Hodgkin lymphoma treatment and side effects

Updated 21 Dec 2018

Treatment for Hodgkin lymphoma is usually very successful. Your healthcare team will look at a number of things when deciding which treatments to recommend. It will depend on your test results, the symptoms you have, what stage the Hodgkin lymphoma is and your general fitness.

Treatment planning

Treatment normally includes chemotherapy and in some cases radiotherapy or steroids. Sometimes, if the Hodgkin lymphoma comes back, a stem cell transplant may be suggested.

If you have any concerns about treatment you should discuss these with your consultant or key worker.

On this page we talk about the specific treatments used for Hodgkin lymphoma. There is more general information about treatment planning and the aims of treatment in our information about treatment for lymphoma.

Clinical trials

Updated 20 Dec 2018

If there’s a clinical trial (study) available that’s suitable for you, your consultant may recommend that you consider this. Clinical trials are widely used in the treatment of Hodgkin lymphoma.

For more information, order or download our booklet, Your guide to clinical trials.

You can also find out more about clinical trials at the UK Clinical Trials Gateway.

Chemotherapy

Updated 20 Dec 2018

Most people with Hodgkin lymphoma will have chemotherapy. Chemotherapy uses cell-killing drugs to kill cancerous cells and stop them from multiplying.

You’ll normally have chemotherapy in an outpatient clinic, which means you will only have to make a daytime visit to the hospital. However, you may need to stay overnight on some occasions and with some particular drugs.

Chemotherapy for Hodgkin lymphoma is usually a combination of drugs known as ABVD. This stands for:

A - Adriamycin™, also known as doxorubicin or hydroxydaunorubicin

B - bleomycin

V - vinblastine

D - dacarbazine.

Some hospitals may offer a different type of chemotherapy drug combination. These include stronger chemotherapy combinations such as escalated BEACOPP. Children and young adults under 18 years old often have a drug combination called OEPA. Your healthcare team will discuss what’s right for you.

Chemotherapy is given in cycles – this is the name for a course of treatment including a break for your body to recover. If you’re having ABVD, a cycle is two treatments with ABVD two weeks apart, so one cycle takes four weeks. The number of cycles you have will depend on how advanced the disease is. Cycles for other drug treatments may be different.

How is chemotherapy given?

Chemotherapy for Hodgkin lymphoma is usually given directly into a vein. This is known as an intravenous or IV infusion. Many people have a tube inserted into their arm or chest that can be used throughout the course of treatment. This means you don’t have to have the treatment injected each time (which can sometimes be uncomfortable after several cycles of treatment).

There are three main ways to do this:

  • A PICC line is where a long thin tube is passed up a vein in your arm to your chest.
  • A central line is put into the main vein in your chest – the end comes out of the skin on your chest so drugs can be given through it. You might hear it being called a Hickman™ line.
  • A ‘port’ is put into your chest and doesn’t come out through your skin. Drugs are injected into it instead.

Your line or port can usually be put in at an outpatient clinic using local anaesthetic to numb the area. So you won’t need to stay in hospital overnight.

Your healthcare team will tell you how to look after your PICC, central line or port. It will be removed after your treatment.

Treatment for early stage disease

If you have early stage disease (I or IIA) your treatment will usually be two to six cycles of chemotherapy. You may also have radiotherapy directed specifically at the affected lymph nodes.

Radiotherapy is used to try to prevent the disease coming back. Your healthcare team will discuss the risks and benefits of radiotherapy with you.

Treatment for advanced stage disease

If you have advanced stage Hodgkin lymphoma (stage IIB-IV) you’ll usually have six cycles of ABVD-based chemotherapy. After two cycles of ABVD you’ll normally have a PET/CT scan, and depending on the result, you may have the next four cycles of chemotherapy without bleomycin (this is known as AVD). You may have some radiotherapy as well (see below).

If you have had more intensive chemotherapy at the start (such as escalated BEACOPP), then you may need only four cycles of chemotherapy in total. This will depend on the result of your PET scan after two cycles of treatment.

Steroids

Updated 20 Dec 2018

You may be given steroids as well as chemotherapy drugs. Steroids can make some chemotherapy treatments more effective and reduce any sickness you may get. The steroid normally given to help with sickness is called dexamethasone, which is given as an injection or as a tablet.

Radiotherapy

Radiotherapy uses high energy rays to kill cancer cells in a specific area. It can be an effective treatment for diseases such as lymphoma which affect a particular part of the body.

It is more common to have radiotherapy if you have early stage disease (IA or IIA) in only one or a couple of areas of the body. Occasionally you might have radiotherapy in later stage disease to try and shrink swollen lymph nodes.

Before you have radiotherapy, you’ll have scans so your doctors know exactly where to target it, and they’ll mark this on your body. The actual treatment only takes a short time and it isn’t painful. You lie still inside a doughnut-shaped scanner with the treatment area exposed.

You normally have radiotherapy as an outpatient (so no need to stay in hospital overnight) for up to three weeks. You’ll come to hospital for treatment every day during this time, apart from weekends.

Radiotherapy doesn’t make you radioactive and it’s fine to be around other people as normal.

Sex and fertility

Treatment for Hodgkin lymphoma can affect your fertility. The level of risk depends on the specific treatment you’ve had. If you’re a woman, the risk to your fertility becomes higher as you get older because there is a possibility that chemotherapy may lead to an earlier menopause.

After you’ve been diagnosed, and before you begin treatment, it would be a good idea to discuss the options available to protect your fertility with your doctor.

While you’re having chemotherapy it’s essential to avoid getting pregnant because the drugs may harm the baby. We also don’t fully understand what effect chemotherapy has on sperm. So if you’re having chemotherapy treatment you should use condoms if you have sex during treatment, and continue to use them for a week after finishing their treatment. Once you’re in remission, talk to your doctor if you are planning to have a child.

