Chemotherapy for Hodgkin Lymphoma

Chemotherapy (chemo) is the use of drugs to kill cancer cells. Chemo is usually injected into a vein under the skin or taken as a pill. Chemo drugs enter the bloodstream and travel throughout the body to reach and destroy cancer cells wherever they may be.

Chemo is the main treatment for most people with Hodgkin lymphoma (other than some people with nodular lymphocyte predominant Hodgkin lymphoma, or NLPHL). Sometimes chemo is followed by radiation therapy.

Which chemo drugs are used to treat Hodgkin lymphoma?

Chemo for Hodgkin lymphoma combines several drugs because different drugs kill cancer cells in different ways. The combinations used to treat Hodgkin lymphoma are often referred to by abbreviations. The most common regimen in the United States is a 4-drug combination called ABVD, which consists of:

• Adriamycin^® (doxorubicin)
• Bleomycin
• Vinblastine
• Dacarbazine (DTIC)

Other common regimens include:

BEACOPP

• Bleomycin
• Etoposide (VP-16)
• Adriamycin (doxorubicin)
• Cyclophosphamide (Cytoxan^®)
• Oncovin^® (vincristine)
• Procarbazine
• Prednisone

Stanford V

• Doxorubicin (Adriamycin)
• Mechlorethamine (nitrogen mustard)
• Vincristine
• Vinblastine
• Bleomycin
• Etoposide
• Prednisone

Radiation is given after chemo in the Stanford V regimen, and it is sometimes given after the ABVD or BEACOPP regimens as well.

Other chemo combinations can also be used for Hodgkin lymphoma. Most use some of the same drugs listed above, but they might include different combinations and be given on different schedules.

Chemo is given in cycles (a period of treatment followed by a rest period to give the body time to recover). Each cycle generally lasts for several weeks.

Most chemo treatments are given in the doctor’s office, clinic, or hospital outpatient department, but some may require a hospital stay. 

Possible side effects of chemotherapy

Chemo drugs can cause side effects. These depend on the type and dose of drugs given and how long treatment lasts. Common short-term side effects include:

• Hair loss
• Mouth sores
• Loss of appetite
• Nausea and vomiting
• Diarrhea
• Increased chance of infection (from having too few white blood cells)
• Easy bruising or bleeding (from having too few blood platelets)
• Fatigue (from having too few red blood cells)

These side effects are usually short-lived and go away after treatment is finished. If serious side effects occur, the chemotherapy may have to be delayed or the doses reduced.

Be sure to tell your doctor or nurse if you do have side effects, as there are often ways to help with them. For example, drugs are usually given to help prevent nausea and vomiting.

Late or long-term side effects: Some chemo drugs can have long-lasting side effects, some of which might not occur until months or years after treatment has ended. For example:

• Doxorubicin can damage the heart, so your doctor may order tests to check your heart function before and during treatment with this drug.
• Bleomycin can damage the lungs, so some doctors order tests of lung function (called pulmonary function tests) before starting patients on this drug.
• Some chemo drugs can increase the risk of getting a second type of cancer later in life (such as leukemia), especially in patients who also get radiation therapy.
• In children and young adults, some chemo drugs can also affect body growth and fertility (ability to have children) later on.

Long-term effects are discussed in more detail in  Living As a Hodgkin Lymphoma Survivor .

Before starting chemo, ask your doctor to explain possible side effects and the chances of having them. 

To learn more, see the Chemotherapy section of our website.