Treatment for Hodgkin lymphoma

Hodgkin lymphoma is usually treated with chemotherapy (anti-cancer drugs). How much chemotherapy you need depends on the stage of the lymphoma. There are four stages – stage 1 is early stage and stage 4 is advanced. Your doctor will also think about any symptoms you have when they decide how much chemotherapy you need.

Radiotherapy (high-energy x-rays) is sometimes given after chemotherapy. You have CT scans to plan the treatment, so the radiotherapy is aimed at the part of the body where the lymphoma is. You may have some side effects from the radiotherapy, such as tiredness or red and sore skin around the area being treated. Talk to your healthcare team about things that can help.

Some people need high-dose treatment with stem cell support. This may be if standard chemotherapy has not worked, or if the lymphoma comes back. Stem cells are collected from your body, and then you are given high doses of chemotherapy. After the chemotherapy, your stem cells are given back to you. This helps your bone marrow recover and start making new blood cells again.

Treatment for Hodgkin lymphoma

Before you start treatment, your lymphoma doctor or nurse will talk to you about your treatment plan. Your lymphoma doctor may be:

  • a haematologist (a doctor who treats blood disorders)
  • an oncologist (a doctor who treats cancer).

The main treatments for Hodgkin lymphoma are chemotherapy and radiotherapy. The treatment you have depends on:

  • the results of your tests
  • which parts of your body are affected
  • how much lymphoma there is in your body (the stage of the lymphoma).

Your doctor or nurse may talk to you about the stage of the lymphoma. This is a way of describing how many areas of your body are affected by lymphoma and where these areas are. We have more information about stages of Hodgkin lymphoma. It is written for people of all ages, not just teenagers and young adults.

Treatment for Hodgkin lymphoma has a very good success rate. Most teenagers and young adults are cured. But some treatments can cause long-term or late effects. This can include changes to your fertility (being able to father a child or get pregnant). Your lymphoma doctor or nurse should talk to you about this before you start treatment. If your fertility could be affected, you may be able to have treatment to preserve your fertility. We have more information about fertility and having fertility preservation.


Clinical trials

Doctors are working all the time to:

  • improve cancer treatments
  • reduce the side effects of treatment.

They do this through research called clinical trials. Your lymphoma doctor may talk to you about having your treatment as part of a clinical trial. We have more information about clinical trials. It is written for people of all ages, not just teenagers and young adults.


Chemotherapy

Chemotherapy is a treatment that uses anti-cancer drugs to destroy cancer cells. It is the main treatment for lymphoma.

Most people have chemotherapy as an outpatient. The drugs are usually given into a vein (intravenously) or as tablets.

You usually have a combination of two or more chemotherapy drugs. There are different combinations of chemotherapy drugs that work well for Hodgkin lymphoma. Your lymphoma doctor will choose the combination that is best for you. We have more information about different chemotherapy drugs, which is written for people of all ages.

People often also have a steroid drug with chemotherapy. The most common one is a tablet called prednisolone. Steroids are an important part of the treatment.

Your course of chemotherapy may last several months. During this time, you have regular check-ups at the hospital.

Side effects of chemotherapy

Different chemotherapy drugs cause different side effects. Some people only have a few side effects and others have more. Everyone is different.

Most side effects are short-term (temporary) and slowly go away after treatment stops.

The most common short-term side effects are:

  • risk of getting an infection
  • losing your hair
  • feeling sick (nausea)
  • tiredness (fatigue).

We have more information about these side effects.

Chemotherapy

This video provides a brief overview of chemotherapy treatment, how it can be given, how it works and possible side effects.

About our cancer information videos

Chemotherapy

This video provides a brief overview of chemotherapy treatment, how it can be given, how it works and possible side effects.

About our cancer information videos


Radiotherapy

Radiotherapy treats cancer by using high-energy rays to destroy cancer cells. It only treats the area of the body that the beams are aimed at. A doctor who specialises in radiotherapy plans your treatment. They are called a clinical oncologist. A person who gives radiotherapy is called a radiographer.

People with Hodgkin lymphoma often have radiotherapy after chemotherapy. Some people have it to treat an area of the body that is still affected by the lymphoma. But you may also have it even if there are no signs of lymphoma after your chemotherapy. This is because radiotherapy helps reduce the risk of lymphoma coming back again.

Before your first radiotherapy treatment, you have your treatment planned. This happens in the radiotherapy department. You have a CT scan or x-rays. The radiographer may also make some small marks on your skin. These help them make sure you are in the right position for each treatment. They usually use permanent marks (like tattoos). The marks are very small, and they will only do them with your permission. It may be a little uncomfortable while they are making the marks.

