Treatments for relapsed or refractory Hodgkin lymphoma

The following are treatment options for relapsed or refractory Hodgkin lymphoma (HL). Relapsed (recurrent) HL means that the cancer has come back after it was treated. Refractory HL means that the cancer did not respond to treatment or it continued to grow even with treatment.

Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan. The treatments offered will depend on where the HL is in the body, how long since it was first treated and the treatments that were used.

Chemotherapy uses anticancer drugs to destroy cancer cells. It may be used to treat HL that comes back after treatment. Chemotherapy may also be used in preparation for a stem cell transplant.

You may be given the same combination of chemotherapy drugs that was originally used to treat the HL if it responded well to them the first time they were given. You may also be offered a different combination of chemotherapy drugs.

The following combinations of chemotherapy drugs may be used to treat relapsed or refractory HL:

• GDP – gemcitabine, dexamethasone and cisplatin
• DICEP – dexamethasone, cyclophosphamide (Procytox), etoposide (Vepesid), cisplatin and mesna (Uromitexan)
• ESHAP – etoposide, methylprednisolone (Medrol), high-dose cytarabine (Cytosar) and cisplatin
• DHAP – dexamethasone, cytarabine and cisplatin
• GDCRBP – gemcitabine, dexamethasone and carboplatin
• GVD – gemcitabine, vinorelbine and pegylated liposomal doxorubicin (Caelyx)
• ICE – ifosfamide (Ifex), carboplatin and etoposide
• COPP – cyclophosphamide, vincristine, procarbazine (Matulane) and prednisone
• CEP – lomustine (Ceenu), etoposide, prednisone and chlorambucil (Leukeran)

Find out more about chemotherapy for Hodgkin lymphoma.

You may be offered radiation therapy to treat HL that comes back or remains in only one lymph node area if you haven’t already received radiation therapy. Radiation therapy uses high-energy rays or particles to destroy cancer cells. It may be given alone or with chemotherapy.

Radiation therapy may also be used in preparation for a stem cell transplant.

Find out more about radiation therapy for Hodgkin lymphoma.

A stem cell transplant is the main treatment used for HL that doesn’t completely go away after treatment with chemotherapy or radiation therapy. It may also be offered if the HL comes back soon after the original treatment is finished.

A stem cell transplant uses high-dose chemotherapy to kill all of the cells in the bone marrow. Healthy stem cells are given to replace the ones in the bone marrow that were destroyed. In an autologous type of transplant, the stem cells are taken from your own bone marrow or blood. In an allogeneic type of transplant, stem cells are collected from another person.

If the HL remains after an autologous stem cell transplant, an allogeneic stem cell transplant may be an option for some people.

Find out more about a stem cell transplant for Hodgkin lymphoma.

Targeted therapy uses drugs to target specific molecules (such as proteins) on cancer cells or inside them to stop the growth and spread of cancer and limit harm to normal cells. You may be offered targeted therapy for relapsed or refractory classical HL if:

• the HL remains or continues to grow after both chemotherapy and radiation therapy
• the HL comes back after a stem cell transplant
• you can’t have a stem cell transplant because you have other health problems or are older

Find out more about targeted therapy for Hodgkin lymphoma.

Immunotherapy helps strengthen or restore the immune system’s ability to find and destroy cancer cells.

You may be offered immunotherapy for relapsed or refractory classical HL if:

• the HL remains or continues to grow after other treatments
• the HL comes back after a stem cell transplant
• you can’t have a stem cell transplant because you have other health problems or are older

Find out more about immunotherapy for Hodgkin lymphoma.

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

Talk to your doctor about clinical trials open to people with HL in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.