Treatment for Hodgkin Lymphoma

Today, there are more treatment options for Hodgkin lymphoma than ever before. Physicians are better able to control the disease or put it into remission, even if the disease is advanced.

Our Hodgkin lymphoma specialists work closely with you, your family and each other to get you back to health. At Fred Hutchinson Cancer Center, we provide all standard therapies for Hodgkin lymphoma and offer you access to the latest treatments through clinical trials. 

“For Hodgkin lymphoma, it's generally the age and the stage of the patient that helps determine the treatments that are used.”
— Ryan C. Lynch, MD, hematologist-oncologist

Treatment Plan

Treatment for Hodgkin lymphoma is different for each person. When it comes to treatment options, we think about every detail of your Hodgkin lymphoma, from type to subtype, along with your goals and priorities.

Why do treatment plans differ?

The treatment plan we design for you depends on many factors, including:

  • Your type and subtype of Hodgkin lymphoma, because different types and subtypes start, grow and respond to treatments differently
  • If your Hodgkin lymphoma is slow-growing (indolent) or fast-growing (aggressive)
  • The stage of your disease
  • If you have had treatment for Hodgkin lymphoma in the past
  • Your age and overall health
  • Your needs and preferences, like what type of treatment schedule works in your life and if you want to join a clinical trial

What is the standard therapy for Hodgkin lymphoma?

While treatment is different for each person, Hodgkin lymphoma is most often treated with chemotherapy. Sometimes this is the only treatment needed, but it may be combined with radiation therapy. Physicians most often use radiation to treat cancer in the spleen or in the lymph nodes in the neck, chest, armpits or groin. Targeted therapies are newer cancer treatments that work more selectively than standard chemotherapy. Both targeted therapies and immunotherapies are often used with relapsed Hodgkin lymphoma.

If initial treatment doesn’t cure your lymphoma or your disease recurs, your physician may recommend a blood or marrow transplant.

At Fred Hutch, our standard always involves caring for you as a whole person. We help you get relief from side effects and provide many other forms of support, like integrative medicine, nutrition counseling and physical therapy.

Our patients can also choose to receive promising new Hodgkin lymphoma therapies that you can only get through a clinical trial. Many people come to Fred Hutch to be part of these studies. Your care team will tell you about studies that may be right for you, so you can think about joining them.

Treatment Process

Depending on your lymphoma type, subtype, stage and overall health, you may respond to treatment in different ways. At Fred Hutch, we choose, combine and schedule your treatments based on what will work best for you. Your care team will make sure you understand each type of treatment and all of your choices.


Hodgkin lymphoma is most often treated with chemotherapy. Sometimes this is the only treatment needed, but it may be combined with radiation therapy.

Chemotherapy, called “chemo” for short, uses medicines to kill fast-growing cells (like cancer cells) or to keep them from dividing, which is how cancers grow. Your hematologist-oncologist prescribes your chemotherapy and sets your treatment schedule. Usually, chemotherapy is given by infusion. Liquid medicine is put into a vein through an intravenous (IV) line. This can be a line in your arm (peripheral venous catheter) or a port in your chest (central venous catheter). Treatment happens in repeating cycles every two to six weeks.

Your Fred Hutch team will talk with you about which drugs we recommend for you, how you’ll take them, your treatment schedule and what to expect. Your team will also explain how to take the best possible care of yourself during and after treatment and connect you with support resources throughout Fred Hutch.

Cancer nurses who specialize in infusions will give you these treatments. They will watch over you during treatment, deal with any medical issues that come up and help keep you comfortable. 

ABVD regimen

Many people with Hodgkin lymphoma receive a chemotherapy combination of drugs called ABVD:

  • Doxorubicin hydrochloride (Adriamycin)
  • Bleomycin 
  • Vinblastine sulfate 
  • Dacarbazine 

For people with the most aggressive forms of Hodgkin lymphoma, your physician may use other combinations.

Learn More About Chemotherapy

Radiation Therapy

Based on your type of Hodgkin lymphoma and if it has spread, your physician may recommend external-beam radiation therapy, alone or along with chemotherapy.

Radiation therapy uses high-energy rays to kill cancer cells. A radiation oncologist decides on the type, dose and schedule of your treatment.

Usually, this means that a machine aims rays right at your tumor. You get this treatment daily, Monday through Friday, for several weeks.

