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How We Treat Hodgkin Lymphoma


  • Lymphoma specialist Ann LaCasce, MD, MMSc, discusses lymphoma and its treatment

  • Our Unique Approach

    Your care will involve the best treatments currently available, combined with new therapies based on research in our laboratories and elsewhere in the field of lymphoma treatment. We carefully consider an array of therapy options, including chemotherapy, radiation therapy, stem cell transplant, targeted therapies, immunotherapy, and clinical trials — many of which were developed by scientists in our own laboratories.

    The Adult Lymphoma Program at Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC) is part of Dana-Farber/Brigham and Women's Center for Hematologic Oncology, one of the world's largest and most respected treatment centers for patients with disorders of the blood or bone marrow. Hematological disorders can take many different forms, and your DF/BWCC care team has specialized knowledge in treating the various manifestations of lymphoma.

    Our laboratory-based work in lymphoma biology informs the use of new approaches to interfering with the pathways and abnormalities that drive lymphoma growth and survival. Each day, we work to translate findings in the laboratory into novel, less toxic treatments.

    Multidisciplinary Team

    At DF/BWCC's Adult Lymphoma Program, our experts manage your diagnosis and treatment plan as a close-knit team in order to decide which approach will best treat your particular disease at each stage. Because we are a highly specialized center, your testing, care, and follow-up are coordinated from your first appointment.

    Your care team includes oncologists, radiation oncologists, stem cell transplant physicians, oncology nurses, nurse practitioners, research scientists, psychiatrists, nutritionists, and social workers. All of these team members work together to make sure your care is as seamless as possible.

    At our weekly lymphoma forum, specialists meet and discuss every new case. These specialists review your care plan to reach a consensus recommendation, which we share with you. We review particularly challenging cases at a division-wide conference with members from across specialty areas. They have expertise in standard therapies and emerging therapies and work to ensure that your care plan offers the best possible outcomes.

    Personalized Treatment

    As a highly specialized program within DF/BWCC's Center for Hematologic Oncology, we focus on the distinct needs of patients with lymphoma. We provide a very personalized approach to your care. For example, if you are likely to have a specific side effect from a treatment, we take care to tailor your therapy to keep your quality of life at the center of the treatment plan.

    We view every patient as an individual, with unique needs and expectations. We take time to involve you and your family in each step of the treatment process. As you go through treatment phases, you and your family will have access to a wide range of support resources — from nutrition services to integrative therapies.

    Offering Expertise through Second Opinions

    • We believe there is great value for patients with suspected or diagnosed Hodgkin lymphoma to receive a second opinion. Many times, our pathologists render a different diagnosis from that of the referring doctor.
    • We routinely evaluate specimens sent to us from outside centers. These specimens are evaluated by our entire team, including our expert hematopathologists.

    Reasons to consider a second opinion include:

    • To confirm your diagnosis.
    • If you have received a diagnosis elsewhere and want to be treated at Dana-Farber/Brigham and Women's Cancer Center.
    • To determine the optimal therapy and timing of treatment.
    • To learn more about your cancer from specialists who are world leaders in this disease, and who have treated hundreds of other patients like you.
    • To learn if you're eligible for a clinical trial.

    Phone: 877-442-DFCI or 877-442-3324

    Online: Complete the Appointment Request Form.

    If you cannot travel to Boston in person, you can take advantage of our Online Second Opinion service.

    For Referring Physicians

    Because you, the referring physician, are an integral part of your patient's care team, we are committed to collaborating with you to provide the best care for your patient.

    If you are a physician and have a patient with diagnosed or suspected Hodgkin lymphoma, we look forward to working with you. Learn how to refer a patient.

    Treatment Approach

    A distinguishing area of our expertise is determining how to integrate therapies, including:

    • Identifying the optimal cycles of chemotherapy.
    • Whether to change the combination of drugs during certain cycles.
    • Whether to add radiation and/or biologic therapy.

    This is a highly complex process that requires deep expertise, and we continually reassess your treatment plan as your therapy progresses.

    We closely monitor you for treatment-related toxicities to ensure that the potential side effects from your therapy impact your life, hobbies, work, and interests as little as possible. Certain treatments may also heighten the risk of contracting disease (such as a secondary malignancy or heart disease) in the future. We are careful to factor this into treatment plans, especially for younger patients. We bring promising new therapies to patients in a carefully monitored setting.

