Adult Hodgkin lymphoma may be grouped for treatment as follows:

Early Favorable

Early favorable adult Hodgkin lymphoma is stage I or stage II, without risk factors that increase the chance that the cancer will come back after it is treated.

Early Unfavorable

Early unfavorable adult Hodgkin lymphoma is stage I or stage II with one or more of the following risk factors that increase the chance that the cancer will come back after it is treated:

Having a tumor in the chest that is larger than 1/3 of the width of the chest or is at least 10 centimeters.
Having cancer in an organ other than the lymph nodes.
Having a high sedimentation rate (in a sample of blood, the red blood cells settle to the bottom of the test tube more quickly than normal).
Having three or more lymph nodes with cancer.
Having B symptoms (fever for no known reason, weight loss for no known reason, or drenching night sweats).

Advanced

Advanced Hodgkin lymphoma is stage III or stage IV. Advanced favorable Hodgkin lymphoma means that the patient has 0–3 of the risk factors below. Advanced unfavorable Hodgkin lymphoma means that the patient has 4 or more of the risk factors below. The more risk factors a patient has, the more likely it is that the cancer will come back after it is treated:

Having a low blood albumin (protein) level (below 4).
Having a low hemoglobin level (below 10.5).
Being male.
Being aged 45 years or older.
Having stage IV disease.
Having a high white blood cell count (15,000 or higher).
Having a low lymphocyte count (below 600 or less than 8% of the white blood cell count).

Treatment Options Overview

There are different types of treatment for patients with Hodgkin lymphoma.

Treatment for adult Hodgkin lymphoma may cause side effects.

Five types of standard treatment are used:

Radiation therapy
Chemotherapy
Immunotherapy
Targeted therapy
Stem cell transplant

Patients may want to think about taking part in a clinical trial.

Side Effects of Treatment for adult Hodgkin lymphoma

Early Effects of cancer treatment may include the following:

Appetite Loss
Low White Cell Count (Leucopenia/Neutropenia)
Bleeding and Bruising (Thrombocytopenia)
Constipation/Diarrhea
Nausea and Vomiting
Edema (Swelling)
Fatigue
Hair Loss (Alopecia)
Infections
Memory or Concentration Problems
Mouth and Throat Problems
Nerve Problems (Peripheral Neuropathy)
Skin and Nail Changes
Sleep Problems and Insomnia
Fertility and Sexual Health Issues

Late effects of cancer treatment may include the following:

Heart problems.
Hypothyroidism (too little thyroid hormone in the blood).
Lung problems, such as trouble breathing.
Infertility (inability to have children).
Loss of bone density.
Neuropathy (nerve damage that causes numbness or trouble walking).
A second cancer
- Acute myelogenous leukemia and Hodgkin lymphoma.
- Solid tumors, such as mesothelioma and cancer of the lung, breast, thyroid, bone, soft tissue, stomach, esophagus, colon, rectum, cervix, and head and neck.

Some late effects may be treated or controlled. It is important to talk with your doctor about the effects cancer treatment can have on you. Regular follow-up to check for late effects is important.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.
When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy).
Combination chemotherapy is treatment using two or more anticancer drugs. Steroid drugs may be added, to lessen inflammation and lower the body's immune response.
Systemic combination chemotherapy is used for the treatment of adult Hodgkin lymphoma.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing.
External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer. Sometimes total-body irradiation is given before a stem cell transplant.
External radiation therapy is used to treat adult Hodgkin lymphoma, and may also be used as palliative therapy to relieve symptoms and improve quality of life.

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to attack cancer cells. Targeted therapies may cause less harm to normal cells than chemotherapy or radiation therapy do.

Monoclonal antibodies: This treatment uses antibodies made in the laboratory, from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow.
The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading.
Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.
Brentuximab and rituximab are monoclonal antibodies used to treat Hodgkin lymphoma.

Immunotherapy

Immunotherapy is a treatment that uses the patient's immune system to fight cancer.
Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer.
Immune checkpoint inhibitor therapy: PD-1 is a protein on the surface of T cells that helps keep the body’s immune responses in check.
When PD-1 attaches to another protein called PDL-1 on a cancer cell, it stops the T cell from killing the cancer cell. PD-1 inhibitors attach to PDL-1 and allow the T cells to kill cancer cells.
Nivolumab and pembrolizumab are types of immune checkpoint inhibitors used to treat Hodgkin lymphoma that has recurred (come back).

Stem cell transplant

Stem cell transplant is a method of giving high doses of chemotherapy and/or total-body irradiation and then replacing blood-forming cells destroyed by the cancer treatment.
Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient (autologous transplant) or a donor (allogeneic transplant) and are frozen and stored.
After the chemotherapy and/or radiation therapy is completed, the stored stem cells are thawed and given back to the patient through an infusion.
These reinfused stem cells grow into (and restore) the body’s blood cells.