Can I Have Sex
Generally, sex during treatment is considered to be safe. Check with your medical team about any precautions you should take, especially if you have low platelets as this heightens your risk of bruising and bleeding.
During chemotherapy treatment, its important to note that:
- you should use a condom to avoid passing chemotherapy to your partner and to protect against infection.
- The pill might be less effective so discuss contraception with your GP or clinical nurse specialist.
Chemotherapy For Hodgkin Lymphoma
Chemotherapy is the use of drugs to kill cancer cells. Chemo is usually injected into a vein under the skin or taken as a pill. Chemo drugs enter the bloodstream and travel throughout the body to reach and destroy cancer cells wherever they may be.
Chemo is the main treatment for most people with Hodgkin lymphoma . Sometimes chemo is followed by radiation therapy.
Chemo is given in cycles that include a period of treatment followed by a rest period to give the body time to recover. In general, each cycle lasts for several weeks.
Most chemo treatments are given in the doctors office, clinic, or hospital outpatient department, but some may require a hospital stay.
What Can I Expect During Abvd Chemotherapy
With ABVD chemotherapy, the four chemotherapy drugs are given through an IV on days 1 and 15 of your treatment 28-day cycle. This process takes about 3 to 4 hours. Your doctors will recommend a certain amount of cycles based on factors such as your overall health and the stage of your cancer.
The has provided estimates of the amount of cycles you may need based on different factors. One factor is favorability, which means the cancer is:
- found in less than three lymph node areas
- does not cause B symptoms
- your erythrocyte sedimentation rate is not elevated
The estimated number of cycles based on these factors are:
- favorable early stage cancer: 2 to 4 cycles
- unfavorable early stage cancer: 4 to 6 cycles
- advanced stage cancer: at least 6 cycles or more
At the same time you receive the chemotherapy drugs, most patients receive premedications with corticosteroids and antihistamines to prevent side effects.
Your doctor may also recommend that you take prescription anti-nausea pills to prevent vomiting and nausea. Its often recommended that you take these drugs before and after receiving chemotherapy.
Youll also have a blood test done either before the first day of your cycle or on the first day to check your white blood cell count.
The drugs administered during ABVD, and other types of chemotherapy, can damage healthy cells and cause many types of side effects. While not everyone will experience all of these side effects, most people will have some. These can include:
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Treatments For Stage 3 Lymphoma
Stage 3 lymphoma is treatable. Your healthcare provider may recommend several different therapies for you. Treatments at this stage are geared towards shrinking or eradicating tumors.
Chemotherapy is the main treatment used for stage 3 lymphoma. Chemo is beneficial for killing cancer cells throughout the body. Based on the drugs used, you may have anywhere from three to eight cycles.
Chemo may be given intravenously or orally. In some instances, Adcetris , a targeted therapy monoclonal antibody drug, may be added to your treatment protocol.
Radiation therapy may be done after chemo to target areas of the body with large or multiple tumors. The type of radiation used is typically external beam radiation. A machine will deliver a focused beam of radiation directly at the tumor site.
Immunologic drugs may be used alone or in addition to chemotherapy. Immunologic medications boost your immune system, so you’re better able to kill or slow down the growth of lymphoma cells. Immunologic drugs are given intravenously.
Targeted drug therapy may be tried. Targeted therapy drugs zero in on the proteins on cancer cells that instruct them to grow and divide.
If you dont respond favorably to treatment, or your lymphoma comes back , a stem cell transplant may be recommended to you. Stem cell transplants are also known as bone marrow transplants. This treatment allows your healthcare provider to give you higher doses of chemotherapy, which damages the bone marrow.
Staging And Prognostic Evaluation
The Ann Arbor classification defines four clinical and pathologic stages of HL . In 1990, the suffix X was incorporated into the classification and indicated the presence of bulky disease, i.e. a single mass exceeding 10 cm in largest diameter or a mediastinal mass exceeding one third of the maximum transverse transthoracic diameter on a standard posterior-anterior chest radiograph at the level of T5T6 . In North America, the division of HL into limited stage and advanced stage has guided modern treatment strategies. The National Cancer Institute of Canada/Eastern Cooperative Oncology Group further distinguishes unfavorable early stage patients as those age 40, ESR 50, mixed cellularity or lymphocyte depleted histology, or 4 sites of disease . The therapeutic implications of these and similar subdivisions used by the European cooperative groups remain unclear .
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Which Chemo Drugs Are Used To Treat Hodgkin Lymphoma
Chemo for classic Hodgkin lymphoma combines several drugs because different drugs kill cancer cells in different ways. The combinations used to treat cHL are often referred to by abbreviations.
ABVD is the most common regimen used in the United States:
Radiation is given after chemo in the Stanford V regimen. It’s sometimes given after the ABVD or BEACOPP regimens, too.
Other chemo combinations can also be used for HL. Most use some of the same drugs listed above, but they might include different combinations and be given on different schedules.
Another drug that can be considered as chemo is brentuximab vedotin . This is an antibody-drug conjugate , which is a monoclonal antibody attached to a chemo drug. For more on this drug, see Immunotherapy for Hodgkin Lymphoma.
