hunter now visits St. Jude every six months, leaving him plenty of time for baseball, hunting and other activities. The 13-year-old and his baseball team have competed in 70 games thus far this year — traveling thousands of miles and amassing more runs than any other team in the state. The young shortstop is strong; he’s healthy. And he’s looking forward to — what else? — the next baseball season.

Reprinted from Promise Autumn 2012

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