How Hodgkin Lymphoma Is Treated

Hodgkin lymphoma is a type of blood cancer that involves the lymphatic system. Treatment for Hodgkin lymphoma is usually based on the stage of this condition. In some instances, a person’s age, overall health, the location of the lymphoma, and other factors play a role in the type of treatment that is most effective. Because some Hodgkin treatment modalities can result in serious side effects that show up much later down the road, physicians may opt for a treatment plan with the lowest incidence of side effects.

The two primary types of treatment for Hodgkin lymphoma include chemotherapy (medications that treat cancer) and radiation therapy. In many instances, both chemotherapy and radiation are used. Other, less common forms of treatment include immunotherapy and stem cell transplant (often used when chemotherapy and radiation therapy are ineffective). 

Surgery is rarely recommended to treat Hodgkin lymphoma, except when doing a biopsy (taking a small amount of tissue to test to find out if it’s cancerous) and when staging (surgical removal of one or more lymph nodes to discover if the lymphoma is confined to one area, or if it has spread).

Other names for Hodgkin lymphoma include Hodgkin's disease and Hodgkin’s lymphoma. 

Hodgkin lymphoma treatment
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Prescriptions

Chemotherapy

Chemotherapy is the primary treatment for those with Hodgkin lymphoma. The definition of chemotherapy (chemo) is the use of medications with the aim of killing cancer cells. Chemotherapy is given intravenously. Sometimes chemotherapy is followed by radiation therapy, such as in the case of nodular lymphocyte-predominant Hodgkin lymphoma.

Common prescription medications for the treatment of Hodgkin lymphoma include several drugs that kill cancer cells in various ways. There are often combination drug preparations, referred to by abbreviations. Common chemotherapy drugs for Hodgkin lymphoma include:

  • ABVD includes Adriamycin (doxorubicin), Blenoxane (bleomycin), Velban (vinblastine), and DTIC (dacarbazine). It is the most common regimen used in the U.S.
  • BEACOPP includes Blenoxane (bleomycin), Etopophos (etoposide, VP-16), Adriamycin (doxorubicin), Cytoxan (cyclophosphamide), Oncovin (vincristine), Matulane (procarbazine), and prednisone.
  • Stanford V includes Adriamycin (doxorubicin), Mechlorethamine (nitrogen mustard), Oncovin (vincristine), Velban (vinblastine), Blenoxane (bleomycin), Etopophos (etoposide, VP-16), and prednisone.

Chemotherapy is commonly given in cycles involving a treatment period followed by a rest period to give the body time to recover from the side effects of chemo. Treatments may be given on an inpatient or outpatient basis.

Radiation therapy may be given after some specific types of chemotherapy.

Side Effects of Chemotherapy

Common short-term side effects of chemotherapy (those that go away shortly after treatment is over) include:

  • Loss of hair
  • Stomatitis (mouth sores)
  • Nausea and vomiting
  • Diarrhea
  • Loss of appetite
  • Compromised immune system (increased chance of infection)
  • Bruising or bleeding from low platelet (blood clotting cells) count
  • Severe fatigue from low red blood cell levels

Long-term or late side effects may include:

  • Heart damage (a side effect of doxorubicin)
  • Damage to the lungs (a side effect of bleomycin)
  • The development of leukemia or other types of cancer later in life (a side effect of many types of chemo drugs and particularly of radiation therapy)
  • Infertility in young adults and in children who receive chemotherapy

It’s important to talk to your health care provider about potential long-term and short-term side effects before starting chemotherapy. Be sure to inquire about what can help prevent side effects.

Immunotherapy

Immunotherapy is a type of drug therapy that helps the body’s immune system recognize and destroy cancer cells more effectively.

Monoclonal Antibodies

The body makes proteins called antibodies to help fight infections. Monoclonal antibodies can be synthetically made to attack specific targets. The target differs depending on the type of cancer. Monoclonal antibodies attack cancer cells, but not the cells that are healthy. Examples of drugs in this classification that treat Hodgkin lymphoma include:

For people with a high risk of recurrence of Hodgkin’s disease, brentuximab may be given for a year after stem cell transplant. It is administered intravenously, commonly ordered every three weeks.

Common side effects of brentuximab include:

  • Fatigue
  • Nausea and vomiting
  • Diarrhea
  • Fever
  • Infections
  • Low blood cell counts
  • Neuropathy (damage to nerves)
  • More

Common side effects of rituximab may include:

  • Fatigue
  • Headache
  • Fever and chills
  • Nausea
  • Rash
  • Increased risk of infection for several months after the drug has been discontinued

More severe side effects could occur during the infusion of any type of monoclonal antibodies, but this is rare. The physician will administer medication that helps to prevent severe reactions. If a reaction does occur during the initial infusion, it’s rare that it will recur with subsequent doses.

The drug rituximab may cause hepatitis B infections to recur. This could lead to liver problems or even death. It’s important to tell your health care providers if you have had hepatitis B in the past before starting on rituximab.

