Treatment options for Hodgkin lymphoma
When you are diagnosed with Hodgkin lymphoma, a team of healthcare professionals decide if you need treatment straight away. They also look at what treatment options you have and will discuss those with you. This depends on factors such as the type and 
of Hodgkin lymphoma, as well as your general health. You might have more than one treatment.
The most common treatments for Hodgkin lymphoma are chemotherapy and radiotherapy.
A team of healthcare professionals will discuss the best treatment for you. This team is called a multidisciplinary team (MDT). The team members specialise in different areas of Hodgkin lymphoma treatment and support.
The team usually includes:
- a haematologist (a doctor who treats blood conditions)
- a clinical oncologist (a specialist in radiotherapy)
- a radiologist who looks at your scans
- a specialist cancer nurse (also called a clinical nurse specialist)
- a pathologist (a specialist who looks at tissue samples)
- a
stem cell transplant specialist
You might not start treatment straightway if you are well. This depends on the type of Hodgkin lymphoma you have and the results of your blood tests and scans.
If you need treatment straight away, your team plan it depending on:
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what stage your Hodgkin lymphoma is
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what type of Hodgkin lymphoma you have
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if you have fevers, sweating or unexpected weight loss, these are called B symptoms
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your general health and level of fitness
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your personal wishes
Your doctor will talk to you about your treatment options. They will discuss the benefits and the possible side effects with you.
Treatment overview
The treatment of Hodgkin lymphoma is usually very successful in many cases and most people are cured. But sometimes Hodgkin lymphoma can come back (relapse). Some relapsed Hodgkin lymphomas can be difficult to treat.
The most common treatments for Hodgkin lymphoma are:
- chemotherapy
- radiotherapy
- targeted cancer drugs
- immunotherapy
- a stem cell transplant
Some people only need one type of treatment. Others need a combination of treatments.
Surgery is not usually used as a treatment for Hodgkin lymphoma. But you might have a small operation to remove a to check for lymphoma cells. This is called a lymph node biopsy.
Chemotherapy
Chemotherapy uses anti cancer drugs called cytotoxic drugs to destroy cancer cells. The chemotherapy drugs circulate throughout the body in the bloodstream. Your treatment usually includes a combination of different chemotherapy drugs and a steroid. This is called a chemotherapy regimen.
Steroids are substances made naturally in the body that affect many functions. They can be made artificially and used in cancer treatment as tablets or injections.
Radiotherapy
Radiotherapy is a type of cancer treatment that uses high energy waves similar to x-rays to kill cancer cells. You have treatment from a radiotherapy machine in the hospital radiotherapy department.
You might have radiotherapy to the lymph nodes where the lymphoma is and the areas around it. This is called involved site radiotherapy (ISRT). You usually have radiotherapy after chemotherapy.
Targeted cancer drugs
Cancer cells have changes in their genes that make them different from normal cells. These changes mean that the cancer cells might grow faster and sometimes spread.
Targeted cancer drugs work by targeting those differences that a cancer cell has. There are different types of targeted cancer drugs. For Hodgkin lymphoma you might have brentuximab or rituximab.
Immunotherapy
Immunotherapy is treatment that stimulates the body's to fight cancer. You might have immunotherapy if your Hodgkin lymphoma has come back. You may have different immunotherapy drugs such as pembrolizumab or nivolumab.
Stem cell transplant
Stem cell transplants are a possible treatment for some types of blood cancers such as lymphoma. You might have a stem cell transplant if you have relapsed Hodgkin lymphoma. Or if your treatment hasn’t worked as well as your doctor would like.
Before you have a stem cell transplant, you have high doses of chemotherapy. This kills the cancer cells and the in your bone marrow. The bone marrow is the spongy tissue inside your bones that makes blood cells.
After the chemotherapy, you have the new stem cells into your bloodstream. You usually have a stem cell transplant using your own cells.
Treatment by stage
Doctors simplify the staging of Hodgkin lymphoma into:
- early (limited) stage
- intermediate stage
- advanced stage
They will consider different things when deciding what stage your Hodgkin lymphoma is. This includes:
- where your Hodgkin lymphoma is
- the size
- what symptoms you have
- other risk factors such as having lots of lymphoma in your chest or being older than 50
Early (limited) stage Hodgkin lymphoma
Early stage generally means stage 1 or 2 lymphoma with no risk factors. It is also called early stage favourable Hodgkin lymphoma.