For Hodgkin lymphoma, physicians most often use radiation to treat cancer in the spleen or in the lymph nodes in the neck, chest, armpits or groin. 

Learn more about Radiation Therapy

Targeted Therapy

Targeted therapies are newer cancer treatments that work more selectively than standard chemotherapy. 

Targeted therapies work in one of three ways:

  • They target a gene or protein that causes cancer growth.
  • They damage cancer cells directly.
  • They tell your immune system to attack certain cells. This is also called immunotherapy.

Who needs targeted therapy?

Patients with relapsed (the disease gets better but then gets worse) or refractory (does not respond to treatment) Hodgkin lymphoma are often good candidates for targeted therapy. 

For relapsed Hodgkin lymphoma, physicians use the targeted therapy brentuximab vedotin along with standard chemotherapy. Brentuximab works like a Trojan horse. It enters cancer cells and then releases a toxin that makes it harder for the cell to reproduce.

Learn More About Targeted Therapy


Immunotherapies are some of the latest innovations at Fred Hutch. They use the power of your immune system to fight your cancer. We are working hard to make immunotherapy part of Hodgkin lymphoma treatment in the best possible way. Our research teams are focused on finding out if immunotherapy can improve outcomes or if we can safely give patients fewer chemotherapy drugs. 

Nivolumab (Opdivo®) and pembrolizumab (Keytruda®) are antibody therapies that may boost your immune system’s anti-cancer response by blocking “off signals” on your T cells.

Who needs immunotherapy?

If you have classic Hodgkin lymphoma that progresses (gets worse or spreads) or comes back after other treatments, immunotherapy may be an option for you.

Learn More About Immunotherapy

Blood or Marrow Transplant

If initial treatment doesn’t cure your lymphoma or your disease comes back, your physician may recommend a blood or marrow transplant. The transplant resets your body’s ability to make healthy blood cells. 

Physicians and researchers at Fred Hutch pioneered blood and marrow transplants decades ago. Today, at Fred Hutch, we continue to improve transplant techniques and develop new options.

A team of Fred Hutch transplant experts will care for you. Your team will include a transplant oncologist, transplant nurse, pharmacist, dietitian, team coordinator and social worker.

Most transplant recipients with Hodgkin lymphoma have a transplant using their own stem cells (autologous transplant).

  • First, your stem cells are collected, frozen and stored.
  • Next, you receive strong chemotherapy to attack your cancer cells, destroy or suppress your immune system and prevent your body from forming new blood cells. You might get radiation therapy, too.
  • Then, your stored stem cells are thawed and returned to your bloodstream to restart your body’s ability to make healthy blood cells again.

If your lymphoma is very aggressive and chemotherapy has not shrunk your tumors, an autologous transplant is usually not an option. In this case, patients have a transplant using cells from a donor (allogeneic transplant).

More people are eligible for allogeneic transplants than ever before, due to advances available at Fred Hutch, such as:

  • Non-myeloablative (lower-intensity) transplants, which use lower-dose chemotherapy
  • Transplants using stem cells from donated umbilical cord blood or haploidentical (half-matched) donors
Learn More About Blood and Marrow Transplants

Monitoring Your Health

While you’re in active treatment, your Hodgkin lymphoma care team will see you regularly for exams and tests to check:

  • How well your treatment is working
  • If there’s any reason to change your treatment
  • If you need help with side effects or supportive care services, like nutrition care or mental health counseling

We update your treatment plan based on the best scientific evidence as well as how your disease responds and what you prefer.

Possible Results of Treatment

Throughout treatment, your care team looks for signs of:

Remission: Fewer signs and symptoms of cancer. Partial remission means some signs and symptoms remain. Complete remission means there are no signs or symptoms.

  • Disease progression: The disease is getting worse or spreading.
  • Relapse: The disease, signs or symptoms have come back after they had improved.
  • Refractory disease: The disease does not respond to treatment.

What about “cured”? Sometimes physicians use the word “cured” if you have been in complete remission for at least five years. After five years, cancer is less likely to come back (recur), but recurrence is still possible. 

Managing Side Effects

You might be wondering about possible side effects from treatment, like hair loss or nausea from chemotherapy. If you are, it might be helpful to know that many of today’s treatments are more targeted to cancer cells, so they don’t cause as many side effects as standard chemotherapy. 