    • As part of your long-term treatment plan, we will screen you for possible side-effects from treatment, such as heart disease and diabetes.
    • We will work with your primary care doctor to reduce these risks as much as possible.

    Treatment for Hodgkin Lymphoma

    Today, patients have a number of therapy options that are very effective in treating Hodgkin lymphoma, including different forms of chemotherapy, radiotherapy, newer targeted drugs, and immunotherapy.

    We carefully consider the decision about when and how to use a particular treatment, and for how long. The decision is based on the stage of your disease, biological factors, symptoms, likely progression of the disease, other medical conditions, and your own preference.

    For pregnant women with Hodgkin lymphoma, treatment is carefully chosen to protect the fetus. Treatment decisions are based on the mother's wishes, the stage of the Hodgkin lymphoma, and the age of the fetus.

    Treatments can include:

    Chemotherapy-Based Regimens

    Combination chemotherapy (treatments combining several chemotherapy drugs) is the backbone of Hodgkin lymphoma therapy, regardless of the stage. Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells by either eliminating the cells or stopping them from dividing. Most of the drugs are given into the vein (intravenous, IV).

    Chemotherapy regimens for Hodgkin lymphoma include:

    • ABVD: Adriamycin (doxorubicin), bleomycin, vinblastine, and dacarbazine. This is the most common chemotherapy regimen at DF/BWCC.
    • BEACOPP: bleomycin, etoposide, Adriamycin, cyclophosphamide, Oncovin, procarbazine, and prednisone.

    Immunotherapy

    The use of therapies that spur the immune system to attack cancerous lymphocytes is showing considerable promise. Newer immunotherapy agents used for some Hodgkin lymphoma include nivolumab, pembrolizumab, and brentuximab.

    Radiation Therapy

    Radiation therapy (radiotherapy) is sometimes incorporated as part of early-stage Hodgkin lymphoma therapy. Radiation therapy may also be used in more advanced stages on parts of the body where there are "bulky" sites of the disease. Whether to use radiation therapy or not is an important part of the treatment decision, which your physician will discuss with you.

    Our specialists have developed techniques to determine the radiation dose and volume that will give you the maximum chance of a cure while minimizing long-term effects. Radiation therapy is highly individualized to determine the appropriate radiation therapy, treatment sites, and dose for each patient.

    • Short-term side effects of radiation therapy can include: skin redness and irritation, temporary hair loss, fatigue, mouth sores/sore throat/taste changes, dry mouth, nausea/vomiting, and diarrhea/cramps.
    • Late side effects of radiation therapy can include: cataracts, dry eyes and mouth, hypothyroidism, lung scarring, heart disease, sterility, and a second malignancy.

    Stem Cell Transplantation

    Stem cell transplantation is sometimes used for recurrent Hodgkin lymphoma (when the cancer returns after conventional therapy) that has not responded to initial treatment. Dana-Farber/Brigham and Women's Cancer Center has one of the largest and most experienced stem cell transplantation programs in the country.

    The vast majority of stem cell transplants for Hodgkin lymphoma are autologous (using your own stem cells). Our lymphoma team is part of the transplant division, and we conduct our own stem cell transplants, allowing for highly coordinated care.

    Adjunctive radiotherapy may be used either before or after the autologous stem cell transplant. This treatment aims to lower the risk that the cancer will come back.

    Investigational Approaches

    The Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC) Adult Lymphoma Program operates a large and growing research program. We have approximately 25 clinical trials actively enrolling patients for the treatment of both newly diagnosed and relapsed/refractory lymphomas.

    The goals of all our clinical trials are to increase the number of patients entering into remissions — particularly complete remissions — and to increase the duration of these remissions. Another goal of the program's clinical research effort is to make the treatment of lymphoma more effective and specific, while also less toxic.

    Clinical trials provide a range of treatment options, including clinical trials of new chemotherapy combinations for patients in all stages of Hodgkin lymphoma using new drugs in development and immunotherapies (therapies designed to harness the immune system).

    A clinical trial of nivolumab, which is a type of immunotherapy, has prompted the U.S. Food and Drug Administration (FDA) to designate it a "breakthrough therapy" for treating relapsed Hodgkin lymphoma. Pembrolizumab was also recently approved by the FDA for relapsed and refractory Hodgkin lymphoma. The therapy targets the immune response, reactivating the T cells in the neighborhood of the tumor cells.

