Hodgkin Lymphoma

General Information | Treatment Options | Additional Resources

Treatment
  • Overview
  • Standard Treatment
  • Clinical Trials
  • Treatment By Stage

There are different types of treatment for patients with adult Hodgkin lymphoma.

Different types of treatment are available for patients with adult Hodgkin lymphoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

For pregnant patients with Hodgkin lymphoma, treatment is carefully chosen to protect the fetus. Treatment decisions are based on the mother's wishes, the stage of the Hodgkin lymphoma, and the age of the fetus. The treatment plan may change as the symptoms, cancer, and pregnancy change. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Patients with Hodgkin lymphoma should have their treatment planned by a team of health care providers with expertise in treating lymphomas.

Treatment will be overseen by a medical oncologist, a doctor who specializes in treating cancer. The medical oncologist may refer you to other health care providers who have experience and expertise in treating adult Hodgkin lymphoma and who specialize in certain areas of medicine. These may include the following specialists:

  • Neurosurgeon.
  • Neurologist.
  • Rehabilitation specialist.
  • Radiation oncologist.
  • Endocrinologist.
  • Hematologist.
  • Other oncology specialists.

Patients may develop late effects that appear months or years after their treatment for Hodgkin lymphoma.

Treatment with chemotherapy and/or radiation therapy for Hodgkin lymphoma may increase the risk of second cancers and other health problems for many months or years after treatment. These late effects depend on the type of treatment and the patient's age when treated, and may include:

  • Acute myelogenous leukemia.
  • Solid tumors, including the development of breast and colorectal cancers in younger patients.
  • Infertility.
  • Heart, lung, thyroid, or bone disease.
  • Fatigue.

Regular follow-up by doctors who are expert in finding and treating late effects is important for the long-term health of patients treated for Hodgkin lymphoma.

Three types of standard treatment are used:

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated. Combination chemotherapy is treatment with more than one anticancer drug.

When a pregnant woman is treated with chemotherapy for Hodgkin lymphoma, it isn't possible to protect the fetus from being exposed to the chemotherapy. Some chemotherapy regimens may cause birth defects if given in the first trimester. Vinblastine is an anticancer drug that has not been linked with birth defects when given in the second half of pregnancy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

For pregnant patients with Hodgkin lymphoma, radiation therapy should be postponed until after delivery, if possible, to avoid any risk to the fetus. If immediate treatment is needed, patients may decide to continue the pregnancy and receive radiation therapy. However, lead used to shield the fetus may not protect it from scattered radiation that could possibly cause cancer in the future.

Surgery

Laparotomy is a procedure in which an incision (cut) is made in the wall of the abdomen to check the inside of the abdomen for signs of disease. The size of the incision depends on the reason the laparotomy is being done. Sometimes organs are removed or tissue samples are taken and checked under a microscope for signs of disease. If cancer is found, the tissue or organ is removed during the laparotomy.

For pregnant patients with Hodgkin lymphoma, treatment options also include:

Watchful waiting

Watchful waiting is closely monitoring a patient's condition without giving any treatment unless symptoms appear or change. Delivery may be induced when the fetus is 32 to 36 weeks old, so that the mother can begin treatment.

Steroid therapy

Steroids are hormones naturally produced in the body by the adrenal glands and by reproductive organs. Some types of steroids are made in a laboratory. Certain steroid drugs have been found to help chemotherapy work better and help stop the growth of cancer cells. Steroids can also help the lungs of the fetus develop faster than normal. This is important when delivery is induced early.

New types of treatment are being tested in clinical trials.

This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.

High-dose chemotherapy and radiation therapy with stem cell transplant

High-dose chemotherapy and radiation therapy with stem cell transplant is a way of giving high doses of chemotherapy and radiation therapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After therapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's clinical trials database.

A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.

Early Favorable Hodgkin Lymphoma

Treatment of early favorable Hodgkin lymphoma may include the following:

  • Combination chemotherapy with or without radiation therapy to parts of the body with cancer.
  • Radiation therapy alone to areas of the body with cancer or to the mantle field (neck, chest, armpits).
  • Clinical trials of new combinations of chemotherapy and/or radiation therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I adult Hodgkin lymphoma and stage II adult Hodgkin lymphoma.

Early Unfavorable Hodgkin Lymphoma

Treatment of early unfavorable Hodgkin lymphoma may include the following:

  • Combination chemotherapy with or without radiation therapy to parts of the body with cancer.
  • Clinical trials of new combinations of chemotherapy and/or radiation therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I adult Hodgkin lymphoma and stage II adult Hodgkin lymphoma.

Advanced Favorable Hodgkin Lymphoma

Treatment of advanced favorable Hodgkin lymphoma may include the following:

  • Combination chemotherapy with or without radiation therapy to parts of the body with cancer.
  • Clinical trials of new combinations of chemotherapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage III adult Hodgkin lymphoma and stage IV adult Hodgkin lymphoma.

Advanced Unfavorable Hodgkin Lymphoma

Treatment of advanced unfavorable Hodgkin lymphoma may include the following:

  • Combination chemotherapy.
  • Clinical trials of new combinations of chemotherapy.
  • A clinical trial of high-dose chemotherapy and stem cell transplant using the patient's own stem cells.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage III adult Hodgkin lymphoma and stage IV adult Hodgkin lymphoma.

Recurrent Adult Hodgkin Lymphoma

Treatment of recurrent Hodgkin lymphoma may include the following:

  • Combination chemotherapy.
  • Combination chemotherapy followed by high-dose chemotherapy and stem cell transplant with or without radiation therapy.
  • Radiation therapy with or without chemotherapy.
  • Chemotherapy as palliative therapy to relieve symptoms and improve quality of life.
  • A clinical trial of high-dose chemotherapy and stem cell transplant.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent adult Hodgkin lymphoma.

Hodgkin Lymphoma During Pregnancy

Hodgkin Lymphoma During the First Trimester of Pregnancy

When Hodgkin lymphoma is diagnosed in the first trimester of pregnancy, it does not necessarily mean that the patient will be advised to end the pregnancy. Each patient's treatment will depend on the stage of the lymphoma, how fast it is growing, and the patient's wishes. For women who choose to continue the pregnancy, treatment of Hodgkin lymphoma during the first trimester of pregnancy may include the following:

  • Watchful waiting when the cancer is above the diaphragm and is slow-growing. Delivery may be induced when the fetus is 32 to 36 weeks old so the mother can begin treatment.
  • Radiation therapy above the diaphragm, with the fetus shielded.
  • Systemic chemotherapy using one or more drugs.

Hodgkin Lymphoma During the Second Half of Pregnancy

When Hodgkin lymphoma is diagnosed in the second half of pregnancy, most patients can delay treatment until after the baby is born. Treatment of Hodgkin lymphoma during the second half of pregnancy may include the following:

  • Watchful waiting, with plans to induce delivery when the fetus is 32 to 36 weeks old.
  • Systemic chemotherapy using one or more drugs.
  • Steroid therapy
  • Radiation therapy to relieve breathing problems caused by a large tumor in the chest.

Cancer information from the NCI PDQ service