Hodgkin's lymphoma medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sowminya Arikapudi, M.B,B.S. [2]
Overview
The optimal therapy for Hodgkin's lymphoma depends on the stage at diagnosis, age, type, and size of tumor. The predominant therapy for Hodgkin's lymphoma is chemotherapy. Adjunctive radiation may be required.
Medical Therapy
Treatment depends on the following:
- The type of Hodgkin's lymphoma (most people have classic Hodgkin's)
- The stage (where the disease has spread)
- Whether the tumor is more than 4 inches (10 cm) wide
- Age and other medical issues
- Other factors, including weight loss, night sweats, and fever
- Tests will be done to see if the cancer has spread. This is called staging. Staging helps guide future treatment and follow-up and gives you some idea of what to expect in the future. Staging is needed to determine your treatment plan. Stages of Hodgkin's lymphoma range from I to IV. The higher the staging number, the more advanced the cancer.
Treatment depends on stage of the cancer:
- Stages I and II (limited disease) can be treated with radiation therapy, chemotherapy, or both.
- Stage III is treated with chemotherapy alone, or a combination of radiation therapy and chemotherapy.
- Stage IV (extensive disease) is most often treated with chemotherapy alone.
- People with Hodgkin's lymphoma that returns after treatment or does not respond to the first treatment may receive high-dose chemotherapy. That is followed by an autologous stem cell transplant.
Chemotherapy
- Drug Regimen: (MOPP) Mechlorethamine AND Oncovin AND Prednisone AND Procarbazine
- Drug Regimen: (ABVD) Adriamycin AND Bleomycin AND Vinblastine AND Dacarbazine
- Drug Regimen: (Stanford V) Adriamycin AND Bleomycin AND Vinblastine AND Vincristine AND Mechlorethamine AND Etoposide AND Prednisone
- Drug Regimen: (BEACOPP) Bleomycin AND Etoposide AND Adriamycin AND Cyclophosphamide AND Oncovin AND Procarbazine AND Prednisone
- Drug Regimen: (GDP)Gemcitabine AND Dexamethasone AND Cisplatin
- Drug Regimen: (CBV) Cyclophosphamide AND Carmustine AND Etoposide AND stem cell transplant
- Drug Regimen: (BEAM) Carmustine AND Etoposide AND Cytarabine AND Melphalan AND stem cell transplant
- Chemotherapy may be used:
- As the primary treatment, with or without radiation therapy, to destroy cancer cells
- To treat relapsed Hodgkin's lymphoma (that comes back after treatment) or refractory Hodgkin's lymphoma (that is resistant to the initial treatment)
- To control the symptoms of advanced (palliative chemotherapy)
Radiation therapy
- Radiation may be used for Hodgkin lymphoma (HL):
- As the primary treatment with chemotherapy to reduce the risk of recurrence
- To shrink bulky tumours before chemotherapy
- Alone, in certain situations
- For early stage favourable Hodgkin's lymphoma when the person cannot tolerate chemotherapy because of other health problems
- When the Hodgkin's lymphoma is a small localized area and the lymph nodes are very small
- For early stage nodular lymphocyte predominant Hodgkin's lymphoma without B symptoms
- To control the symptoms of advanced Hodgkin's lymphoma (palliative radiation therapy)
- The dose and schedule for the radiation therapy are determined by:
- The extent of the disease
- Whether or not the radiation therapy is given with chemotherapy
- Whether the treatment is intended to be curative or palliative
External beam radiation therapy
Hodgkin lymphoma is often treated with external beam radiation therapy. A machine directs radiation to the tumor and some of the surrounding tissue.
Radiation field
- Each person’s situation is unique, and the radiation fields may be adjusted depending on the extent of the disease. Radiation treatments are given to different areas of the body when treating Hodgkin lymphoma. The radiation field is the part of the body that receives the radiation. Some of radiation fields to treat Hodgkin lymphoma are:
- Involved field: only the lymph node areas with Hodgkin lymphoma (the standard field used in combination with chemotherapy)
- Chemotherapy is given first, followed by involved field radiation to the original site of the disease.
- Mantle field: lymph nodes in the neck, chest and axilla
- Upper abdominal field: lymph nodes in the upper abdomen and possibly the spleen
- Pelvic field, or Inverted (upside down) Y field: lymph nodes in the pelvis and groin
- Extended field: the mantle field and uppermost part of the inverted Y field
- This is seldom used anymore because nearly all people with Hodgkin lymphoma are treated with chemotherapy.
