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Treatment of Hodgkin lymphoma

Hodgkin lymphoma is treated by a specialist doctor called a haematologist and a radiation oncologist may also be involved in your care.

There are a number of things when deciding on the best treatment for a patient. These include:

  • The stage of the disease and the size of the lymph nodes
  • Age and general health/fitness
  • Blood test results
  • Presence of B symptoms (e.g. weight loss, fever, night sweats)

Sometimes patients 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 payients you talk to at your hospital are having different treatments. Always ask your doctor questions you may have about your lymphoma and managing 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.

Treatment of early stage Hodgkin lymphoma

  • "Early stage" refers to Stage IA and Stage 2A 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 and chest area. 
  • Now, many doctors will also use chemotherapy to treat early stage Hodgkin lymphoma, or a combination of chemotherapy medicines and radioherapy. 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 stage Hodgkin lymphoma

  • Advanced stage refers to 2B, stage 3A and 3B and stage 4A and 4. Patients with advanced Hodgkin lymphoma are generally treated with chemotherapy which is usually given as a combination of different chemotherapy medicines given over a period of time (sometimes up to 6-8 months). 
  • There has been a number of  clinical trials over the last decade which have tested various different combinations of chemotherapy medicines 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 no detectable disease following treatment. Some patients who have Hodgkin lymphoma will experience a relapse, and whilst it can be very distressing to experience relapsed disease, it can be treated.
  • The treatment for relapsed disease will depend on the first treatment given and the duration and depth of response to it. The doctor may choose to use a combination of chemotherapy medicines 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 medicines 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 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.
  • 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.