Hodgkin lymphoma treatment

How is Hodgkin lymphoma treated?

Treatment depends mainly on the stage, or extent of disease in your body. Other factors that are considered include the exact type of Hodgkin lymphoma you have, your age and general health. These days, most people treated for Hodgkin lymphoma can be cured. Many others who are treated remain disease-free and well for a long time. Treatment usually involves chemotherapy or radiotherapy or a combination of both. In selected cases, a stem cell transplant (also called a peripheral blood stem cell or bone marrow transplant) may be used.

Early-stage disease

The great majority of people with early-stage Hodgkin lymphoma (stages 1 and 2) are cured. There are often several options available for your treatment, which your doctor should discuss with you. Early-stage disease is usually treated with a combination of chemotherapy and radiotherapy. The decision regarding which of these options should be used will depend on your disease stage and which side effects of treatment are important to you.

Advanced-stage disease

Advanced-stage disease (stages 3 and 4) is usually treated with a longer course of chemotherapy. In most patients, the chemotherapy will continue for six months or even longer. Occasionally radiotherapy is also used in this stage.

Relapsed and resistant disease

Finding out that your disease has come back or relapsed can be devastating. If your disease does relapse there are usually ways of trying to get it back under control. These might involve using more chemotherapy, which might be a different type to before, or using more intensive or high-dose chemotherapy followed by a stem cell transplant.

Palliative care

If a decision is made not to continue with anti-cancer treatment (chemotherapy and radiotherapy) for your lymphoma there are still many things that can be done to help you to stay as healthy and comfortable as possible for some time. Palliative care is aimed at relieving any symptoms or pain you might be experiencing as a result of your disease or its treatment, rather than trying to cure or control it.

Radiotherapy

Radiotherapy is a form of local therapy, because it only destroys cancer cells in the treated area (radiation field). It is commonly used to treat disease that is confined to one area of the body. Radiotherapy uses high-energy x-rays to kill cancer cells and shrink cancers. Radiotherapy is usually given in small doses (also known as fractions) each week day (Monday to Friday) over a few weeks in the radiotherapy department of a hospital.

Before radiotherapy begins, the radiotherapist (doctor who specialises in treating people with radiotherapy) will carefully calculate the correct dose of radiation therapy for you. The areas of your body that need to be treated will be marked with tiny ink dots on your skin using a special pen.

When you are having radiotherapy you usually lie on a table underneath the radiotherapy machine which delivers the planned dose of radiation. Important structures like your heart and lungs are shielded as much as possible to ensure that they are not affected by the treatment given. Radiotherapy is painless. In fact you do not see or feel anything during the actual treatment. You will however need to stay perfectly still for a few minutes while the treatment is taking place. You might like to bring along some music to help you relax.

Chemotherapy

Chemotherapy literally means therapy with chemicals. Many chemotherapy drugs are also called cytotoxics (cell toxic) because they kill cells, especially ones that multiply quickly like cancer cells. Chemotherapy is given as a combination of drugs, in several cycles (or courses) of treatment with a rest period of a few weeks in between each cycle. A typical chemotherapy regime for Hodgkin lymphoma might involve around six cycles of a combination of drugs, given over a period of six months. There are many different ways of giving chemotherapy. It may be given through a vein (intravenously or IV), usually in your arm or hand, or in tablet form (orally).

If you are having several cycles of intravenous chemotherapy, your doctor may recommend that you have a central venous catheter (also called a central line) inserted. Once in place, chemotherapy and any other IV drugs can be given through the line and blood tests can usually be taken from the line. There are several different kinds of central lines used. Some are intended for short-term use while others remain in place for months and even years.

In most cases you do not need to be admitted for chemotherapy. It is usually given in the outpatient department of the hospital. Sometimes, however, depending on the type of chemotherapy being given and your general health, you may need to be admitted to the ward for a short while.

Stem cell transplant

Occasionally, a stem cell transplant is given, providing some people a better chance of cure or long-term control of their disease. It is generally only suitable in situations where the lymphoma has come back (relapsed) or is at high risk of relapse, and where it doesn’t respond well to standard (conventional) treatment.