B symptoms are defined by the following:
- fever, temperature greater than 100.4°F (38°C)
- unintentional weight loss of more than 10 percent of body weight over the past six months
- drenching night sweats
The presence of B symptoms is incorporated into the prognostic criteria for early stage classical Hodgkin lymphoma, and can impact treatment decisions.
Optimal treatment for advanced stage Hodgkin lymphoma always includes chemotherapy. There are several options for chemotherapy that use a combination of drugs. The most common regimen in the United States is ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine). The chemotherapy regimen your provider chooses is based on your overall function, any other medical issues, and extent of disease.
Those with a bulky or large tumor site before the initiation of treatment may also need radiation after chemotherapy.
Oral changes and inflammation during chemotherapy are common. These can include changes to taste buds, decreased saliva production, mouth sores, bleeding, and dry mouth.
Good oral care and hygiene is advised during chemotherapy. This includes removing dentures, cleaning your teeth and gums, and doing oral rinses with a solution of salt and baking soda on a frequent basis. For dry mouth, you can use over-the-counter saliva substitutes. Apply lubricants to dry, cracked lips.
Many cancer centers have dedicated dietitians on staff. You may find it helpful to receive specific guidelines on food and supplement suggestions to use during cancer treatment. Dietary modifications often have to be made due to oral pain or sores, impaired taste buds, dry mouth, or nausea.
We advise refraining from eating raw seafood or meat, and taking extra precautions to wash and prepare food well.
If you don’t achieve complete remission or a cure with initial treatment, you may need second-line treatment with chemotherapy. This is then followed by an autologous stem cell transplant (using your own stem cells).
If Hodgkin lymphoma returns after the transplant, you can become a candidate for a second stem cell transplant. This is typically an allogeneic transplant (using stem cells from a donor).
Candidacy for either type of transplant is determined by many factors. These include age, health status, organ function, blood tests, and the response of the lymphoma to prior treatments.
New lymphoma treatments have been developed to target mechanisms of how Hodgkin lymphoma grows. Targeted treatments are different from chemotherapy, which affects many cells.
There are many different types and classes of targeted therapy. Discuss these with your oncologist or healthcare provider. For those who have classical Hodgkin lymphoma, targeted therapies are generally used with relapsed or refractory disease.
The difference between these two types of lymphoma relates to the appearance of the cancerous cells.
If the cancerous cells are classified as Reed-Sternberg cells, the diagnosis is classical Hodgkin lymphoma. If the cancerous cells are classified as lymphocyte-predominant cells (also known as popcorn cells), the diagnosis is nodular lymphocyte predominant Hodgkin lymphoma.
For non-Hodgkin lymphoma, there are many subtypes. These are also defined by the features of the cancerous cells.
Your treatment plan is based on unique features of your disease and is intended to reduce the risk of lymphoma recurrence. Upon completion of treatment, your oncologist or healthcare provider will give you a surveillance plan. This will initially include repeat clinical exams and visits, and blood tests every few months. It may also include periodic imaging with chest X-rays or CT scans.
Make sure you follow the recommended guidelines, which are intended to detect a relapse as early as possible. Inform your healthcare provider if any new symptoms or enlarged lymph nodes develop, as well.
Staging for Hodgkin lymphoma is based on the Ann Arbor system. This system looks at the distribution of involved lymph nodes. It also looks at the sites of lymphoma outside the lymph nodes (such as organ or bone marrow involvement). This is the same staging system used for non-Hodgkin lymphoma.
Other cancers are staged by different systems.
A remission, either partial or complete, means that the lymphoma has decreased in size/extent. A partial remission means that while there has been a reduction in lymphoma size/extent, detectable disease remains. A complete remission means that there is no detectable lymphoma. It’s possible, though, that a small amount of lymphoma remains in the body that is below the level of detection.
A cure means that the lymphoma will not come back. The longer you stay in complete remission, the more likely you’re cured.
Lauren Maeda is a board-certified medical oncologist/hematologist, specializing in the treatment of non-Hodgkin and Hodgkin lymphomas. She maintains an active clinical practice in her role as clinical assistant professor at Stanford University Medical Center in Stanford, California.