- How is Hodgkin disease treated?
- Chemotherapy for Hodgkin disease
- Radiation therapy for Hodgkin disease
- Monoclonal antibodies for Hodgkin disease
- High-dose chemotherapy and stem cell transplant for Hodgkin disease
- Clinical trials for Hodgkin disease
- Complementary and alternative therapies for Hodgkin disease
- Treating classic Hodgkin disease, by stage
- Treating nodular lymphocyte predominant Hodgkin disease (NLPHD)
- Treating Hodgkin disease in children
- Hodgkin disease in pregnancy
- More treatment information
Chemotherapy for Hodgkin disease
Chemotherapy (chemo) is the use of drugs to kill cancer cells. The drugs can be taken as pills or injected into a vein under the skin. Chemotherapy is systemic therapy, which means the drugs enter the bloodstream and travel throughout the body to reach and destroy cancer cells wherever they may be.
Doctors give chemo in cycles, in which a period of treatment is followed by a rest period to give the body time to recover. Each cycle generally lasts for several weeks. Most chemo treatments are given on an outpatient basis (in the doctor’s office, clinic, or hospital outpatient department), but some may require a hospital stay.
The chemo regimens for Hodgkin disease combine several drugs because different drugs kill cancer cells in different ways. The combinations used to treat Hodgkin disease are often referred to by abbreviations that are easier to remember than the drugs’ full names. The most common regimen in the United States is a 4-drug combination called ABVD, which consists of:
Other common regimens include:
- Doxorubicin (Adriamycin)
- Mechlorethamine (nitrogen mustard)
- Etoposide (VP-16)
- Adriamycin (doxorubicin)
- Cyclophosphamide (Cytoxan®)
- Oncovin® (vincristine)
Radiation is given after chemo in the Stanford V regimen, and it is sometimes given after the ABVD or BEACOPP regimens as well.
Other chemotherapy combinations may also be used for Hodgkin disease. Most use the same drugs as listed above, but they may include different combinations and be given on different schedules.
Possible side effects
Chemo drugs attack cells that are dividing quickly, which is why they work against most types of lymphoma cells. But other cells in the body, such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemotherapy, which can lead to side effects.
The side effects depend on the type and dose of drugs given and the length of time they are taken. They can include:
- Hair loss
- Mouth sores
- Loss of appetite
- Nausea and vomiting
- Increased chance of infections (from having too few white blood cells)
- Easy bruising or bleeding (from having too few blood platelets)
- Fatigue (from having too few red blood cells)
These side effects are usually short-term and go away after treatment is finished. If serious side effects occur, the chemotherapy may have to be delayed or the doses reduced.
There are often ways to lessen these side effects. For example, drugs are usually given to help prevent nausea and vomiting.
Drugs known as growth factors, such as G-CSF (Neupogen®) or GM-CSF (Leukine®), are sometimes given to help the body make more white blood cells and thus reduce the chance of infection. Antibiotics may also be given at the earliest sign of an infection, such as a fever.
If your white blood cell counts are very low during treatment, you can help lower the risk of infection by carefully limiting your exposure to germs. During this time, your doctor may advise you to:
- Wash your hands often.
- Avoid fresh, uncooked fruits and vegetables and other foods that might carry germs.
- Avoid fresh flowers and plants because they may carry mold.
- Make sure other people wash their hands before they come in contact with you.
- Avoid large crowds and people who are sick (wearing a surgical mask offers some protection in these situations).
- your platelet counts are very low, you may be given drugs or platelet transfusions to help protect against bleeding. Fatigue caused by anemia (very low red blood cell counts) can be treated with drugs or with red blood cell transfusions.
Long-term side effects: Some chemo drugs can have long-term side effects that occur months or years after treatment has ended.
For example, doxorubicin can cause heart damage, so your doctor may order a test to check your heart function before and during treatment with this drug.
Bleomycin can cause lung damage, so some doctors order tests of lung function (called pulmonary function tests) before starting patients on this drug.
Some chemo drugs can increase the risk of getting a second type of cancer later in life (such as leukemia), especially in patients who have also received radiation therapy.
In children and young adults, some chemo drugs can also affect body growth and fertility (ability to have children) later on.
Long-term effects are discussed in more detail in the section, “What happens after treatment for Hodgkin disease?”
Before starting chemotherapy, ask your doctor to explain the possible side effects and your chances of having them.
Last Medical Review: 12/10/2012
Last Revised: 02/07/2014