You are always at the center of everything we do. Hodgkin lymphoma physicians, nurses and advanced practice providers are here to help prevent or manage the side effects of treatment. 

Get Help with Side Effects

Before you begin treatment, we talk with you in advance about what to expect, based on your treatment plan, and what can help if you do have side effects.

At your appointments, we want you to tell us about any side effects you are having. If you have questions or concerns between appointments, you can call or email us. We will make sure you know how to reach care providers at Fred Hutch after hours, if that’s when you need us. 

We have many tools to help you feel better, such as:

  • Antibiotics, vaccines and antiviral drugs to prevent or treat infections
  • Transfusions, steroids and medicines that help the immune system treat low levels of blood cells (low blood counts)
  • Nutrition care and medicines to help with digestive problems
  • Conventional and integrative therapies for pain

Coping with Side Effects

Common Side Effects

Side effects are different depending on which treatment you get. They also depend on other things, like how strong your immune system is. These are some of the common side effects of treatment for Hodgkin lymphoma:

  • Unusual tiredness (fatigue)
  • Hair loss
  • Higher risk of infection (due to low levels of white blood cells)
  • Anemia (due to low levels of red blood cells)
  • Easy bruising or bleeding (due to low levels of platelets)
  • Problems in your digestive tract, like sores in your mouth, nausea, vomiting, constipation or diarrhea
  • Rash or other skin changes
  • Numbness, tingling or pain from nerve damage (neuropathy)
  • Fever

Supportive Care Services

Along with treating your Hodgkin lymphoma, Fred Hutch provides a range of services to support you and your caregiver before, during and after treatment. This is part of how we take care of you — not just your disease.

From dietitians to chaplains, we have experts who specialize in caring for people with cancer. We also offer support groups to help connect patients to each other. We understand this may be one of the most intense and challenging experiences you and your family ever go through. We’re here to provide the care you need. 

Learn more about Supportive Care

Caregiving During Treatment

If your loved one is getting chemotherapy, targeted therapy, immunotherapy or radiation therapy, there are many ways you can help. Caregiving during active treatment for Hodgkin lymphoma often means doing tasks like these:

  • Keeping track of their appointments and driving them to and from treatment
  • Watching for changes in their condition and telling their care team about any symptoms
  • Providing physical care, like helping them take medicines
  • Spending time with them and encouraging them
  • Taking care of things at home that they may not be able to do, like grocery shopping and cleaning

Caregiving for Transplant Patients

Caregivers have a special role in bone marrow transplants. This intense treatment involves strong chemotherapy with serious side effects. During the initial recovery period, which often takes at least a month, your loved one will need daily help. We have classes to help transplant caregivers get ready. During recovery, a transplant registered nurse is available by phone 24 hours a day, 7 days a week, to help you.

Continuing Care

When your disease is in remission and your active treatment ends, it is still important to get follow-up care on a regular basis. At follow-up visits, you will see the same team who treated your Hodgkin lymphoma. They will check your overall health and look for signs that your cancer has come back (signs of recurrence). 

Your team will also help with any long-term side effects (which go on after treatment ends) or late effects (which may start after treatment is over).

Schedule For Follow-up Visits

Just like we personalize your treatment plan for you, we personalize your follow-up schedule, too. Your hematologist-oncologist will base your schedule on many things, including:

  • Your type and subtype of Hodgkin lymphoma
  • If your disease was slow-growing (indolent) or fast-growing (aggressive)
  • Which treatments you had and how your disease responded 
  • How the disease and treatments affected you 
  • How long it has been since your treatment ended

Most patients have follow-up appointments for at least five years, and some patients have them for the rest of their lives. It is common to have follow-up visits more often in the first months and years after active treatment ends and less often as time goes on.

What Happens at Follow-up Visits

Hodgkin lymphoma follow-up usually means seeing your hematologist-oncologist for a physical exam and having blood tests to check your blood cell levels. If there are any changes, you might have tests to check the health of your bone marrow.  

Your physician will let you know if you need any imaging tests. You might have tests like a CT (computed tomography) scan or PET (positron emission tomography) scan. These can help check for recurrence (the cancer has come back), but they also expose you to some radiation. Together, you and your physician will decide on the benefits and risks.

Meet the Hodgkin Lymphoma Care Team