ON THIS PAGE: You will learn about the different ways doctors use to treat people with this type of lymphoma. To see other pages, use the menu.
This section tells you the treatments that are the standard of care for this type of lymphoma. “Standard of care” means the best treatments known. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn if it is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Your doctor can help you consider all your treatment options. To learn more about clinical trials, see the About Clinical Trials and Latest Research sections.
In cancer care, different types of doctors and other health care professionals often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called an multidisciplinary team. Cancer care teams also include a variety of other health care professionals, including physician assistants, oncology nurses, nurse practitioners, social workers, pharmacists, counselors, dietitians, and others.
The original treatments for Hodgkin lymphoma, developed in the 1960s and 1970s, were very effective at treating the disease. However, some people who received these treatments developed serious side effects later in life, including infertility (the inability to have children), heart problems (such as heart failure, leaky heart valves, and heart attacks), and secondary cancers, such as lung cancer and breast cancer. These long-term problems were partly caused by the types of chemotherapy used at that time and partly caused by the use of high doses of radiation therapy delivered to large areas of the body. Learn more about the late effects of treatment for Hodgkin lymphoma.
To avoid or reduce the risk of these problems, current treatment plans for Hodgkin lymphoma are aimed at the best chance of curing the Hodgkin lymphoma while avoiding causing long-term side effects as much as possible. This has led doctors to choose newer types and doses of chemotherapy and directing radiation therapy, if used, at smaller areas of the body.
Most people with cHL, even stage I or stage II, often receive chemotherapy. In some patients, this is followed by radiation therapy to the affected lymph node areas. It may be possible to treat some people with early-stage disease (stage I or II) with a relatively short course of chemotherapy with or without radiation therapy. Patients should discuss with their doctor whether chemotherapy can be limited and/or whether radiation therapy is necessary in the treatment plan. For stage III or stage IV disease, chemotherapy is the primary treatment, although additional radiation therapy may be recommended, especially to areas of large lymph nodes.
Descriptions of the most common treatment options for Hodgkin lymphoma are listed below. Treatment options and recommendations depend on several factors, including:
The type and stage of lymphoma
Possible side effects
Results of regular PET-CT scans during treatment
The patient’s preferences and overall health
Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options and ask about anything that is unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment, including any potential side effects. Learn more about making treatment decisions.
Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication, or a hematologist, a doctor who specializes in treating blood disorders.
Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or by mouth, in a pill or capsule that is swallowed. Many people with Hodgkin lymphoma receive chemotherapy through a port-a-cath placed under the skin. Learn more about catheters and ports in cancer treatment.
A chemotherapy regimen usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or combinations of different drugs at the same time.
Many different types of chemotherapy may be used for Hodgkin lymphoma. The most commonly used combination of drugs in the United States is called ABVD. Another combination of drugs, known as BEACOPP, is now widely used in Europe in patients with advanced Hodgkin lymphoma and is sometimes used in the United States. The drugs that make up these 2 common combinations of chemotherapy are listed below. There are other combinations that are less commonly used and not listed here.
ABVD: Doxorubicin (Adriamycin), bleomycin (Blenoxane), vinblastine (Velban, Velsar), and dacarbazine (DTIC-Dome). ABVD chemotherapy is usually given every 2 weeks for 2 to 8 months.
BEACOPP: Bleomycin, etoposide (Toposar, VePesid), doxorubicin, cyclophosphamide (Cytoxan, Neosar), vincristine (Vincasar PFS, Oncovin), procarbazine (Matulane), and prednisone (multiple brand names). There are several different treatment schedules, but different drugs are usually given every 2 to 3 weeks.
The type of chemotherapy, number of cycles of chemotherapy, and the additional use of radiation therapy are based on the stage of the Hodgkin lymphoma and the type and number of prognostic factors. Talk with your doctor about the specifics of your treatment plan. Some doctors choose to monitor how well these treatments are working with repeat PET scans after 2 to 3 months of treatment. If the PET scans show that the treatment is not working, the chemotherapy may be changed. If the PET scans show that treatment is working, then the doctor may decide to lower the subsequent number of drugs used or the total number of treatment cycles.
If Hodgkin lymphoma comes back after first-line treatment with ABVD or BEACOPP, known as a recurrence, there are several second-line treatments. Many of these treatments are given in preparation for an autologous stem cell transplant (see below), but they can also be given to control the disease and its symptoms.
ICE: Ifosfamide (Ifex), carboplatin (Paraplatin), and etoposide. ICE is usually given every 2 or 3 weeks for 2 to 3 cycles.
