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This comprehensive booklet for people with Hodgkin lymphoma, their families, and caregivers includes a glossary of terms and details on what to expect during each stage of diagnosis, treatment, and follow-up care.
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Treatment for Hodgkin lymphoma is changing due to new drugs and research findings from clinical trials. Therefore, before treatment begins, it is important to consider getting a second opinion from a hematologist-oncologist who is experienced in treating patients with Hodgkin lymphoma or works in consultation with a lymphoma specialist.
For many people with Hodgkin lymphoma, starting treatment helps them focus on moving ahead and looking forward to recovery. Hodgkin lymphoma is considered one of the most curable forms of cancer.
The information on this page covers treatment for adults with Hodgkin lymphoma. Visit childhood Hodgkin lymphoma to learn about signs and symptoms, diagnosis, and treatment information for children with Hodgkin lymphoma.
Pretreatment considerations
Fertility concerns
While many treatments for Hodgkin lymphoma have no or little adverse effects on future fertility, some cancer treatments can limit a person's ability to conceive or have a baby. Adults of childbearing age and parents of children diagnosed with Hodgkin lymphoma should ask their doctors for information on what may lessen the risk of infertility.
See our free publication, Fertility and Cancer (PDF), for more details.
Pregnancy
Because Hodgkin lymphoma primarily affects adolescents and young adults, it is one of the most common types of cancer diagnosed during pregnancy. If a person is pregnant when diagnosed with Hodgkin lymphoma, the treatment options depend on several factors, including:
- The trimester at the time of diagnosis
- The stage and aggressiveness of the disease
- Whether or not the patient has life-threatening symptoms
Patients should work with their hematologist-oncologist and a high-risk obstetrician.
If possible, treatment should be delayed until at least the second trimester (the second three months of pregnancy), because the risks of treatment to the fetus are greatest during the first trimester.
For patients in their second and third trimesters, doctors may consider delaying treatment until after delivery of the baby, if they determine that a delay in therapy would not impair the patient’s health. Combination chemotherapy regimens with non-antimetabolite drugs, given after the first trimester, appear to be safe for both the pregnant person and the baby.
Other treatment choices include symptom management with corticosteroids or vinblastine alone until the time of delivery. Treatment choices for pregnant patients with HL must be individualized, taking into consideration the patient’s wishes, the symptoms and stage of the disease, and the length of time until delivery can occur safely. The timing of delivery should be carefully planned by the treatment team.
Learn more about the impact Hodgkin lymphoma treatment may have on fertility and reproductive health.
Treatment planning
The goal of Hodgkin lymphoma treatment is to cure the disease. About 80 percent of all patients diagnosed with Hodgkin lymphoma can be cured by current treatment approaches. The cure rate is higher, approaching 90 percent, in younger patients with early-stage favorable disease. Even if disease recurs, many patients can be cured with further treatment.
Most patients become long-term survivors of the disease.
Treatment goals aim to:
- Cure at all stages
- Minimize both short-term and long-term side effects and complications
- Weigh the risks of side effects against treatment benefits
The treatment your doctor recommends is based on several factors, including:
- Your disease subtype
- Your disease stage and category
- Whether your disease is either refractory (the disease does not respond to treatment) or relapsed (the disease has recurred after treatment)
- Your age
- Whether you have coexisting diseases or conditions (e.g., heart disease, kidney disease, or diabetes)
You may find it helpful to bring a loved one with you to your doctor's visits for support, to take notes and to ask follow-up questions. It's a good idea to prepare questions in advance that you would like to ask when you visit your doctor. You can also record your conversations with your doctor and listen more closely when you get home.
Learn more about communicating with your blood cancer specialist or find a list of suggested questions to ask your healthcare providers.
Types of treatment for Hodgkin lymphoma
Doctors use several types of approaches and treatment combinations for adults and children with Hodgkin lymphoma:
Chemotherapy is the most common treatment for Hodgkin lymphoma. A combination chemotherapy regimen consists of two or more chemotherapy drugs.
Chemotherapy is usually given in cycles. Each cycle is made up of a number of treatment days followed by a rest period (a few days or weeks) in between each cycle. Then another cycle begins. Generally, a treatment cycle is three to four weeks long. Some patients may have to stay in the hospital for a short time if they develop a fever or have other signs of infection. Some patients who need antibiotics may stay in the hospital until the infection is gone.
