# Treatment methods for Hodgkin lymphoma
Chemotherapy
Chemotherapy is the cornerstone of Hodgkin lymphoma treatment and is used in almost all stages. The goal is to reach and attack malignant cells throughout the body.
ProveniIncluded in official guidelines, or approved by EMA or FDA
Standard chemotherapy consists of a combination of four drugs, traditionally designated ABVD: an anthracycline, bleomycin, vinblastine, and dacarbazine. These drugs work in different ways on dividing cells and disrupt their growth.
Known side effects include nausea, vomiting, hair loss, fatigue, and increased risk of infection due to a decline in white blood cells. In some patients, long-term damage to the heart or lungs develops. These effects can occur during and after treatment and vary greatly from person to person. Hospitals regularly monitor these risks with heart ultrasounds and lung function tests.
A number of patients, especially younger adults and those with bulky disease, receive escalating doses of chemotherapy — so-called PET-based intensification — where the intensity is adjusted based on response after a few cycles. This happens in specialist centres.
Radiotherapy
Radiotherapy is rarely used as the sole treatment, but is an important part of the combined approach, especially in early stages or for residual disease areas.
ProveniIncluded in official guidelines, or approved by EMA or FDA
Radiation targets the lymph node clusters (mediastinum, neck, armpit, groin) that were involved at presentation. At this time there is discussion in the scientific community about the optimal dose and dosing; some centres use lower doses to reduce long-term side effects (heart and lung problems, secondary cancers), especially in younger patients.
Side effects depend on the irradiated area: skin reactions, fatigue, possible oesophagitis (if the chest is irradiated), and in the long term increased risk of heart and lung disease or secondary tumours.
Autologous stem cell transplantation
For patients with primary refractory disease (who do not respond to induction chemotherapy) or early relapse, autologous stem cell transplantation (ASCT) is considered.
ProveniIncluded in official guidelines, or approved by EMA or FDA
Patients first undergo chemotherapy to kill tumour cells; their own stem cells are then collected, frozen and stored, and after intensive chemotherapy (+ sometimes radiotherapy) returned to restore the blood-forming system. This offers approximately 50% survival rate in patients with refractory or early relapse disease — considerably better than chemotherapy alone in this group.
Side effects are serious and include infections, bleeding, organ damage (kidneys, lungs, liver), graft failure, and graft-versus-host disease (GVHD) if the graft attacks body cells. Many patients require long-term supportive care.
Immune checkpoint inhibitors
This is a relatively new, rapidly evolving part of Hodgkin lymphoma treatment.
ProveniIncluded in official guidelines, or approved by EMA or FDA
Nivolumab (anti-PD-1) and pembrolizumab (anti-PD-1) are approved for patients with relapsed or refractory classical Hodgkin lymphoma, both as first-line treatment after insufficient response to chemotherapy and in preparation for stem cell transplantation. These drugs free the immune system from blockade by tumour cells.
Recent research (July 2026) shows that certain biomarkers (including based on transcriptomic profiles) can help predict who is likely to respond to this therapy.
Known side effects are immune-related (immune-mediated) side effects: lung inflammation, bowel inflammation, thyroid disease, hepatitis, and rarely more serious complications such as heart inflammation. These can occur months after starting and require continuous monitoring and sometimes corticosteroids or discontinuation.
Bispecific antibodies
ResearchediPositive results in clinical studies, not yet standard treatment
Bispecific antibodies such as epcoritamab (targeting CD20 and CD3) are in investigational stages for Hodgkin lymphoma, particularly for relapsed/refractory disease. They connect tumor cells with patients' T-cells to activate them.
Studies (July 2026) show heterogeneity in side effects depending on dosage and population, suggesting that further refinement of dosing and patient selection is needed.
CAR-T-cell therapy
ResearchediPositive results in clinical studies, not yet standard treatment
CAR-T cells are patients' own T-cells that are genetically programmed to recognize and attack tumor cells (targeting CD30 or CD20). For Hodgkin lymphoma, this is being investigated particularly for relapsed/refractory disease, especially after autologous transplantation failure.
Side effects include cytokine release syndrome (fever, low blood pressure, fatigue), neurological symptoms, and immunotoxicity. Treatment requires hospitalization and intensive hospital care.
Bevorolimab and other experimental immunotherapies
ExperimentaliOngoing in study setting, outcome still unknown
Various experimental approaches are being investigated, including combinations of checkpoint inhibitors, new cytotoxic agents, and machine learning-based biomarker validation for better patient selection.
Supportive Treatment
This does not form part of "active" cancer treatment, but is essential:
ProveniIncluded in official guidelines, or approved by EMA or FDA
- **Infection prophylaxis**: antibiotics, antiviral medications, and antifungal drugs during periods of very low white blood cell counts
- **Growth factors**: G-CSF to stimulate white blood cell production after chemotherapy
- **Transfusions**: of red blood cells or platelets if needed
- **Supportive care**: medications for nausea, nutritional support, psychosocial counseling
These measures reduce complications and improve quality of life during active cancer treatment.
---
_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._