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Treatments and drugs
By Mayo Clinic staffThe most important factor in Hodgkin's lymphoma treatment is the stage of the disease. The number and regions of lymph nodes affected and whether only one or both sides of your diaphragm are involved also are important considerations. Other factors affecting decisions about treating this disease include:
- Your age
- Your symptoms
- Whether you're pregnant
- Your overall health status
The goal of treatment is to destroy as many malignant cells as possible and bring the disease into remission. As many as 95 percent of people with stage I or stage II Hodgkin's lymphoma survive for five years or more with proper treatment. The five-year survival rate for those with widespread Hodgkin's lymphoma is about 60 to 70 percent, according to the American Cancer Society. But those numbers are based on people treated before 1990, so the outcome may be even more promising for people with more recent diagnosis and treatment.
Treatment options include:
Chemotherapy
When the disease progresses and involves more lymph nodes or other organs, chemotherapy is the preferred treatment. Chemotherapy uses specific drugs in combination to kill tumor cells. The drugs travel through your bloodstream and can reach nearly all areas of your body.
A major concern with chemotherapy is the possibility of long-term side effects and complications, such as heart damage, lung damage, liver damage, fertility problems and secondary cancers, such as leukemia.
Although severe effects aren't common, an ongoing effort is being made to find equally effective regimens with less toxicity. Drug regimens have been developed for Hodgkin's lymphoma that substantially diminish the likelihood of long-range, life-threatening complications, including acute leukemia, in people who have received multiple courses of chemotherapy and radiation therapy.
Chemotherapy regimens are commonly referred to by their initials, such as:
- ABVD, which consists of doxorubicin (Adriamycin), bleomycin, vinblastine and dacarbazine.
- BEACOPP, which consists of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisone.
- Stanford V, which consists of doxorubicin, vinblastine, mechlorethamine, etoposide, vincristine, bleomycin and prednisone. Those taking this regimen are also treated with radiation therapy.
- COPP/ABVD, which consists of cyclophosphamide, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, vinblastine and dacarbazine.
- MOPP, which consists of mechlorethamine, vincristine, procarbazine and prednisone.
ABVD is currently the preferred treatment. Some people at high risk may receive a more intensive treatment, such as BEACOPP.
Radiation
When the disease is confined to a limited area, radiation therapy may be the treatment of choice. With radiation therapy, high-energy X-rays are used to kill cancer cells. It's typical to radiate the affected lymph nodes and the next area of nodes where the disease might progress. The length of radiation treatment varies, depending on the stage of the disease. Radiation therapy may be used alone, but it is commonly used with chemotherapy. If you relapse after radiation therapy, chemotherapy becomes necessary.
Some forms of radiation therapy may increase your risk of heart disease, stroke, thyroid problems, infertility and other forms of cancer, such as breast or lung cancer. Radiation can also damage nearby healthy tissue. Most children with Hodgkin's lymphoma are treated with chemotherapy, but they may also receive low-dose radiation therapy.
Bone marrow or stem cell transplant
If the disease returns after treatment, you may need a bone marrow or stem cell transplant. For this procedure, your own bone marrow or stem cells (autologous) are removed and treated to kill cancerous cells. Then the marrow or stem cells are frozen and stored for safekeeping. Next you receive high-dose chemotherapy to destroy cancerous cells in your body. Finally your frozen marrow or stem cells are thawed and injected into your body through your veins.
- What you need to know about Hodgkin lymphoma. National Cancer Institute. http://www.cancer.gov/cancertopics/wyntk/hodgkin/allpages. Accessed June 4, 2009.
- Overview: Hodgkin disease. American Cancer Society. http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?dt=84. Accessed June 4, 2009.
- Gottschalk SM, et al. Overview of Hodgkin lymphoma in children and adolescents. http://www.uptodate.com/home/index.html. Accessed June 4, 2009.
- Mauch PM. Clinical presentation and patterns of disease distribution on Hodgkin lymphoma in adults. http://www.uptodate.com/home/index.html. Accessed June 4, 2009.
- Horwitz S, et al. Treatment of advanced stage (stage III-IV) Hodgkin lymphoma. http://www.uptodate.com/home/index.html. Accessed June 4, 2009.
- Bartlett, NL. Modern treatment of Hodgkin lymphoma. Current Opinion in Hematology. 2008;15:408.
- General information about adult Hodgkin lymphoma. National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/treatment/adulthodgkins/Patient. Accessed June 7, 2009.
- Ng AK, et al. Late effects of Hodgkin's disease and its treatment. The Cancer Journal. 2009;15:164.
- Complementary and alternative therapies. American Cancer Society. http://www.cancer.org/docroot/ETO/ETO_5.asp?sitearea=ETO. Accessed June 7, 2009.
- Stages of adult Hodgkin lymphoma. National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/treatment/adulthodgkins/Patient/page2. Accessed June 7, 2009.
- Ansell SM (expert opinion.) Mayo Clinic, Rochester, Minn. June 12, 2009.