If you are having radiotherapy to your neck, you may need to wear a mask during each treatment. The mask is made for you before you have treatment. We have more information about radiotherapy masks, which is written for people of all ages.

You go to the hospital radiotherapy department to have treatment. You usually have radiotherapy every day from Monday to Friday, with a rest at the weekend. Your course of radiotherapy may last for a few weeks, but each daily treatment only takes a few minutes.

During treatment, you need to lie still. You are left on your own in the room, but only for a few minutes. You can talk to the radiographer, who watches you from the next room.

Side effects of radiotherapy

Radiotherapy is not painful, and you cannot see or feel the treatment when it is being given. You may start feeling tired after having a few treatments. Your skin may also get red and sore in the areas being treated. Other side effects depend on the area of your body being treated. For example, radiotherapy near your neck might give you a sore throat. Your doctor or nurse can tell you more about the side effects you might have.

Always tell your doctor, nurse or radiographer about any side effects. They will do their best to help make things easier.

Radiotherapy explained

Consultant Clinical Oncologist Vincent Khoo describes external beam radiotherapy, how it works, and what it involves.

Information about our videos

Radiotherapy explained

Consultant Clinical Oncologist Vincent Khoo describes external beam radiotherapy, how it works, and what it involves.

Information about our videos


High-dose treatment with stem cell support

Most people are cured with standard chemotherapy and radiotherapy treatment, and do not need high-dose treatment with stem cell support. But some people need bigger doses of chemotherapy, to improve their chances of being cured. You may be offered high-dose treatment if:

  • the lymphoma doesn’t go away with standard treatment
  • the lymphoma comes back after standard treatment (called recurrent or relapsed lymphoma).

If standard treatment was not enough, high doses of chemotherapy may kill the lymphoma cells. But high-dose treatment also destroys the stem cells in your bone marrow (spongy material in the middle of bones). Because of this, after the treatment you have stem cell support to help you recover. Without this, it could take weeks or even months for your body to start making new stem cells again.

What are stem cells?

Stem cells are blood cells at the earliest stage of development. All of our blood cells develop from stem cells in the bone marrow. When they are fully developed, they go into the bloodstream.

Bone marrow blood cells
Bone marrow blood cells

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Blood cells do not live long. The bone marrow normally makes millions of new blood cells every day to replace blood cells as they are needed.

How stem cell support works

Before you have high-dose treatment, some of your stem cells are collected and stored. You can normally have them collected as a day patient.

The first part of collecting stem cells from the blood is making them move from the bone marrow into the blood. To do this, you have daily injections under the skin. The injections are of a drug called a growth factor. This stimulates your bone marrow to make lots of stem cells. These travel from your bone marrow into your blood.

When there are enough stem cells in your blood, they can be collected. This takes about 3 to 4 hours. You lie down on a couch, and a nurse puts a short, thin tube (cannula) into a vein in each arm. If you have a central line, they can use that 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. Then it is returned to you through the cannula in your other arm.

The cell separator spins as the blood goes through it. This is to separate out the stem cells, which are collected in a bag. When it has collected enough stem cells, you can go home. Your stem cells are carefully frozen and stored until you need them.

A few weeks later, you go into hospital to have the high-dose treatment. The aim is to remove any remaining lymphoma cells.

A few days later, your stem cells are given back to you through a drip (infusion). Your stem cells travel to your bone marrow. After a few weeks, your bone marrow starts to make new blood cells again. This helps you recover from the side effects of the high doses of chemotherapy.

You usually stay in hospital to have high-dose treatment and stem cell support. The treatment may only last from one to a few days, but you will probably be in hospital for a few weeks. This is because it can take 2 to 3 weeks for your body to start to start making new blood cells again. Until your bone marrow recovers, you are at a high risk of getting an infection, so you need to stay in hospital.

We have more information about high-dose treatment and stem cell support. This is written for people of all ages, not just teenagers and young adults.


After treatment

After treatment, you have regular check-ups with your lymphoma team at the outpatient clinic. This is a good time to ask any questions or talk about anything that is worrying you.

Your team will explain:

  • how often you will have these check-ups
  • possible signs of the lymphoma returning that you should be aware of
  • any possible late effects of treatment.

They may give you and your GP a letter with this information and a list of the treatments you have had. This is called a treatment summary.

Your lymphoma doctor or nurse will also tell you about things you can do to help your recovery. These include:

  • not smoking
  • having a healthy diet
  • doing regular exercise.

This will also help to prevent late effects of treatment and keep your body healthy.

If you notice any new symptoms between appointments, contact your doctor or nurse for advice.

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