For early stage Hodgkin lymphoma, you usually have 2 cycles of chemotherapy followed by radiotherapy. A cycle of chemotherapy means that you have the drugs and then a rest to allow your body to recover. Each cycle is usually 4 weeks.
You might have a PET-CT scan after 2 cycles of chemotherapy. Depending on the results of your PET-CT scan, you might have another 1 or 2 cycles of chemotherapy before radiotherapy. Some people don’t have radiotherapy.
The treatment for nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is slightly different. You usually have radiotherapy on its own if you have early stage NLPHL. If you have very early stage lymphoma that is removed when you have a biopsy, your doctor might prefer to wait and monitor you before starting any treatment.
Intermediate stage Hodgkin lymphoma
Intermediate stage usually means stage 1 or 2 with one or more risk factors. It is also called early stage unfavourable Hodgkin lymphoma.
There are a few treatment options your doctor may discuss with you for intermediate stage Hodgkin lymphoma. You might have 4 to 6 cycles of chemotherapy, sometimes followed by radiotherapy. You may have a PET-CT scan midway through your treatment so your doctor can see how well your treatment is working.
Intermediate stage NLPHL is usually treated in the same way as classical Hodgkin lymphoma but you might have a targeted cancer drug called rituximab as well. In some cases your doctor may decide to wait for a little while before starting treatment if it is not causing any problems for you.
Advanced stage Hodgkin lymphoma
Advanced stage generally means that you have stage 3 or 4 Hodgkin lymphoma. However stage 2 with B symptoms and bulky disease or sites is usually treated as advanced stage.
You usually have 4 to 6 cycles of chemotherapy if you have advanced stage Hodgkin lymphoma.
You usually have a PET-CT scan after 2 cycles of chemotherapy so your doctor can decide how many more cycles of treatment you need and whether it needs to be intensified or reduced. You may have another PET-CT scan when you finish your chemotherapy to decide if you need radiotherapy or not.
For advanced stage NLPHL, you usually have targeted therapy called rituximab with chemotherapy. Some people also have radiotherapy.
Lymphoma that has come back
Lymphoma that comes back after treatment is called relapsed or recurrent Hodgkin lymphoma.
You usually have another lymph node biopsy and PET-CT scan if your doctors think that your Hodgkin lymphoma has relapsed.
If you have Hodgkin lymphoma that comes back, it may still be possible to get rid of your lymphoma again. This will depend on:
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how well further treatment works for your type of Hodgkin lymphoma
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the treatment you have already had
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your general health and level of fitness
For some people, treatment can cure Hodgkin lymphoma that comes back. Even if your lymphoma can't be cured, you will be able to have treatment to shrink the lymphoma. You may then be very well for some time.
Treatment for relapsed Hodgkin lymphoma includes:
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high dose chemotherapy
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a stem cell transplant
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radiotherapy
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targeted therapy
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immunotherapy
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more chemotherapy
For relapsed NLPHL, you usually have targeted cancer drugs and chemotherapy. If your lymphoma is early stage when it comes back, you might have targeted cancer drugs on their own.
For some people NLPHL can change (transform) into a different type of lymphoma called . Your doctor will check if your lymphoma has transformed when they do a lymph node biopsy. You will have a different treatment if your lymphoma transforms into non Hodgkin lymphoma.
Sometimes treatment for Hodgkin lymphoma doesn’t work as well as doctors would hope. If this happens your doctor might change the type of treatment you have.
Your feelings
It can be hard to cope with the news that your cancer has come back or that it isn’t responding to treatment. You may feel shocked and anxious even if treatment is still likely to get rid of your lymphoma again.
Talking to friends and family about your feelings can help. You may also want to think about having counselling. A trained counsellor can help you to talk about your fears and worries. And sometimes it feels easier to talk to someone outside your family and friends. Many people with cancer find that counselling can help them to deal with their emotions and to discuss any difficulties that they have.
Fertility and cancer treatment
Chemotherapy and radiotherapy for Hodgkin lymphoma can affect your ability to have children (fertility). Talk to your doctor about this before treatment if this important for you.
They can help you look at fertility treatments or getting support to help you cope.
Clinical trials
Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.
Getting a second opinion
Some people like to get an opinion from a second doctor. This is before they decide on their treatment. Most doctors are happy to refer you to another NHS specialist if you would find this helpful.
Vaccinations
Your doctor or specialist nurse may recommend that you have flu and pneumonia vaccinations. The vaccinations help to protect you from these infections if you have low immunity during treatment.
