Ingrid Glimelius – Clinical, epidemiological and tumour biology studies of different cancer forms

Our research focuses on clinically important questions in several cancer forms. Our studies are based on our knowledge from the clinic and takes advantage of the many national and local registries in Sweden.

Mantle cell lymphoma

Mantle cell lymphoma is currently one of the lymphomas with poorest long-term survival and novel treatment concepts are urgently needed. However, in addition to the short expected survival there are also other challenges such as an ageing population, many new drugs and difficulties knowing for which patient groups new drugs should be introduced.

The survival is still poor for patients with mantle cell lymphoma and the aging population is a challenge in selecting the right treatment.

International studies and clinical trials

By active participation in the Nordic Mantle Cell lymphoma group, we have been involved in introducing and evaluating several new targeted drugs for mantle cell lymphoma. In a randomized phase III trial in elderly patients, we are testing whether a chemotherapy free concept can improve survival while using the first-generation tyrosine kinase inhibitor Ibrutinib (the ENRICH trial).

We have also recently finished the VALERIA-trial testing and showing that a minimal residual disease (MRD) approach is feasible when guiding treatment length in patients with relapsed and refractory mantle cell lymphoma patients. We are now actively including patients in the follow-up trial ALTAMIRA where a MRD guided treatment approach is tested in first line in elderly patients while using the second-generation tyrosine kinase inhibitor acalabrutinib (Calquence®) is feasible.

We are seeing an active transition in the use of also novel targeted drugs and immunotherapy for our lymphoma patients today, adding to the effect of conventional chemotherapy. At the clinical trial unit at Akademiska sjukhuset, Uppsala, patients are offered participation in trials providing the most recent drugs and treatments that are available

New prognostic and predictive markers

In addition, we investigate the tumour microenvironment in mantle cell lymphoma, with the aim to identify new prognostic and predictive markers. We do a comprehensive characterisation of the genetics, epigenetics and tumour biological features in lymphoma tumours. We hope to also develop and further improve the detection of relapses in mantle cell lymphoma patients by exploring novel minimal residual disease (MRD) methods for our patients.

In a register-based approach of our research we are also focusing on the many side-effect’s patients can experience after needing those intensive treatments. We are specifically investigating the risk of second malignancies and secondary infections.

Hodgkin lymphoma

Hodgkin lymphoma affects young adults and is today a curable disease with intensive chemotherapy. We have since many years studied cancer survivorship in Hodgkin lymphoma patients and we have been able to evaluate very long-term effects and side effects of oncological therapies. We have a close collaboration with the epidemiology group at Karolinska Institutet. Our studies on the ability to have a child after a lymphoma treatment has gained high international interest and been presented at many conferences.

In addition, we have an extensive ongoing collaboration with the Pathology department, IGP, where we study the tumour microenvironment in Hodgkin lymphoma, and with the Lymphoma group in Uppsala, chaired by Gunilla Enblad.

The tumour microenviroment in Hodgkin lymphoma, with tumour cells and surrounding inflammatory cells. Photo: Peter Hollander.

Pregnancy and the risk of cancer

Another research focus in the group is perinatal risk factors, pregnancy and the risk of cancer. Our studies on the association between pregnancies and later cancer risk in the mother have recently been published in two original papers and a review article.

In the first article we show that a full-length pregnancy protects against epithelial ovarian cancer to a higher extent than a pregnancy resulting in preterm delivery. In the second article, we show a decreased risk of breast cancer for females experiencing high blood pressure prior to and during pregnancy. In the review we both illustrate and discuss different aspects of pregnancy and a later risk of several solid malignancies.

Solid cancers

We also study solid cancers, particularly studies on ovarian cancer and cervical cancer. Moreover, we have ongoing studies on testicular cancer and are at present investigating, in particular, the risk associated with psychiatric comorbidity and testicular cancer.