Chemotherapy for Hodgkin lymphoma

Chemotherapy is a common treatment for Hodgkin lymphoma. It uses anti cancer drugs to destroy cancer cells, these are called cytotoxic drugs. Chemotherapy works by disrupting the growth of cancer cells. The drugs circulate throughout the body in the bloodstream so they can reach the lymphoma cells wherever they are.

You usually have a combination of chemotherapy drugs to treat Hodgkin lymphoma. These combinations are called:

• ABVD

• escalated BEACOPDac or escalated BEACOPP

Check the name of the chemotherapy you are having with your doctor or nurse. We have more information about cancer drugs on our cancer drugs A to Z list.

When you have chemotherapy

When you have chemotherapy depends on:

• where the lymphoma is in your body

• the type of Hodgkin lymphoma you have

The most common treatment for Hodgkin lymphoma is chemotherapy followed by radiotherapy. This treatment aims to cure your Hodgkin lymphoma with the least amount of side effects from treatment.

Your doctor might offer you different types of chemotherapy or other treatment if:

• your treatment is not working as well as your doctor would like

• your lymphoma has come back (relapses)

• you are over 60

Types of chemotherapy

You normally have several chemotherapy drugs together during a course of treatment. Some chemotherapy combinations include steroids.

You usually have a PET-CT scan in the middle of your chemotherapy course to see how well it is working.

Chemotherapy for early stage Hodgkin lymphoma

Your doctor might call this early stage favourable Hodgkin lymphoma.

You usually have 2 cycles of ABVD chemotherapy. A chemotherapy cycle means you have the drugs and then a rest to allow your body to recover. Each cycle lasts 4 weeks.

 ABVD contains the following chemotherapy drugs:

• adriamycin (doxorubicin)

• bleomycin

• vinblastine

• dacarbazine

If you have early stage nodular lymphocyte predominant Hodgkin lymphoma (NPLHL) without any symptoms, you might have radiotherapy on it’s own. NPLHL is a rare type of Hodgkin lymphoma. 

Chemotherapy for intermediate stage Hodgkin lymphoma

This is also called early stage unfavourable Hodgkin lymphoma.

You may have one of the following:

• 4 cycles of ABVD followed by radiotherapy

• 6 cycles of ABVD without radiotherapy

• 2 cycles of escalated BEACOPP or BEACOPDac and 2 cycles of ABVD, sometimes followed by radiotherapy

You may have a PET-CT scan midway through your treatment to check how well the treatment is working. This helps your doctor decide which treatment is best for you to have next.

BEACOPP and BEACOPDac contain the following cancer drugs:

• bleomycin

• etoposide

• doxorubicin

• cyclophosphamide

• vincristine

• procarbazine or dacarbazine

• prednisolone, which is a steroid

Chemotherapy for advanced stage Hodgkin lymphoma

You may have one of the following:

• ABVD for 6 cycles

• escalated BEACOPP for 4 to 6 cycles

• a combination of ABVD and escalated BEACOPP

If you are over 60

You might have a different treatment if you are over 60. You may have one of the following:

• AVD. This is the same as ABVD but without bleomycin

• ChlvPP - chlorambucil, vinblastine, procarbazine and prednisolone

• CHOP - cyclophosphamide, doxorubicin, vincristine and prednisolone

• ACOPP - doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisolone

• VEPEMB - vinblastine, cyclophosphamide, procarbazine, etoposide, mitoxantrone, bleomycin and prednisolone

If you have NPHL

If you have NPHL you might have a targeted cancer drug called rituximab. You usually have rituximab with chemotherapy, such as R-CHOP.

R-CHOP contains the following cancer drugs:

• rituximab

• cyclophosphamide

• doxorubicin

• vincristine

• prednisolone

Chemotherapy for Hodgkin lymphoma that hasn't responded to treatment or has come back

You may have different combinations of chemotherapy if your first chemotherapy treatment hasn’t worked very well or if the lymphoma has come back (relapsed). Your doctor might call this second line chemotherapy or chemotherapy for relapsed disease.