ESHAP or DHAP: Etoposide, methylprednisolone (Solu-Medrol), high-dose cytarabine (Cytosar-U), and cisplatin (Platinol). Dexamethasone (multiple brand names), high-dose cytarabine, and cisplatin. ESHAP or DHAP regimens are given every 3 weeks for 2 to 3 cycles.
GVD, Gem-Ox, or GDP: Gemcitabine (Gemzar), vinorelbine (Navelbine), and doxorubicin. Gemcitabine and oxaliplatin (Eloxatin). Gemcitabine, dexamethasone, and cisplatin. Gemcitabine-based regimens are either given 2 weeks in a row followed by an off-week or every other week.
Brentuximab vedotin (Adcetris): Brentuximab vedotin (Adcetris) is an antibody drug conjugate. This means it delivers chemotherapy only to cells that have a special protein on the surface called CD30. Brentuximab vedotin is usually given every 3 weeks for up to 16 cycles, although sometimes it is given every 4 weeks. This drug is an important therapy once previous chemotherapy stops working. It is being tested as an adjunct or replacement for chemotherapy before stem cell transplantation for patients with recurrent Hodgkin lymphoma. It was also approved in 2015 by the U.S. Food and Drug Administration (FDA) for use in certain patients after stem cell transplantation who are at a high risk for recurrence.
It is unclear which of these chemotherapy treatments is best for patients with Hodgkin lymphoma. The best treatment may differ depending on the type and stage of the lymphoma. For this reason, many clinical trials are underway to compare these different treatments. These clinical trials are designed to find out which combination works best with the fewest short-term and long-term side effects.
During chemotherapy, your doctors will usually repeat some of the original tests, especially PET-CT scans. These tests are used to watch the lymphoma and see how well treatment is working.
The side effects of chemotherapy depend on the individual and the doses used, but they can include fatigue, risk of infection, nausea and vomiting, peripheral neuropathy (tingling or pain in the fingers and toes), hair loss, loss of appetite, and constipation. These side effects usually go away once treatment is finished. Although the risk of long-term side effects has decreased as treatments have improved, chemotherapy still can cause long-term side effects. People with lymphoma may also have concerns about if or how their treatment may affect their sexual function and fertility. Talk about these topics with the health care team before treatment begins. Learn more about late effects of treatment.
Learn more about the basics of chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.
Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A radiation oncologist is a doctor who specializes in giving radiation therapy to treat cancer. Radiation therapy for Hodgkin lymphoma is always external-beam radiation therapy, which is radiation given from a machine outside the body. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.
Whenever possible, radiation therapy is now directed only at the affected lymph node areas. This helps reduce the risk of damaging healthy tissues. Some patients may be able to receive newer radiation therapy techniques. These include:
Involved-site radiotherapy, which focuses the radiation on the lymph nodes that contain cancer
Intensity modulated radiotherapy (IMRT), which varies the strength and direction of the radiation beams so less healthy tissue is affected
Proton therapy, which uses protons rather than x-rays to treat the cancer, may be used in certain patients.
The immediate side effects from radiation therapy depend on the area of the body that is being treated. These may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Patients who receive radiation to the neck may have a sore mouth and/or throat. Most side effects go away soon after treatment is finished.
Although the risk for long-term side effects has decreased with improvements in treatment, radiation therapy may still cause long-term side effects, also called late effects, including thyroid damage if radiation to the neck is given, secondary cancers, and vascular damage, including damage to blood vessels in the heart if radiation to the chest is given. To reduce the risk of long-term side effects, clinical trials are being done to find out the best doses and smallest possible area to direct the radiation therapy.
Learn more about the basics of radiation therapy.
Stem cell transplantation/bone marrow transplantation
A stem cell transplant is a medical procedure in which a patient’s bone marrow is replaced by highly specialized cells, called hematopoietic stem cells, that develop into healthy bone marrow. Hematopoietic stem cells are blood-forming cells found both in the bloodstream and in the bone marrow. Today, this procedure is more commonly called a stem cell transplant, rather than bone marrow transplant, because it is stem cells that are typically collected from the blood that are being transplanted, not stem cells from the actual bone marrow tissue.
Before recommending transplantation, doctors will talk with the patient about the risks of this treatment and consider several other factors, such as the results of any previous treatment and the patient’s age and general health. It is very important to talk with a doctor at an experienced transplant center about the risks and benefits of stem cell transplantation.
Stem cell transplantation is not used as a first treatment for Hodgkin lymphoma, but it may be recommended for patients who have lymphoma remaining after chemotherapy or if the lymphoma returns following treatment.
