Hodgkin Lymphoma: Treatment Choices

There are many treatment choices for Hodgkin lymphoma (HL), also called Hodgkin disease. The one that's best for you depends on things like:

• Type of HL

• The stage of the lymphoma and where it is in your body

• Whether you have any B symptoms: weight loss, unexplained fever, or night sweats

• Results of certain blood or urine tests

• Your age

• Your overall health

• Your personal concerns and preferences

Learning about your treatment choices

You may have questions and concerns about your treatment choices. You may want to know how you’ll feel, how your body will work after treatment, and if you’ll have to change your normal activities.

Your healthcare provider (oncologist) is the best person to answer your questions. They can explain what your treatment choices are, how well treatment is expected to work, and what the risks and side effects may be.

Your healthcare provider may advise a specific treatment. Or they may offer more than one and ask you to decide which you’d like to use. It can be hard to make this decision. It's important to take the time you need to make the best decision.

Deciding on the best plan may take some time. Talk with your healthcare provider about how much time you can take to explore your choices. You may want to get a second opinion before deciding on your treatment plan. You may also want to involve your partner, spouse, family, or friends in this process.

Types of treatment for Hodgkin lymphoma

HL treatments may be local or systemic. You may have both.

Local treatments remove, destroy, or control cancer cells in a certain place in the body. Surgery and radiation are local treatments.

Systemic treatments destroy or control cancer cells throughout the body. Chemotherapy and targeted therapy are examples.

Commonly used treatments for Hodgkin lymphoma

Here's a list of common HL treatments:

Radiation therapy

Radiation therapy uses high-energy X-rays or beams of other particles to kill cancer cells. Many people with HL get radiation as part of their treatment. It may be the only treatment or as part of a treatment plan that includes chemotherapy.

Chemotherapy

This treatment uses strong medicines to kill cancer cells. Chemotherapy (chemo) is the most common treatment for HL. It may be used alone or with radiation. Most people get more than one chemo medicine, called combination therapy. Chemo is most often given right into your blood through a vein (IV).

Stem cell transplant

If HL comes back after treatment (relapses), very high doses of chemo may be needed. These high doses can permanently damage or destroy the bone marrow. Stem cell transplants allow healthcare providers to give higher doses of chemo.

Bone marrow is where blood cells and immune system cells are made. A stem cell transplant is used to rebuild healthy bone marrow after high-dose chemo. The stem cells may come from a donor (an allogenic transplant). Or they may come from you (an autologous transplant). If your own cells are used, they're collected before you get the high-dose chemo. The cells are stored in a freezer to be used later.

Immunotherapy

This treatment is also called biologic therapy. It boosts your immune system to help it find and destroy the lymphoma cells. These medicines are put right into your blood through a vein (IV). Immunotherapy for HL includes:

• Monoclonal antibodies.  These medicines are manmade forms of immune system proteins. They target a certain part of a cancer cell. They can be used alone or along with chemo to treat certain types of HL. 

• Immune checkpoint inhibitors. An important part of the immune system is to protect the body from harmful cells, like cancer. Checkpoints are proteins on immune cells. They help your body know the difference between normal cells and abnormal cells. So checkpoints turn the immune system on or off to start an immune response. Cancer cells sometimes use checkpoints to keep the immune system from finding them. Checkpoint inhibitors are medicines that target checkpoints to boost the immune system's ability to find and fight cancer.

Clinical trials for new treatments

Researchers are always looking for new ways to treat HL. These new methods are tested in clinical trials. Taking part in a clinical trial means you get the best treatment available today, and you might also get new treatments that are thought to be even better. Before starting treatment, ask your oncologist if there are any clinical trials you should think about.

Working with your oncologist to choose a treatment plan

Your oncologist will help you make a treatment plan. Talking about your treatment choices will be one of the most important meetings you'll have with your oncologist.

At first, thinking about treatment choices may seem overwhelming. Talk with your healthcare providers, nurses, and loved ones. Make a list of questions. Consider the benefits and possible side effects of each choice. Discuss your concerns with your healthcare provider before making a decision.