You might have second line chemotherapy before high dose chemotherapy and a stem cell transplant .

Some second line chemotherapy drug combinations include:

• GDP (gemcitabine, dexamethasone, cisplatin)

• DHAP (dexamethasone, cytarabine, cisplatin)

• IGEV (ifosfamide, gemcitabine, vinorelbine)

• ICE (ifosfamide, carboplatin, etoposide)

• IVE (ifosfamide, etoposide, epirubicin)

High dose chemotherapy

You might have high dose chemotherapy combinations called BEAM or LEAM with a stem cell transplant. These combinations include the chemotherapy drugs:

• carmustine (BiCNU) or lomustine (CCNU)

• etoposide

• cytarabine (Ara-C, cytosine arabinoside)

• melphalan

How you have chemotherapy

You have most chemotherapy drugs for Hodgkin lymphoma as a drip into your bloodstream (intravenously). You may also have some drugs as tablets that you swallow.

Into your bloodstream

You have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

Or you might have treatment through a long line: a central line, a PICC line or a portacath. These are long plastic tubes that give the drug into a large vein in your chest. The tube stays in place throughout the course of treatment. This means your doctor or nurse won't have to put in a cannula every time you have treatment.

Taking your tablets

Speak to your pharmacist if you have problems swallowing the tablets.

Whether you have a full or an empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, no more or less.

Talk to your healthcare team before you stop taking a cancer drug or if you miss a dose.

Where you have chemotherapy

You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so it’s a good idea to take things in to do. For example, newspapers, books or electronic devices can all help to pass the time. You can usually bring a friend or family member with you.

You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.

For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.

Some hospitals may give certain chemotherapy treatments to you at home. Your doctor or nurse can tell you more about this.

Watch the video below about what happens when you have chemotherapy. It is almost 3 minutes long.

Side effects

Common chemotherapy side effects include:

• feeling sick

• loss of appetite

• losing weight

• feeling very tired

• increased risk of getting an infection

• bleeding and bruising easily

• diarrhoea or constipation

• hair loss

Side effects depend on:

• which drugs you have

• how much of each drug you have

• how you react

Tell your treatment team about any side effects that you have.

Most side effects only last for a few days or so. Your treatment team can help to manage any side effects that you have.

Possible long term side effects

After some types of chemotherapy you might develop long term effects weeks, months or years after the treatment has ended. Different types of chemotherapy cause different problems. And doctors can't tell who will get a long term effect and who won't. 

Loss of fertility

Some chemotherapy used to treat Hodgkin lymphoma can cause damage to your ovaries or testicles. This can mean that you may not be able to 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

Menopause

For women, chemotherapy can cause an early menopause. Doctors can treat this with hormone replacement therapy.

Second cancers

There is a small chance that your treatment can increase the risk of getting another type of cancer in the future. Your doctor will discuss this with you. 

This is because both chemotherapy drugs and radiotherapy work by damaging cells. They kill the lymphoma cells, but they can damage healthy cells too.

Chemotherapy used to treat Hodgkin lymphoma can increase your risk of getting a blood cancer such as leukaemia or Non Hodgkin lymphoma.

Chemotherapy can also slightly increase your risk of getting other cancers such as:

• lung
• stomach
• pancreatic

It is important to remember that this risk is very low.

Heart or lung problems

Some drugs used to treat Hodgkin lymphoma can cause heart problems. You might have regular heart tests. 

Some chemotherapy drugs, particularly bleomycin, can cause inflammation of the lungs. Your doctors will probably stop giving you bleomycin straight away if this happens to you.

Dietary or herbal supplements and chemotherapy

Let your doctors know if you:

• take any supplements
• have been prescribed anything by alternative or complementary therapy practitioners

It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. Some could be harmful.

Clinical trials

Although chemotherapy works very well for Hodgkin lymphoma, research trials are looking at ways of making it work even better while reducing side effects.

When you go home

Chemotherapy for Hodgkin lymphoma can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. Your nurse will give you telephone numbers to call if you have any problems at home.