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, vincristine, procarbazine, prednisone
    • AVD—Adriamycin® (doxorubicin), vinblastine, dacarbazine
  • 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).

Monoclonal 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
  • Classical Hodgkin lymphoma at high risk of relapse or progression as post-autologous hematopoietic stem cell transplantation (post auto-HSCT) consolidation
  • Classical Hodgkin lymphoma after failure of auto-HSCT or after failure of at least two prior multi-agent chemotherapy regimens, in patients who are not auto-HSCT candidates
  • Certain other lymphomas with CD30 expression

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

Treatment by Stage

Treatment options for classical Hodgkin lymphoma (cHL) vary depending on the stage of the disease. 

Treatment of Early-Stage (Stage I-II) Favorable HL. The cure rate for patients in this category exceeds 90 percent. The current treatment approach is to administer chemotherapy alone or chemotherapy followed by radiation therapy to areas of the body where lymphoma was found.

For many years, ABVD has been the most commonly used chemotherapy regimen for these patients. ABVD poses less of a risk for later development of leukemia or infertility than many other chemotherapy combinations used for adults. Another treatment regimen is escalated BEACOPP. 

Treatment of Early-Stage (Stage I-II) Unfavorable HL. For patients in this category, the disease is considered to be high risk. Initial treatment usually consists of either a chemotherapy and radiation or chemotherapy alone. Treatment is generally more intense for these patients than for those in the favorable category. Some drug combinations used for treatment of these patients include: ABVD or ABVD followed by escalated BEACOPP.

Treatment of Advanced-Stage (Stage III-IV) HL. Even in advanced stages, HL is curable. In general, patients with advanced-stage HL are treated with more intense regimens of combination chemotherapy. Some drug combinations used for treatment of these patients include:

  • Brentuximab vedotin + AVD
  • ABVD
  • ABVD followed by escalated BEACOPP
  • Escalated BEACOPP

Dose-escalated BEACOPP results in a good cure rate, but it puts patients at a slightly higher risk of developing leukemia or other second cancers. Patients are also at a much higher risk of infertility, and it is less commonly used for this reason.

Use of radiation therapy is limited to a small number of patients, those who have areas of bulky disease (large masses) at diagnosis or evidence of residual disease observed on PET-CT scans after treatment. Even in these cases, the role of radiation therapy for advanced-stage HL varies.

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.

Minimal/measurable residual disease (MRD) refers to cancer cells that may remain in the body after treatment ends. Besides the use of PET-CT scans to identify residual disease, there are other methods that are under study which may be used to complement these imaging techniques.

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