Some chemotherapy combinations
Early-stage classical Hodgkin lymphoma (cHL)
- ABVD: Adriamycin® (doxorubicin), bleomycin, vinblastine, dacarbazine
- Dose-escalated BEACOPP: Bleomycin, etoposide, Adriamycin® (doxorubicin), cyclophosphamide, vincristine, procarbazine, prednisone
- AVD: Adriamycin® (doxorubicin), vinblastine, dacarbazine
Combination chemotherapy is administered with or without radiation therapy. Radiation can be used at the end of a chemotherapy regimen depending on how well the patient responded to the chemotherapy.
Advanced-stage cHL
- A+AVD: Adcetris® (brentuximab vedotin), Adriamycin® (doxorubicin), vinblastine, dacarbazine
- ABVD
- ABVD followed by escalated BEACOPP
- BrECADD: brentuximab vedotin, etoposide, cyclophosphamide, doxorubicin, dacarbazine, dexamethasone
- Escalated BEACOPP
- N+AVD: nivolumab (Opdivo®) + AVD
Occasionally, chemotherapy is followed by involved-site radiation therapy (ISRT).
For information about the drugs listed on this page, visit our cancer drug listing.
Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells in a small, targeted area of the body. Since radiation can also harm normal cells, whenever possible, radiation therapy is directed only at the affected lymph node areas in order to reduce the long-term side effects.
Involved-site radiation therapy (ISRT)
ISRT is sometimes used to treat Hodgkin lymphoma. It selectively treats the lymph nodes where the cancer started and the cancerous masses near those nodes. With a special machine, carefully focused beams of radiation are directed at the cancer. This is also called “external beam therapy” (EBT). The size of the targeted area is restricted to minimize radiation exposure to adjacent, uninvolved organs, and to decrease the side effects associated with radiation therapy.
With careful planning, the exposure of uninvolved organs can be either reduced or avoided during radiation therapy. Magnetic resonance imaging (MRI), positron emission tomography-computed tomography (PET-CT), and other specialized imaging techniques can enhance treatment planning.
Learn more about radiation therapy.
Stem cell transplantation is a procedure in which patients receive healthy stem cells to replace their own stem cells that have been destroyed by cancer or cancer treatments. The goal of stem cell transplantation is to cure the patient by destroying the cancer cells with high doses of chemotherapy and then to help the body start a new supply of blood cells.
Stem cell transplantation is higher risk than chemotherapy alone or in combination with radiation therapy. The effectiveness of therapies for newly diagnosed Hodgkin lymphoma patients has reduced the need for stem cell transplantation and it isn't recommended for initial treatment of Hodgkin lymphoma patients. However, it may provide a cure for patients with disease that is relapsed (returned after treatment) or refractory (does not respond to treatment).
The two types of stem cell transplantation are:
- Autologous stem cell transplantation A procedure in which stem cells are removed from a patient, frozen and stored, and then returned to the patient’s bloodstream after intensive chemotherapy. In almost all cases, this is the type of stem cell transplantation used to treat Hodgkin lymphoma. It remains the standard therapy for relapsed and refractory cases of Hodgkin lymphoma.
- Brentuximab vedotin is also sometimes given to treat patients before transplant or administered in select patients as maintenance treatment after autologous stem cell transplantation
- Allogeneic stem cell transplantation treatment that uses stem cells from a matched donor. This type of transplantation has been successful in some patients with Hodgkin lymphoma after several relapses of the disease, but it is not commonly used as a treatment for Hodgkin lymphoma. Generally, it is only done if the disease relapses after an autologous transplantation.
Learn more about stem cell transplantation.
Taking part in a clinical trial may be the best treatment choice for some Hodgkin lymphoma patients. Clinical trials are underway to develop treatments that increase the remission rate or cure the disease. Today's standard treatments for cancer are based on earlier clinical trials. LLS continues to invest funds in Hodgkin lymphoma research.
Read more about clinical trials.
Get free clinical trial support! Visit our Clinical Trial Support Center (CTSC).
Connect with registered nurses with expertise in blood cancers who can personally assist you or your caregiver through each step of the clinical trial process.
