There are many different treatment plans for Hodgkin lymphoma (HL), also called Hodgkin’s disease. These treatments are often very effective, making HL one of the most curable types of cancer.

Doctors recommend different treatment options based on several factors, such as a person’s age, general health, and personal preferences. Additionally, different subtypes and stages of HL are treated differently. Finally, whether or not HL is “favorable” plays a role in treatment decisions. Favorable Hodgkin lymphoma is less likely to relapse (come back after being treated). Factors such as how big the lymphoma is, which symptoms a person has, and the results of certain tests help determine whether HL is favorable or unfavorable.

Treatments are usually carried out by a team of experts. Over the course of treatment, you may see a:

• Hematologist-oncologist, a doctor who specializes in blood disorders and blood cancers
• Medical oncologist, a doctor who helps diagnose cancer and coordinate treatment
• Radiation oncologist, a specialist in radiation therapy

Treatments for Classic Hodgkin Lymphoma

Most people with HL have classic Hodgkin lymphoma (cHL). This type of cancer develops when lymphocytes (a type of white blood cell) grow out of control. People with cHL have cancer cells called Reed-Sternberg cells in the lymph nodes.

Chemotherapy for cHL

Chemotherapy drugs help kill lymphoma cells throughout the body. Multiple chemotherapy medications are often given in combination. The most common chemotherapy plan for cHL is called ABVD. It consists of the drugs:

• Doxorubicin (sold as Adriamycin)
• Bleomycin (sold as Blenoxan)
• Vinblastine (sold as Velbin)
• Dacarbazine (sold as DTIC-Dome)

Other chemotherapy regimens include:

• AAVD, which includes doxorubicin, brentuximab vedotin (sold as Adcetris), vinblastine, and dacarbazine
• Stanford V, which comprises doxorubicin, Mustargen (mechlorethamine), vincristine, vinblastine, bleomycin, VP-16 (etoposide), and prednisone
• BEACOPP, a combination of bleomycin, etoposide, doxorubicin, cyclophosphamide (sold as Cytoxan), vincristine (formerly sold as Oncovin), procarbazine (sold as Matulane), and prednisone

Chemotherapy is given in cycles — treatment schedules in which a person takes drugs at regular intervals and has rest periods in between. A person’s stage often influences how many cycles of chemotherapy they receive:

• People with stage 1 or stage 2 cHL who have favorable disease often undergo two to four cycles of ABVD.
• People with unfavorable stage 1 or stage 2 disease may receive four to six cycles of ABVD, or three cycles of Stanford V.
• People with stage 3 or stage 4 cHL often use six cycles of ABVD, or multiple cycles of more aggressive regimens like Stanford V or BEACOPP.

After two or three months of treatment, doctors may assess whether chemotherapy is working using imaging tests, such as a positron emission tomography or CT scan. Depending on the results of these scans, doctors may recommend additional chemotherapy cycles or other chemotherapy drugs.

Radiation Therapy for cHL

People with classic Hodgkin lymphoma often go through radiation treatments. During radiation therapy, a machine delivers high-energy beams or particles to the part of the body that contains cancer. Often, doctors recommend a newer type of radiation treatment called involved-site radiation therapy (ISRT). ISRT targets the cancerous lymph nodes while largely leaving nearby tissues alone.

Radiation treatments are often given after chemotherapy. Radiation therapy is especially recommended for people with bulky disease (large tumors). Some people with favorable early-stage disease may have radiation alone, without receiving any chemotherapy drugs.

Immunotherapy for cHL

Some people with classic Hodgkin lymphoma use immunotherapy drugs, which help the body’s immune system fight cancer more effectively. Two immunotherapy medications, Keytruda (pembrolizumab) and Opdivo (nivolumab), are often used. These drugs are approved by the U.S. Food and Drug Administration (FDA) to treat cHL that has relapsed or is refractory (resistant to treatment). Another immunotherapy drug, Adcetris (brentuximab vedotin), may also be used for relapsed or refractory disease or for newly diagnosed stage 3 or stage 4 cHL.