    Relapsed Disease

    Relapses can occur, but fortunately, effective treatments exist, and the disease may be curable even after recurrence or relapse following initial treatment. There are a number of recently approved therapies, such as nivolumab, pembrolizumab, and brentuximab.

    A large and expanding number of other effective treatment options is available, and you will have the opportunity to speak with your physician about which regimen is most appropriate for you.

    Once treatment starts for relapsed disease, you will be monitored closely for evidence that the treatment is working. Adjustments are made to enhance its effectiveness and your tolerance for the therapy.

    New Directions in Treatment

    Our current research focuses on drugs directed at specific molecular targets, or with antibodies reactive against proteins on the surface of tumor cells. Another novel therapy uses inhibitors of angiogenesis (new blood vessel development) and stimulators of the immune response.

    New treatment approaches, including therapies that spur the immune system to attack cancerous lymphocytes, are showing considerable promise.

    Many members of the clinical research team also have active programs of laboratory-based investigation in lymphoma malignancies. Researchers work closely with other scientists across Harvard Medical School-affiliated institutions.

    Treatments by Stage

    The treatments outlined below are those commonly used; however, treatment plans can vary based on each patient's situation.

    Early Favorable Hodgkin Lymphoma

    Treatment of early favorable Hodgkin lymphoma may include:

    • Combination chemotherapy.
    • Combination chemotherapy with radiation therapy to parts of the body with cancer.
    • Radiation therapy alone to areas of the body with cancer.

    Early Unfavorable Hodgkin Lymphoma

    Treatment of early unfavorable Hodgkin lymphoma may include:

    • Combination chemotherapy.
    • Combination chemotherapy with radiation therapy to parts of the body with cancer.

    Advanced Favorable Hodgkin Lymphoma

    Treatment of advanced favorable Hodgkin lymphoma may include:

    • Combination chemotherapy.
    • Combination chemotherapy with radiation therapy to parts of the body with cancer.

    Advanced Unfavorable Hodgkin Lymphoma

    Treatment of advanced unfavorable Hodgkin lymphoma may include:

    • Combination chemotherapy.
    • Combination chemotherapy with radiation therapy to parts of the body with cancer.
    • Clinical trials of new combinations of chemotherapy.

    Recurrent Adult Hodgkin Lymphoma

    Treatment of recurrent Hodgkin lymphoma may include:

    • Combination chemotherapy.
    • Some types of immunotherapy.
    • Combination chemotherapy followed by high-dose chemotherapy and stem cell transplant with or without radiation therapy.
    • Radiation therapy with or without chemotherapy.
    • Chemotherapy as palliative therapy to relieve symptoms and improve quality of life.

    Studying the Influence of Genetics in Lymphoma

    Our investigators are interested in learning more about the genes that contribute to lymphoma. This study will identify and study individuals with non-Hodgkin's lymphoma, Hodgkin's disease, or CLL/SLL who also have other family members with one of these diseases. We are particularly interested in families in which parents and children or brothers and sisters are both affected by lymphoma.

    Participants will provide medical history along with blood samples, saliva samples, and mouth swabs. All information can be provided by mail. No travel to Boston is necessary. Investigators will use the information you provide to increase our understanding of the causes of lymphoma.

    How to Participate

    If you are interested and believe that your family history makes you eligible, please email Harrison Bai at harrisonp_bai@dfci.harvard.edu. Please include the following information:

    • Your diagnosis (type of lymphoma)
    • Your family members who have also had lymphoma (i.e. mother, brother, daughter, etc.)
    • Please indicate if you are willing to sign a medical release for research purposes and/or are willing to donate a blood sample, saliva sample, and mouth swab for research purposes
    • Your contact information (name, email/phone number, mailing address)

    Your Care

    All outpatient therapy is provided at the Yawkey Center for Cancer Care at Dana-Farber Cancer Institute, one of the most advanced outpatient cancer centers in the country.

    If you need to be hospitalized during your care, or if you undergo stem cell transplantation, you will be admitted to Brigham and Women's Hospital (BWH) or the Dana-Farber Inpatient Hospital located within BWH. Your primary oncologist and nurse will closely monitor your care and will coordinate your care with the inpatient team and additional specialists, who will address any other symptoms you may be experiencing. This model ensures seamless care from the outpatient to the inpatient setting. Learn more about your stay.

    If radiation therapy is part of your care plan, Radiation Oncology has two units, one at Brigham and Women's Hospital and the other at Dana-Farber.