Chemotherapy for Hodgkin Lymphoma

Chemotherapy (chemo) is at least part of the main treatment for most people with Hodgkin lymphoma, other than some people with nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL).

Chemo is the use of drugs to treat cancer. It is usually injected into a vein under your skin or taken as a pill. Chemo drugs travel through your bloodstream to reach and destroy cancer cells wherever they are in your body.

How is chemo given for Hodgkin lymphoma?

Chemo is given in cycles that include a period of treatment followed by a rest period to give the body time to recover. In general, each cycle lasts for several weeks.

Most chemo treatments are given in the doctor’s office, clinic, or hospital outpatient department, but some may require a hospital stay.

Sometimes, chemo is used along with an immunotherapy medicine to treat Hodgkin lymphoma. Sometimes it is followed by radiation therapy.

Which chemo drugs are used to treat Hodgkin lymphoma?

Chemo for classic Hodgkin lymphoma (cHL) combines several drugs because different drugs kill the cancer cells in different ways. The most common combinations used to treat cHL are often referred to by abbreviations:

Other chemo combinations can also be used for Hodgkin lymphoma. Most use some of the same drugs listed above, but they might include different combinations and be given on different schedules.

A drug that is sometimes thought of as chemo is brentuximab vedotin (Adcetris). This is an antibody-drug conjugate (ADC), which is a monoclonal antibody attached to a chemo drug. For more on this drug, see Immunotherapy for Hodgkin Lymphoma.

Possible side effects of chemo

Chemo drugs can cause side effects. These side effects depend on the type and dose of drugs and how long treatment lasts.

Before starting chemo, ask your cancer care team to explain any possible side effects and your chances of having them. Also ask what you can do to help prevent them.

Short-term side effects

Common short-term side effects include:

• Hair loss
• Mouth sores
• Loss of appetite
• Nausea and vomiting
• Diarrhea or constipation
• Fatigue
• Increased chance of infection (from having too few white blood cells)
• Easy bruising or bleeding (from having too few blood platelets)

These side effects usually go away over time after treatment ends. If serious side effects occur, your chemo may be delayed or the doses reduced.

Be sure to tell your cancer care team if you have side effects. They can often help you manage them. For example, there are drugs to help prevent nausea and vomiting.

Late or long-term side effects

Some chemo drugs can have long-lasting side effects. These might not happen until months or even years after your treatment ends.

For example:

• Doxorubicin can damage your heart. Your cancer care team may order tests to check your heart function before and during treatment with this drug.
• Bleomycin can damage your lungs. Some doctors order tests of lung function, called pulmonary function tests, before starting people on this drug.
• Some chemo drugs can increase the risk of getting a second type of cancer later in life, such as leukemia.
• In children and young adults, some chemo drugs can affect body growth and fertility (ability to have children) later in life.

Long-term effects are discussed in more detail in After Hodgkin Lymphoma Treatment.