Treatments for early-stage Hodgkin lymphoma

Early-stage (also called limited-stage) Hodgkin lymphoma (HL) includes stages 1 and 2. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

The standard treatment for early-stage HL is chemotherapy. Depending on how well the cancer responds to the chemotherapy, some people with early-stage HL will also be given radiation therapy.

Chemotherapy uses drugs to destroy cancer cells. For HL, different drugs are usually given at the same time. This is called combination chemotherapy.

The most common combination chemotherapy used to treat early-stage HL is ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine). ABVD is usually given for 2 to 4 cycles, depending on how well the HL responds to the chemotherapy.

During and after chemotherapy with ABVD, your healthcare team will do a PET scan (if using PET-guided therapy) or a CT scan (if not using PET-guided therapy) to see how well this treatment is working.

If your healthcare team is not using PET-guided therapy, early-stage HL will be treated with 2 to 4 cycles of chemotherapy followed by radiation therapy.

If your healthcare team is using PET-guided therapy, the results of the PET scan after 2 to 4 cycles of chemotherapy are used by your healthcare team to decide about further treatment. PET scan results are graded using a system called the Deauville score. A Deauville score of 1, 2 or 3 is considered negative, which means no HL has been found. A Deauville score of 4 or 5 is considered positive and means that there is still HL found. Your healthcare team will also consider your age and overall health when planning further treatment.

If the PET scan is positive, you may be given radiation therapy or additional chemotherapy followed by radiation therapy. Your healthcare team will offer 1 of the following combinations:

• ABVD for another 2 to 4 cycles
• AVD (doxorubicin, vinblastine and dacarbazine)
• BEACOPP or escBEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisone)
• escBPDac (bleomycin, prednisone and dacarbazine)

The “esc” in escBEACOPP and escBPDac stands for escalated, which means that it is given in higher doses over a shorter period of time.

Find out more about chemotherapy for Hodgkin lymphoma.

Radiation therapy uses high-energy rays or particles to destroy cancer cells. External radiation therapy is used for HL. A machine directs radiation through the skin to the tumour and some of the tissue around it. External radiation therapy is also called external beam radiation therapy.

Doctors give radiation to the smallest area possible to help lower the risk of side effects. They will use different techniques to accurately target the area to be treated and spare as much surrounding normal tissue as possible. For early-stage HL, they will give radiation only to the lymph nodes where the cancer started and a very small amount of nearby tissue.

Radiation therapy is given after chemotherapy is finished.

Find out more about radiation therapy for Hodgkin lymphoma.

Talk to your healthcare team 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.