Chemotherapy treatment

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.

A course of chemotherapy is made up of a number of cycles. You have treatment, usually over 1 to 3 days, depending on the particular combination of drugs. Then you have a break of a few weeks to allow your body to recover from the effects of the chemotherapy. Then another cycle begins. The number of cycles you have depends on:

  • which drugs you are having
  • the stage and type of your Hodgkin lymphoma
  • results of any tests
  • how well your lymphoma responds to treatment

Types of chemotherapy

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

Limited (early) stage

You might have 2 to 4 cycles of ABVD chemotherapy, which contains the drugs:

  • adriamycin (doxorubicin)
  • bleomycin
  • vinblastine
  • dacarbazine

Advanced stage

You may have ABVD for 6 to 8 cycles. Or you might have:

  • ChlvPP – chlorambucil, vinblastine, procarbazine and prednisolone
  • Escalated BEACOPP – bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisolone
  • GemP – gemcitabine, cisplatin and prednisolone
  • ESHAP - etoposide, prednisolone, cytarabine and cisplatin (more likely for Hodgkin lymphoma that has come back)

High dose treatment

You might have BEAM or LEAM chemotherapy with a stem cell transplant, if chemotherapy doesn't work well or your lymphoma comes back.

These combinations include the drugs:

  • carmustine (BiCNU) or lomustine (CCNU)
  • etoposide
  • cytarabine (Ara-C, cytosine arabinoside)
  • melphalan

How you have chemotherapy

Into your bloodstream

You have the treatment through a drip into your arm or hand. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

Tablets or capsules

You must take tablets and capsules according to the instructions your doctor or pharmacist gives you.

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

You should take the right dose, not more or less.

Talk to your specialist or advice line before you stop taking a cancer drug.

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.

Before you start chemotherapy

You need to have blood tests to make sure it’s safe to start treatment. You have these either a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.

Side effects

Common chemotherapy side effects include:

  • feeling sick
  • loss of appetite
  • losing weight
  • feeling very tired
  • a lower resistance to infections
  • bleeding and bruising easily
  • diarrhoea or constipation
  • hair loss
Contact your doctor or nurse immediately if you have signs of infection. These include a temperature above 37.5C or below 36C, or generally feeling unwell. Infections can make you very unwell very quickly.

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 treatment 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 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

Menopause

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

Second cancers

Your treatment might increase the risk of you getting another type of cancer in the future.

If you have had chemotherapy to treat Hodgkin 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.

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.

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. The nurse will give you telephone numbers to call if you have any problems at home.

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. They could be harmful.

Last reviewed: 
05 Oct 2020
Next review due: 
05 Oct 2023
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  • Electronic Medicines Compendium
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  • Essential Haematology (8th edition)
    A.V Hoffbrand and D.P Steensma
    Wiley, 2019

  • Overview of the treatment of classic Hodgkin lymphoma in adults
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    Up To Date, Feb 2020

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