Hodgkin lymphoma is highly treatable, even in its advanced stages. However, not everyone responds to treatment the same way. About 35 to 40 percent of people with advanced Hodgkin lymphoma require additional treatment after the first attempt.

It’s natural to feel frustrated or disappointed if your first course of treatment doesn’t seem to be effective. Keep in mind, that there are other options available, and your next treatment option might work better for you.

First-line treatments

When deciding on your initial treatment, your doctor will consider things such as:

  • the type of Hodgkin lymphoma
  • the stage of the cancer at diagnosis
  • the specific symptoms you’re experiencing
  • whether the disease is “bulky,” which means the tumors have grown beyond a certain width
  • personal factors such as your overall health, age, and preferences

Stages 3 and 4, as well bulky cases, are considered advanced stages of Hodgkin lymphoma. If you have advanced Hodgkin lymphoma, your doctor will likely recommend a more intense chemotherapy regimen, usually lasting about 12 weeks. Radiation therapy is also commonly recommended after chemotherapy, especially for bulky cases.

Second-line treatments

Successful treatment should remove all traces of Hodgkin lymphoma from your body. After your initial treatment is complete, your doctor will run tests to look for remaining signs of the disease. If the cancer is still present, other options need to be explored.

Stem cell transplantation

A stem cell transplant is the likely next step if your cancer is refractory, or if your cancer has relapsed. The term “refractory” means the cancer is resistant to first-line treatment. A relapse means that your cancer has returned after treatment.

Applying chemo and radiation therapy is a delicate process. These therapies can be quite effective, but they can also harm healthy cells in your body. In turn, these treatments can lead to difficult side effects and the possible emergence of second cancers.

At a certain point, the negative side effects may outweigh the potential benefits. When this happens, your doctor won’t simply provide a stronger dose. Instead, they may recommend stem cell transplants. This procedure restores blood marrow cells after you receive more intense treatment.

There are two primary types of stem cell transplants.

The first is an autologous stem cell transplant, which uses your own blood stem cells. These are collected from bone marrow or blood several times leading up to treatment. The cells are then frozen while you undergo therapy. When complete, the undamaged cells are returned to your body to aid in your recovery.

The second is an allogeneic stem cell transplant, which uses blood stem cells from a donor.

To prevent complications, the donor’s tissue type needs to be closely related to your own. Immediate family members such as your parents, siblings, or children are more likely to be potential donors. Other donors can be found through registries such has the National Marrow Donor Program. It can take several weeks or more before a match is found.

After receiving treatment, it may take six months or more for your immune system to recover. During this time, you’ll be highly susceptible to infections. It’s important to take extra precautions not to expose yourself to germs.

Clinical trials

Doctors and drug developers are continually working to create more effective treatments with fewer side effects. Before any treatment is approved for widespread use, it’s carefully studied using volunteers. If your cancer didn’t respond to the first treatment, you may want to consider participating in a clinical trial.

There are many reasons to volunteer for a trial. One reason is the possibility of receiving the newest and potentially best treatment available. In some trials, researchers will pay for your treatment in addition to lodging and travel costs while you’re involved. You’ll also be contributing to the scientific knowledge of Hodgkin lymphoma. This helps scientists develop better treatments.

However, there are downsides too. As with all cancer therapies, the risks and benefits need to be carefully considered. Because the drugs provided in clinical trials are still being studied, they may be less effective. The drugs could also cause more negative side effects than researchers expect.

If you volunteer to take part in a clinical trial, there’s also a possibility you may be assigned to be part of the control group. Participants in control groups are given placebos, which allow researchers to compare their progress to people taking the actual drug. Medical ethnics prevent people from being assigned to a control group if they’re substantially more likely to die, suffer irreversible harm, or experience significant discomfort.

Immunotherapy

Immunotherapy is a new form of treatment designed to help your own immune system attack cancer cells.

“Checkpoint inhibitors” are a common type of immunotherapy. The cells in your immune system have a substance that prevents them from targeting healthy cells. Some cancer cells use this to their own advantage. Drugs such as nivolumab (Opdivo) and pembrolizumab (Keytruda) block these checkpoints. This allows your immune system cells to attack the cancer cells. During a 2017 clinical trial for nivolumab, 65 percent of participants who failed their first treatment experienced complete or partial remission after being given the drug.

Another form of immunotherapy is monoclonal antibodies (mAbs), which are artificial versions of immune system proteins. These can attack cancer cells directly, or contain radioactive molecules that poison cancer cells. This therapy generally produces less intense side effects than standard chemotherapy regimens.

New drugs are continually being approved by the FDA or studied in clinical trials. When discussing second-line treatment options with your doctor, be sure to ask about the latest developments in therapeutic clinical trials for Hodgkin lymphoma.

Palliative care

Treating cancer can be a difficult process. Palliative care is designed to ease the discomfort and stress of treatment, taking into account your psychological, social, and spiritual needs. It’s common for people living with cancer to feel stress and frustration if their first course of treatment isn’t successful. That’s why palliative care is especially important if you’re undergoing additional treatment.

If you aren’t sure what options you have for palliative care, talk to your doctor.

The takeaway

Treatments for Hodgkin lymphoma have come a long way over the last few decades. New drugs and therapies are continually being developed. These new approaches have the potential to treat the disease more effectively and with fewer side effects.

Staying up to date on the newest developments may help you to make informed decisions if your first treatment fails. Building a strong, trusting relationship with your doctor can also help you feel more comfortable asking questions and exploring different treatment options.