Our Treatment 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 Cancer Center is part of Dana-Farber Brigham Cancer Center'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 Dana-Farber Brigham Cancer Center 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 Dana-Farber Brigham Cancer Center'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 Dana-Farber Brigham Cancer Center'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.
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.
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.
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 Dana-Farber Brigham Cancer Center.
- 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 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.