Hodgkin lymphoma treatment
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.
In this section we talk about the specific treatments used for Hodgkin lymphoma. You might want to read our general information about how blood cancer treatment is planned and managing your treatment.
We also have some important information on staying safe if you’ve got blood cancer, covering things like risk of infection and vaccinations.
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)
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.
Hinna and Leanne share the side effects they found most difficult when they had blood cancer, and their tips for managing:
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.
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.
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.
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.
Asking for help to work through chemo
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 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.
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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, Blood stem cell and bone marrow transplants: The seven steps.
New treatments for relapsed Hodgkin lymphoma
If you can't have a stem cell transplant, or if your lymphoma comes back after the transplant, there are other drug options available.
If you relapse after a stem cell transplant
You may be able to have:
- Brentuximab vedotin, if you've already had a stem cell transplant
- Nivolumab, if you've already had a stem cell transplant and brentuximab vedotin
If you can't have a stem cell transplant
You may be able to have:
- Brentuximab vedotin, if you've already had two other treatments and a stem cell transplant isn't an option
- Pembrolizumab, if you've already had brentuximab vedotin and a stem cell transplant isn't an option (this treatment is given for two years)
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.
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.
If you're treated during the coronavirus (COVID-19) pandemic and you have refractory disease, you may be given brentuximab vedotin followed by nivolumab, instead of the standard treatment for refractory Hodgkin lymphoma (high doses of chemotherapy followed by a stem cell transplant).
Having this less intensive treatment means you won't need to stay in hospital for as long and it also reduces the risk of neutropenia - a possible side effect of stronger treatments. Speak to your healthcare team if you have any questions about your treatment options.
This interim treatment option is recommended by NICE, whose guidance is for healthcare in England, but may be (and often is) adopted in other countries of the UK too.
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.
You can find out more about clinical trials in the UK at the NHS website Be Part of Research.
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.
You shouldn’t have live vaccines while you’re having treatment, as they could cause serious illness. Live vaccines include the measles, mumps and rubella vaccine (MMR) and the yellow fever vaccine.
Once you’ve completed your treatment and you’re in remission (you have no active cancer) your healthcare team can let you know when it’s safe to have live vaccines. You will usually need to wait between six and 24 months, depending on the type of treatment you’ve had.
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.
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