Lymphomas

Hodgkin Lymphoma

Hodgkin lymphoma, formerly known as Hodgkin disease, is a cancer of the lymphatic system, which is part of the body’s immune system. It is far less common than non-Hodgkin lymphoma. The lymphatic system is composed of lymphoid tissue, lymph and lymphatic vessels. Lymphoid tissue is found in many parts of the body, including the lymph nodes, spleen, bone marrow, thymus, adenoids and tonsils, and digestive tract. These tissues are primarily made of white blood cells called lymphocytes. 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

Hodgkin lymphoma is classified into two main types. Classical Hodgkin lymphoma (HL) makes up the majority of Hodgkin lymphoma diagnoses, while nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is less common. The cancer cells found in classical HL are Reed-Sternberg cells, which are large, abnormal B-cells. Those found in NLPHL are large popcorn-shaped cells called popcorn cells.

Classical Hodgkin lymphoma has four main subtypes, including lymphocyte-depleted Hodgkin lymphoma, lymphocyte-rich Hodgkin lymphoma, mixed cellularity Hodgkin lymphoma and nodular sclerosis Hodgkin lymphoma. These subtypes vary in where they occur in the body and the age group they affect.

Hodgkin Lymphoma Treatment Options

Depending on the type of Hodgkin lymphoma you are diagnosed with, 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 (see Common Forms of Lymphoma). It is common for a treatment plan to include a combination of chemotherapy, immunotherapy and/or targeted therapy. Your doctor may also prescribe the use of a steroid along with chemotherapy to reduce inflammation and because some of these drugs offer anti-cancer effects. Following are the most common treatments options for Hodgkin lymphoma.

Chemotherapy

Chemotherapy is the use of drugs to stop the growth of cancer cells either by killing them or preventing them from dividing and growing. Chemotherapy is a treatment option for all stages of Hodgkin lymphoma and is often the first treatment option used. A single chemotherapy drug or a combination of chemotherapy drugs or a chemotherapy drug plus a monoclonal antibody may be used.

Radiation therapy

Radiation therapy involves the use of high-energy rays to destroy cancer cells. Radiation therapy is typically used after chemotherapy, especially to target a large or bulky tumor mass, but it can be used by itself to treat some cases of NLPHL. The most common radiation therapy used for Hodgkin lymphoma is external-beam radiation therapy (EBRT) that delivers a beam of radiation from a machine outside of the body.

Immunotherapy

Immunotherapy is a treatment option designed to boost the body’s natural defenses to fight cancer. It can be used to treat some people with Hodgkin lymphoma. Immunotherapy works in a few different ways. In some instances, it may target or identify a specific type of cell that is cancerous. And in other instances, it can activate a part of the immune system to fight against a specific cancer.

Stem cell transplantation

Stem cell transplantation (also known as bone marrow transplantation) may be used if other treatment options are not effective. High doses of chemotherapy are given to destroy cancer cells and suppress the patient’s immune system before the stem cells are injected into the patient to make healthy blood cells that will replace immature blood-forming cells in the bone marrow. Autologous stem cell transplantation uses the patient’s own stem cells, from either the bone marrow or blood. Allogeneic stem cell transplantation uses the stem cells from a volunteer donor whose tissue type closely matches that of the patient. People receiving any type of allogeneic transplant may have graft-versus-host disease (GvHD), which occurs when the donor cells attack the patient’s cells. GvHD can be treated with steroids or other drugs that suppress your immune system.

Clinical trials

Clinical Trials are a valuable treatment option to consider. Many of the advances in cancer treatment are helping save lives today because of the research conducted through clinical trials. By participating in a trial, you may have access to cutting-edge treatments that are not yet widely available. Ask your doctor if you may be eligible for a clinical trial.

Refractory HL

Hodgkin lymphoma that does not result in complete remission after treatment is called refractory Hodgkin lymphoma. If you receive this diagnosis, talk with your medical team about options, which could include consulting with a specialist who has experience treating refractory Hodgkin lymphoma, trying a different treatment and investigating clinical trials.

Side Effects

Managing side effects is important because if you feel better, you are more likely to complete your treatment, which offers a greater chance for a successful outcome. Common side effects of treatment may include fatigue, diarrhea, nausea and vomiting, peripheral neuropathy (tingling in hands or feet), hair loss, loss of appetite, constipation, risk of infection, dry mouth, cough, skin reactions, mouth sores and easy bruising (see Side Effects).

Your doctor may prescribe medications or suggest over-the-counter treatments to prevent or manage some of the more common side effects. It is extremely important to talk openly with your doctor about any side effects you experience and to call your doctor’s office immediately if one begins suddenly.

Pain Management

Untreated pain from diagnostic tests, treatments and the disease itself can affect your ability to complete treatment as planned. That is why it's so important to let your health care team know right away if you are in pain. The more you share about your pain, the better they will be able to help you. Although you can't expect to be entirely pain-free, your health care team will do everything possible to make sure you’re comfortable.

 

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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