Treatment Options for Hodgkin’s Lymphoma

Hodgkin's disease is a relatively rare form of lymphoma, a kind of cancer that affects B- and T-cell lymphocytes. These cells play a vital role in the immune system, but the cancer causes them to rapidly grow out of control. Because the lymphatic system is so extensive, lymphoma can easily spread to other areas of the body, making treatment difficult. Nevertheless, both Hodgkin's and non-Hodgkin's lymphomas generally respond well to treatment if detected early.

Choices of treatment and the success of treatment will depend on a number of factors, including the patient's health, medical history, and age. The most important factor, though, will be the extent of the disease in the body, called its staging. The recommended treatment options for Hodgkin's lymphoma will vary based on this staging, which is typically represented by a scale of I to IV.

Stages I and II

If the cancer is detected on only one side of the diaphragm, treatment will depend on whether there are any unfavorable factors. These include the following:

• Bulky growths
• Multinodal (occurring in several locations)
• Fever
• Night sweats
• Weight loss

Favorable

If the diagnosis is favorable, the most common Hodgkin's treatment is chemotherapy, administered as two to four cycles of the ABVD regimen or eight weeks of the Stanford V regimen. This is followed by local radiation therapy at the site of the disease. An oncologist will usually order a PET/CT scan following treatment to assess the efficacy of the protocol, at which point additional steps might need to be taken

Unfavorable

For cases that involve unfavorable factors, the chemotherapy dosages may be increased to four to six cycles of ABVD or 12 weeks of Stanford V, again followed by radiation and a PET/CT scan.

Stages III and IV

At these stages, the best treatment option for Hodgkin's lymphoma is chemotherapy at full doses (ABVD for 6 or more cycles or 12 weeks of Stanford V). In the most severe instances, a doctor may order the BEACOPP regimen. If this is unsuccessful, the doctor may recommend a stem cell transplant.

Resistance and Recurrence

The goal of treatment, in any stage, is the complete removal of all cancerous cells. In followup tests, the doctor will look for any sign that such cells remain in the body. If they do, it is generally accepted that the disease will not respond to more of the same treatment. Instead, oncologists typically suggest a different combination of chemotherapy drugs or localized radiation treatments if such treatments had not already been tried. Radiation cannot be applied to the same area twice, no matter how much time passes between treatments. Stem cell transplants—either autologous (using one's own cells) or allogenic (using donor cells)—are usually the final option, in cases where no other treatment has proven effective.