Chemotherapy for Hodgkin lymphoma
Chemotherapy is one of the main treatments for Hodgkin lymphoma (HL).
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to treat cancer. It is usually a systemic therapysystemic therapyTreatment that travels through the bloodstream to reach cells all over the body. that circulates throughout the body and destroys cancer cells, including those that may have broken away from the primary tumour.
Chemotherapy may be used:
- as the primary treatment, with or without radiation therapy, to destroy cancer cells
- to treat relapsed HL (that comes back after treatment) or refractory HL (that is resistant to the initial treatment)
- to control the symptoms of advanced HL (palliative chemotherapy)
Drugs, doses and schedules vary from person to person.
HL is treated with combination chemotherapy. The most common chemotherapy combination used to treat HL is ABVD:
- doxorubicin (Adriamycin)
- bleomycin (Blenoxane)
- vinblastine (Velbe)
- dacarbazine (DTIC)
ABVD is usually given every 28 days for 6 cycles.
Other chemotherapy combinations used to treat HL are:
- Stanford V– usually given every 28 days for 3 cycles
- mechlorethamine (nitrogen mustard, Mustargen)
- vincristine (Oncovin)
- etoposide (Vepesid)
- prednisone (Deltasone)
- BEACOPP – usually given every 21 days for 8 cycles
- cyclophosphamide (Cytoxan, Procytox)
- procarbazine hydrochloride (Matulane)
- MOPP – usually given every 28 days for 6 cycles
- procarbazine hydrochloride
MOPP is rarely used now because of more severe side effects (such as secondary cancers and infertility) compared to ABVD. However, there are circumstances where it may be helpful, such as in patients with significant heart or lung problems.
If HL does not respond to a chemotherapy regimen, a combination of drugs other than the original treatment may be used.
If HL recurs, chemotherapy is used to treat it.
- The same chemotherapy combination may be used if there was good response for some time the first time it was given.
- Another combination, such as GDP may be given (usually every 21 days for 6 cycles).
- gemcitabine (Gemzar)
- dexamethasone (Decadron, Dexasone)
- cisplatin (Platinol AQ)
- High-dose chemotherapy may be given in preparation for a stem cell transplant. The chemotherapy regimens may be:
- carmustine (BiCNU, BCNU)
- BEAM or miniBEAM
- cytarabine (Cytosar, Ara-C)
- melphalan (Alkeran, L-PAM)
- The drug brentuximab vedotin (Adcetris) may be given. Health Canada recently approved this drug for people who have not responded to at least 2 combination chemotherapy regimens or who have relapsed after an autologous stem cell transplant. Speak to your oncologist about your eligibility for the drug.
For more detailed information on specific drugs, go to sources of drug information.