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Chemotherapy (chemo) is the use of drugs to kill cancer cells. Chemo is usually injected into a vein under the skin or taken as a pill. Chemo drugs enter the bloodstream and travel throughout the body to reach and destroy cancer cells wherever they may be.

Chemo is at least part of the main treatment for most people with Hodgkin lymphoma (other than some people with nodular lymphocyte-predominant Hodgkin lymphoma, or NLPHL). Sometimes it might be used along with an immunotherapy medicine, and sometimes chemo is followed by radiation therapy.

How is chemo given?

Chemo is given in cycles that include a period of treatment followed by a rest period to give the body time to recover. In general, each cycle lasts for several weeks.

Most chemo treatments are given in the doctor’s office, clinic, or hospital outpatient department, but some may require a hospital stay.

Which chemo drugs are used to treat Hodgkin lymphoma?

Chemo for classic Hodgkin lymphoma (cHL) combines several drugs because different drugs kill the cancer cells in different ways. The most common combinations used to treat cHL are often referred to by abbreviations:

ABVD

• Adriamycin (doxorubicin)
• Bleomycin
• Vinblastine
• Dacarbazine (DTIC)

AVD, which is the same regimen but without the bleomycin, is often combined with another drug such as brentuximab vedotin (Adcetris) or nivolumab (Opdivo).

BEACOPP

• Bleomycin
• Etoposide (VP-16)
• Adriamycin (doxorubicin)
• Cyclophosphamide
• Oncovin (vincristine)
• Procarbazine
• Prednisone

BrECADD

• Brentuximab vedotin (see below)
• Etoposide
• Cyclophosphamide
• Adriamycin (doxorubicin)
• Dacarbazine
• Dexamethasone

Radiation therapy is sometimes given after chemo.

Other chemo combinations can also be used for HL. Most use some of the same drugs listed above, but they might include different combinations and be given on different schedules.

A drug that is sometimes thought of as chemo is brentuximab vedotin (Adcetris). This is an antibody-drug conjugate (ADC), which is a monoclonal antibody attached to a chemo drug. For more on this drug, see Immunotherapy for Hodgkin Lymphoma.

Possible side effects of chemo

Chemo drugs can cause side effects. These depend on the type and dose of drugs given and how long treatment lasts.

Common short-term side effects include:

• Hair loss
• Mouth sores
• Loss of appetite
• Nausea and vomiting
• Diarrhea
• Increased chance of infection (from having too few white blood cells)
• Easy bruising or bleeding (from having too few blood platelets)
• Fatigue (from having too few red blood cells)

These side effects usually go away over time after treatment ends. If serious side effects occur, chemo may have to be delayed or the doses reduced.

Be sure to tell your doctor or nurse if you do have side effects. There are often ways to help with them. For instance, drugs are often used to help prevent nausea and vomiting.

Late or long-term side effects: Some chemo drugs can have long-lasting side effects. Some of these might not occur until months or even years after treatment has ended. For example:

• Doxorubicin can damage the heart, so your doctor may order tests to check your heart function before and during treatment with this drug.
• Bleomycin can damage the lungs, so some doctors order tests of lung function (called pulmonary function tests) before starting patients on this drug.
• Some chemo drugs can increase the risk of getting a second type of cancer later in life (such as leukemia), especially in patients who also get radiation therapy.
• In children and young adults, some chemo drugs can also affect body growth and fertility (ability to have children) later on.

Long-term effects are discussed in more detail in Living as a Hodgkin Lymphoma Survivor.

Before starting chemo, ask your doctor to explain possible side effects and your chances of having them. Also ask what you can do to help prevent them.