Surgeries and Specialist-Driven Procedures

Radiation

Radiation therapy is used to kill cancer cells with the use of high-energy rays. This type of treatment is considered the most beneficial when Hodgkin lymphoma affects only one area of the body.

Radiation treatments are given much like an X-ray is taken, but the radiation is much stronger than that of an X-ray. Radiation therapy is painless and takes only a few minutes, but the preparation for the treatment may take longer. Special shields are used to prevent radiation from targeting healthy, surrounding tissue. Young children may need to be sedated so they will stay still during the treatment.

Side Effects

Due to the long-term side effects of radiation therapy, it’s usually given in low doses.

Short-term side effects may include:

  • Redness, blistering, or peeling of skin in the area where treatment is administered
  • Dry mouth
  • Fatigue
  • Diarrhea
  • Nausea
  • Low blood counts and increased risk of infection (when radiation is administered in several areas of the body)

Long-term side effects may include:

  • Damage to the thyroid gland (if radiation is administered in the neck area)
  • Abnormal bone growth (in children), which could result in deformities
  • An increased risk of heart attacks and stroke
  • An increased risk of other types of cancer

Stem Cell Transplants

Stem cell transplants may be used to treat Hodgkin lymphoma that does not respond completely to chemotherapy. High doses of chemotherapy may then be used to kill the cancerous cells, but this also damages the ability of the bone marrow to produce blood cells. Stem cell transplants replenish the body’s ability to produce normal blood cells after high doses of chemotherapy are given.

Types of Stem Cell Transplants

There are two primary methods of stem cell transplantation; each comes from a different source of stem cells.

  • An autologous stem cell transplant uses stem cells collected from a person’s own blood, which is harvested before the transplant procedure. While the person is getting chemo, radiation treatment, or both, the stem cells are frozen, then thawed once Hodgkin treatment is complete. Once the person is ready to receive the procedure, the stem cells are administered intravenously. For Hodgkin lymphoma, an autologous stem cell transplant is the most common type of transplant.
  • The second type of transplant is an allogeneic stem cell transplant, in which the stem cells come from a donor.

Home Remedies and Lifestyle

There are several lifestyle changes, such as diet and exercise, thought to help prevent or treat lymphoma, but none have been proven by medical science. Although some of the research is positive, there is not enough evidence to show that home remedies, diet, or lifestyle changes effectively treat Hodgkin lymphoma.

Diet

Although there may be quite a bit of hype surrounding various diets for the treatment (or even the cure) of cancer, there is no evidence that any type of food or diet can prevent, cure or effectively treat cancer. According to Lymphoma Action, people with cancer should be very leery of claims that diet can cure any type of cancer, including Hodgkin lymphoma. This includes alternative cancer diets, such as macrobiotic diets (a diet plan comprised of vegetarian foods), Gerson therapy (coffee enemas), and more.

Cancer Research UK reports that there is a “lack of scientific evidence" to suggest any alternative cancer diets work, and that "some unproven alternative diets may not be safe and may make things worse.”

Supplements

People with Hodgkin lymphoma who can tolerate a healthy, balanced diet may not require any type of vitamins or supplements, such as Echinacea, said to boost the immune system. However, people diagnosed with Hodgkin who have a lack of appetite, are underweight, or have other eating problems may be advised by their health care provider to take a multivitamin or mineral supplement. 

Vitamins or natural supplements may adversely interfere with other medications taken for Hodgkin’s lymphoma, particularly when supplements are taken in high doses or over a long time-span. The National Center for Complementary and Integrative Health recommends that people who are being treated for cancer talk with their health care provider before taking supplements.

Foods to Avoid for Those with Hodgkin Lymphoma

Treatment such as chemotherapy and radiation can suppress your immune system. In addition, a person with HIV is more likely to develop Hodgkin lymphoma than a person without HIV. Not everyone with Hodgkin’s lymphoma has a suppressed immune system, but those who do may be advised to avoid certain foods. Examples include the following.

Some types of fruit may interfere with how well drugs for Hodgkin lymphoma work. Before medications can begin to work in the body, they must be properly broken down and absorbed in the bloodstream. One type of enzyme that helps to break down medications is called CYP3A. Some foods (such as grapefruit, blackberries, pomegranates, and some varieties of oranges and grapes) block the action of CYP3A, increasing the amount of drug in the body and potentially causing more side effects from chemotherapy. This may cause Hodgkin treatment to be less effective.

Food that has the risk of harboring bacteria or other organisms should be avoided for those who are immunosuppressed. These include:

  • Rare meat
  • Raw foods
  • Raw eggs (or eggs with runny yolks)
  • Raw cookie dough
  • Homemade mayonnaise
  • Unpasteurized foods (such as raw milk or yogurt and unpasteurized fruit juices)
  • Salad bars and buffets
  • Raw alfalfa and other sprouts
  • Soft cheese that is mold-ripened (such as Brie, blue-veined cheese, gorgonzola, Roquefort, and more).

