During chemotherapy, you're given potent drugs that must be toxic enough to damage or kill lymphoma cells. At the same time, chemotherapy drugs can affect normal cells and cause side effects.
Chemotherapy is the mainstay of treatment for Hodgkin lymphoma and usually involves a combination of drugs. The drugs are dissolved in fluid and usually administered through a peripheral intravenous (IV) line.
Some chemotherapy combinations for Hodgkin lymphoma include:
- ABVD: doxorubicin (Adriamycin®), bleomycin (Blenoxane®), vinblastine (Velban®), dacarbazine (DTIC-Dome®)
- BEACOPP: bleomycin (Blenoxane®), etoposide (Etopophos®, Toposar®, VePesid®, VP-16), doxorubicin (Adriamycin®), cyclophosphamide (Cytoxan®), vincristine (Oncovin®), procarbazine (Matulane®), prednisone
- Stanford V: mechlorethamine (Mustargen®), doxorubicin (Adriamycin®), vinblastine (Velban®), vincristine (Oncovin®), bleomycin (Blenoxane®), etoposide, (Etopophos®, Toposar®, VePesid®, VP-16), prednisone
For information about the drugs mentioned on this page, visit Drug Listings.
Early-Stage Favorable Hodgkin Lymphoma Treatment. For patients with stage I or stage II Hodgkin lymphoma with no unfavorable risk factors, the cure rate exceeds 90 percent. The current treatment approach is to administer combination chemotherapy either alone or with reduced amounts of radiation.
- ABVD is the most effective and least toxic regimen available to date. Current practice guidelines for treatment of early-stage, low-risk HL suggest that at least 90 percent of patients can be cured with as few as two courses of ABVD, followed by involved field radiation with a reduced dose of radiation.
- The Stanford V regimen is a brief but dose-intensive regimen that is rarely used. It is associated with a lower risk for chemotherapy-related infertility, secondary cancers and toxicity to the heart and lungs. Radiation therapy is an important part of the Stanford V regimen.
- Other treatment regimens omit radiotherapy altogether and treat with chemotherapy alone. Sometimes the use of PET-CT scan results, either during or after treatment, can guide whether or not radiation therapy is included. Concerns about the late effects of radiotherapy (especially an increased risk of developing secondary cancers) have led some oncology groups to recommend chemotherapy alone for some patients, particularly when the risk of developing a secondary cancer is considered to be high. Examples of patients who meet these criteria may be women younger than 35 years or those who have a family history of breast cancer and for whom the radiation therapy would involve breast tissue.
Early-Stage Unfavorable Hodgkin Lymphoma Treatment. Patients with stage I and stage II Hodgkin lymphoma with unfavorable risk factors are considered to have higher-risk disease and are also treated with chemotherapy, either alone or with radiation therapy. Treatment generally requires at least four to six cycles of combination chemotherapy, sometimes followed by involved field radiation therapy. Drug combinations used for treatment include
- Dose-escalated BEACOPP.
Advanced-Stage Hodgkin Lymphoma. Hodgkin lymphoma is potentially curable in late stages. In general, patients with advanced-stage HL (stage III or IV disease) are treated with six cycles of combination chemotherapy. Drug combinations used for treatment include
- ABVD (preferred regimen)
- Dose-escalated BEACOPP (in selected patients who are younger than 60 years and who have an IPS [International Prognostic Score] of 4 or higher). This regimen results in a good cure rate but patients carry a small risk of developing leukemia or other secondary cancers. Patients are also at a much higher risk of infertility. For this reason it is a less commonly used treatment in the United States and Canada. It may be used for patients who have advanced HL.
- Stanford V (this regimen is rarely used)
- Brentuximab vedotin (Adcetris®) in combination with doxorubicin, vinblastine, and dacarbazine
Radiotherapy is reserved for the minority of patients with initial sites of bulky disease (large masses) or residual cancer observed on PET-CT scans. Even in these situations, the role of radiation therapy for advanced disease is variable.