Treatment for Hodgkin lymphoma

You will have chemotherapy (chemo), which uses anti-cancer drugs to destroy the lymphoma cells. Some people also need radiotherapy. Radiotherapy uses high-energy rays to kill cancer cells.

Chemotherapy Back to top

The amount of chemo you need depends on how much lymphoma you have in your body.  Doctors call this the stage of the lymphoma. Your doctors will know the stage of your lymphoma from scans such as CT| and PET scans|.

• Stage 1 - One group of lymph nodes is affected.
• Stage 2 - Two or more groups of lymph nodes are affected on the same side of the diaphragm (the sheet of muscle underneath the lungs).
• Stage 3 - Lymph nodes above and below the diaphragm are affected.
• Stage 4 - The lymphoma has spread outside the lymph nodes to organs such as the liver, lungs or bones.

As well as giving each stage a number, doctors also use a letter code - either A or B - to show whether or not you have specific symptoms. If you have lost weight, have heavy sweats (especially at night) or have had high temperatures not caused by infection, your stage will have the letter B next to the number (eg stage 2B). If you don’t have any of these symptoms, your lymphoma will have the letter A next to the stage, (eg stage 2A).

Waiting to hear about the stage of the cancer can feel pretty scary, but it’s important to find out this information, as it helps your doctors plan the right treatment.

Chemotherapy is the main treatment for Hodgkin lymphoma. It’s usually given into a vein (intravenously) through a central line or a PICC line. Your bloodstream carries the chemo drugs around your body to wherever they’re needed. You’ll be given a combination of chemo drugs over a few days, followed by a gap of a few weeks. This is known as a cycle of treatment. During the gap between treatments your body (and blood cells) have time to recover from any side effects before the next lot of treatment is given. Your whole treatment will probably last for several months in total. You’re most likely to have your treatment as an outpatient (day patient), but sometimes you might have to stay in hospital for a few days.

There are different combinations (or regimens) of chemotherapy drugs that work well as treatments for Hodgkin lymphoma. Often a steroid drug called prednisolone is given with chemotherapy. Your specialist will  choose the combination of chemotherapy drugs that’s best for your situation.

Side effects

Different chemo drugs cause different side effects. Some people just have a few side effects and others have more. It's hard to know how they will affect you as everyone’s different.

Most side effects are short-term (temporary) and gradually disappear once treatment stops. The most common temporary side effects are being more at risk of getting an infection, losing your hair, feeling sick and tiredness.

There’s lots more information in the chemotherapy| section.

Sometimes side effects can be long-term. For example, although chemo usually only temporarily affects fertility (being able to have children), sometimes it’s permanent. If you’re having chemo that might affect your fertility, your doctor or nurse should tell you about this. If there’s a chance that your fertility will be affected, your doctor will talk to you about things that can be done to help you to be able to have children in the future. For example, guys may be able to store sperm before treatment starts - see our fertility| section.  

Sometimes there can be other effects of the treatment that happen years later, which are called late effects. Your specialist can talk to you about this.

Radiotherapy Back to top

Radiotherapy treats cancer by using high-energy x-rays to destroy cancer cells. Radiotherapy is targeted carefully to only treat the part of the body where the lymphoma is. It’s usually given after chemotherapy.

You’ll go to the hospital radiotherapy department for your treatment. Radiotherapy is usually given Monday-Friday, with a rest at the weekend. A course of radiotherapy treatment is normally given over a few weeks but each individual treatment only takes a few minutes. 

Before your treatment starts you’ll go to the radiotherapy department to have your treatment planned using a CT scan|. This helps them make sure your radiotherapy is really accurate. 

During treatment, you need to lie really still. You'll be left on your own in the room, but it's only for a few minutes and you can talk to the radiographer through an intercom. Some hospitals have music playing while you have your treatment.

Side effects

Radiotherapy isn't painful, but you’ll probably feel tired after you’ve had a few treatments. It can also make your skin over the areas being treated red and sore. Other side effects depend on the part of your body being treated, for example radiotherapy near your neck might give you a sore throat.

Always tell your doctor or nurse specialist about any side effects you’re having - there’s usually something they can do to make things easier.

If you smoke it’s best to give up because of the effect smoking has on your lungs, especially if you’re having radiotherapy to the chest. To find out more have a look in the radiotherapy| section.

High-dose treatment Back to top

Most people are cured with standard doses of chemotherapy but some people need larger doses to improve their chances of being cured. You may be offered high dose treatment if your Hodgkin lymphoma doesn’t go away with standard chemo or if it comes back after treatment (recurrent or relapsed Hodgkin lymphoma). Your doctors will tell you what’s best for your situation. 

High-dose treatment can kill the lymphoma cells that are left behind if standard chemotherapy is not enough. But, a side effect of this is that it can ‘wipe out’ your bone marrow so it can’t make blood cells anymore. So, after high-dose treatment your doctors ‘rescue’ your bone marrow by giving you special cells called stem cells. The stem cells mean your bone marrow can make blood cells for you again and you recover from treatment faster.

Stem cells are special blood cells that can make all the other types of blood cells you need. They live in the bone marrow inside our bones. Bone marrow is where blood cells are made - the bone marrow is a bit like a 'factory' for making blood.

What happens?

Stem cells are collected from your body and stored. Then you have high doses of chemotherapy, higher than you would normally be able to have.

Before you have your stem cells collected, you’re given injections of 'growth factor'. This gets your bone marrow to make lots of extra stem cells so many that they spill over from your bone marrow into your blood.

When there are enough stem cells in your blood they can be collected. This takes about 3-4 hours.

You lie down on a couch, and a short thin tube (cannula) will be put into a vein in each arm. (Or, if you have a central line this can be used instead.) Each cannula is connected by tubing to a machine called a cell separator. Some of your blood goes from one arm through the tubing into the cell separator and is then returned to you through the cannula in your other arm. As the blood goes through the cell separator, it’s spun to separate out the stem cells, which are collected in a bag.

This process keeps going until enough stem cells have been collected. Then you can go home. A nurse or doctor labels the bag of stem cells and sends them to be stored safely until you need them.

After you have high-dose chemotherapy, your stem cells will be ready to be given back to you through a drip. Sometimes people are given stem cells that come from someone else (a donor) rather than their own cells.

Stem cell transplants are complicated treatments and so they are carried out in specialist cancer treatment hospitals.