Chemotherapy drugs for Hodgkin's lymphoma and their side effects

There are many different combinations of chemotherapy drugs used to treat Hodgkin’s lymphoma. Your specialist will pick the drug combination which best suits your stage and type of lymphoma. These chemotherapy combinations are called regimens. The names of the combinations are often shortened by using the first letter of each drug. 

Most people with early stage Hodgkin's lymphoma have 2 to 4 cycles of ABVD chemotherapy, which contains the drugs Adriamycin (doxorubicin), bleomycin, vinblastine and dacarbazine.

For advanced stage Hodgkin's lymphoma some people have ABVD for up to 8 cycles. Other possible combinations include

• ChlvPP - chlorambucil, vinblastine, procarbazine and prednisolone
• Stanford V - mustine, doxorubicin, vinblastine, vincristine, bleomycin, etoposide and steroids
• BEACOPP - bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisolone

If chemotherapy does not work well or the lymphoma comes back some people have BEAM chemotherapy with a stem cell transplant. 

Although chemotherapy works very well for Hodgkin's lymphoma, research trials are looking at ways of making it work even better while reducing side effects. So some trials are changing the dose of drugs in the ABVD combination. Other trials are comparing ABVD to other types of combination chemotherapy. You can find information about these trials on the Hodgkin's lymphoma research page.

All chemotherapy drugs have side effects but they vary from person to person. Some people have very few side effects at all. Your doctor can prescribe medicines to control or reduce side effects such as sickness or diarrhoea. It is important to remember that most effects are temporary. They will go away when your treatment is finished. All the drugs have different side effects so it is helpful to ask your doctor or nurse which are most common with the chemotherapy drugs you will have.

There are some side effects that are quite common with many chemotherapy drugs. These are

• Low numbers of blood cells
• Feeling and being sick
• Diarrhoea
• A sore mouth and moth ulcers
• Hair loss or thinning
• Feeling tired and run down

The links above take you to information about coping with these side effects in the main cancer drugs section of CancerHelp UK. There is also information about the side effects of specific chemotherapy drugs. There is information about many of the drugs used to treat Hodgkin’s lymphoma, including a page on ABVD and individual pages about

• Doxorubicin (also called Adriamycin)
• Bleomycin
• Etoposide (also called VP16)
• Vincristine (also called Oncovin)
• Dacarbazine
• Vinblastine
• Procarbazine
• Cyclophosphamide

Remember - if at any time when you have chemotherapy drips or pumps running, you think there is a problem, call a nurse straight away. Some of these drugs can cause a lot of damage if they leak into the tissues around a vein. Having the drugs through a central line reduces the chance of problems.

If you are having medicines to control side effects and they are not working, do tell your doctor or chemotherapy nurse. There are lots of different anti sickness and anti diarrhoea medicines, for example. A different type may work better for you.

Chemotherapy can have long term effects on some people's health. The most common is infertility. If you are young and have not yet had children your doctor will try to choose the drugs that are least likely to cause infertility. Other long term effects are much less common, but include heart disease, damage to the lungs and the risk of getting another cancer in the future.

Infertility

Unfortunately some chemotherapy used to treat Hodgkin's lymphoma can cause damage to your ovaries or testicles. This can mean that you can't have children (infertility). It is difficult for doctors to say definitely whether this will happen to you. It depends on

• The chemotherapy drugs you are having
• Your total dose of the drugs
• Your age if you are a woman

It may be possible for men and teenage boys to store sperm before they start their chemotherapy. This is called sperm banking. Ask your doctor if you think you would like to do this.

For women, chemotherapy can cause an early menopause. Doctors can treat this with hormone replacement therapy. A lot of research is looking into ways of trying to preserve the fertility of young women given chemotherapy, such as freezing pieces of ovarian tissue and replacing them after treatment. But this research is still at a very early stage. It is possible to freeze unfertilised eggs, but it can take a few weeks to harvest the eggs and that may not be possible if you need to start your treatment quickly. There is detailed information about ways women can keep their fertility in the section about fertility and chemotherapy in CancerHelp UK.

Look at the page about sex and fertility in the living with Hodgkin's lymphoma section for information about coping with these effects of chemotherapy.

Second cancers

Your treatment might increase the risk of you getting another type of cancer in the future. Chemotherapy drugs and radiotherapy work by damaging cells. They damage and kill the Hodgkin’s lymphoma cells, but can damage healthy cells as well. The damage can lead to other cells becoming cancerous some years after your treatment. Recent research seems to show that with treatments used 10 years ago, 1 in 10 people (10%) develop a second cancer after 10 years. But newer treatments are less likely to cause a second cancer and probably have a lower risk.

If you have had chemotherapy to treat Hodgkin's lymphoma, you have a small increased risk of getting leukaemia in the future (between 1 and 3 %). Research that followed people treated as children has found that this risk peaks about 5 years after treatment and then drops away over the next 10 years. So 15 years after your treatment, your leukaemia risk is no longer increased.

Doctors don't know whether this increased risk of cancer in the future is only because of treatment. People who get lymphoma have a slightly increased risk of getting cancer anyway. So doctors have to weigh up the benefit to you of treating the lymphoma against the long term risks of another cancer. You will need to go back to the hospital for check ups for many years. Your doctors will check for any signs of a second cancer so that they can find and treat it as early as possible.

Heart disease

Some drugs used to treat Hodgkin’s lymphoma can cause heart problems. This is also true of radiotherapy to the middle of the chest. You may have a slightly increased risk of a heart attack or other heart problems in the future. But your doctors will be trying their best to treat your lymphoma effectively while trying to keep down the long term risks of treatment as much as possible.

Lung damage

Some chemotherapy drugs, particularly bleomycin, can cause inflammation of the lungs. This usually shows up at the time you are treated. It is called pneumonitis (new-mon-itis). If you get this side effect, your doctors will probably stop giving you bleomycin straight away. Usually once you stop having the bleomycin, the lung inflammation goes away. In rare cases, the lung damage does not get better and causes a cough or breathlessness.