Other Treatments for Hodgkin Lymphoma
Bone Marrow Transplant
Hodgkin lymphoma affects bone marrow function. Sometimes levels of healthy blood cells can drop too low. This can happen if the lymphoma is resistant to treatment. It can also happen with recurring or advanced lymphoma. Chemotherapy can kill healthy cells in the bone marrow. This can make it hard for the body to fight infections and disease. It can lead to life-threatening infections.
A bone marrow transplant (BMT) can help bone marrow to function again. BMT uses healthy stem cells (immature, unformed cells) from:
- The person's own bone marrow
- Someone who donates their stem cells
If the transplant works, the new injected cells should be free of cancer. These cells travel to bone marrow sites throughout the body. They slowly grow more healthy red or white blood cells, or platelets.
A BMT can be:
Peripheral Stem Cell Transplant
Stem cells can mature into other types of blood cells. Stem cells can come from the recipient or a donor. If they come from the recipient, they will be taken from the blood before treatment starts. Blood cells are separated through apheresis. The stem cells may be treated before they are frozen. This is to kill any cancer cells. During the transplant, the stem cells are returned to the body. In time, they replace healthy cells that were destroyed during treatment.
This procedure allows for higher doses of chemo- or radiation therapy.
Splenectomy is the surgery to remove the spleen. The spleen is in the upper left part of the abdomen. It is part of the lymph system. This surgery is sometimes advised for people with Hodgkin lymphoma.
This surgery can often be done laparoscopically. It is done through small cuts in the abdomen. It is possible to live without a spleen, but this raises the risk of certain bacterial infections such as pneumonia. Vaccines and lifestyle changes can help protect against certain infections.
Monoclonal antibody therapy is a form of immunotherapy. Monoclonal antibodies are made in a lab. They work with the immune system to fight cancer or stop its growth.
This treatment may be used if Hodgkin lymphoma comes back or other treatments do not work.
The medicines are given through an IV every few weeks. They may be given with chemotherapy or at a separate time.
Some problems may be:
- Feeling tired
- Nausea or vomiting
- Nerve pain
- Rarely, breathing problems and low blood pressure
Treatment During Pregnancy
Treatment of Hodgkin lymphoma depends how fast the cancer is spreading, where it is located, and how far along the pregnancy is. Options include:
- Watchful waiting —The doctor will closely monitor the course of the disease for any changes or progression. This may be an option for Hodgkin lymphoma that is:
- Growing slowly AND
- Above the diaphragm (a muscle that separates the chest and abdominal cavities).
- Radiation therapy—Steps will be taken to protect the unborn baby (fetus). Radiation therapy can be used to ease symptoms, like problems breathing.
- Steroid therapy —Used to help ease symptoms, such as swelling and pain.
Treatment may be adjusted or delayed until the fetus is 32 to 36 weeks old. At this point, delivery can be induced. The birth parent can then begin standard treatment. If the pregnancy is in the second half, watchful waiting may be used until delivery can be induced. Comfort measures can be used anytime during the pregnancy.
This involves removing healthy stem cells from the person's own body. The stem cells can be taken from the bone marrow or right from circulating blood. Circulating blood is taken and spun in a machine. This process, called apheresis, splits up the blood parts. The blood is then put back into the body. The stem cells are frozen until cancer cells are removed with treatment. The healthy stem cells are then returned to the body. This grows the blood cell count.
This type of BMT involves a second person known as a donor. Certain markers on the donor's blood cells must match those of the recipient (person receiving them). The recipient is given medicines to lower the immune system. This is to prevent rejection of the donor's bone marrow. Before the BMT, treatment must kill the cancerous lymphoma cells.
The donated marrow is given through a vein in the recipient's chest. The recipient is then isolated for a time to reduce the chance of infection. This is done while the healthy stem cells grow the blood cell count. It can take up to a month for bone marrow to be fully working.
- Adult Hodgkin lymphoma treatment (PDQ)—patient version. National Cancer Institute website. Available at: https://www.cancer.gov/types/lymphoma/patient/adult-hodgkin-treatment-pdq.
- Hodgkin lymphoma (HL). EBSCO DynaMed website. Available at:https://www.dynamed.com/condition/hodgkin-lymphoma-hl.
- Immunotherapy for Hodgkin lymphoma. American Cancer Society website. Available at: https://www.cancer.org/cancer/hodgkin-lymphoma/treating/monoclonal-antibodies.html.
- Stem cell transplantation. Leukemia & Lymphoma Society of America website. Available at: http://www.lls.org/lymphoma/hodgkin-lymphoma/treatment/stem-cell-transplantation.
- Mohei Abouzied, MD, FACP
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