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Treatment of Hodgkin lymphoma

Hodgkin lymphoma is treated by either a haematologist or a medical oncologist. A radiation oncologist may also be involved in your care.

There are a number of things which you and your doctor will consider when deciding on the best treatment for your condition. These include:

  • The stage of the disease and the size of the lymph node lumps
  • Your age and general health/fitness
  • Your blood test results
  • Whether or not you have B symptoms (e.g. weight loss, fever, night sweats)

Sometimes people with the same stage of Hodgkin lymphoma will have different treatments because of the differences in their general health and/or symptoms. So don’t be concerned if the people you may talk to at your clinic are having different treatments. Always ask your doctor questions you may have at any time concerning your disease, treatment and managing any side effects of the treatment. It may be helpful to take someone with you to your doctor appointments to help you remember what was said, and to take a list of your questions. If you don’t fully understand what is being said, don’t be afraid to ask your doctor to explain it again.

The following describes some of the treatment options which may be helpful for your particular situation and disease state. Click here for more details on treatment options such as radiation therapy, chemotherapy, bone marrow/stem cell transplantation.

Treatment of early stage Hodgkin lymphoma

  • "Early stage" refers to Stage IA (and sometimes Stage IIA) Hodgkin lymphoma where the cancer is localised to one or two lymph nodes located in a similar part of the body e.g. the neck area. 
  • Until recently, radiation therapy was the main treatment for early stage Hodgkin lymphoma. Called "mantle zone" radiotherapy, the treatment involved radiation to the swollen lymph node and the surrounding area. This form of treatment successfully cured the cancer for many people.
  • Now, many doctors will also use chemotherapy to treat early stage Hodgkin lymphoma, or a combination of chemotherapy and radiation therapy. This enables the treatment to target not only the obvious areas of disease (such as swollen lymph nodes) but also disease that might not yet be noticeable. The doctor will decide which treatment is most appropriate for your particular situation.

Treatment of advanced Hodgkin lymphoma

  • If the cancer has spread to other parts of the body (stage 3 and 4) it is referred to as advanced disease. People with advanced Hodgkin lymphoma are generally treated with chemotherapy which is usually given as a combination of different chemotherapy drugs given over a period of time (sometimes up to 6-8 months). 
  • There have been many clinical trials over the past few decades which have tested various different combinations of chemotherapy drugs for the treatment of Hodgkin lymphoma. The doctor will discuss with you which treatment will be best suited to your particular situation.

Treatment of relapsed Hodgkin lymphoma

  • Relapsed disease is when the cancer comes back again after a period of "remission" (defined as a reduction in the tumour size by more than half or the lymphoma is undetectable) following treatment. Some people who have Hodgkin lymphoma will experience a relapse, which is most likely to happen within 2 years of the end of the first treatment. While it can be very distressing to experience relapsed disease, it is quite common and it can be treated.
  • The treatment for relapsed disease will depend on the first treatment given and your response to it. The doctor may choose to use a combination of chemotherapy drugs or, in some cases, a treatment of high dose chemotherapy and stem cell transplantation.

Treating Hodgkin lymphoma in later life

  • Approximately one in every five people diagnosed with Hodgkin lymphoma is aged 60 years or older. Older people are more likely to have other health problems at the time of diagnosis which may add some complexity to treating the Hodgkin lymphoma. For example, an existing health problem may exclude certain types of chemotherapy drugs because of their effect on the heart.
  • Older age and other health problems may also mean the person is less able to tolerate the treatment side effects and/or they may take longer to recover from treatment. In particular, chemotherapy causes damage to the bone marrow and an older person may take longer to build back healthy blood cells. 
  • The doctor will carefully assess each person’s health status and response to treatment and discuss the best approach to treating the cancer. Simple strategies such as extending the period between treatment doses and/or reducing the dose of chemotherapy and/or adding in some supportive medication (e.g. growth factors) will help an older person cope better with their treatment.

Clinical trials

  • A major part of developing new treatments for Hodgkin lymphoma involves clinical trials - carefully planned research that is conducted on patients in order to test new medications or new treatment approaches. The new treatment is usually compared with an existing treatment to assess if the outcome is more beneficial for patients.
  • Some of the research currently underway in Hodgkin lymphoma includes investigating medicines that specifically target the cancer cells (biologic therapies), and treatments to attack the Epstein Barr virus (which increases the possibility of developing Hodgkin lymphoma).
  • Your doctor may discuss with you the option of a treatment as part of a clinical trial, or you may wish to discuss clinical trials as a treatment option with your doctor.