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Types of Chemo for Treatment of Hodgkins Lymphoma

Hodgkin lymphoma is a type of cancer that attacks the lymphatic system, which is part of the immune system. The cancer results in abnormal B lymphocytes, white blood cells that are part of the immune system. While it used to be nearly always fatal, Hodgkin lymphoma (also known as Hodgkin disease) now has cure rates of over 80 percent. If the disease is caught early and responds well to treatment, cure rates exceed 95 percent. There are two main types of Hodgkin lymphoma: Lymphocyte-predominant Hodgkin lymphoma and Classic Hodgkin lymphoma, which has four subtypes. Lymphocyte-predominant Hodgkin lymphoma has a different type of malignant cell than the one found in Classic Hodgkin lymphoma.

  1. Treatment Overview

    • Classic Hodgkin disease is normally treated with a combination of chemotherapy and radiation. Lymphocyte-predominant Hodgkin lymphoma is often treated in its early stages with radiation only or, especially in children, with a "wait-and-see" approach because it tends to move slowly. In late stages, lymphocyte-predominant Hodgkin lymphoma is treated in the same manner as late-stage classic Hodgkin disease.

    Chemotherapy for Hodgkin Lymphoma

    • Several combinations of chemotherapy drugs are commonly used to treat Hodgkin disease. The most common one is ABVD, consisting of doxorubicin (Adriamycin), bleomycin, vinblastine and dacarbazine. This combination is used to treat every stage of classic Hodgkin disease and late stages of lymphocyte-predominant Hodgkin lymphoma. The first drug combination used to treat Hodgkin disease was MOPP---mechlorethamine, vincristine, procarbazine and prednisone. It is still used today, mostly in alternating cycles with ABVD. MOPP has some severe side effects, including male sterility and high risk of leukemia (blood cancer). BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisone) is used in late stages of Hodgkin disease. It, too, carries a risk of leukemia with it. Stanford V (doxorubicin, vinblastine, mechlorethamine, etoposide, vincristine, bleomycin and prednisone) is a newer chemotherapy combination that is always used with radiation therapy after the drug cycles have been completed.

    Other Treatments

    • Radiation treatments, either to the site of the initial tumor or to a wider area of the body, usually accompany chemotherapy at every stage of Hodgkin disease. It is currently unclear how necessary radiation is in late-stage Hodgkin disease patients who respond well to chemotherapy, but late-stage patients with a partial response seem to benefit from radiation and chemotherapy combined. Patients who do not respond to treatments or relapse after treatment usually receive high-dose chemotherapy, which destroys their blood cells. Before treatment, these patients' stem cells are collected; they are given back these cells after treatment, so that new and hopefully healthy blood will regenerate in their body. The chemotherapy drugs used in these cases include carmustine, etoposide, cytarabine and melphalan (the BEAM protocol) and ifosfamide, carboplatin and etoposide (the ICE protocol).

    Late Effects of Treatments

    • Chemotherapy drugs and radiation treatments can have severe effects on the body. Because Hodgkin disease patients live longer now, these effects are of greater concern. They include (but are not limited to) heart problems in patients, who were treated with chest radiation or the drug doxorubicin; several types of cancers including breast and lung (the latter is a particular problem in smokers who were treated with mechlorethamine) and infertility in patients treated with procarbazine or abdominal radiation.

    Other Considerations

    • Classic Hodgkin lymphoma occurs most frequently in people of child-bearing age. When diagnosed during pregnancy, it is possible to treat the mother with the chemotherapy drug vinblastine in the first trimester or with minimal radiation dose if the tumor is above the diaphragm. If the disease is diagnosed late in the pregnancy, and the doctors determine it is possible to wait, treatment may be delayed until after delivery of the baby. Hodgkin disease does not harm the baby, and pregnancy does not make the disease itself worse.

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