energy radiation to kill lymphoma cells ■ Stem cell transplantation, usually in combination with high-dose chemotherapy, which involves replacing a patient’s immune system with healthy immune cells Each of these types of therapies is described in detail in this chapter. Treatment of Hodgkin Lymphoma 56 Part 2 What Is Chemotherapy? Chemotherapy drugs work by attacking cells that grow and multiply very quickly, which is a common characteristic of cancer cells. During chemotherapy, patients receive the treatment at certain intervals, such as once every two weeks, followed by a rest period. This regular treatment schedule is called a cycle. The length of the rest period and the number of cycles vary depending on the patient’s disease and the types of drugs used. Most patients with HL are treated with combination chemotherapy, meaning two or more drugs, instead of a single drug. The purpose of combining drugs is to increase how effectively they damage or kill cancer cells, to diminish the chances of the cancer cells becoming resistant to treatment, and to allow lower doses of each drug to be used to minimize side effects. The chemotherapy drugs are combined to create a treatment regimen—a specific schedule that determines which drugs are given on which days of each treatment cycle. Oncology nurses are usually responsible for administering the chemotherapy prescribed. Most patients receive their chemotherapy treatments in an outpatient clinic, hospital outpatient department, or doctor’s office, but sometimes patients have to stay overnight in the hospital for their treatment. How Is Chemotherapy Given? Depending on the drug, chemotherapy can be administered orally (as a pill or capsule that is swallowed), intravenously (as a liquid that is infused directly into a vein, commonly known as an “IV”), or intrathecally (as an injection into the fluid around the spinal cord [lumbar puncture]). 57 Understanding Hodgkin Lymphoma Most HL chemotherapy drugs are given by IV. One reason for this is that IVs provide flexibility in dosing, allowing the medication to be given all at once or slowly over many hours or days. Another reason is that many chemotherapy drugs cannot be given orally, either because they cannot be easily absorbed from the stomach into the bloodstream, or because they are too harsh for the stomach lining to tolerate. To administer IV chemotherapy, a doctor, nurse, or physician assistant inserts an IV catheter, which is a small flexible tube used to deliver medications. While some catheters are designed for short-term use, others can stay in the patient’s body for weeks or months, making it easier to administer multiple cycles of chemotherapy over time. Several commonly used types of catheters are described in Table 6.1. Patients and caregivers should discuss with their doctor which catheter, if any, would be best for their particular situation. Table 6.1. Catheters Used to Administer Chemotherapy Type of Catheter Description Advantages Disadvantages Peripheral Venous Catheter A needle is used to insert a small, flexible tube into a small vein in the hand or arm. Can be inserted quickly and easily by a nurse; no need for surgical insertion. Good for a single infusion or other temporary use. Cannot be left in place for more than three days at a time due to infection risk. Sterile dressing needs to be kept clean and dry and replaced daily; the line needs to be injected periodically with a blood thinner (heparin) to prevent blockage. Treatment of Hodgkin Lymphoma 58 Part 2 Table 6.1. Catheters Used to Administer Chemotherapy (continued) Type of Catheter Description Advantages Disadvantages Peripherally Inserted Central Catheter (PICC Line) A long, thin plastic tube is inserted into a large vein in the arm, and the tip is guided up through the body into the large vein that enters the heart. Can be kept in place longer than a peripheral venous catheter. Can be used to draw blood samples as well as to give drugs. Good for patients who need to have many short infusions or continuous infusions in a hospital or at home. Not intended to remain in place as long as some catheter types. Tunneled Catheter (e.g., Hickman, Broviac) One to three tubes are surgically inserted into the subclavian vein (underneath the