Treatment response monitoring
During treatment, patients need to be monitored to check their response to therapy. Response to treatment is important in predicting long-term outcomes. Patients who do not reach complete remission with first-line treatment have a worse prognosis, so there is great value in identifying these patients early in the course of their disease.
Imaging tests are used to distinguish between tumor and scar tissue. PET-CT scans help doctors determine if the disease is responding to treatment. PET-CT has become the standard method for assessment of treatment response in most types of lymphoma.
Minimal/measurable residual disease (MRD)
MRD refers to cancer cells that may remain in the body after treatment ends. Besides PET-CT scans, there are other methods to identify residual disease under study that may be used to complement these imaging techniques.
Learn more about blood cancer tests that help doctors identify MRD:
An Introduction to Molecular Profiling
Learn about molecular profiling, how doctors conduct these tests, and how it can be used to treat Hodgkin lymphoma.
Hodgkin lymphoma treatment side effects
Cancer treatment for Hodgkin lymphoma can produce side effects. The goal of treatment is to kill the cancer cells, but cancer treatments can damage healthy cells too, which causes side effects.
Patients react to treatments in different ways. Some patients may have very mild side effects while other patients may have more severe side effects, sometimes requiring hospitalization. For most patients, treatment side effects are temporary and go away once therapy ends.
Before you start treatment, talk with your doctor about potential side effects. There are drugs and other therapies that can prevent or manage many side effects. Always tell your healthcare team about any side effects you experience.
Also, speak with your doctor about long-term and late effects of treatment and how treatment can affect fertility.
Learn more about the long-term and late effects of treatment.
Hodgkin lymphoma and treatment can make patients more susceptible to infections because these treatments weaking immune cell function and can lower the number of normal white blood cells.
Infections can be very dangerous. It is very important to take fevers seriously and to go to the hospital if you have a fever of or over 100.4°F.
Hodgkin lymphoma patients are advised to get certain vaccinations once they have finished their treatment, including vaccinations for pneumococcal pneumonia and influenza. There are two types of pneumococcal vaccines available for adults: a pneumococcal polysaccharide vaccine (PPSV23) and a pneumococcal conjugate vaccine (PCV13).
Immunizations using "live" vaccines, such as the herpes zoster or shingles vaccine, should not be administered. Patients who have HL can receive the shingles vaccine Shingrix® because it is an “inactivated” rather than a “live” vaccine. COVID-19 vaccines are also recommended. Speak to your doctor for more information.
To learn more, view, download or order our free guide, Side-Effect Management: Reducing Your Risk of Infection (PDF).
Learn more about infections, iron overload, or low blood counts and how to manage them.
Blood cell counts are often low in patients who are treated with chemotherapy. Chemotherapy is toxic to healthy cells in the bone marrow and may cause a severe deficiency of:
- Red blood cells, resulting in a condition called “anemia”
- Platelets, resulting in a condition called “thrombocytopenia”
- White blood cells
- Neutrophil deficiency results in a condition called “neutropenia”
- Monocyte deficiency results in a condition called “monocytopenia”
If the number of white blood cells (particularly the type called “neutrophils”) drops severely and for an extended time, patients may develop infections that require antibiotic treatment and possible hospitalization.
White blood cell growth factors may be part of treatment. The body needs neutrophils (white blood cells) to fight infection. Neupogen® (filgrastim) or Neulasta® (pegfilgrastim), both also called granulocyte-colony stimulating factor (G-CSF), and Leukine® (sargramostim), also called granulocytemacrophage colony stimulating factor (GM-CSF) can increase the number of neutrophils (white blood cells).
To learn more, view, download or order Side-Effect Management: Managing Low Blood Cell Counts (PDF).
Learn more about infections or low blood counts and how to manage them.
While many treatments for Hodgkin lymphoma have no or little adverse effect on future fertility, some cancer treatments can limit a person’s ability to conceive or have a baby. Adults of childbearing age and parents of children diagnosed with Hodgkin lymphoma should ask their doctors for information that may help lessen the risk of infertility. It may be helpful to speak to a fertility specialist before starting treatment.
Learn more about the impact Hodgkin lymphoma treatment may have on fertility and reproductive health.