There are 2 types of stem cell transplantation, depending on the source of the replacement blood stem cells: autologous (AUTO) and allogeneic (ALLO).
In an AUTO transplant, the patient’s own stem cells are used. The stem cells are collected from the patient when he or she is in remission after previous treatment. The stem cells are then frozen until they are needed. An AUTO transplant allows for more intense chemotherapy doses to destroy leftover lymphoma cells followed by returning the saved stem cells to the body so the bone marrow and blood cells can recover.
In an ALLO transplant, stem cells are obtained from a donor whose tissue matches the patient’s on a genetic level. This testing is called HLA typing. Most often, a patient’s brother, sister, or other relative serves as the donor, although an unrelated person can be a donor as well. The patient receives chemotherapy to stop his or her immune system from destroying the donor’s cells. The goal of an ALLO transplant is for the donor’s immune system to destroy the patient’s cancer cells.
For both types, the goal of transplantation is to destroy all of the cancer cells in the marrow, blood, and other parts of the body using chemotherapy and/or radiation therapy and then allow replacement blood stem cells to create healthy bone marrow. The chemotherapy and/or radiation therapy given before the transplant also suppress the patient’s bone marrow tissue and the patient’s immune system. In an ALLO transplant, this helps prevent the donor cells from being rejected by the body, and in fact, these donor cells can be active in destroying remaining cancer cells.
It is important to talk with the doctor about the potential risks and benefits of both types of transplants to determine the best choice for an individual patient.
Learn more about the basics of stem cell and bone marrow transplantation.
Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.
In 2016, the FDA approved nivolumab (Opdivo) for the treatment of patients with classical Hodgkin lymphoma that has recurred or progressed after AUTO transplantation and post-transplant treatment with brentuximab vedotin (Adcetris). This drug is called a checkpoint inhibitor or PD-1 inhibitor. When nivolumab is used by itself in patients with Hodgkin lymphoma who have had a recurrence after AUTO transplantation, about 2 of every 3 patients show improvement in their scans for an average of 9 months, although it is unlikely that these patients are cured. There are side effects, but they are generally mild. Talk with your doctor for more information.
Learn more about the basics of immunotherapy.
Getting care for symptoms and side effects
Hodgkin lymphoma and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the disease, an important part of care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.
Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process. People often receive treatment for the lymphoma and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional support, relaxation techniques, emotional support, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy or radiation therapy. Talk with your doctor about the goals of each treatment in your treatment plan.
Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and palliative care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be addressed as quickly as possible.
Learn more about palliative care.
Progressive Hodgkin lymphoma
Progressive disease occurs when the cancer becomes larger or spreads while the original lymphoma is being treated. However, progressive disease is uncommon for people with Hodgkin lymphoma.
If progression happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Also, clinical trials might be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan. Complete recovery from progressive Hodgkin lymphoma is not always possible.
Often, a doctor will recommend a stem cell transplant (see above). This treatment appears to be more effective for progressive Hodgkin lymphoma than standard chemotherapy. Palliative care is also important to help relieve symptoms and side effects.
For most patients, a diagnosis of progressive Hodgkin lymphoma is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.
Remission and the chance of recurrence
A remission is when lymphoma cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.
A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the disease returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the lymphoma does return. Learn more about coping with the fear of recurrence.
If the lymphoma does return following remission after the original treatment, it is called recurrent lymphoma. Recurrence is uncommon for people with Hodgkin lymphoma. However, if Hodgkin lymphoma does recur, a cycle of testing much like that done at the time of diagnosis will begin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options.
Most often, the first step is to give a second-line chemotherapy treatment, such as ICE, ESHAP, DHAP, gemcitabine-based treatments, or brentuximab vedotin (see Chemotherapy above).
The goal of chemotherapy is to regain control over the recurrent Hodgkin lymphoma. For most patients, this treatment is used to prepare for a stem cell transplant, which provides the best possible chance of curing the disease. Radiation therapy may be included in the treatment plan, before or after a stem cell transplant, especially if radiation therapy was not used during the initial treatment period. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent lymphoma. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.
People with recurrent lymphoma often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope.
Learn more about dealing with cancer recurrence.
If treatment fails
Recovery from lymphoma is not always possible. If the lymphoma cannot be cured or controlled, the disease may be called advanced or terminal.
This diagnosis is stressful, and advanced cancer is difficult to discuss for many people. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important. It is also important to discuss newer treatment options that are being tested in clinical trials. Finding a second opinion may be useful, too.
Patients who have advanced cancer and who are expected to live less than 6 months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced care planning.
After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.
The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with lymphoma. Or, use the menu to choose another section to continue reading this guide.