Hodgkin Lymphoma

Hodgkin lymphoma most often starts in the lymph nodes in the chest, neck or underarm. It may spread to other lymph nodes or organs, such as the liver or lungs.

Most Hodgkin lymphoma cases are classical Hodgkin lymphoma and nodular lymphocyte-predominant Hodgkin lymphoma. The cancer cells are large, abnormal B-cells with more than one nucleus (Reed-Sternberg cells). Classical Hodgkin lymphoma has four main subtypes: nodular sclerosis, mixed cellularity, lymphocyte-rich and lymphocyte-depleted. Nodular lymphocyte-predominant Hodgkin lymphoma accounts for the rest of the Hodgkin lymphoma diagnoses. It has large cells that are variants of Reed-Sternberg cells.

Treating Hodgkin Lymphoma

Several treatment options are available to choose from. Doctors weigh many factors before they decide on the best treatment plan, including:

  • Stage of disease
  • Extent of lymphoma
  • Disease subtype
  • Presence of symptoms
  • Age, gender and overall health

Chemotherapy is the main treatment for Hodgkin lymphoma. These are drugs that stop the growth of cancer cells. Chemotherapy may be a first-line therapy, which means you receive it before other types of treatment. Usually, people will receive multiple drugs for a certain amount of time.

If a first-line therapy does not work - or stops working - you may receive second-line therapy. Several chemotherapy combinations for both may be considered.

You may also receive chemotherapy along with radiation therapy or before a stem cell transplant.

Radiation therapy may be given after chemotherapy for classical Hodgkin lymphoma. This is more likely for a large or bulky tumor. Doctors may use it alone to treat early-stage nodular lymphocyte-predominant Hodgkin lymphomas. Or they may combine it with other types of treatment for a later stage of this type of Hodgkin lymphoma.

  • External beam radiation therapy is the most common type of radiation therapy used. It delivers a beam of radiation from a machine outside of the body.
  • Total body irradiation is a type of EBRT given to the entire body. You may receive this before stem cell transplantation. 

Targeted therapies have been specifically developed to attack a specific molecule in cancer cells — often with less harm to normal cells than chemotherapy or radiation therapy. Monoclonal antibodies (mAbs — pronounced “mabs”) may be an option for both classical and nodular lymphocyte-predominant Hodgkin lymphomas. It may work if the lymphoma cells have a certain protein on their surfaces. The mAbs are laboratory-made versions of immune system proteins designed to attack cancer cells. A mAb that carries a toxin to the cancer cell may be used as a first-line treatment of later-stage classical Hodgkin lymphoma combined with chemotherapy.

Immunotherapy uses the immune system to fight cancer. It offers new hope for people with relapsed Hodgkin lymphoma or with cancer that is harder to treat. Immune checkpoint inhibitors are approved to treat some cases of classical Hodgkin lymphoma.

  • One immune checkpoint inhibitor was approved in 2016 for classical Hodgkin lymphoma. This is for cases where the cancer has recurred or progressed after a certain type of stem cell transplant and post-transplant drug therapy (see Treatment Planning).
  • Another immune checkpoint inhibitor was approved in 2017 for children and adults with classical Hodgkin lymphoma that has stopped responding to treatment or returned after three or more therapies. 

Stem cell transplantation may be used if other treatment options are not effective (see Stem Cell Transplantation). Doctors most often use stem cells from the patient’s own body (an autologous stem cell transplant). These are harvested, frozen and returned to the patient after high-dose chemotherapy.

Surgery is not used for most lymphomas but may be used to remove a tumor or the spleen.

Corticosteroids may be combined with chemotherapy to help it work better.

Clinical trials may offer you access to new therapies not otherwise available.

      Refractory or relapsed Hodgkin Lymphoma

      The goal of treatment is remission. This occurs when you do not have cancer symptoms and your doctor cannot detect any lymphoma in your body. Remission may last for a while or be permanent.

      If initial treatment does not result in complete remission, the disease is known as primary refractory Hodgkin lymphoma. Your doctor may suggest different drug therapies.

      Even with remission, Hodgkin lymphoma sometimes returns (relapses). If this happens, your doctor will review your diagnosis and may choose a different treatment option. This often involves using a second-line combination chemotherapy treatment. It may include radiation therapy and a stem cell transplant. Your doctor may suggest a clinical trial.

      Common Drug Therapies for Hodgkin Lymphoma

      These therapies may be used alone or in combination. Possible combination therapies are listed below. 

      Commonly Used Medications for Hodgkin Lymphoma

      bleomycin (Blenoxane)
      brentuximab vedotin (Adcetris)
      chlorambucil (Leukeran)
      dacarbazine (DTIC-Dome)
      doxorubicin hydrochloride (Adriamycin)
      mechlorethamine (Mustargen)
      nivolumab (Opdivo)
      pembrolizumab (Keytruda)
      procarbazine (Matulane)
      vinblastine (Velban)
      vincristine (Oncovin)
      Some Possible Combination Therapies
      AAVD: doxorubicin (Adriamycin), brentuximab vedotin (Adcetris), vinblastine (Velban) and dacarbazine (DTIC-Dome)
      ABVD: doxorubicin (Adriamycin), bleomycin (Blenoxane), vinblastine (Velban) and dacarbazine (DTIC-Dome)
      ABVD + R: doxorubicin (Adriamycin), bleomycin (Blenoxane), vinblastine (Velban), dacarbazine (DTIC-Dome) and rituximab (Rituxan)
      BEACOPP: bleomycin (Blenoxane), etoposide (Etopophos), doxorubicin (Adriamycin), cyclophosphamide, vincristine (Oncovin), procarbazine (Matulane) and prednisone
      ChlVPP: chlorambucil (Leukeran), vinblastine (Velban), procarbazine (Matulane) and prednisone
      DHAP: dexamethasone, high-dose cytarabine and cisplatin
      ESHAP: etoposide (Etopophos), methylprednisolone, high-dose cytarabine and cisplatin
      GDP: gemcitabine (Gemzar), dexamethasone and cisplatin
      Gem-Ox: gemcitabine (Gemzar) and oxaliplatin (Eloxatin)
      GVD: gemcitabine (Gemzar), vinorelbine (Navelbine) and doxorubicin
      ICE: ifosfamide, carboplatin and etoposide (Etopophos)
      Stanford V: doxorubicin (Adriamycin), mechlorethamine (Mustargen), vincristine (Oncovin), bleomycin (Blenoxane), etoposide (Etopophos) and prednisone

      As of 10/13/21