Depending on the stage of the disease, doctors may use different treatment approaches and combinations for adults and children with HL:
- Chemotherapy and other anticancer drug therapy
- Stem cell transplantation
- Your physician might suggest that you could participate in a clinical trial. Clinical trials can involve new drug therapy, new drug combinations, or new approaches to stem cell transplantation.
Pre-treatment Considerations
Adults of childbearing age and parents of minors diagnosed with HL should ask their doctors for information about lessening the risk for infertility during treatment.
Finding the Best Treatment Approach
The goal of HL treatment is to cure the disease. The treatment plan your doctor creates is based on many factors, such as:
- Your disease subtype
- Your disease stage and category
- Whether your disease is either relapsed or refractory
- Your overall health and whether you have any additional health conditions
- Whether you're pregnant
Be sure to discuss with your doctor:
- The results you can expect from treatment
- The potential side effects, such as long-term effects and late-term effects
- The possibility of participating in a clinical trial, where you’ll have access to advanced medical treatment that may be more beneficial to you than standard treatment.
You might find it helpful to ask a loved one to accompany you to your doctor visits for support, and for taking notes and asking follow-up questions. It's helpful to prepare questions beforehand that you would like to ask when you visit your physician. You can also record your conversations with your doctor so that you can listen to the information more closely once you get home.
Other Treatment Considerations
- If you're 60 years or older, your treatment may vary from standard approaches. For instance, your body may not be able to handle toxic chemotherapy drugs or you may have other ailments that are common as we grow older. These factors, among others, might make choosing a proper treatment more difficult
- If your child is being treated for HL, therapy may differ slightly from that of the average adult.
During chemotherapy, you are administered highly potent drugs that are toxic enough to damage or kill lymphoma cells. However, the drugs will also impact normal cells and cause side effects. Not all treated HL patients experience side effects the same way.
Physicians often put four or more chemotherapy drugs together to treat HL. Each type of drug works in a different fashion to kill the cancerous cells. Combining different types of drugs can increase their overall combined effectiveness. The drugs are typically given through a catheter (a thin, flexible tube or intravenous line) surgically placed in a vein, usually in your upper chest.
A combination of radiation therapy and chemotherapy can be an effective two-fold approach to treating both stage I and stage II HL. Patients who have more widespread disease (stages III and IV and category B) are usually treated only with chemotherapy.
Involved field radiation therapy administered along with chemotherapy is called combined modality therapy. It involves two major steps performed at different times, often in an outpatient oncology center. First, chemotherapy drugs are given to kill neighboring lymphoma cells. Second, radiation is delivered by high-energy rays to decrease the size of the lymphoma cell masses.
You might need to stay in the hospital for a short period of time during your treatment. If your therapy is especially intense, it could lead to infection, or to significant decreases in blood cell counts, making hospitalization necessary.
With involved field radiation the treatment is directed solely to the parts of your body that are affected by HL. A machine called a linear accelerator, or linac, sends beam radiation to the specific targeted area(s) of your body as you lie on a moveable table. Parts of your body not affected by HL, such as reproductive organs or the eyes, are specifically shielded to help reduce treatment side effects. While the procedure itself is painless, some people may feel uncomfortable staying very still in one position for several minutes as the radiation is administered. Several days later, your radiation therapy is followed up with chemotherapy.
Combined treatment of radiation therapy and chemotherapy may not be used if you have the nodular lymphocyte predominant Hodgkin Lymphoma (NLPHL) subtype. In this case, only radiation therapy is used—it is not combined with chemotherapy.
NLPHL is a slow-growing form of HL that's often diagnosed during stage I, resulting in an almost 100% survival rate. Therefore, it is key to not to over treat the disease.
- Autologous stem cell transplantation, which uses your own stem cells.
- Allogeneic stem cell transplantation, which uses the stem cells from a suitable donor. Autologous transplantation has fewer risks and complications than allogeneic transplantation.
The effectiveness of the therapies used to treat newly diagnosed patients has decreased the number of HL patients in need of stem cell transplantation. However, autologous stem cell transplantation may cure some patients whose HL has come back after a period of remission. Researchers are conducting clinical trials to study both standard and reduced-intensity allogeneic stem cell transplantation to treat some HL patients who have a suitable donor.
Treatment Outcomes
Many HL patients are cured after their first course of treatment. For the small number of patients who experience a relapse of HL, additional treatment with chemotherapy, sometimes combined with high dose chemotherapy and stem cell transplantation, is usually successful. Many of these patients are cured or have long disease-free periods.
Refractory HL
Some patients still have cancer cells in their bone marrow or other places after HL treatment. The term, 'refractory Hodgkin Lymphoma' describes a disease that does not go into remission (but may be stable) or that gets worse within 6 months of the latest treatment.
If you have refractory HL, you may undergo high-dose chemotherapy with stem cell transplantation.
Relapsed HL
If the lymphoma in your bone marrow or other parts of your body comes back after a period of remission (when there is no sign of the disease) of six months or more, you have relapsed. If you relapse a long time after initial treatment, you may undergo a treatment similar to the type that you received when you were first diagnosed. This treatment usually gives patients extended disease-free periods, and the disease is still potentially curable.
To learn more, visit www.lls.org.
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