Treatment

Most people will have chemotherapy as their main treatment but they may have surgery and radiotherapy as well.

Surgery

Most people will have minor surgery to remove a lymph node for diagnosis of Hodgkin lymphoma. Recovery from this type of surgery takes on average 2-7 days. Very rarely people may have their spleen removed ( a ‘splenectomy’) – this can be done laparoscopically in which case the recovery time is up to 2 weeks or as an open operation – the recovery time is up to 6 weeks.

Chemotherapy

There are two types of chemotherapy used in Hodgkin Lymphoma. They are:

• Standard chemotherapy
• High dose chemotherapy and bone marrow transplant – this treatment is used for relapsed disease and for disease that has not responded to standard ‘first line’ chemotherapy.

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• Bone marrow transplant.

Most people will begin their treatment with standard chemotherapy; they are likely to be given a combination of chemotherapy drugs-:

• Adriamycin (Doxorubicin)
• Bleomycin
• Vinblastine
• Dacarbazine

These are the drugs most commonly used and may be called ‘ABVD’ in medical evidence

• Bleomycin
• Etoposide
• Adriamycin
• Cyclophosphamide
• Oncovin
• Procarbazine
• Prednisolone

This drug combination may be called ‘BEACOPP’ in medical evidence.

In early lymphoma 2 or 4 cycles of treatment are likely to be given and in more advanced disease 4-8 cycles. Treatment is given over 1-3 days at the beginning of each three-four week cycle (total treatment time 12-32 weeks).

Treatment may be given weekly for 12 weeks using the Stanford V regime. The standard chemotherapy regime is ABVD. A rare but severe side effect is bleomycin pneumonitis – the symptoms are severe breathlessness and reduced exercise tolerance. The treatment usually involves many months of high dose steroids (see steroid drugs below) and can be fatal. Those who survive may be left with permanently reduced lung function

Of note because Hodgkin Lymphoma affects younger people the long term effects of treatment are particularly likely to affect this group and are summarised here:

• Infertility
• Secondary cancers
• Lung damage
• Heart disease

Those who do not respond to standard chemotherapy during the first course of chemotherapy treatment or whose lymphoma relapses after treatment are likely to go on to have high dose chemotherapy and bone marrow transplant treatment. The side effects of this treatment can be severe.

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• Side effects of Chemotherapy

Radiotherapy

Early Hodgkin Lymphoma radiotherapy is usually used to target groups of affected lymph nodes either in the neck, the chest or the abdomen. Treatment is given daily over 2-3 weeks and may be combined with 2-4 cycles of ABVD chemotherapy. Treatment may vary between different hospitals.

Radiotherapy is not usually used in advanced Hodgkin disease but may be used for areas of residual disease that have not completely responded to standard chemotherapy

Radiotherapy may be used to treat small areas of relapsed disease usually as a 2-3 week course. Radiotherapy is used palliatively to treat symptoms such as pain. Treatment may be given once or over several days to weeks.

For side effects during radiotherapy treatment please refer to general notes. Of note because Hodgkin Lymphoma affects young people the long term effects of treatment are particularly likely to affect this group and are summarised here:

• Skin damage/pigmentation to treated area
• Lung damage
• Heart disease
• Second cancers

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• Radiotherapy & Brachytherapy

Steroid drugs

These drugs (including prednisolone and dexamethasone) are used in short bursts during chemotherapy treatment. In general side effects are minimal. However if used for prolonged periods the following side effects are very common – significant weight gain, osteoporosis and diabetes mellitus. Rarer side effects include psychiatric problems ranging from depression and anxiety to major psychotic episodes.

Treatment of relapsed or advanced Hodgkin Lymphoma

People whose Hodgkin lymphoma has relapsed after successful first line treatment are likely to go on to have high dose chemotherapy and Peripheral Blood Stem Cell Transplant (PBSCT) or bone marrow transplant especially if they are fit. If disease returns again it may be kept under control for some time with further chemotherapy. As a person has more treatments over time they are likely to collect disabling effects related to both the disease and its treatment.

Amended February 2009