Other cHL Treatment Options

People with relapsed or refractory cHL may need different treatment plans that consist of higher treatment doses or other medications. Some people may receive high-dose chemotherapy, followed by a stem cell transplant. During transplantation, a person receives new stem cells to replace the blood cells that were lost during aggressive treatments. Doctors also usually recommend that people with relapsed or refractory classic Hodgkin lymphoma participate in a clinical trial.

Treatments for Nodular Lymphocyte-Predominant Hodgkin Lymphoma

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is often treated differently from cHL. NLPHL is a rare type of lymphoma, affecting about 5 percent of people with Hodgkin lymphoma. It often grows very slowly and may not require aggressive treatments. People with NLPHL may have different treatment plans depending on their lymphoma stage and symptoms.

Three out of four people with NLPHL are diagnosed with early-stage lymphoma. “Early-stage” means that lymphoma cells are located within only one group of lymph nodes, one small part of an organ, or multiple groups of nearby lymph nodes. People with stage 1 or stage 2 NLPHL who have minimal symptoms may be able to use a watch-and-wait approach, in which treatments are delayed until symptoms get worse. Some undergo ISRT.

Doctors may recommend more aggressive treatments for people with early-stage NLPHL that have certain risk factors. These risk factors include having bulky disease (a large mass in the chest) or B symptoms (fever, night sweats, and weight loss). People with these risk factors often receive both chemotherapy and ISRT. Doctors also recommend this treatment plan for people with advanced-stage (stage 3 or stage 4) NLPHL. Many people with NLPHL receive the ABVD chemotherapy regimen, although other combinations of chemotherapy drugs may also be recommended.

Many people with NLPHL are treated with Rituxan (rituximab), a type of immunotherapy or targeted therapy drug. Rituximab may be given alone or along with chemotherapy drugs. The FDA has approved rituximab as a treatment for other blood cancers such as non-Hodgkin lymphoma (NHL) and chronic lymphocytic leukemia. Rituximab is not officially approved for HL, but doctors may recommend using it off-label for NLPHL.

Treatment Side Effects

Many Hodgkin lymphoma treatments can cause side effects, disrupting a person’s quality of life. However, these side effects can often be reduced, and they usually go away once treatment is done. Make sure to tell your cancer care team about any health issues you experience.

Chemotherapy can cause many possible side effects, including:

• Nausea or vomiting
• Decreased appetite
• Diarrhea
• Hair loss
• Sores in the mouth
• Tiredness
• Frequent infections
• Breathing problems

Immunotherapy drugs often cause milder side effects than chemotherapy drugs. While using these medications, people may experience side effects like diarrhea, weight changes, skin rashes, or flu symptoms.

Radiation therapy leads to some general effects, such as skin reactions and tiredness. It may also cause more specific side effects depending on which part of the body was irradiated. For example, radiation therapy treatments for the chest can lead to a cough or pain while swallowing.

Chemotherapy and radiation therapy can both cause long-term health conditions. People who use these treatments are at increased risk for:

• Developing other cancers, including NHL, lung cancer, and breast cancer
• Infertility (not being able to have biological children)
• Heart disease
• Lung or breathing problems
• Hypothyroidism (a disorder in which the thyroid gland doesn’t make enough hormones)
• Severe infections
• Chronic fatigue

Ask your health care team whether you have a higher chance of developing any future health problems. If your cancer goes into remission, continue to have regular follow-up appointments with your doctor to look for potential long-term effects.

Side effects can decrease quality of life and make it hard for a person to continue using cancer treatments. Palliative care can help lessen or eliminate these side effects. Palliative care can be used by people with any lymphoma stage at any point along the treatment journey. The goal of palliative care is to reduce symptoms and side effects and provide emotional, spiritual, or logistical support. Make sure to tell your doctor if you are having trouble managing your lymphoma treatment.

Talk With Others Who Understand

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