Treatment of Hodgkin’s Lymphoma

Summary

Treatment for Hodgkin’s lymphoma is very effective, and most people with the condition eventually recover. There are many treatment options for Hodgkin’s lymphoma. The primary treatment for Hodgkin’s lymphoma is chemotherapy. However, other treatment options such as radiotherapy and steroid medicine are also used.

Introduction

The primary treatment for Hodgkin’s lymphoma is chemotherapy alone or chemotherapy followed by radiation therapy. Sometimes chemotherapy can be combined with steroid medications. Surgery is usually avoided in Hodgkin’s lymphoma, except for a biopsy, used to diagnose the condition. In general, treatment for Hodgkin’s lymphoma is very effective, and most people with the condition eventually recover.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. Chemotherapy is administered in various ways depending on the cancer type.

If doctors think the cancer is curable, chemotherapy is usually injected into a vein (intravenous chemotherapy). If treatment is not possible, the patient needs to take chemotherapy drugs to relieve the symptoms.

Chemotherapy is normally administered on an outpatient basis for a couple of months, so the patient does not need to stay in the hospital overnight. However, in some cases, treatment symptoms or side effects can be particularly distressing with longer hospital stays.

There can be multiple side effects of chemotherapy, the most serious of which is possible bone marrow damage. It can interfere with the formation of healthy blood cells and cause problems such as:

  • breathlessness
  • fatigue
  • bleeding and bruising more easily
  • increased vulnerability to infection

If these problems occur, treatment may need to be postponed to produce healthy blood cells. Growth factor drugs can also stimulate the formation of blood cells.

Other possible side effects of chemotherapy include:

  • nausea and vomiting
  • loss of appetite
  • tiredness
  • diarrhoea
  • mouth ulcers
  • hair loss
  • skin rashes
  • infertility, which may be permanent or temporary

Most side effects of chemotherapy go away when treatment is stopped. Some treatments can help subside these side effects, so the doctors and the healthcare team should be informed of any side effects that are particularly bothering the patients.

If routine chemotherapy fails or Hodgkin’s lymphoma recurs after treatment, higher doses of chemotherapy may be given.

However, a higher dosage of chemotherapy destroys the bone marrow, causing various problems described above. A bone marrow transplant or stem cell therapy may be needed to replace the damaged bone marrow.

Radiotherapy

Radiation therapy is commonly used to treat early-stage Hodgkin’s lymphoma, where the cancer is in only one part of the body.

Radiation therapy is painless, but it can have some serious side effects. These can vary and are directly related to the part of the body that is being treated. For example, throat treatment can cause a sore throat, and head treatments can lead to hair loss.

Some other side effects include:

  • nausea and vomiting
  • tiredness
  • loss of appetite
  • dry mouth

Although most side effects are short-term, there is a risk of long-term problems, such as infertility and persistent skin darkening in the treated area.

Steroid medicine

Steroid drugs are used for advanced Hodgkin’s lymphoma as a more intensive treatment or in combination with chemotherapy if initial treatment fails.

Steroids are usually given intravenously along with chemotherapy.

Some of the side effects of steroid medicine include:

  • indigestion
  • increased appetite, leading to weight gain
  • feeling agitated
  • problems sleeping

Side effects of steroid medications usually improve after treatment is stopped.

Rituximab

If a person is diagnosed with a rare type of Hodgkin’s lymphoma called lymphocyte-dominant Hodgkin’s lymphoma, that person may be given chemotherapy with a drug called rituximab.

Rituximab is a type of biologic therapy called a monoclonal antibody. It attaches to the surface of cancer cells and stimulates the immune system to attack and kill the cancer cells.

It is administered through a drip directly into a vein over several hours.

Common side effects of rituximab are as follows:

  • tiredness
  • headaches
  • fever
  • diarrhoea
  • muscle pain
  • nausea

Patients may be given additional medicines to prevent or reduce side effects. Any side effects should improve over time once the body gets used to this medicine.

Brentuximab vedotin

Brentuximab vedotin is a new drug for the treatment of certain types of Hodgkin’s lymphoma. It is administered to people with CD30 positive Hodgkin’s lymphoma, such as:

If the patient already had a stem cell transplant using their own cells or are unable to receive chemotherapy.

If a stem cell transplant cannot be done using own cells, but the patient has already received two or more other treatments.

It is administered similar to rituximab, but the treatment session lasts approximately 30 minutes.

Side effects of brentuximab vedotin may include​1–3​:

  • shortness of breath
  • skin rash
  • back pain
  • cough
  • fever
  • headache
  • chills
  • vomiting
  • nausea

References

  1. 1.
  2. 2.
    Hodgkin lymphoma-Treatment. Cancer Research UK. Published 2020. Accessed March 2022. https://www.cancerresearchuk.org/about-cancer/hodgkin-lymphoma/treatment
  3. 3.
    TREATMENT. Leukemia & Lymphoma Society. Published 2022. Accessed March 2022. https://www.lls.org/lymphoma/hodgkin-lymphoma/treatment