Treatment
Chemotherapy is a key part of treatment for Hodgkin lymphoma, no matter what stage the
disease is in. It uses powerful medicines that travel through your bloodstream to kill cancer cells wherever they may
be in the body. Most of these medicines are given through an IV (into a vein), but some can also be taken as pills.
Common Chemotherapy Combinations
Doctors usually use a combination of chemotherapy drugs to treat Hodgkin lymphoma. The most
commonly used combination is called ABVD, which includes:
A – Doxorubicin
B – Bleomycin
V – Vinblastine
D – Dacarbazine
In some cases, bleomycin is replaced with:
Nivolumab (N) – leading to the N-AVD regimen
Brentuximab vedotin (BV) – leading to the A+AVD regimen
For people with higher-risk or more aggressive disease, doctors may recommend a stronger
regimen like BrECADD.
How Chemotherapy Is Given
Chemotherapy is given in cycles. For example, in the ABVD regimen, patients receive medicine
on Day 1 and Day 15 of each cycle. A full cycle lasts 28 days. N-AVD and A+AVD follow the same schedule.
If the lymphoma does not respond to initial treatment, additional therapy may be needed, such
as:
High-dose chemotherapy with a stem cell transplant
Other therapies, depending on the patient’s response and health
Treatment of Nodular Lymphocyte-Predominant Hodgkin Lymphoma (NLPHL)
NLPHL is a rare subtype of Hodgkin lymphoma and is often treated differently than the
classical form.
Treatment Options May Include:
Radiation therapy alone for early-stage disease
Antibody therapy with rituximab (in some cases, rituximab alone may be enough)
Combination treatments such as:
R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone)
R-ABVD (rituximab plus ABVD drugs)
For certain low-risk patients, doctors may recommend watchful waiting, which means monitoring
the disease closely without starting treatment right away.
Every Patient Is Unique
The right treatment plan depends on:
The type and stage of Hodgkin lymphoma
How the cancer responds to initial treatment
Your overall health and personal preferences
Your care team will work with you to choose the best treatment approach based on your
individual situation.
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Chemotherapy
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Radiation Therapy
Radiation therapy uses waves of high-energy rays to target and kill cancer cells. The doctor may recommend radiation therapy following completion of chemotherapy. Doctors commonly use radiation techniques called involved-field radiation therapy or involved-nodal radiation therapy to treat Hodgkin lymphoma. These techniques allow targeting of only the area of the body where the lymphoma is located. Different than patients with classical Hodgkin lymphoma those with Nodular Lymphocyte Predominant Hodgkin lymphoma who have early stage disease (stage I or II) might be treated with radiation therapy alone.
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Proton beam radiation therapy
Proton therapy is an advanced type of radiation therapy that uses “protons” rather than X-ray “photons” to deliver radiation to the tumor. In conventional radiotherapy, the photon beams can deposit radiation and damage healthy cells as they pass through the body. Proton therapy deposits most of the radiation directly at the tumor site, resulting in less damage to healthy tissue and fewer side-effects.
- Please see Understanding Proton Therapy to learn more.
Treatment of Hodgkin Lymphoma in "Relapse":
A relapse, or recurrence, is the return of cancer after it appears to have been successfully treated and put into remission, meaning that no cancer can be detected in the body. Treatment of recurrent or relapsed Hodgkin lymphoma may include more aggressive regimens of chemotherapy as well as immunotherapy, stem-cell transplantation, or clinical trials.
Chemotherapy and Immunotherapy
There are several treatment options if Hodgkin lymphoma returns:
Combination chemotherapy: Using more than one chemotherapy drug together.
Chemotherapy with immunotherapy: Immunotherapy helps the immune system fight cancer. This may include drugs like PD-1 antibodies (such as nivolumab or pembrolizumab) or antibody-drug conjugates like brentuximab vedotin (BV).
There are several treatment options for Hodgkin lymphoma, especially if the disease comes back or doesn’t respond to the first treatment. These treatments are designed to help your immune system fight the cancer, reduce symptoms, and bring the disease back into remission.
Common Treatment Approaches
Chemotherapy with immunotherapy: This combines traditional cancer-killing drugs with medicines that boost your immune system. These may include drugs like PD-1 inhibitors
(such as nivolumab or pembrolizumab) or antibody-drug therapies like brentuximab vedotin (BV).
