Hodgkin Lymphoma: Treatment Options

Hodgkin lymphoma, formerly known as Hodgkin's Disease, is a highly curable form of cancer, with more than 80 percent of all patients surviving for five years, and many are cured. Most people with Hodgkin lymphoma will receive combination chemotherapy, some with and some without radiation. Other treatments may include stem cell or bone marrow transplantation, and surgery. A summary of treatment options for Hodgkin lymphoma patients is listed below.

Chemotherapy
Chemotherapy is a type of cancer treatment that utilizes drugs (as opposed to radiation, for example). Chemotherapy for Hodgkin lymphoma often consists of giving multiple drugs together, called combination chemotherapy, in a defined way, called a treatment regimen. Drug combinations are used because different medications damage or kill cancer cells in different ways, making them more vulnerable to the treatment. Drugs added together in lower doses also help reduce the likelihood of side effects without reducing the overall amount of effective chemotherapy. Chemotherapies used in the treatment of Hodgkin lymphoma include:

  • ABVD: Doxorubicin (Adriamycin, Rubex); Bleomycin (Blenoxane); Vinblastine (Velban, Velsar); and Dacarbazine (DTIC)
  • Stanford V: Mechlorethamine (Mustargen); Doxorubicin (Adriamycin, Rubex); Vinblastine (Velban, Velsar); Bleomycin (Blenoxane); Etoposide (VP-16, VePesid); Prednisone (Deltasone); and Involved Field radiation
  • BEACOPP: Bleomycin (Blenoxane); Etoposide (VP-16, Vepesid); Doxorubicin (Adriamycin, Rubex); Cyclophosphamide (Cytoxan); Vincristine (Oncovin); Procarbazine (Matulane); and Prednisone (Deltasone)

Radiation Therapy
Radiation therapy - also called radiotherapy - uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation may be combined with chemotherapy.

The term “radiation field” is used to describe the part of the body selected to receive radiation therapy. Hodgkin lymphoma generally spreads predictably from one lymph node to another. When the lymphoma is confined to a specific area of the body, for example, the neck, involved-field radiation may be given, meaning the therapy is limited to a small area. When radiation therapy is given more broadly to larger common areas, it is called extended-field radiation.

Transplantation
Hodgkin lymphoma patients who fail to achieve complete remission following frontline therapy or who relapse after achieving complete remission are often treated with second-line chemotherapy regimens, followed by a bone marrow or stem cell transplant. Because very high doses of chemotherapy or radiation are used to destroy cancer cells, healthy bone marrow cells are also destroyed. Therefore, a transplant of bone marrow or stem cells is needed to restore healthy bone marrow. Since transplants place great strain on the body, it is not a treatment option for everyone. Among the things to consider are age, medical history, cancer stage, response to previous therapy and chances for a successful transplant.  Brentuximab vedotin (Adcetris) was approved in 2011 by the U.S. Food and Drug Administration (FDA) for the treatment of relapsed/refractory HL after failure of stem cell transplantation or after failure of two previous chemotherapy regimens in patients who are not eligible for stem cell transplantation.  In 2015, brentuximab vedotin was FDA-approved as a consolidation treatment after autologus stem cell transplantation in patients with HL who are at high risk of disease relapse or progression.  In May 2016, nivolumab (Opdivo) was approved by the FDA for the treatment of patients with cHL that has relapsed or progressed after autologous stem cell transplantation and post-transplantation brentuximab vedotin.

Relapsed/ Refractory Hodgkin Lymphoma
For those patients who relapse (the lymphoma returns following remission) or become refractory (the lymphoma is resistant to primary treatment), secondary therapies are often successful in providing another remission and may even cure their Hodgkin lymphoma. There are a number of treatment options available for patients with relapsed or refractory Hodgkin lymphoma. Exactly which treatment is prescribed for an individual patient depends on several factors, including when the relapse occurs, the patient’s age, the extent of disease and previous therapies received. The standard secondary treatment for the majority of patients consists of high-dose platinum- or gemcitabine-based combination chemotherapy, usually followed by an autologous stem cell transplant in which a patient’s own stem cells are used. Other single-agent and combination chemotherapy treatments used include:

  • Brentuximab vedotin (Adcetris)
  • Nivolumab (Opdivo)
  • GVD: (gemcitabine, vinorelbine,  liposomal doxorubicin)
  • ESHAP: (etoposide, methylprednisolone, cisplatin and cytarabine)
  • DHAP: (dexamethasone, cisplatin and cytarabine)
  • ICE: (ifosfamide, carboplatin and etoposide)
  • IGEV: (ifosfamide, gemcitabine and vinblastine)

Treatments Under Investigation
Although the cure rate in HL is already high, research continues to look for ways to treat the minority of patients who are resistant (refractory) to treatment and those who relapse.  Many promising therapies are currently under investigation in clinical trials for HL including:

  • Gemcitabine (Gemzar)
  • Ifosfamide (Ifex)
  • Panobinostat (Farydak)
  • Pembrolizumab (Keytruda)

For additional information on all of these therapies, as well as treatments for Hodgkin lymphoma that are currently under investigation, view or order your free copy of the Foundation's Hodgkin Lymphoma Fact Sheet or the Spanish language version, Obteniendo los Dato: Linfoma de Hodgkin.  For more information about relapsed or refractory Hodgkin lymphoma, see the LRF Hodgkin Lymphoma: Relapsed/ Refractory Fact Sheet.

Please note: It is critical to remember that today’s scientific research is continuously evolving. Treatment options for Hodgkin lymphoma may change as new treatments are discovered and current treatments are improved. Therefore, it is important that patients check with their physician for any treatment updates that may have recently emerged.