Which medication may be included in the chemotherapy regimen for a patient with advanced stage Hodgkins disease?

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.

A course of chemotherapy is made up of a number of cycles. You have treatment, usually over 1 to 3 days, depending on the particular combination of drugs. Then you have a break of a few weeks to allow your body to recover from the effects of the chemotherapy. Then another cycle begins. The number of cycles you have depends on:

• which drugs you are having
• the stage and type of your Hodgkin lymphoma
• results of any tests
• how well your lymphoma responds to treatment

Types of chemotherapy

You normally have several chemotherapy drugs together during a course of treatment. Some chemotherapy combinations include a course of steroids.

Limited (early) stage

You might have 2 to 4 cycles of ABVD chemotherapy, which contains the drugs:

• adriamycin (doxorubicin)
• bleomycin
• vinblastine
• dacarbazine

Advanced stage

You may have ABVD for 6 to 8 cycles. Or you might have:

• ChlvPP – chlorambucil, vinblastine, procarbazine and prednisolone
• Escalated BEACOPP – bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisolone
• GemP – gemcitabine, cisplatin and prednisolone
• ESHAP - etoposide, prednisolone, cytarabine and cisplatin (more likely for Hodgkin lymphoma that has come back)

High dose treatment

You might have BEAM or LEAM chemotherapy with a stem cell transplant, if chemotherapy doesn't work well or your lymphoma comes back.

These combinations include the drugs:

• carmustine (BiCNU) or lomustine (CCNU)
• etoposide
• cytarabine (Ara-C, cytosine arabinoside)
• melphalan

How you have chemotherapy

Into your bloodstream

You have the treatment through a drip into your arm or hand. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

Tablets or capsules

You must take tablets and capsules according to the instructions your doctor or pharmacist gives you.

Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, not more or less.

Talk to your specialist or advice line before you stop taking a cancer drug.

Where you have chemotherapy

You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so it’s a good idea to take things in to do. For example, newspapers, books or electronic devices can all help to pass the time. You can usually bring a friend or family member with you.

You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.

For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.

Some hospitals may give certain chemotherapy treatments to you at home. Your doctor or nurse can tell you more about this.

Clare Disney (nurse): Hello, my name is Clare and this is a cancer day unit.

So when you arrive and you’ve reported into with the receptionist, one of the nurses will call you through when your treatment is ready, sit you down and go through all the treatment with you.

Morning, Iris. My name is Clare. I am the nurse who is going to be looking after you today. We’re going to start by putting a cannula in the back of your hand and giving you some anti sickness medication. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment. Is that okay?

Before you have each treatment you’ll need to have a blood test to check your bloods are okay. And you’ll also be reviewed by one of the doctors to make sure you’re fit and well for your treatment. Sometimes you’ll have the blood test taken on the day of your treatment; other times you’ll have it the day before your treatment when you see the doctor.

Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.

So, depending on where your cancer is some people have their chemotherapy drug, their cancer drug by drip, some will have an injection and other people will have tablets.

So, Iris, your chemotherapy is going to be given to you in what we call cycles and the cycles are given every three weeks for a period of six cycles. So, you will be coming in for approximately five months for your chemotherapy.

Depending on where your cancer is and what type of cancer you have will be dependent on how often you come in for treatment. An example of a treatment cycle would be for you to come in on Day 1, Day 8 and Day 15 then to have a week’s break before you come back again for Day 1 treatment.

Depending on the type of treatment that you are having we will also give you some anti sickness tablets to take alongside your chemotherapy and also some drugs to prevent any reactions if that’s appropriate.

All chemotherapy is given over different time periods so it’s best to check with your nurse about how long you are likely to be in the unit for. This can range from anything up to an hour to an all day treatment slot so please be prepared to bring along some bits to keep you occupied, such as books and music.

So, before you go home it’s important to make sure you have got the tablets you need to go home with your anti sickness medications and any other symptom control tablets that you may require. Also, to make sure that you’ve got the telephone numbers for the oncology unit to phone if you have a temperature or you are experiencing any other symptoms at home that you need to ask advice about.

So, please make sure when you leave the unit that you’ve got all the information you require and if you’ve got any questions at all don’t hesitate to ask the nurse who will be able to answer them for you.

Before your next cycle of treatment you will come in and see the doctor in the clinic room, you’ll have a blood test and an examination to make sure you are fit and well for treatment you will then come back the following day or later on that week for treatment.

Before you start chemotherapy

You need to have blood tests to make sure it’s safe to start treatment. You have these either a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.

Side effects

Common chemotherapy side effects include:

• feeling sick
• loss of appetite
• losing weight
• feeling very tired
• a lower resistance to infections
• bleeding and bruising easily
• diarrhoea or constipation
• hair loss

Contact your doctor or nurse immediately if you have signs of infection. These include a temperature above 37.5C or below 36C, or generally feeling unwell. Infections can make you very unwell very quickly.

Side effects depend on:

• which drugs you have
• how much of each drug you have
• how you react

Tell your treatment team about any side effects that you have.

Most side effects only last for a few days or so. Your treatment team can help to manage any side effects that you have.

Possible long term side effects

After some types of chemotherapy treatment you might develop long term effects weeks, months or years after the treatment has ended. Different types of chemotherapy cause different problems. And doctors can't tell who will get a long term effect and who won't. 

Loss of fertility

Some chemotherapy used to treat Hodgkin lymphoma can cause damage to your ovaries or testicles. This can mean that you can't have children (infertility). It is difficult for doctors to say definitely whether this will happen to you. It depends on:

• the chemotherapy drugs you are having
• your total dose of the drugs
• your age if you are a woman

Menopause

For women, chemotherapy can cause an early menopause. Doctors can treat this with hormone replacement therapy.

Second cancers

Your treatment might increase the risk of you getting another type of cancer in the future.

If you have had chemotherapy to treat Hodgkin lymphoma, you have a small increased risk of getting leukaemia in the future (between 1 and 3%). Research that followed people treated as children has found that this risk peaks about 5 years after treatment and then drops away over the next 10 years. So 15 years after your treatment, your leukaemia risk is no longer increased.

Heart or lung problems

Some drugs used to treat Hodgkin lymphoma can cause heart problems. You might have regular heart tests. Some chemotherapy drugs, particularly bleomycin, can cause inflammation of the lungs. Your doctors will probably stop giving you bleomycin straight away if this happens to you.

Clinical trials

Although chemotherapy works very well for Hodgkin lymphoma, research trials are looking at ways of making it work even better while reducing side effects.

When you go home

Chemotherapy for Hodgkin lymphoma can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.

Dietary or herbal supplements and chemotherapy

Let your doctors know if you:

• take any supplements
• have been prescribed anything by alternative or complementary therapy practitioners

It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. They could be harmful.