For Hodgkin lymphoma you have several chemotherapy drugs together during a course of treatment. Some chemotherapy combinations include a course of steroids. You usually have radiotherapy as well as chemotherapy for Hodgkin lymphoma.
A course of chemotherapy is made up of a number of cycles. At the beginning of each cycle you have treatment, usually over 1 to 3 days depending on the particular drugs. Then you have a break of a few weeks before another cycle begins. You don’t usually have to stay in hospital for treatment.
Specific Drugs and Drug Combinations Used in Hodgkin's Disease
The chemo regimens for Hodgkin disease combine several drugs because different drugs kill cancer cells in different ways. The combinations used to treat Hodgkin disease are often referred to by abbreviations that are easier to remember than the drugs’ full names. The most common regimen in the United States is a 4-drug combination called ABVD, which consists of:
- Adriamycin® (doxorubicin)
- Bleomycin
- Vinblastine
- Dacarbazine (DTIC)
1. Stanford V
- Doxorubicin (Adriamycin)
- Mechlorethamine (nitrogen mustard)
- Vincristine
- Vinblastine
- Bleomycin
- Etoposide
- Prednisone
2. BEACOPP
- Bleomycin
- Etoposide (VP-16)
- Adriamycin (doxorubicin)
- Cyclophosphamide (Cytoxan®)
- Oncovin® (vincristine)
- Procarbazine
- Prednisone
Possible Side Effects
All chemotherapy drugs have side effects but they vary from person to person. Some people have very few side effects at all. Your doctor can prescribe medicines to control or reduce side effects such as sickness or diarrhoea. It is important to remember that most effects are temporary. They will go away when your treatment is finished. All the drugs have different side effects so it is helpful to ask your doctor or nurse which are most common with the chemotherapy drugs you will have.
There are some side effects that are quite common with many chemotherapy drugs. These are:
- Low numbers of blood cells
- Feeling and being sick
- A sore mouth and mouth ulcers
- Hair loss or thinning
- Feeling tired and run down
- Diarrhoea
- Doxorubicin (also called Adriamycin)
- Bleomycin
- Etoposide (also called VP16)
- Vincristine (also called Oncovin)
- Dacarbazine
- Vinblastine
- Procarbazine
- Cyclophosphamide
- Mustine
If you are having medicines to control side effects and they are not working, do tell your doctor or chemotherapy nurse. There are lots of different anti sickness and anti diarrhoea medicines, for example. A different type may work better for you.
Serious Side Effects
Serious side effects can also occur and may vary depending on the specific drugs used. They include:
- Neutropenia is a severe drop in white blood cells. Neutropenia increases the chance for infection from suppression of the immune system and is a potentially life-threatening condition. Drugs known as granulocyte colony stimulating factor (G-CSF) are used to help boost white blood cell count. These drugs, which include filgrastim (Neupogen) and pegfilgrastim (Neulasta) can help lessen the risk for neutropenia occurrence and, if neutropenia does occur, to reduce its length and severity.
- Anemia is a lack of red blood cells. Erythropoietin stimulates red blood cell (hemoglobin) production and can help reduce or prevent this side effect. It is available as epoetin alfa (Epogen, Procrit) and darbepoetin alfa (AranespIn patients with cancer, these drugs should be used to only treat anemia associated with chemotherapy and to increase hemoglobin levels to no more than 12 g/dL. Treatment should stop as soon as chemotherapy is complete. These drugs may not be safe or appropriate for all patients.
- Infection. Patients must take precautions against infections (see "Infection Prevention" in Transplant section).
- Liver and kidney damage
- Abnormal blood clotting (thrombocytopenia)
- Allergic reaction
Long-Term Complications
Long-term complications include the following:
- Fatigue and general aches and pains are called somatic symptoms. Fatigue is especially common after chemotherapy and can even last for years.
- Many women stop menstruating after chemotherapy. The risk for infertility is highest for women with advanced stage Hodgkin’s disease who are treated after age 30. Studies indicate that the risk for infertility is higher with BEACOPP than with ABVD. Researchers are studying whether taking oral contraceptives during chemotherapy can reduce the risk.
- Bone thinning (osteoporosis) may be related to steroid treatments such as prednisone.
- Heart failure may occur with the use of anthracyclines (such as doxorubicin).
- Bleomycin (Blenoxane) is particularly toxic to the lungs. Vinblastine may also pose a risk when used in combination with radiation therapy.
Chemotherapy (usually ABVD) plus involved-field radiation, referred to as combined modality, is a common treatment approach for patients with more advanced-stage disease and for those who have early-stage bulky (large mass) disease. Chemotherapy with low-dose radiation is also used in children with excellent results, even for late stage cancer.