Treatment and Side Effects Management of Hodgkin Lymphoma
The following are common therapies used to treat HL. All of the treatments listed may not be required or prescribed in your case. Talk with your health care team to discuss the best option for your disease.
Chemotherapy uses drugs to destroy cancer cells. More than half of all people treated for cancer receive some kind of chemotherapy. Each person has a unique response to chemotherapy. Side effects will vary depending on the type, dose and frequency of the drug or drug combination you receive.
Chemotherapy can destroy cancer cells almost anywhere in your body, but it can also destroy normal cells. It is given through a vein, or taken in pill form. Chemotherapy is usually given in cycles, which means you may receive treatment for several weeks then take a break for your body to recover.
For HL, doctors use a combination of different drugs to kill cancer cells. In the U.S., the most common chemotherapy regimens for the initial treatment of HL include:
- ABVD: doxorubicin (Adriamycin®), bleomycin (Blenoxane®), vinblastine (Cytoxan®), dacarbazine (DTIC-Dome®)
- In cases of stage III of IV CHL, some patients now receive A+AVD, which removes the bleomycin from ABVD and adds in its place brentuximab vedotin (Adcetris®), an antibody drug conjugate that targets the CD30 protein on lymphoma cells.
- BEACOPP: Blenoxane, etoposide (Etopophos®, Toposar®, VePesid®, VP-16), Adriamycin, cyclophosphamide (Cytoxan®), vincristine (Oncovin®), procarbazine (Matulane®), prednisone
- Stanford V: mechlorethamine (Mustargen®), Adriamycin, Cytoxan, Oncovin, Blenoxane, etoposide, prednisone
Immunotherapy pushes the body’s immune system to work harder to fight the cancer. In 2016, Nivolumab (Opdivo®) was approved for patients with CHL that has relapsed after a stem cell transplant in patients who also received brentuximab vedotin post-transplant. In 2017, pembrolizumab (Keytruda®) was approved by the FDA to treat people with classical Hodgkin lymphoma, or those who have relapsed after three or more prior lines of therapy.
Radiation Therapy uses high-energy rays (ionizing radiation) to kill cancer cells. The goal is to damage as many cancer cells as possible without harming healthy tissue. To minimize damage to healthy cells, radiation doses are calculated very precisely; treatment areas are carefully defined; and treatment is spread out over time. After radiation treatment ends, cancer cells will keep dying for days or even months. Some people with cancer, only need radiation therapy. Others receive radiation before, during or after other treatments.
You will be referred to a radiation oncologist who will deliver your radiation care.
Stem Cell Transplant
Stem Cell Transplant is sometimes used to treat HL. This treatment is seldom recommended for newly diagnosed HL. In a transplant, the stem cells are removed from a patient’s blood or bone marrow, then frozen and stored. Very high doses of chemotherapy, with or without radiation therapy, are then given in order to kill the cancer. These high doses can destroy bone marrow too. When this happens, the body is no longer able to make new blood cells. After the treatment ends, the stored stem cells are thawed and put back into the patient's bloodstream through a vein. Over time, the stem cells return to the bone, replacing the marrow and making new, normal blood cells. This type of transplant is referred to as an autologous stem cell transplant because the cells being re-infused into the body are the patient’s own.
Targeted Therapy uses new kinds of drugs to identify and target cancer cells, causing less harm to normal cells. Some targeted therapies work by interfering with a tumor’s ability to grow its own blood supply; others interrupt the signaling system within the cancer cell to prevent it from growing and dividing.
Targeted therapy is given by mouth, through a vein, or as an injection. Most people with HL are cured with chemotherapy and radiation therapy. Targeted therapies may be an option if cancer returns or no longer responds to traditional treatments. Targeted therapy also may be given in combination with other treatments, such as chemotherapy. Brentuximab vedotin (Adcetris®) is a targeted drug against CD30 that is approved for HL after a stem cell transplant as a “consolidation” treatment (meant to help maintain or deepen remission). It is also approved for patients who have suffered a relapse after stem cell transplant, or after at least 2 prior lines of treatment. Others are being tested in clinical trials.
Side Effects Management
It helps to learn about the side effects of treatment(s) before you begin so you will know what to expect. When you know more, you can work with your health care team to manage your quality of life during and after treatment.
There are many medications to address side effects from cancer treatment. Everyone reacts differently to treatment and experiences side effects differently. Talk to your health care team about any side effects you are experiencing so they can help you feel better. Your doctor may be able to discuss options such as lowering the dose of your treatment to help improve your quality of life if side effects persist and are not easily managed.
The following are common side effects:
- Hair loss
- Mouth sores or dry mouth
- Loss of appetite
- Nausea and vomiting
- Skin changes
- Increased chance of infections (from having too few white blood cells)
- Easy bruising or bleeding (from having too few blood platelets)
- Fatigue (from having too few red blood cells)
You may also experience side effects of treatment well after your treatment has ended. It is important to talk to your doctor about long-term effects of treatment as part of your post-treatment plan.