The treatment of Hodgkin lymphoma has advanced dramatically over the past several decades, resulting in one of the highest cure rates among cancers. Thanks to improvements in chemotherapy regimens, radiotherapy techniques, and targeted biological therapies, the prognosis for most patients is highly favourable. Selecting the appropriate treatment depends on factors such as disease stage, patient age and overall health, symptom presence, and lymphoma subtype.
Treatment begins after thorough diagnosis and review by a multidisciplinary team, ensuring a personalised plan focused on eradicating cancer while minimising side effects and preserving quality of life.
Chemotherapy
Chemotherapy is the cornerstone of Hodgkin lymphoma treatment. The most common regimen is ABVD, which includes Adriamycin (doxorubicin), Bleomycin, Vinblastine, and Dacarbazine. Doctors use ABVD for both early and advanced stages, giving it in cycles every two weeks. The total number of cycles depends on the disease severity and the patient’s response.
For more aggressive or relapsed disease, intensive regimens like BEACOPP or ESHAP may be used. These carry higher side effect risks but may be necessary for resistant cases.
Common chemotherapy side effects include nausea, fatigue, hair loss, lowered white blood cells, and increased infection risk. Doctors use supportive medications and growth factors to manage these effects, and they closely monitor patients throughout treatment.
Radiotherapy
Doctors often combine radiotherapy with chemotherapy, especially for early-stage Hodgkin lymphoma or bulky disease. They usually prefer involved-site radiotherapy (ISRT), which targets only the affected lymph nodes to minimise damage to healthy tissue.
Treatment usually involves daily sessions over 2–4 weeks. While painless, side effects can include fatigue, skin irritation, sore throat (if the neck is treated), and mild nausea.
Radiotherapy’s long-term risks—such as secondary cancers, fertility issues, and cardiovascular disease—are especially concerning for younger patients. Its use is carefully balanced to maximise benefit and reduce harm.
Targeted Therapy and Immunotherapy
Recent innovations include targeted therapies like Brentuximab vedotin, an antibody-drug conjugate that targets CD30 on Reed-Sternberg cells. This is particularly effective in relapsed or refractory cases, either alone or with chemotherapy.
Checkpoint inhibitors such as nivolumab and pembrolizumab enhance immune recognition of cancer cells, offering hope for patients unresponsive to standard therapies.
While often better tolerated than chemotherapy, these therapies may cause side effects including fatigue, rash, diarrhoea, and autoimmune reactions affecting organs like lungs, liver, or endocrine glands.
Stem Cell Transplant
For relapsed or refractory Hodgkin lymphoma, a stem cell transplant may be performed. This involves high-dose chemotherapy to eliminate cancer cells, followed by infusion of healthy stem cells to restore bone marrow.
Most transplants are autologous, using the patient’s own harvested stem cells. This procedure offers a chance for long-term remission but involves intensive treatment, prolonged hospitalization, and risks such as infection and organ toxicity.
Allogeneic transplants from donors are rarer due to higher complication rates but may be considered in select cases.
Fertility Preservation
Because chemotherapy and radiotherapy can impair fertility, discussions about preservation options—such as sperm banking, egg or embryo freezing, and ovarian tissue preservation—are critical before treatment, especially for adolescents and young adults. Fertility specialists typically collaborate with oncology teams to facilitate this.
Supportive Care and Monitoring
Supportive care throughout treatment helps manage side effects and maintain well-being. Antiemetics, pain management, and growth factors improve tolerability. Psychological support, counseling, and peer groups address anxiety, body image concerns, and fear of recurrence.
After treatment, patients enter surveillance with regular follow-ups including physical exams, blood tests, and occasional imaging to detect relapse early. Survivors are also monitored for late effects like secondary cancers, thyroid dysfunction, and cardiac disease.
Special Considerations for Children and Elderly
In children and adolescents, treatment aims to maximise cure rates while minimising long-term side effects by limiting radiotherapy and using the lowest effective chemotherapy doses. Elderly patients may require treatment modifications due to comorbidities and reduced tolerance, balancing effectiveness with quality of life.
Holistic and Lifestyle Support
Recovery extends beyond medical treatment. Patients are encouraged to maintain a healthy diet, stay physically active as tolerated, avoid tobacco and excess alcohol, and receive recommended vaccinations, including annual flu shots, due to immune compromise.
In conclusion, Hodgkin lymphoma treatment is highly effective and improving continuously. While chemotherapy and radiotherapy remain the foundation, targeted therapies and immunotherapy provide additional options, especially for resistant disease. With early diagnosis, multidisciplinary care, and comprehensive support, most patients achieve remission and enjoy full, healthy lives.
