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Hodgkin's Lymphoma Treatment Options By Stages [I to IV]

The hodgkin’s lymphoma treatment depends on many factors, including but not limited to the type of HL, stage of the disease, patient’s age, and performance status, the presence of adverse prognostic factors, along with other factors.

Following are the preferred treatment approaches for different stages of HL, but the final decision is taken after clinical assessment of the patient by an oncologist.

STAGE (SUBTYPE) TREATMENT
Stages I and II
(classical HL)
Chemotherapy is the standard treatment upfront. Type of chemotherapy and number of cycles are determined by the presence/absence of poor prognostic factors. Further decision to add chemotherapy and/or radiation therapy depends upon the response to initial therapy (as assessed by PET-CT scan) and presence/absence of poor prognostic factors and disease bulk.
Stage III and IV
(classical HL)
In patients with Stage III to IV, chemotherapy is the standard treatment upfront. Type of chemotherapy is determined by the presence/absence of poor prognostic factors. Further decision to add chemotherapy and/or radiation therapy is taken depending upon the response to initial therapy (as assessed by PET-CT scan) and disease bulk.
Stage I and II
(NLPHL)
In the absence of poor prognostic factors, observation or radiotherapy alone may be sufficient.
In the presence of poor prognostic factors, chemotherapy with targeted therapy (rituximab) with/without radiotherapy is preferred.
Stage III and IV
(NLPHL)
Chemotherapy with targeted therapy (rituximab) with/without radiotherapy is the preferred treatment.

Following is the brief description of various treatment types employed for HL:

  1. Chemotherapy: Chemotherapy is the mainstay of treatment for HL. Chemotherapy means treatment with anti-cancer drugs that kill or decrease the growth of rapidly-growing cancer cellsCertain standard combination regimen involving multiple drugs are used for the treatment of HL, for example, ABVD (Adriamycin, Bleomycin, Vinblastine, and Dacarbazine), and Stanford V (Adriamycin, Mechlorethamine, Vincristine, Vinblastine, Bleomycin, Etoposide, Prednisone).

    Many pharmaceutical companies are conducting a number of clinical trials to find out new drugs and drug-combinations with increased efficacy and specificity to target HL cells. Chemotherapy may be associated with side effects due to its effect on normal body cells apart from cancerous.

  2. Radiation Therapy: Radiation therapy (or radiotherapy) uses high-energy x-rays or other high-energy radiations which are directed to the affected area to kill cancer cells.

    It is generally employed for the treatment of HL, especially in case of bulky disease limited to a part of the body. Radiation therapy alone is recommended for the treatment of early-stage NLPHL.

    Sometimes, it is used as palliative therapy to relieve pain, bleeding, and obstructive problems associated with the advanced-stage disease.

  3. Monoclonal Antibodies: Monoclonal antibody is a targeted therapy which can be directed to certain protein characteristic of cancer cells.

    For the treatment of HL, Brentuximab Vedotin (that targets CD30 protein on HL cells) and Rituximab (that targets CD20 protein on the HL/NLPHL cells) may be employed.

    These drugs help immune cells to destroy the cancer cells. Brentuximab Vedotin is generally employed for the treatment of advanced-stage HL in combination with chemotherapy or to treat a refractory disease that is not responding to chemotherapy and radiation therapy. Rituximab is employed in the treatment of NLPHL along with other chemotherapy drugs.

  4. Immune checkpoint inhibitors: Cancer cells utilize certain mechanisms to escape from the immune system of the patient from attacking these cells. Immune checkpoint inhibitors deactivate the checkpoints on cancer cells and thus enable the immune system to recognize and kill cancer cells.

    Nivolumab and pembrolizumab target PD-1 protein on T-cells and activate the immune system to kill the PD-L1 expressing HL cells. Trials have shown immunotherapy to be beneficial for the treatment of advanced stage disease unresponsive to chemotherapy.

  5. Autologous Stem Cell Transplant (SCT): SCT can be considered for some patients with HL who are the good candidate for the same (younger patients in good health) and are not responding to chemotherapy and/or radiotherapy.

    In this technique, patient’s own stem cells are first collected from the healthy bone marrow tissue or peripheral blood (preferred). Then, the patient receives high-dose chemotherapy to kill all the lymphoma cells.

    The collected stem cells are re-administered to the patient to slowly replenish the blood cells in the patient body. This is the most common type of SCT employed for the treatment of HL.

  6. Palliative Treatment: It helps in improving the overall quality of life by providing relief from the symptoms caused by the disease. It may include surgery, radiotherapy, placing stents to ease airway obstruction, or using drugs to reduce pain and other symptoms.

It is very important to assess the benefits of each treatment option versus the possible risks and side effects before making a treatment decision. Sometimes patient’s choice and health condition are also important to make a treatment choice.

Following are ultimate goals of treating Hodgkin’s lymphoma:

  • Prolongation of life.
  • Reduction of symptoms.
  • Improvement in quality of life.

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