Chemotherapy for Hodgkin lymphoma

Chemotherapy uses anticancer (cytotoxic) drugs to destroy cancer cells. It is the main treatment for Hodgkin lymphoma (HL). Your healthcare team will consider the type of HL, stage, tumour size (bulkiness) and other prognostic factors, as well as your personal needs, to plan the drugs, doses and schedules of chemotherapy. You may also receive other treatments.

Chemotherapy is given for different reasons. You may have chemotherapy to:

• destroy cancer cells in the body
• treat HL that has come back after treatment or did not respond to the first treatment
• to prepare for a stem cell transplant
• to relieve pain or control the symptoms of advanced HL (called palliative chemotherapy)

Chemotherapy is a systemic therapy. This means that the drugs travel through the blood to reach and destroy cancer cells all over the body, including those that may have spread outside of the lymph nodes.

Before chemotherapy starts, your doctor may do tests, such as an echocardiogram and pulmonary function tests, to check how well your heart and lungs are working. These can be used as a baseline to monitor any effects of chemotherapy.

Chemotherapy can sometimes affect your fertility (the ability to get or stay pregnant or get someone else pregnant). Before you start cancer treatment, talk to your doctor if you want to have children in the future. There may be ways to protect your fertility before or during treatment.

How the cancer responds to chemotherapy is important for determining a prognosis (the expected outcome of the disease) and planning other treatment. The response is measured both partway through the treatment and after it is finished. Imaging tests, such as CT scans, MRIs and PET scans, measure whether a tumour has become smaller.

The test results after the first few chemotherapy cycles help the doctor adjust the next cycles to lessen side effects but keep treatment effective. If tests show that the treatment is working, the doctor may lower the number of drugs used or the cycles of chemotherapy given. If tests show that the treatment is not working, the doctor may change the type of chemotherapy or increase the number of cycles.

The test results after the end of chemotherapy may be used to decide whether radiation therapy is needed. Tests are usually done at least 3 weeks after chemotherapy is finished.

The most common combination used to treat HL is called ABVD. This chemotherapy is given every 2 weeks for 2 to 8 months, depending on the stage and response to treatment. ABVD includes doxorubicin, bleomycin, vinblastine and dacarbazine.

Other combinations of chemotherapy drugs used to treat HL are:

• BEACOPP – bleomycin, etoposide, doxorubicin, cyclophosphamide (Procytox), vincristine, procarbazine (Matulane) and prednisone
• A + AVD – brentuximab vedotin (Adcetris), doxorubicin, vinblastine and dacarbazine

BEACOPP is given every 3 weeks for 6 to 24 weeks. A + AVD is given every 2 weeks for up to 6 months. The length of treatment depends on the stage of HL and the response to treatment.

If HL does not respond to drugs used in earlier treatments or if it comes back, the following chemotherapy combinations may be used:

• DICEP – dexamethasone, cyclophosphamide, etoposide (Vepesid), cisplatin and mesna (Uromitexan)
• ICE – ifosfamide (Ifex), carboplatin and etoposide
• DHAP – dexamethasone, cytarabine and cisplatin
• ESHAP – etoposide, methylprednisolone (Medrol), high-dose cytarabine and cisplatin
• GDCRBP – gemcitabine, dexamethasone and carboplatin
• GVD – gemcitabine, vinorelbine and pegylated liposomal doxorubicin (Caelyx)
• bendamustine (Treanda) with or without other chemotherapy drugs
• GDP – gemcitabine, dexamethasone and cisplatin
• COPP – cyclophosphamide, vincristine, procarbazine (Matulane) and prednisone
• CEP – lomustine (Ceenu), etoposide, prednisone and chlorambucil (Leukeran)

High-dose chemotherapy is given in preparation for a stem cell transplant. The chemotherapy combinations that may be used are:

• BEAM – carmustine (BICNU), etoposide, cytarabine and melphalan (Alkeran)
• 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 only a few side effects.

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
• diarrhea
• constipation
• low blood cell counts (called bone marrow suppression)
• thyroid problems (hypothyroidism)
• hair loss
• fatigue
• skin problems
• 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.

Details on specific drugs change regularly. Find out more about sources of drug information and where to get details on specific drugs.

Find out more about chemotherapy and side effects of chemotherapy. To make the decisions that are right for you, ask your healthcare team questions about chemotherapy.