- Total nodal irradiation is the term used when radiation is given to all fields. It is basically a combination of the mantle and inverted Y fields. This approach may be used for people with widespread, advanced stage disease. Total body irradiation is the term used when low-dose radiation is given to the entire body in preparation for a stem cell transplant.
Stem cell transplants
- Stem cell transplants may be considered for people with Hodgkin lymphoma in the following cases:
- When the Hodgkin lymphoma is not responding to other treatments or standard treatment has failed to work (refractory disease)
- If the Hodgkin lymphoma comes back after an initial response to treatment (relapsed disease)
stage I & II Hodgkin's lymphoma
- Chemotherapy
- Drug Regimen: (ABVD) Adriamycin AND Bleomycin AND Vinblastine AND Dacarbazine
- Radiation therapy
- External beam radiation therapy may be offered. It is given after chemotherapy to the areas where the Hodgkin's lymphoma was initially found or before chemotherapy to shrink a large tumor. Radiation therapy may be given alone:
- If the person cannot tolerate chemotherapy because of other health issues
- If the Hodgkin's lymphoma is localized in a small area of lymph nodes
- For nodular lymphocyte predominant Hodgkin's lymphoma when no B symptoms are present
Stage III & IV Hodgkin's lymphoma
- Chemotherapy
- Drug Regimen: (MOPP) Mechlorethamine AND Oncovin AND Prednisone AND Procarbazine
- Drug Regimen: (ABVD) Adriamycin AND Bleomycin AND Vinblastine AND Dacarbazine
- Drug Regimen: (Stanford V) Adriamycin AND Bleomycin AND Vinblastine AND Vincristine AND Mechlorethamine AND Etoposide AND Prednisone
- Drug Regimen: (BEACOPP) Bleomycin AND Etoposide AND Adriamycin AND Cyclophosphamide AND Oncovin AND Procarbazine AND Prednisone
- Radiation therapy
External beam radiation therapy may be offered for stage III Hodgkin's lymphoma. It is given after chemotherapy if the Hodgkin's lymphoma is localized in an area of the body and can be included in the radiation field.
Recurrent disease
- Chemotherapy
- Drug Regimen: (ABVD) Adriamycin AND Bleomycin AND Vinblastine AND Dacarbazine
- Drug Regimen: (Stanford V) Adriamycin AND Bleomycin AND Vinblastine AND Vincristine AND Mechlorethamine AND Etoposide AND Prednisone
- Drug Regimen: (BEACOPP) Bleomycin AND Etoposide AND Adriamycin AND Cyclophosphamide AND Oncovin AND Procarbazine AND Prednisone
- Drug Regimen: (GDP)Gemcitabine AND Dexamethasone AND Cisplatin
- Drug Regimen: (CBV) Cyclophosphamide AND Carmustine AND Etoposide AND stem cell transplant
- Drug Regimen: (BEAM) Carmustine AND Etoposide AND Cytarabine AND Melphalan AND stem cell transplant
- Radiation therapy
External beam radiation therapy may be offered for relapsed or primary refractory Hodgkin's lymphoma if the original treatment was chemotherapy only and the Hodgkin's lymphoma remains or returns in only a single area. Radiation therapy may be given alone or with more chemotherapy. Radiation therapy may also be used along with chemotherapy in preparation for a stem cell transplant.
- Stem cell transplant
A stem cell transplant may be offered for Hodgkin's lymphoma that relapses within a few months of original treatment or for refractory disease.
Complications of Radiation therapy
Skin reactions
- Fatigue
- Sore throat and painful swallowing
- Taste changes
- Nausea and vomiting
- Diarrhea
- Bone marrow suppression
- Dental cavities
- Thyroid problems
- Fertility problems
- Heart and lung problems
- Second cancers
Complications of Chemotherapy
- Bone marrow suppression
- Nausea and vomiting
- Loss of appetite
- Sore mouth
- Fatigue
- Hair loss
- Diarrhea
- Constipation
- Skin changes
- Cystitis
- Muscle and joint pain
- Fluid retention
- Pain at the injection site
- Inflammation of the vein
- Allergic reactions
- Organ damage
- Second cancers