Side effects from chemotherapy and radiation therapy vary from person to person. Many side effects appear shortly after the start of treatment but stop once treatment is completed. The side effects a patient experiences depend on:
- The dose and type of chemotherapy
- The location of radiation therapy
- Age
- Overall health or diagnosis of any chronic health conditions (e.g., diabetes or kidney disease)
Treatment with chemotherapy and/or immunotherapy drugs may cause:
- Mouth sores
- Nausea
- Vomiting
- Acid reflux
- Bloating
- Constipation
- Diarrhea
- Appetite changes
- Taste changes
- Extreme fatigue
- Neuropathy (numbness and pain, usually in the hands or feet)
- Muscle or joint pain
- Fever
- Cough
- Shortness of breath
- Cognitive issues (“chemo brain”)
- Hair loss
- Rash or itchiness
Side effects of radiation therapy depend on the area treated. Fatigue and skin in the treated area that is red, dry, sore, or painful are common. Treatment to the head and neck may cause mouth sores, dry mouth, or changes in taste. Chest radiation can cause cough or difficulty swallowing. Radiation to the abdomen can cause nausea, vomiting, diarrhea, and cramps.
Allogenic stem cell transplantation can cause graft-versus-host disease.
Learn more about Hodgkin lymphoma treatment side effects and how to manage them.
Long-term and late effects of treatment
Long-term effects: Side effects of treatment that may last for months or years after treatment ends. Fatigue is an example.
Late effects: Side effects of treatment that may not show up until years after treatment ends. Heart disease is an example.
Not everyone who is treated for Hodgkin lymphoma develops long-term or late effects. It depends on the patient's age, overall health, and specific treatment. You should talk to your doctors about any long-term or late effects that you think may be related to treatment.
Learn more about the long-term and late effects of treatment.
Relapsed and refractory Hodgkin lymphoma
Most patients with classical Hodgkin lymphoma are cured by their initial (first-line) treatment; however,in some patients—especially those with advanced-stage Hodgkin lymphoma—the disease comes back.
- Relapse means the disease comes back after a remission following treatment
- Refractory means the disease has not responded to treatment.
For these patients, Hodgkin lymphoma is still potentially curable.
Treatment of relapsed or refractory Hodgkin lymphoma
Some treatment approaches for relapsed or refractory cHL include the following (a biopsy may be done before these treatments can begin):
- Additional drug combinations
- BeGEV (gemcitabine/bendamustine/vinorelbine)
- Bendamustine (Bendeka®)
- Bendamustine + carboplatin + etoposide
- Brentuximab vedotin (Adcetris®)
- Brentuximab vedotin + bendamustine
- Brentuximab vedotin + nivolumab (Opdivo®)
- DHAP (dexamethasone, cisplatin, high-dose cytarabine)
- Everolimus (Afinitor®)
- GCD (gemcitabine, cisplatin, dexamethasone)
- GEMOX (gemcitabine, oxaliplatin)
- GVD (gemcitabine, vinorelbine, liposomal doxorubicin)
- GVD + pembrolizumab (Keytruda®)
- ICE (ifosfamide, carboplatin, etoposide)
- ICE + brentuximab vedotin (Adcetris®)
- ICE + nivolumab (Opdivo®)
- ICE + pembrolizumab (Keytruda®)
- IGEV (ifosfamide, gemcitabine, vinorelbine)
- Lenalidomide (Revlimid®)
- Nivolumab (Opdivo®)
- Pembrolizumab (Keytruda®)
- Vinblastine
- Stem cell transplantation
- Clinical trial
For information about the drugs listed on this page, visit our cancer drug listing.
Follow-up care
Follow-up medical care is important for every Hodgkin lymphoma patient. Follow-up care helps the doctor monitor you to see if disease has recurred or relapsed, or to see if more treatment is needed. Talk to your doctor about how often to have follow-up visits and what laboratory tests, scans, or other imaging you need. It is important to get a record of your cancer treatment, including the drugs you received, so that your doctor can follow up on specific long-term effects that may be associated with your treatment.
Find more information about follow-up care, including what to expect, long-term and late effects of treatment, survivorship clinics, and other resources, such as The National Comprehensive Cancer Network (NCCN) treatment guidelines.
Use the Survivorship Workbook to collect all the important information you need throughout diagnosis, treatment, follow-up care, and long-term management of a blood cancer.
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