Chemotherapy alone or with radiation: Some patients may be treated with chemotherapy by itself or combined with radiation therapy, depending on the situation.
Immunotherapy alone or in combinations: In some cases, immunotherapy can be used by itself or in combination with other treatments.
Doctors choose the best treatment based on several factors, including your age, the amount of cancer in your body, how the disease is behaving, and your overall health.
Examples of Current Treatment Options
- Brentuximab vedotin (BV) alone
- BV combined with chemotherapy
- PD-1 inhibitors (like nivolumab or pembrolizumab) with chemotherapy
- BV and PD-1 inhibitors used together, without chemotherapy
These treatments are designed to control the disease and help you achieve remission
again.
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Immunotherapy
Forms of immunotherapy commonly used to treat Hodgkin lymphoma include monoclonal antibodies, conjugated monoclonal antibodies and targeted therapies, which prevent the cancer cells from multiplying. Currently these types of therapies are given in combination with chemotherapy to patients with newly diagnosed Hodgkin lymphoma and as a single therapy or in combination therapies to patients with disease that has returned after initial treatment.
Important clinical trials in the United States and Europe are ongoing which may help to clarify the possible advantages of such treatment as initial therapy in different stages of Hodgkin lymphoma.
Antibody Drug Conjugates
Antibody-drug conjugates (ADCs) are special treatments that combine an antibody with a small amount of chemotherapy. The antibody helps guide the chemotherapy directly to the cancer cells, which may reduce damage to healthy cells. Brentuximab vedotin is a CD30 antibody-drug conjugate that is now approved in combination with chemotherapy for frontline treatment of advanced stage Hodgkin Lymphoma and clinical trials have and are evaluating it in frontline treatment for early-stage Hodgkin lymphoma. It is also used in some patients for relapsed Hodgkin lymphoma, alone or in combination, and as a maintenance therapy after autologous stem cell transplant in some patients.
Immune checkpoint inhibitors
Immune checkpoint inhibitors in the form of PD-1 antibodies are a form of immunotherapy that has been shown to be very active in Hodgkin lymphoma. Monoclonal antibodies to programmed cell death 1 (PD-1) are approved for treatment of Hodgkin lymphoma and are studied in combination therapy with chemotherapy and BV at relapse. They have been evaluated in combination with chemotherapy for treatment of newly diagnosed Hodgkin lymphoma as well and are now recommended in combination with chemotherapy for advanced stage Hodgkin lymphoma.
Stem Cell Transplantation
For patients whose Hodgkin lymphoma comes back after treatment (called a relapse), or whose lymphoma doesn't respond to the initial treatment (called refractory disease), there are second-line treatment options. These may include more chemotherapy, immunotherapy with special drugs like antibody-drug conjugates or PD-1 inhibitors, or a combination of these. While these treatments can help, they usually don't keep the cancer away long-term.
That's why the most effective approach for relapsed or refractory Hodgkin lymphoma is to first use second-line therapy to get the patient into remission (either again or for the first time), followed by an autologous stem cell transplant. In this procedure, doctors collect the patient’s own stem cells from the blood and freeze them. Then, the patient receives very high doses of chemotherapy to kill any remaining cancer—but this also wipes out healthy blood cells. Afterward, the preserved stem cells are given back through an IV so they can regrow into healthy bone marrow and blood cells.
Researchers are studying whether some patients could skip the stem cell transplant and instead continue with maintenance immunotherapy, like PD-1 inhibitors. One current study is looking at using PD-1 drugs as maintenance for patients who respond well to a combination of chemo and PD-1 treatment.
In some cases, after recovery from the autologous transplant, doctors may recommend maintenance therapy using a drug called brentuximab vedotin, which is a type of antibody-drug conjugate.
Clinical Trials
Clinical trials allow patients to try a new treatment before it is available to the general public, or a new combination of therapies before the combination is approved. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be for a certain type of cancer or if a combination is better than a single drug. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may be a new, groundbreaking drug or it may have no effect. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation.
Important clinical trials are being conducted to determine the best initial therapies for patients with early and late stages of the disease and best treatments at relapse.
