Treatments for classical Hodgkin lymphoma

Classical Hodgkin lymphoma (HL) is commonly known as HL. It is treated based on the stage.

Treatment of stage 1 and 2 (early) HL is also based on whether the HL is favourable or unfavourable. Favourable means that it’s easier to treat because you don’t have any unfavourable (adverse) prognostic factors. Unfavourable means that it needs more or longer treatment because you have one or more unfavourable factors.

Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Stage 1 and stage 2 favourable Hodgkin lymphoma

The main treatment for stage 1 and stage 2 favourable HL is chemotherapy, with or without radiation therapy.

Chemotherapy

Chemotherapy uses anticancer drugs to destroy cancer cells. Combination chemotherapy is treatment with more than one anticancer drug. The most common combination chemotherapy used to treat classical HL is ABVD. ABVD includes doxorubicin, bleomycin, vinblastine and dacarbazine. ABVD is usually given for 2 to 4 cycles.

Another combination chemotherapy sometimes used for HL is BEACOPP, which is bleomycin, etoposide, doxorubicin, cyclophosphamide (Procytox), vincristine, procarbazine (Matulane) and prednisone. BEACOPP is stronger than ABVD so it is only used for younger people who have a large amount of HL.

After chemotherapy, the healthcare team will do a CT scan or PET scan to see how well the treatment is working and to determine if more treatment is needed.

Find out more about chemotherapy for Hodgkin lymphoma.

Radiation therapy

Radiation therapy uses high-energy rays or particles to destroy cancer cells. You may be offered radiation therapy after chemotherapy for early favourable HL. Find out more about radiation therapy for Hodgkin lymphoma.

Stage 1 and stage 2 unfavourable Hodgkin lymphoma

The main treatment for stage 1 and stage 2 unfavourable HL is chemotherapy, with or without radiation therapy.

Chemotherapy

The most common chemotherapy combinations used to treat early unfavourable HL are:

  • ABVD – doxorubicin, bleomycin, vinblastine and dacarbazine
  • BEACOPP – bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisone

After chemotherapy, the healthcare team will do a CT scan or PET scan to see how well the treatment is working and to determine if more treatment is needed. Sometimes a biopsy will also be done.

People with bulky (large) tumours often need chemotherapy for longer and may need radiation therapy to those areas.

Find out more about chemotherapy for Hodgkin lymphoma.

Radiation therapy

You may be offered radiation therapy after chemotherapy for early unfavourable HL. Find out more about radiation therapy for Hodgkin lymphoma.

Stage 3 and stage 4 Hodgkin lymphoma

The main treatment for stage 3 and stage 4 (advanced) HL is chemotherapy.

Chemotherapy

The most common chemotherapy combinations used to treat advanced HL are:

  • ABVD – doxorubicin, bleomycin, vinblastine and dacarbazine
  • BEACOPP – bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisone
  • A + AVD – brentuximab vedotin (Adcetris), doxorubicin, vinblastine and dacarbazine

The healthcare team will often do a CT scan or PET scan during or after chemotherapy to decide how much more treatment is needed. Depending on the results of the scan, you may be given more chemotherapy. Sometimes a biopsy is also done.

Find out more about chemotherapy for Hodgkin lymphoma.

Radiation therapy

Radiation therapy is sometimes used to treat bulky tumours. Find out more about radiation therapy for Hodgkin lymphoma.

Targeted therapy

Targeted therapy drugs, such as brentuximab vedotin, may be used along with chemotherapy to treat advanced HL. Targeted therapy uses drugs to target specific molecules (such as proteins) on cancer cells or inside them to stop the growth and spread of cancer and limit harm to normal cells.

Find out more about targeted therapy for Hodgkin lymphoma.

If you can’t have or don’t want cancer treatment

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

Clinical trials

Talk to your doctor about clinical trials open to people with HL in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

Expert review and references

  • American Cancer Society. Treating Classic Hodgkin Lymphoma by Stage . 2018.
  • BC Cancer Agency. BCCA Protocol Summary for Treatment of Hodgkin Lymphoma with Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine. 2015: http://www.bccancer.bc.ca/chemotherapy-protocols-site/Documents/Lymphoma-Myeloma/LYABVD_Protocol_1Feb2015.pdf.
  • Cancer Research UK. About Hodgkin lymphoma . 2018.
  • Eichenauer DA, Aleman BMP, Andre M, Federico M, Hutchings M, Ilridge T, et al. Hodgkin lymphoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Annals of Oncology . 2018: 29(Supplement 4):19–29.
  • Lash, Bradley W. Medscape Reference: Hodgkin Lymphoma Overview . 2018: Monday, January 14, 2019.
  • Lash, Bradley W. Medscape Reference: Hodgkin Lymphoma Treatment and Management . 2018.
  • Lash, Bradley W. Medscape Reference: Hodgkin Lymphoma Guidelines . 2018: Monday, January 14, 2019.
  • National Cancer Institute. Adult Hodgkin Lymphoma Treatment (PDQ®) Patient Version . 2018.
  • National Cancer Institute. Adult Hodgkin Lymphoma Treatment (PDQ®) Health Professional Version . 2018.
  • National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines: Hodgkin Lymphoma (Version 3.2018) . 2018: Monday, January 14, 2019.