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Chemotherapy and Drug Therapy

Chemotherapy is the mainstay of treatment for HL. A combination chemotherapy regimen consists of two or more chemotherapy drugs. Generally, the drugs are dissolved in fluid and usually administered via a peripheral intravenous (IV) line. If finding an accessible vein is problematic, a central line (a port, or a peripherally inserted central venous catheter (a PICC or PIC line) may be used for some HL patients. 

Chemotherapy is given in cycles of treatment that are separated by periods of rest. Chemotherapy drugs can have strong side effects so the body needs time to recover in between treatment cycles. Typically, the cycles are between 3 and 4 weeks long but they vary in length, depending on the drugs employed, stage and subtype of HL, and how well your disease responds to treatment. 

Some Chemotherapy Combinations

Early-stage classical Hodgkin lymphoma (cHL)

  • Chemotherapy combinations
    • ABVD (Adriamycin® [doxorubicin], bleomycin, vinblastine, dacarbazine)
    • Escalated BEACOPP (bleomycin, etoposide, Adriamycin [doxorubicin], cyclophosphamide, Oncovin® [vincristine], procarbazine, prednisone)
  • Combination chemotherapy is administered with or without radiation therapy.

Advanced-stage cHL

  • Chemotherapy combinations
    • A+AVD (Adcetris® [brentuximab vedotin], Adriamycin [doxorubicin], vinblastine, dacarbazine)
    • ABVD
    • ABVD followed by escalated BEACOPP
  • Occasionally, chemotherapy is followed by involved-site radiation therapy (ISRT).

Monocolonal Antibody Therapy

This is a type of targeted therapy. When the body’s immune system identifies something harmful, such as bacteria or a virus, it produces antibodies. Antibodies are proteins that help fight infection. Monoclonal antibodies are a type of protein made in the laboratory that can bind to only one substance. By design, they can only attack a specific target, typically a substance on cancer cells (though sometimes they are designed to bind to a substance on immune cells, in order to improve their function). This targeting can reduce damage to normal, healthy cells. 

Brentuximab vedotin (Adcetris®). In patients with classical HL, the malignant Hodgkin and Reed-Sternberg cells typically express a protein called CD30. Brentuximab vedotin is an anti-CD30 antibody attached to a chemotherapy drug. It binds to cells that express CD30 and then enters the cancer cells. Once inside the cancer cells, it releases the chemotherapy drug. By targeting only cells that express CD30, fewer normal cells are harmed.

Brentuximab vedotin, given intravenously (IV), is approved for the treatment of adult patients with previously untreated Stage III or IV classical Hodgkin lymphoma (cHL), in combination with doxorubicin, vinblastine, and dacarbazine. The drug is also approved for other indications such as some cases of relapsed HL and certain other lymphomas with CD30 expression. 

For information about the drugs listed on this page, visit Drug Listings.

Treatment by Stage

Early-Stage Classical Hodgkin Lymphoma 

Early-Stage Favorable Hodgkin Lymphoma Treatment. The cure rate for patients diagnosed in early-stage favorable HL (either stage I or stage II with no unfavorable risk factors) exceeds 90 percent. The current treatment approach is to administer chemotherapy alone (without radiation therapy) or a combined modality therapy (combination chemotherapy followed by radiation therapy to areas of the body where lymphoma was found). To date, ABVD (Adriamycin® [doxorubicin], bleomycin, vinblastine, dacarbazine) is the most effective and least toxic regimen available. It poses less of a risk for later development of leukemia or infertility than many other adult chemotherapy combinations.

Current practice guidelines for treatment of early-stage favorable HL suggest that at least 90 percent of patients can be cured with as few as two courses of ABVD, followed by a reduced dose of radiation.

Concerns about the late effects of radiation therapy (especially an increased risk of developing a second cancer) have led some oncology groups to recommend the use of chemotherapy alone for some patients, particularly when the risk of developing a second cancer is considered to be significant. Patients who are at a higher risk of developing a second cancer include women younger than age 30 and with a family history of breast cancer, and those who will have radiation therapy involving their breast tissue. 

Early-Stage Unfavorable Hodgkin Lymphoma Treatment. For patients in this category, the disease is considered to be high risk. Initial treatment usually consists of either a combined modality therapy (chemotherapy plus radiation therapy) or chemotherapy alone. Treatment is generally more intense for these patients than for those in the favorable category. Results of PET-CT scans done both during and after treatment may affect decisions about the type and duration of chemotherapy and the use of radiation therapy.. Drug combinations used for treatment include

  • ABVD
  • ABVD followed by escalated BEACOPP

Advanced-Stage Classical Hodgkin Lymphoma

Even in advanced stages, HL is curable. In general, patients with advanced-stage HL are treated with more intense regimens of combination chemotherapy. Drug combinations used for treatment include

  • A+AVD (Adcetris® [brentuximab vedotin], Adriamycin [doxorubicin], vinblastine, dacarbazine)
  • ABVD
  • ABVD followed by escalated BEACOPP
  • Escalated BEACOPP 

Dose-escalated BEACOPP 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, and for this reason, it is less commonly used. It may be used for patients who have advanced HL. Radiation therapy is reserved for the few 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. 

Treatment Response Monitoring

During treatment, patients need to be monitored to check their response to therapy. Response to treatment is important in predicting long-term outcomes. Patients who fail to reach complete remission with first-line treatment have a worse prognosis, so there is great value in identifying these patients early in the course of their disease.

Imaging tests are used to distinguish between tumor and fibrous (scar) tissue. PET-CT scans help doctors determine if the disease is responding to treatment. PET-CT has become the standard method for assessment of treatment response in most types of lymphoma.

The Deauville score, based on a five-point scale developed in 2009, is now an internationally recognized way of using PET-CT to assess treatment response. This scale determines the “FDG uptake” (the absorption of this radioactive material by tissues) in the involved sites. The Deauville score is then used to determine if any treatment modifications are needed.

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