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Chemotherapy for Hodgkin lymphoma
Chemotherapy uses anticancer (cytotoxic) drugs to destroy cancer cells. Most people with Hodgkin lymphoma (HL) have chemotherapy. Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of chemotherapy. You may also receive other treatments.
Chemotherapy is used to treat all stages of HL. It is sometimes combined with radiation therapy. This is called chemoradiation. The 2 treatments are given during the same time period.
Chemotherapy is given for different reasons. You may have chemotherapy:
- to destroy cancer cells in the body
- to treat HL that has come back after treatment or was resistant to the initial treatment
- in preparation for a stem cell transplant
- to control the symptoms of advanced HL (called palliative chemotherapy)
Chemotherapy is usually a systemic therapy. This means that the drugs travel through the bloodstream to reach and destroy cancer cells all over the body, including those that may have spread outside of the lymph nodes.
Chemotherapy drugs used for Hodgkin lymphoma
The most common combination used to treat HL is called ABVD. This chemotherapy is given on day 1 and day 14 of a 28-day cycle. ABVD is:
- doxorubicin (Adriamycin)
- bleomycin (Blenoxane)
- vinblastine (Velbe)
- dacarbazine (DTIC)
Other combinations of chemotherapy drugs used to treat HL are:
- BEACOPP – bleomycin, etoposide (Vepesid, VP-16), doxorubicin, cyclophosphamide (Cytoxan, Procytox), vincristine (Oncovin), procarbazine (Natulan) and prednisone
- Stanford V – mechlorethamine (nitrogen mustard, Mustargen), doxorubicin, vinblastine, vincristine, bleomycin, etoposide and prednisone
BEACOPP is given every 14 or 21 days. Stanford V is given over 12 weeks.
Some of these same drugs may also be given in different combinations and on different schedules.
The following combinations of chemotherapy drugs may be used if HL does not respond to chemotherapy combinations used in earlier treatments or if it comes back after treatment:
- ESHAP – etoposide, methylprednisolone (Medrol), high-dose cytarabine (Cytosar, Ara-C) and cisplatin (Platinol AQ)
- ASHAP – doxorubicin, methylprednisolone, high-dose cytarabine and cisplatin
- ICE – ifosfamide (Ifex), carboplatin (Paraplatin, Paraplatin AQ) and etoposide
- DHAP – dexamethasone (Decadron, Dexasone), cytarabine and cisplatin
- GVD – gemcitabine (Gemzar), vinorelbine (Navelbine) and pegylated liposomal doxorubicin (Caelyx)
- IGEV – ifosfamide, gemcitabine and vinorelbine
High-dose chemotherapy is given in preparation for a stem cell transplant. The chemotherapy regimens that may be used are:
- BEAM – carmustine (BiNCU, BCNU), etoposide, cytarabine and melphalan (Alkeran, L-PAM)
- CBV – cyclophosphamide, carmustine and etoposide
Side effects can happen with any type of treatment for HL, but everyone’s experience is different. Some people have many side effects. Other people have few or none at all.
Chemotherapy may cause side effects because it can damage healthy cells as it kills cancer cells. If you develop side effects, they can happen any time during, immediately after or a few days or weeks after chemotherapy. Sometimes late side effects develop months or years after chemotherapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.
Side effects of chemotherapy will depend mainly on the type of drug, the dose, how it’s given and your overall health. Some common side effects of chemotherapy drugs used for HL are:
- loss of appetite
- nausea and vomiting
- sore mouth and throat
- low blood cell counts (called bone marrow suppression)
- hair loss
- skin changes
- fertility problems
- lung damage
- heart damage
Tell your healthcare team if you have these side effects or others you think might be from chemotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.
Information about specific cancer drugs
Details on specific drugs change regularly. Find out more about sources of drug information and where to get details on specific drugs.
Questions to ask about chemotherapy
Establishing a national caregivers strategy
The Canadian Cancer Society is actively lobbying the federal government to establish a national caregivers strategy to ensure there is more financial support for this important group of people.