What is chemotherapy?

Chemotherapy (chemo) is a treatment for cancer that uses medicines. These medicines work by destroying fast-growing cells in the body, such as cancer cells. Chemotherapy is an important part of treatment for most people with Hodgkin lymphoma, also called Hodgkin disease. For this treatment, you'll see a medical oncologist. This is a healthcare provider who specializes in using medicines to treat cancer.

How is chemotherapy given for Hodgkin lymphoma?

Chemotherapy is most often given by IV (intravenously) through a vein. It may also be taken by mouth as a pill. Or given as a shot (injection). The treatment may be done as an outpatient visit to a hospital. This means you go home the same day. Or it may be at your healthcare provider’s office, a chemotherapy clinic, or at home. In some cases, you may stay in the hospital during treatment.

You get chemo in cycles over a period of time. This means you take the medicine for a set amount of time. Then you have a rest period. Each period of treatment and rest is one cycle. You may have several cycles. Having treatment in cycles helps by:

• Killing more cancer cells. Chemotherapy mostly kills cancer cells while they're actively growing and dividing. Cancer cells aren't dividing all the time. So having more than one cycle of chemotherapy gives the treatment more chances to kill cancer cells.

• Giving your body a rest. Treatment is hard on other cells in your body that divide quickly. This includes cells in the lining of your mouth and stomach. Damage to these healthy cells causes side effects, such as mouth sores and an upset stomach (nausea). Between cycles, your body can get a rest from the chemotherapy. During this time your healthy cells can recover, and side effects can ease.

• Giving your mind a rest. Having chemotherapy can be stressful. Taking breaks between cycles can let you get an emotional break between treatments.

What are common chemotherapy combinations used to treat Hodgkin lymphoma?

For Hodgkin lymphoma, your healthcare provider is likely to give you more than one medicine. This is called combination chemotherapy. Many different kinds of chemotherapy are used to treat Hodgkin lymphoma. The combinations are usually referred to by acronyms created by using the first letter of each of the medicines used. The most common combination used to treat Hodgkin disease is ABVD. ABVD stands for:

• A - Adriamycin (doxorubicin)

• B - Blenoxane (bleomycin)

• V - Velban, Velsar (vinblastine)

• D - DTIC (dacarbazine)

A regimen called AAVD, a variation of the ABVD regimen, may be used. It's the same as the ABVD regimen, but Adcetris (brentuximab vedotin) is used instead of Blenoxane (bleomycin).

Another combination used is called BEACOPP. BEACOPP stands for:

• B - Bleomycin

• E - Etoposide

• A - Adriamycin (doxorubicin)

• C - Cyclophosphamide

• O - Oncovin, Vincasar PFS (vincristine)

• P - Procarbazine

• P - Prednisone

A combination chemotherapy often given with radiation therapy (after the chemo) is called Stanford V. It includes these medicines: 

• Doxorubicin (Adriamycin)

• Mechlorethamine (nitrogen mustard)

• Vincristine

• Vinblastine

• Bleomycin

• Etoposide

• Prednisone

What are common side effects of chemotherapy?

Chemotherapy medicines are designed to attack and kill cells that divide quickly, including lymphoma cells. These medicines can also affect normal cells that divide quickly. These include hair, nails, the lining of your mouth and GI (gastrointestinal) tract, and bone marrow cells where new blood cells are made. Chemo side effects are different for everyone. They depend on:

• The type of medicines you get

• How often you get them

• How long your treatment lasts

• Your age, overall health, and other factors

Your medical oncologist and chemotherapy nurse will talk with you about possible side effects with your treatment. Some common side effects for the chemotherapy medicines most often used for Hodgkin lymphoma include:

• You don't feel like eating

• Easy bruising or bleeding, due to a lack of blood cells (platelets) that cause clotting

• Hair loss

• Infection, from low white blood cell counts

• Mouth sores

• Nausea and vomiting

• Loose stool or diarrhea

• Tiredness, from a lack of red blood cells (anemia)

• Tingling or numbness in fingers or toes because of nerve damage (peripheral neuropathy)

There are medicines that can help reduce (and sometimes prevent) many of these side effects and help you recover from chemo more quickly. Most of these side effects go away over time after treatment ends.

Some chemo medicines can cause long-term or late side effects. Before treatment, your healthcare provider may test how well your heart and lungs are working. This is done because some chemo medicines can affect these organs. So your healthcare provider will watch them closely. Tell your healthcare provider about any new symptoms, especially:

• Shortness of breath with walking or when lying down

• Chest pain

• Coughing

• Swelling in your legs or feet

Some chemo medicines might raise your risk for getting another type of cancer later. Another side effect is a risk of not being able to have a child (infertility). If this is a concern for you, talk with your healthcare provider about your choices before you start treatment.

Working with your healthcare provider

It's important to know which medicines you're taking. Write your medicines down. Ask your healthcare team how they work, and what side effects they might have. Keep a written record of your treatment schedule and any signs or symptoms you have. Talk with your healthcare providers about what signs to look for, and when to call them. Be sure you know how to get help after office hours, and on weekends and holidays.

It may also be helpful to keep a record of your side effects. Write down physical and emotional changes you notice. And changes in your thoughts, too. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your medical team to manage your side effects.