Chemotherapy is the use of drugs to kill cancer cells. Some drugs can be taken as a pill, while others are injected into a vein under the skin or into a muscle. Chemotherapy is systemic therapy, which means the drug enters the bloodstream and circulates throughout the body to reach and destroy cancer cells. This makes this treatment useful for cancer that has spread widely.

Several drugs are always used in chemotherapy for HD because different drugs kill cancer cells in different ways. The many drugs used in combination to treat HD are often referred to by abbreviations that are easier to remember.

Although other drug combinations may be used, the most commonly used treatment combination in the US is called ABVD, which refers to Adriamycin, Bleomycin, Vinblastine, and Dacarbazine. Another combination is called OEPA (Oncovin, Etoposide, Prednisone, and Adriamycin). Other drugs that may be used are cyclophosphamide, procarbazine, mechlorethamine or nitrogen mustard, and methotrexate. More than one combination may be used over the course of treatment.

Side effects: Drugs used in cancer chemotherapy specifically attack rapidly dividing cells. These drugs are effective because cancer cells spend more of their time dividing and reproducing than normal cells do. But these drugs can also damage normal cells, causing side effects. These side effects depend on the type and dose of drugs given and the length of time they are taken.

Some normal tissues, such as the bone marrow, the lining of the mouth and intestines, and the hair follicles, also grow rapidly to replace cells that wear out. These rapidly reproducing cells are most likely to be affected by chemotherapy. As a result, your child may have hair loss, mouth sores, lowered resistance to infection (due to low white blood cell counts), easy bruising or bleeding (due to low blood platelets), and/or fatigue (due to low red blood cells). Loss of appetite, nausea, and vomiting result in part from damage to intestinal cells, but effects of certain drugs on areas of the brain controlling appetite and vomiting also contribute to these problems.

These side effects are temporary and go away after treatment is finished. Your child’s doctor will try to prevent or reduce the side effects from chemotherapy as much as possible. If your child has side effects, your cancer care team can suggest steps to ease their impact. For example, drugs can be given along with the chemotherapy to prevent or reduce nausea and vomiting.

Some chemotherapy drugs may have long-term side effects that occur long after therapy has ended. These may affect a patient's heart, lungs, growth, and ability to have children. If a male patient is old enough and is scheduled to receive drugs that cause sterility, sperm banking should be considered before chemotherapy is started.

The following drugs are associated with a high risk of infertility:

• carmustine (BCNU)
• lomustine (CCNU)
• busulfan (Myleran, Busulfex)
• chlorambucil (Leukeran)
• cyclophosphamide (Cytoxan)
• procarbazine (Matulane)
• mechlorethamine (Mustargen)
• melphalan (Alkeran)

Some of these drugs that affect fertility are commonly given for Hodgkin disease or other lymphomas.

The severity of these long-term side effects will vary, depending on the patient’s age at the time of treatment.

There is also an increased risk of developing a second type of cancer (especially leukemia) later in life.

Ask your child's doctor to explain all of the possible side effects of chemotherapy and the chances of your child having them in particular. Monitoring your child for long-term effects is discussed in the section "What Happens After Treatment for Hodgkin Disease in Children?".

Revised 8-26-03