Lymphomas

Hodgkin lymphoma

Hodgkin lymphoma is a cancer that starts in the part of the body’s immune system known as the lymphatic system. The lymphatic system is composed of lymphoid tissue, lymph and lymphatic vessels. Lymphoid tissue, made up primarily of white blood cells called lymphocytes, is found in many parts of the body, including the lymph nodes, spleen, bone marrow, thymus, adenoids, and tonsils and digestive tract. Hodgkin lymphoma typically starts in the lymph nodes in the chest, neck or underarm and may spread to other lymph nodes or to other organs, such as the liver or lungs.

Classifying Hodgkin Lymphoma

The two main classifications of this type of lymphoma are classic Hodgkin lymphoma (CHL) and nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL). CHL, which makes up the majority of all Hodgkin lymphoma cases, is characterized by the presence of large, abnormal B cells called Reed-Sternberg cells.

Treating Hodgkin Lymphoma

Cure is the goal of treatment for most people with Hodgkin lymphoma. Your doctor will recommend one or more treatments based on the stage, type and location of your disease, as well as your age and general health. Each option can cause side effects that may occur during treatment or much later (see page 14). Discuss potential side effects with your doctor to help you make the most informed treatment decision. Common treatments include the following:

Chemotherapy

Chemotherapy is a systemic treatment that travels through the body to damage and destroy cancer cells. Many combinations may be used, and chemotherapy may be followed by radiation therapy. The most common chemotherapies include the following:

  • ABVD
    • doxorubicin (Adriamycin)
    • bleomycin (Blenoxane)
    • vinblastine (Velban)
    • dacarbazine (DTIC-Dome)
  • BEACOPP
    • bleomycin
    • etoposide (Etopophos)
    • doxorubicin
    • cyclophosphamide (Cytoxan)
    • vincristine (Oncovin)
    • procarbazine (Matulane)
    • prednisone
  • Stanford V
    • doxorubicin
    • mechlorethamine (Mustargen)
    • vincristine
    • bleomycin
    • etoposide
    • prednisone

Radiation Therapy

Radiation therapy involves the use of high-energy rays to destroy cancer cells. With external-beam radiation therapy, a beam of radiation is delivered from a machine outside the body. This type of treatment is typically used to treat Hodgkin lymphoma and is most effective when Hodgkin disease is confined to one part of the body and is often used after chemotherapy, especially to target a large or bulky tumor mass. Radiation therapy can be used by itself to treat some cases of nodular lymphocyte-predominant lymphoma. Your doctor will target the radiation beam as precisely as possible to avoid damaging healthy cells, which can reduce side effects.

Immunotherapy

Immunotherapy is a type of treatment in which a person’s own immune system is stimulated to recognize and destroy cancer cells. Some immunotherapies are used to treat Hodgkin lymphoma.

To avoid attacking normal cells, the immune system uses checkpoints (molecules on immune cells that must be turned on or off to start an immune response). Cancer cells sometimes use these checkpoints to avoid being attacked by the immune system. Immune checkpoint inhibitors target these checkpoints, boosting the immune response against the cancer cells and, as a result, shrinking some tumors or slowing their growth. Nivolumab (Opdivo) is the first immune checkpoint inhibitor approved to treat Hodgkin lymphoma.

Monoclonal antibodies are laboratory-made proteins designed to attack a certain target, such as a substance on the surface of lymphocytes. Brentuximab vedotin (Adcetris) and rituximab (Rituxan) are monoclonal antibodies designed to treat Hodgkin lymphoma by blocking the growth of the cancer cells, killing them or keeping them from spreading.

Although immunotherapy comes with side effects, for many patients, the side effects can be less severe than those with traditional treatments.

High-dose Chemotherapy and Stem Cell Transplantation

High-dose chemotherapy and stem cell transplantation (also known as a bone marrow transplant) is sometimes used if other treatment options are ineffective. High doses of chemotherapy are given to destroy cancer cells and then stem cells are injected into the patient to make healthy blood cells that will replace immature blood-forming cells in the bone marrow. An autologous stem cell transplant is a transplant of the patient’s own stem cells, from either the bone marrow or blood. In an allogeneic stem cell transplant, the stem cells come from a volunteer donor whose tissue type closely matches that of the patient. If available, a sister or brother offers the best chance of a close match. If a sibling or another family member is not a good match, an unrelated volunteer donor may be found through a national registry.

Clinical Trials

Clinical trials offer access to the newest treatment strategies and regimens. Ask your doctor if you may be a candidate for a clinical trial.

 

Treatment Options During Pregnancy

If you are pregnant, your doctor may recommend different treatment strategies that depend on the stage of the lymphoma, how aggressive it is and if you are in the first or second half of your pregnancy. Considering these and other factors, your doctor may suggest the following:

  • Watchful waiting, which means no treatment until signs or symptoms appear or change
  • Inducement of delivery at 32 to 36 weeks, so treatment can begin sooner
  • Radiation therapy, using a lead shield to protect the fetus
  • Systemic chemotherapy, using one or more drugs
  • Steroid therapy
 

 

Additional Resources

 

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