Chemotherapy (chemo) is the use of drugs to kill cancer cells. Chemotherapy for Hodgkin disease is usually injected into a vein under the skin or taken as a pill. Chemo 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. The most common regimen in the United States is a 4-drug combination called ABVD, which consists of:
- Adriamycin® (doxorubicin)
- Dacarbazine (DTIC)
Other common regimens include:
- Etoposide (VP-16)
- Adriamycin (doxorubicin)
- Cyclophosphamide (Cytoxan®)
- Oncovin® (vincristine)
- Doxorubicin (Adriamycin)
- Mechlorethamine (nitrogen mustard)
Radiation is given after chemo in the Stanford V regimen, and it is sometimes given after the ABVD or BEACOPP regimens as well.
Other chemo combinations can also be used for Hodgkin disease. Most use some of the same drugs listed above, but they might 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 (where new blood cells are made), 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-lived 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.
Infections can be very serious in people getting chemo. 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 reduce your 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.
If 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.
Late or long-term side effects: Some chemo drugs can have long-lasting side effects, some of which might not occur until months or years after treatment has ended. For example:
- Doxorubicin can damage the heart, so your doctor may order tests to check your heart function before and during treatment with this drug.
- Bleomycin can damage the lungs, 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 also get 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 “What happens after treatment for Hodgkin disease?”
Before starting chemo, ask your doctor to explain the possible side effects and the chances of having them.
Last Revised: 02/09/2016