lymphoma { The stage and category of the disease { Disease that has not responded to treatment { Disease that has come back after treatment { Other medical problems, such as a very low red blood cell count (anemia), diabetes mellitus, heart or kidney disease. Combination chemotherapy along with “involved field radiation therapy” is the most common treatment. Involved field radiation therapy uses high-energy rays to target the HL cells. Other parts of the body are protected to reduce harm to healthy cells. Chemotherapy without radiation therapy may be the treatment for patients with widespread Hodgkin lymphoma, fever, night sweats or weight loss. Chemotherapy is given in “cycles,” usually several weeks apart. A number of cycles are needed. The treatment may last from six to 10 months. It is outpatient treatment for most patients. Some patients may have to stay in the hospital for a short time if they develop a fever or have other signs of infection. Some patients who need antibiotics may stay in the hospital until the infection is gone. Nodular Lymphocyte-Predominant Hodgkin Lymphoma. Patients with nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) need different treatment than patients with other HL subtypes. NLPHL HL The Lymphoma Guide I page 17 is slow-growing (indolent) and close to 100 percent of patients see long-term survival. The treatment for patients with NLPHL is involved field radiation. Patients do respond to chemotherapy, but the disease tends to come back more often after chemotherapy. For more information, see the free LLS publication Hodgkin Lymphoma. Examples of Some Treatment Approaches Used for Hodgkin Lymphoma ABVD – Adriamycin® (doxorubicin), bleomycin, vinblastine and dacarbazine BEACOPP – bleomycin, etoposide, Adriamycin (doxorubicin), cyclophosphamide, Oncovin® (vincristine), procarbazine and prednisone Stanford V – mechlorethamine, doxorubicin, vinblastine, vincristine, bleomycin, etoposide and prednisone Brentuximab vedotin (Adcetris®) High-dose chemotherapy may also kill normal blood-forming cells in the marrow. Chemotherapy may cause very low counts of red blood cells, white blood cells or platelets. Some patients may need a blood transfusion or drugs called blood cell growth factors until the side effects of chemotherapy wear off. Examples of red blood cell growth factors are Aranesp® (darbepoetin alfa) and Procrit® (epoetin alfa). These can increase red blood cell counts. You can view, print or order the free LLS publication Blood Transfusion at www.LLS.org/resourcecenter or you can contact our Information Specialists for a copy. Want more information? HL page 18 I 800.955.4572 I www.LLS.org Hodgkin lymphoma affects the body’s ability to fight infection. Chemotherapy and radiation can add to the problem. Good treatment and following the doctor’s advice will help lower the risk of infection. White blood cell growth factors may be part of treatment. Neupogen® or Neulasta® (also called granulocyte-colony stimulating factor or G-CSF) and Leukine® (also called granulocyte-macrophage colony stimulating factor or GM-CSF) can increase the number of neutrophils (white blood cells). See Side Effects of Lymphoma Treatment on page 35 for more information. Relapsed Hodgkin Lymphoma. In some patients, Hodgkin lymphoma may come back (called a “recurrence” or “relapse”). The doctor will treat these patients again with chemotherapy. The treatment often gives patients very long disease-free periods. Another treatment option for relapsed HL is brentuximab vedotin (Adcetris®). This drug has been FDA approved for the treatment of HL after failure of autologous stem cell transplant and in HL patients who are not autologous stem cell transplant candidates after failure of at least two multiagent chemotherapy regimens. Stem Cell Transplantation When doctors are planning treatment, they use a number of factors to determine a patient’s need for a stem cell transplant. These factors may include the patient’s disease, subtype, stage, other treatment received and the patient’s physical ability to have the transplant. While a stem cell transplant is not an option for every patient, it can be an important