Hodgkin Lymphoma

For classic Hodgkin lymphoma, usually treatment starts with chemotherapy medicine. You will get chemotherapy in cycles, with a period of treatment followed by a rest period to let your body recover.

After several cycles of treatment, you will have a PET scan or CT scan to see how the cancer is responding to chemotherapy medicines. After that, many people have more chemotherapy and often radiation therapy.

If your disease does not respond well to treatment or returns after the first round of treatment, doctors may suggest high-dose chemotherapy and a stem cell transplant. Another option is immunotherapy.

Nodular lymphocyte-predominant Hodgkin lymphoma tends to grow more slowly and may be treated differently than classic Hodgkin lymphoma. Chemotherapy would be less intensive than for the classic form of this disease. Your doctor might also suggest surgery or radiation.

Immunotherapy can be used on its own or along with other treatments. Some types of immunotherapy boost the body’s immune system. Others train the immune system to target part of cancer cells or a substance that helps cancer grow. These therapies may stop the cancer cells from growing, dividing, making repairs or communicating with other cells.

We use immunotherapy as your main treatment if Hodgkin lymphoma comes back after treatment (relapses). For people who are newly diagnosed, we offer clinical trials that provide immunotherapy as a first treatment.

• Monoclonal antibodies are immune system proteins made in a lab to fight disease. They find and attach to the target and help kill cancer cells.
• Some monoclonal antibodies also carry chemotherapy medicine to cancer cells. They are called antibody drug conjugates. Brentuximab vedotin is an example.

• Immune checkpoint inhibitors boost the immune system’s ability to find and kill cancer cells. This type of therapy is used to treat some adults with Hodgkin lymphoma and is being studied as a treatment for younger people.

Many of our patients with lymphoma take part in research studies along with their standard medical treatment. Your doctor will talk with you about any new options that might help. Then you can decide if you want to take part. It is always your choice.

Because of our research leadership, we can offer options such as phase 1 clinical trials of the newest treatments.

Learn more about cancer clinical trials at Seattle Children’s

• You can search for many clinical trials offered at Seattle Children’s on our Current Research Studies page or on ClinicalTrialsgov. Read our guide about searching for trials on ClinicalTrials.gov (PDF).
• Contact us at 206-987-2106.
• Email us.

Most people with Hodgkin lymphoma are treated with chemotherapy using more than 1 medicine. Chemotherapy means giving medicines that go throughout your body to kill cancer cells.

Our patients receive chemotherapy at our hospital campus in Seattle. You may get chemotherapy at our outpatient infusion center as a day procedure or stay overnight in our Cancer and Blood Disorders Center - Inpatient.

See more about getting chemotherapy at Seattle Children’s.

Doctors often use radiation therapy along with chemotherapy to kill cancer cells and reduce the size of any tumors.

Options include:

• X-rays: A machine outside the body delivers strong beams of X-raysinto the body.
• Proton therapy: Unlike X-rays, proton beams stop once they reach their

Before treatment, imaging studies help find the exact location of Hodgkin lymphoma so doctors give radiation only to the affected areas. We focus beams carefully to help limit damage to healthy tissue.

Our radiation oncologist, Dr. Ralph Ermoian, is very experienced caring for young people. He helps your team decide if radiation may be helpful and what type of radiation to use.

Research has shown that some people do not need radiation therapy. It depends on your lymphoma and how well it responds to other therapy.

Learn more about Seattle Children's Radiation Therapy Service.

Most people with Hodgkin lymphoma do not have surgery, except for a biopsy to help diagnose the disease. During a biopsy, doctors usually remove a whole lymph node to check for cancer. In some cases, they may remove a small sample of tissue from another place in your body that has a tumor.

Most of the time, lymphoma spreads throughout the lymph system, so it is rare to have a tumor in a specific place. Even if you do have a tumor, doctors are likely to treat it with chemotherapy and radiation, not surgery.

Rarely, if a person has nodular lymphocyte–predominant Hodgkin lymphoma in only 1 node, they may be treated with surgery alone.

We do surgery at our hospital campus in Seattle. Learn more about surgery to treat tumors at Seattle Children’s.

If lymphoma comes back after first treatment, your doctor may suggest high doses of chemotherapy followed by a transplant of your own hematopoietic (him-at-oh-poy-EH-tik) stem cells. These are young cells that grow into different types of blood cells.

