Hodgkin's Lymphoma: Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells and shrink tumors. Chemotherapy is a well-established and widely used treatment for all cancers and most of us probably know someone who has undergone "chemo". It follows, then, that most of us also know that chemotherapy has serious side effects.

The side effects are largely due to the fact that, because chemotherapy is applied to the whole body (a "systemic" treatment), it not only destroys cancer cells in a specific location but harms many normal, noncancerous cells as well. Chemotherapy drugs are engineered to attack cells that divide rapidly. They do a good job of attacking metastasizing cancer cells but also damage rapidly dividing cells such as red and white blood cells, platelets, cells in the digestive lining and, as you might guess, hair follicles.

Many advances have been made (and are still underway) in chemotherapy over the years, and more and more drugs are becoming available to target specific kinds of cancer cells and to minimize side effects.

Undergoing "chemo," however, is still a difficult process for the patient. But for lymphoma patients--especially non-Hodgkin lymphoma patients--chemotherapy is often an essential treatment because the disease often spreads throughout the body.

Chemotherapy treatments for lymphomas vary widely depending on the patient and the stage of the disease. Drugs may be taken by pill, or administered via injection. A lymphoma patient may take only a single drug or undergo a regimen involving a combination of drugs. Two types of drug agents are routinely used for chemotherapy: alkylating agents and nucleosides.

Alkylating Agent: A cytotoxic (toxic to cells) agent that inhibits cell division by reacting with DNA.
Nucleosides: These inhibit DNA and RNA replication and thereby prevent cancer cells from growing.

These are no longer the only options as researchers continue to develop new drugs. In fact, there are countless possible treatment regimens because drugs are frequently used in combination. With so many variables it is very important to get second or even third opinions regarding the type and stage of your lymphoma and the recommended treatment.

Here we list some of the more prevalent treatments. The type of treatment depends on the patient and on the type and stage of lymphoma. Multiple treatments might also be necessary for some patients. This is by no means comprehensive and is only intended to present a broad outline.

The mainstream chemotherapy regimen is:

ABVD composed of 4 drugs:

Other treatments that may be used, especially for disease that is resistant to other treatments:

Non-Chemotherapy Options

Stanford V: Used by Stanford in California
Radiation Therapy: A 1997 study in the Annals of Oncology suggests that people who have stage III or stage IV Hodgkin's and only achieve partial remission with chemotherapy can have a high remission success rate with follow-up radiation therapy.
Bone Marrow Transplantation (BMT): BMT and peripheral blood stem cell transplantation (PBSCT) are the use of high doses of chemotherapy with a rescue of the immune system afterward.
Clinical Trials: Often used for people who are not responsive to conventional treatment or who wish to help researchers test new therapies. New research is underway to engineer chemotherapeutic agents that attack proteins inside cells rather than DNA.

Side Effects of Chemotherapy

Chemotherapy is tough on the body. The drugs attack the entire body and this can produce a variety of complications. Common side effects include nausea and vomiting, diarrhea, hair loss, weight loss, Depression, mouth sores, leukopenia (decreased white blood cell count; may lower resistance to infection)

Most of the above side effects are temporary and usually (though not always) not too serious. Potentially serious side effects may include neutropenia (a severe drop in white blood cells), anemia (decreased red blood cell count), peripheral neuropathy (nerve damage), liver and kidney damage, thrombocytopenia (abnormal blood clotting), allergic reaction, and tumor lysis syndrome (specific to bulky lymphomas–cells split apart and release fragments into the bloodstream).

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Note: "Hodgkin's lymphoma, "Hodgkin's disease" and "Hodgkin lymphoma" are used interchangeably on this site.

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