Side effects

You may experience some side effects from chemotherapy, steroids and radiotherapy.

Side effects from chemotherapy

For most people with Hodgkin lymphoma, side effects from chemotherapy aren’t severe and they usually go away when treatment stops. They may include:

  • fever
  • difficulty pooing (constipation)
  • tiredness
  • cough/breathlessness
  • hair loss
  • bleeding and/or bruising
  • anaemia (a lack of red blood cells) which can cause paleness, tiredness and breathlessness
  • mouth sores
  • feeling sick and being sick (nausea and vomiting)
  • poor appetite (loss of taste)
  • weight changes.

You’re unlikely to have all of these side effects.

Some side effects are associated with specific drugs. For example the bleomycin drug in ABVD can cause a cough or breathlessness. Let your doctor know straight away if this occurs during or after treatment.

Also, the dacarbazine drug in ABVD may cause some pain at the spot where it’s given. If this happens there are things which can be done to help, so you should tell your nurse or doctor immediately if you feel pain.

You’ll be given drugs called anti-emetics to stop you feeling sick and to help with the vomiting you might get with certain treatments. If you have any other side effects, tell your healthcare team.

Side effects from steroids

Side effects from steroids can include:

  • feeling agitated
  • weight gain
  • a build-up of water (water retention) around your face and ankles
  • increase in appetite
  • raised blood sugar, particularly in people with diabetes.

Side effects from radiotherapy

These will depend on the area of the body being treated but common side effects are tiredness (fatigue), and redness in the treated area. Your healthcare team will speak to you in more detail about this.

Supportive care

Updated 20 Dec 2018

You may also need supportive care, during and after treatment. Supportive care includes prevention and treatment of infection, blood transfusions, mouth care, dietary advice, pain management and dealing with complications associated with your illness or your treatment.

Download our fact sheets on Understanding infection, Blood transfusions, Mucositis and Managing Sickness and Vomiting.

For dietary advice for people with a weakened immune system, order or download our booklet, Eating well with neutropenia.

Relapsed or refractory disease

In a small number of people, Hodgkin lymphoma doesn’t respond to the first treatment (refractory disease), or comes back although it responded well at first (relapse). If this is the case for you, it’s important to remember that there’s still a good chance of a successful outcome.

In these cases, if you’re otherwise fit and well, your doctor may recommend using higher doses of chemotherapy followed by a stem cell transplant, sometimes called a bone marrow transplant. This aims to give you healthy stem cells to replace those which are destroyed by the high dose chemotherapy.

For more information about stem cell transplants, order or download our booklet, The seven steps: blood stem cell and bone marrow transplants.

New treatments for relapsed Hodgkin lymphoma

You may be given a drug called brentuximab vedotin if you relapse following a stem cell transplant, or don’t respond well to other treatments and a stem cell transplant isn’t currently an option for you.

Brentuximab vedotin is what’s known as an antibody drug conjugate (ADC) - a combination of an antibody and a chemotherapy drug. (Antibodies are proteins which fight infection and are produced naturally by white blood cells, but they can also be created in a laboratory for use in drug treatments.) ADCs deliver chemotherapy in a way that’s much more targeted than usual, and may cause fewer side effects.

Two new drugs called nivolumab and pembrolizumab can now be used to treat people whose Hodgkin lymphoma has relapsed after a stem cell transplant, and treatment with brentuximab vedotin hasn’t been successful. Nivolumab and pembrolizumab are what’s known as immunotherapy drugs. They help activate your immune system so it’s more effective at fighting the cancer.

Follow-up

If your condition responds well to initial treatment, there’s a high chance that you won’t need further treatment. However, it’s really important that you still come for follow-up checks and monitor yourself for any symptoms, because unfortunately the disease can return. This is known as relapse. The earlier a relapse is identified, the better the chance of a successful outcome. Your healthcare team will tell you how often you should come for follow-up checks.

After treatment you may wonder whether there are any specific signs or symptoms you should be looking out for. An obvious reason to contact the hospital team would be any new swellings. Similarly, you should report fever, drenching sweats or unexplained weight loss. It’s a good idea to tell the hospital team about any changes in your general health or any new signs or symptoms you notice.

Vaccines and blood transfusions

Once you’ve completed your treatment and you’re in remission (you have no active cancer), you shouldn’t receive live vaccines such as yellow fever, measles and shingles, as these may cause serious illness. Ask your healthcare team for more advice about vaccines.

People with Hodgkin lymphoma mustn’t receive blood - or any other blood product such as platelets - that hasn’t been treated with radiation (irradiated). It’s important you carry a card to tell other medical teams about this. Your healthcare team should give you one of these cards. If you haven’t been offered a card yet, you could speak to your key worker or doctor about it on your next visit. You may also want to wear a special bracelet to give this information to doctors caring for you if you’re unconscious or unable to explain.

In an emergency, if you need a blood transfusion to save your life, non-irradiated blood can be used so the transfusion isn’t delayed.

The outlook

In general, the long-term outlook for people with Hodgkin lymphoma is good, especially if it’s diagnosed early. Treatment leads to a cure in the majority of cases. However, the outlook and treatment options for individual people depend on a range of things, including their age, general health and whether they have any other specific health problems.

If you want to find out more

Cancer Research UK has more information on the general outlook for Hodgkin lymphoma. Remember that statistics can only give an overall picture. Your own outlook is individual to you and will depend on your age, level of fitness and the stage of your disease. The Cancer Research UK information nurses can help you with any questions you may have about these statistics on 0800 800 4040.

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