Doctors recommend a stem cell transplant if there are high-risk features when Hodgkin lymphoma comes back. These include:

• Cancer returns to a place that has been treated with radiation
• B symptoms
• Cancer outside of lymph nodes
• A short time between the last treatment and the return of lymphoma

High-dose chemotherapy treats tumors more effectively than lower-dose chemo. But the drugs damage your bone marrow’s ability to make new blood cells. That is why you need a transplant of your stored, healthy stem cells.

A stem cell transplant using a person’s own cells is called autologous (aw-TAH-luh-gus). Before high-dose chemotherapy, doctors remove some of your stem cells. The cells are frozen and stored. After chemotherapy is finished, doctors return the stem cells to your body through a vein.

In rare cases, or if the Hodgkin lymphoma comes back after the transplant, doctors may transplant stem cells from a donor whose cells closely match yours. This type of stem cell transplant is called allogeneic (A-loh-jeh-NAY-ik).

For either type of transplant, you may get radiation before the transplant or after you recover from the transplant.

We do the transplants at Seattle Children’s, working closely with our partner Fred Hutch. Fred Hutch is one of the largest stem cell transplant centers in the world.

Learn more about the Pediatric Blood and Marrow Transplant Program.

• Our outcomes for patients with Hodgkin lymphoma are better than the national average. We treat more young people with lymphoma than any other center in the region.
• Your child will benefit from the work of physician-scientists at Fred Hutchinson Cancer Center and UW Medicine, as well as at Seattle Children’s. The National Cancer Institute has named our partnership a comprehensive cancer center.
• A doctor specially trained in diagnosing and treating cancer in children and adolescents (pediatric oncologist) will guide your care. Our team’s experience helps us recommend the right treatment at the right time to have the best results.

• Our approach to treatment will depend on your specific type of Hodgkin lymphoma and how it responds to the first therapy given. This is called risk-adapted, response-driven therapy. Our goal is to cure the disease and limit any long-term effects from the treatment.
• We offer advanced treatment options such as immunotherapy, chemotherapy, stem cell transplants, surgery, radiation therapy and new approaches offered in research studies.
• Our doctors are leaders in lymphoma research, such as using the immune system to fight cancer (immunotherapy). As research leaders, we can offer our patients the very latest treatments being studied, including phase 1 clinical trials.
• For those who need stem cell transplants, we work closely with Fred Hutch, whose doctors pioneered this lifesaving treatment. Our team works with your family through the whole process — preparing for transplant, doing the transplant here at Seattle Children’s and caring for you as you recover.
• We work to help you have a healthy life after you beat cancer. Eric Chow chairs the Outcomes and Survivorship Committee of the Children’s Oncology Group (COG). COG is a global organization of cancer specialists who work to improve care and cure rates for young people with cancer. Researchers at Seattle Children’s lead studies within COG and at Seattle Children’s and Fred Hutch to better understand and reduce the late effects of lymphoma therapy on young people.
• Read more about cancer research and clinical trials at Seattle Children’s.

• Our specialty is treating cancer in young people while helping them grow up to be healthy and productive adults. We take care of you from diagnosis through all phases of treatment and follow-up survivor care.
• Our team cares for you as a whole person. We don’t just treat disease. As needed, you will receive care from specialists in nutrition, pain management, pharmacy, palliative care, physical therapy and emotional health. Read more about the supportive care we offer.
• Children and adolescents do not react to illness, injury, pain and medicine in the same way as adults. They need — and deserve — care designed just for them. Our experts focus on how treatments today affect growing bodies in the future. We plan your treatment based on our years of experience and the newest research on what is best and safest.
• We know that teens and young adults with cancer have different challenges than young children. Our Adolescent and Young Adult Cancer Program focuses on your needs, which may include fertility preservation.
• People who have been cured of cancer may be affected for months or years by their disease or treatment. Our Cancer Survivor Program provides long-term follow-up care to help children, teens and young adults stay healthy after being treated for cancer in childhood.

• A diagnosis of lymphoma can be scary. We help take positive steps right away by offering appointments in 1 to 3 days to people suspected to have cancer. If your needs are not urgent, new patients can be seen in 1 to 2 weeks.
• During visits, we take time to explain your condition. We help you fully understand your treatment options and make the choices that are right for your family.
• Our social workers and child life specialists help you and your family through the challenges of cancer. We connect you to community resources and support groups.
• We work with families from around the Northwest and beyond. Whether you live nearby or far away, we can help with financial counseling, schooling, housing, transportation, interpreter services and spiritual care. Read about our services for patients and families.