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:
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ABVD
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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:
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where the lymphoma is in your body
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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:
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your treatment is not working as well as your doctor would like
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your lymphoma has come back (relapses)
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you are over 60
Types of chemotherapy
You normally have several chemotherapy drugs together during a course of treatment. Some chemotherapy combinations include
You usually have a
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:
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adriamycin (doxorubicin)
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bleomycin
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vinblastine
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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:
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4 cycles of ABVD followed by radiotherapy
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6 cycles of ABVD without radiotherapy
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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:
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bleomycin
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etoposide
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doxorubicin
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cyclophosphamide
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vincristine
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procarbazine or dacarbazine
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prednisolone, which is a steroid
Chemotherapy for advanced stage Hodgkin lymphoma
You may have one of the following:
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ABVD for 6 cycles
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escalated BEACOPP for 4 to 6 cycles
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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:
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AVD. This is the same as ABVD but without bleomycin
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ChlvPP - chlorambucil, vinblastine, procarbazine and prednisolone
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CHOP - cyclophosphamide, doxorubicin, vincristine and prednisolone
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ACOPP - doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisolone
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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:
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rituximab
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cyclophosphamide
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doxorubicin
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vincristine
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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
Some second line chemotherapy drug combinations include:
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GDP (gemcitabine, dexamethasone, cisplatin)
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DHAP (dexamethasone, cytarabine, cisplatin)
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IGEV (ifosfamide, gemcitabine, vinorelbine)
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ICE (ifosfamide, carboplatin, etoposide)
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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:
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carmustine (BiCNU) or lomustine (CCNU)
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etoposide
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cytarabine (Ara-C, cytosine arabinoside)
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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
You must take tablets according to the instructions your doctor or pharmacist gives you.
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.
Clare Disney (nurse): Hello, my name is Clare and this is a cancer day unit.
So when you arrive and you’ve reported into with the receptionist, one of the nurses will call you through when your treatment is ready, sit you down and go through all the treatment with you.
Morning, Iris. My name is Clare. I am the nurse who is going to be looking after you today. We’re going to start by putting a cannula in the back of your hand and giving you some anti sickness medication. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment. Is that okay?
Before you have each treatment you’ll need to have a blood test to check your bloods are okay. And you’ll also be reviewed by one of the doctors to make sure you’re fit and well for your treatment. Sometimes you’ll have the blood test taken on the day of your treatment; other times you’ll have it the day before your treatment when you see the doctor.
Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.
So, depending on where your cancer is some people have their chemotherapy drug, their cancer drug by drip, some will have an injection and other people will have tablets.
So, Iris, your chemotherapy is going to be given to you in what we call cycles and the cycles are given every three weeks for a period of six cycles. So, you will be coming in for approximately five months for your chemotherapy.
Depending on where your cancer is and what type of cancer you have will be dependent on how often you come in for treatment. An example of a treatment cycle would be for you to come in on Day 1, Day 8 and Day 15 then to have a week’s break before you come back again for Day 1 treatment.
Depending on the type of treatment that you are having we will also give you some anti sickness tablets to take alongside your chemotherapy and also some drugs to prevent any reactions if that’s appropriate.
All chemotherapy is given over different time periods so it’s best to check with your nurse about how long you are likely to be in the unit for. This can range from anything up to an hour to an all day treatment slot so please be prepared to bring along some bits to keep you occupied, such as books and music.
So, before you go home it’s important to make sure you have got the tablets you need to go home with your anti sickness medications and any other symptom control tablets that you may require. Also, to make sure that you’ve got the telephone numbers for the oncology unit to phone if you have a temperature or you are experiencing any other symptoms at home that you need to ask advice about.
So, please make sure when you leave the unit that you’ve got all the information you require and if you’ve got any questions at all don’t hesitate to ask the nurse who will be able to answer them for you.
Before your next cycle of treatment you will come in and see the doctor in the clinic room, you’ll have a blood test and an examination to make sure you are fit and well for treatment you will then come back the following day or later on that week for treatment.
Side effects
Common chemotherapy side effects include:
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feeling sick
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loss of appetite
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losing weight
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feeling very tired
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increased risk of getting an infection
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bleeding and bruising easily
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diarrhoea or constipation
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hair loss
Contact your hospital advice line 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:
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which drugs you have
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how much of each drug you have
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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.