To reduce the risk of foodborne infections, be sure to speak with a health care provider and other members of your medical team (such as nurses or dietitians) about what to eat and what to avoid if you have a suppressed immune system.

Antioxidants

Many people proclaim that antioxidants (abundantly available in many foods, such as red berries) can help reduce the risk of cancer. Although antioxidants have been found to absorb free radicals (unstable molecules that are thought to damage body tissue and contribute to some types of cancer), there is no scientific evidence to back the claims that antioxidants lower the risk of getting Hodgkin lymphoma or other types of cancer. It’s also important to note that taking too many antioxidant supplements may result in harmful side effects.

Green Tea

Green tea comes from the leaves of the Camellia sinensis plant, which commonly comes from India and China. Green tea is thought to have beneficial effects due to its high antioxidant catechin (also known as flavonoid) content. An ongoing study conducted in Japan discovered that adults who drank green tea (five or more cups daily) had a lower chance of getting blood cancers (including Hodgkin lymphoma). 

However, the National Cancer Institute does not recommend green tea for the prevention or treatment of any type of cancer. In addition, if you choose to consume green tea, it's better to stick to the drink: high doses of green tea supplements may have side effects.

Chili Peppers

Hot chili peppers have an active component called capsaicin. Early studies suggest that capsaicin could possibly helping with treating some types of cancer, but it may also lead to cancer in other forms. Lymphoma has not yet been shown to be impacted by chili peppers.

Physical Activity

There are many proven benefits of physical activity for people with Hodgkin lymphoma. However, these are secondary health benefits. Physical exercise is not used as a primary form of treatment for Hodgkin lymphoma. Exercise may benefit those with Hodgkin's disease by:

  • Potentiating mainstream treatment (such as chemotherapy), improving its outcome
  • Lowering side effects from lymphoma treatment
  • Boosting the immune system
  • Lowering susceptibility to infection
  • Lowering the risk of blood clots, called thrombosis (a common side effect of lymphoma as well as chemotherapy)
  • Improving energy levels and muscle strength
  • Lessening fatigue
  • Helping to maintain healthy blood pressure, blood sugar levels, and weight
  • Improving emotional well-being by helping a person cope with stress

While physical activity can have many benefits, it’s vital to check with your health care provider before beginning any exercise routine.

Studies on Hodgkin Lymphoma and Exercise

People with lymphoma often experience a decline in physical functioning as well as a reported lower quality of life. A 2019 study involving 36 people diagnosed with Hodgkin lymphoma and non-Hodgkin lymphoma discovered that a supervised program of cardiovascular, resistance, flexibility, and postural exercise improved physical functioning, reduced fatigue, and improved mood and overall quality of life.

Complementary and Alternative Medicine

Complementary and alternative medicine (CAM) includes therapies such as yoga, massage, acupuncture, meditation, mindfulness, and more. Complementary therapy is not intended to replace traditional treatment (such as chemotherapy), but rather to enhance the effects.

Some research has shown that complementary therapy may have benefits for those undergoing the treatment of Hodgkin lymphoma. These benefits include:

  • Reducing nausea
  • Reducing the perception of pain
  • Lowering fatigue
  • Lessening anxiety and depression
  • Reducing stress
  • Improving psychological well-being

Unlike complementary therapy, alternative therapy is used in place of conventional treatment; this includes treatment such as herbs, supplements, and homeopathic remedies. There are currently no proven alternative medicines or therapy for the treatment of Hodgkin lymphoma.

Acupuncture

There is some scientific evidence that acupuncture may help to reduce symptoms of nausea and vomiting—common side effects of chemotherapy—when administered along with anti-nausea medication.

It’s important to note that complementary treatment is not always safe. Although serious side effects are rare, according to Lymphoma Action, 1 in 10 people who received acupuncture experienced pain or bleeding. For people with Hodgkin lymphoma with a low platelet (clotting cells) or white blood cell count, acupuncture could increase the risk of bleeding or infection.

Other CAM Treatment Modalities

Massage: A popular CAM that uses touch and pressure to stimulate the skin, blood, and lymphatic system to promote relaxation. Although massage can help boost blood circulation, it has not been shown to effectively treat Hodgkin lymphoma.

Mindfulness practice: Techniques to help a person manage thoughts and to stay in the moment (letting go of future or past thinking). Mindfulness is considered safe for people with Hodgkin lymphoma and may help with stress management.

A Word From Verywell

There is an overwhelming amount of information available on the treatment of Hodgkin lymphoma. Many sources claim that natural products can help to treat or prevent different types of cancer, but it’s important to ensure you consider only credible sources. Be sure to discuss any treatment options you are considering (including natural, complementary, and lifestyle changes) with your health care provider and/or cancer care team as part of your decision-making process.

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Article Sources
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