Treatments for relapsed or refractory Hodgkin lymphoma

Relapsed (recurrent) Hodgkin lymphoma (HL) means that the cancer has come back after it was treated. Refractory HL means that the cancer didn’t completely respond to treatment or it kept growing during treatment.

When relapsed or refractory HL is found, your healthcare team will order tests to find out where it is in the body and to check your overall health. These tests are often the same as the ones you had when you were first diagnosed.

Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan. The treatments offered will depend on where the HL is in the body, how long it has been since it was first treated and which treatments you have already been given.

The following are treatment options for relapsed or refractory HL.

Chemoimmunotherapy combines chemotherapy with an immunotherapy drug. Chemotherapy uses drugs to destroy cancer cells. Immunotherapy helps strengthen or restore the immune system’s ability to find and destroy cancer cells.

The types of immunotherapy drugs used with HL are antibody drug conjugates (ADCs) and immune checkpoint inhibitors. These are combined with standard chemotherapy drugs that have been used for HL.

Chemoimmunotherapy may also be used as part of a stem cell transplant.

The same combination of chemoimmunotherapy drugs are given to treat relapsed HL, if the cancer had responded well to them when they were first given.

Find out more about chemoimmunotherapy for Hodgkin lymphoma.

If HL responded well to a combination of chemotherapy drugs the first time that the drugs were given, you may be given the same combination if HL relapses. Your healthcare team may also use a different combination of chemotherapy drugs to treat relapsed or refractory HL:

• GDP – gemcitabine, dexamethasone and cisplatin
• DICEP – dexamethasone, cyclophosphamide, etoposide, cisplatin and mesna
• DHAP – dexamethasone, cytarabine and cisplatin
• ICE – ifosfamide, carboplatin and etoposide
• ESHAP – etoposide, methylprednisolone, cytarabine and cisplatin

Chemotherapy may also be given to relieve symptoms of relapsed or refractory HL and improve quality of life (called palliative chemotherapy).

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.

You may be offered radiation therapy to treat relapsed or refractory HL that is in only 1 area of lymph nodes, and you haven’t been given radiation therapy in that area. It may be given alone or with combination chemotherapy.

Radiation therapy may also be used to prepare for a stem cell transplant or to treat symptoms such as pain and improve quality of life (called palliative radiation therapy).

Find out more about radiation therapy for Hodgkin lymphoma.

A stem cell transplant replaces stem cells.

An autologous stem cell transplant may be offered for relapsed or refractory HL. After a stem cell transplant, you may be offered consolidation therapy with the immunotherapy drug brentuximab vedotin (Adcetris). Consolidation therapy is given after a stem cell transplant to destroy any HL that remains in the body and reduce the risk of recurrence.

If HL comes back after an autologous stem cell transplant, some people may be offered an allogeneic stem cell transplant.

Find out more about stem cell transplant for Hodgkin lymphoma.

Immunotherapy helps strengthen or restore the immune system’s ability to find and destroy cancer cells. It may be offered for relapsed or refractory HL when:

• it has come back after a stem cell transplant
• you can’t have a stem cell transplant or more chemotherapy or chemoimmunotherapy treatments

The immunotherapy drugs used for relapsed or refractory HL are:

• pembrolizumab (Keytruda)
• nivolumab (Opdivo)

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.

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.