Bv And Checkpoint Inhibitors
cHL is characterized by the presence of a minority of bi- or multinucleated Hodgkin and Reed-Sternberg cells that universally express CD30 in an inflammatory tumor microenvironment. BV is an anti-CD30 monoclonal antibody conjugated to the microtubule-disrupting agent monomethyl auristatin-E. PD-L1 and PD-L2 are upregulated by HRS cells in about 90% of patients and induce T-cell exhaustion, which contributes to immune escape of HRS cells. CPIs are monoclonal antibodies that block the interaction between inhibitory ligands such as PD-L1 and PD-L2 on the tumor cells and PD-1 receptors on immune effector cells.
Diagnosing Stages Of Lymphoma
There are several diagnostic tests used to determine the lymphoma stage. Testing can also help determine how you’re responding to your current treatment for this disease. These tests vary, based on your symptoms.
Swollen or enlarged lymph nodes will be biopsied to confirm a diagnosis of Hodgkins or non-Hodgkins lymphoma. In many instances, the entire lymph node will be removed for laboratory testing. This ensures that enough tissue is available for analysis and diagnosis.
A bone marrow aspiration and biopsy will be done to determine if cancer has spread to the bones. Usually, the bone marrow is taken from the hip bone for this test.
A spinal tap to remove and test cerebrospinal fluid may be done if your doctor suspects that lymphoma has spread to the brain.
Sampling of pleural fluid or peritoneal fluid may be done to check for spread into the chest or stomach. Lymphoma can cause fluid buildup in these and other areas of the body. These tests use fluid extracted from the abdomen or chest to look for cancer cells.
Imaging tests will be done to identify enlarged lymph nodes and organs where cancer may have spread. They include:
- Chest X-ray
- Computed tomography scan: A cross-sectional detailed X-ray study
- Ultrasound: Uses sound waves to produce images
- Magnetic resonance imaging scan: Uses magnetic fields
- Bone scan: Uses a radioactive tracer to look for bone damage and cancer
- Positron-emission tomography scan: Uses radioactive sugar to identify highly active cells
Physical Emotional And Social Effects Of Cancer
Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.
Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.
Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options.
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Could Acupuncture Help Me
There is some evidence that acupuncture can help with nausea and vomiting as side effects of chemotherapy. It could also help to relieve pain. As with all complementary therapies, speak to a member of your medical team before you decide whether to have acupuncture. They might advise that you avoid it if you are at risk of low platelets or low neutrophils as a side effect of chemotherapy. This is because it could increase your risk of bleeding or infection.
Role Of Radiotherapy In The Management Of R/r Chl
The role of radiotherapy in the R/R setting has not been revisited well in this era of novel treatment options. Radiotherapy can be used pre-ASCT or post-ASCT on residual lesions or in patients with extranodal or bulky disease and as part of the conditioning regimen using total lymphoid irradiation, but comparative data about efficacy of radiotherapy in these settings are scarce and outdated. Earlier studies have shown that patients who receive radiotherapy have a decreased risk of local recurrence, and thus for patients with limited-stage disease at relapse, radiotherapy may be an effective option. Using radiotherapy in patients who have a PR pre-ASCT would be an interesting strategy to increase the CMR rate, and studies investigating this approach are warranted. In addition, the synergistic effects of radiation with immunotherapy, as described in a few case reports, should be investigated more extensively and could be an option for patients who relapse after ASCT or are ineligible for ASCT.
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Bv And Cpi Treatment For Patients Who Relapse After Asct Or Are Ineligible For Asct
Patients who relapse after ASCT or are ineligible for ASCT due to chemotherapy-resistant disease generally have a poor prognosis. In , we summarize the most important recent studies in patients with R/R cHL who have progression after at least 1 line of salvage treatment. The first breakthrough in the post-ASCT setting was the application of monotherapy with BV in heavily pretreated R/R patients, which showed an ORR of 75% and a CMR rate of 34% with a median PFS of 20.5 months in those with a CMR. The PFS rate at 5 years, however, was only 22% with an OS of 41%, highlighting the need for additional treatment options .
Overview of recently reported trial results incorporating BV or CPIs for patients after 1 line of salvage treatment
A study that investigated pembrolizumab monotherapy showed an ORR of 69% and a CMR rate of 22%, with a 2-year PFS of 31% and OS of 91%. Several different CPIs and also combinations of CPIs have been investigated in R/R cHL.,,, In a phase 1 trial, 64 patients were randomized between ipilimumab-BV, nivolumab-BV, and triple therapy with ipilimumab-nivolumab-BV. The trial showed differences in toxicity profile and efficacy between the 3 regimens, with the highest percentage of grade 3/4 adverse events in the triplet and ipilimumab-BV group, whereas the highest ORR and CMR rates were found in the triplet and nivolumab-BV group.
Is It Safe To Drink Alcohol
Generally, it should be OK to have the occasional alcoholic drink between chemotherapy cycles when you feel well enough, but check with your hospital consultant whether it is safe for you. Alcohol can interact with some drugs and affect how well they work. Remember, too, that you might feel the effects of alcohol more quickly now than you did before you had treatment.
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Goals Of Therapy And Response Assessment
Hodgkin lymphoma has gone from an incurable disease to one with a cure rate of almost 75%. In general, the goal of therapy is to obtain complete remission . Even in patients who fail to achieve CR, however, there are effective salvage regimens available that can result in long-term survival or cure.
Treatment response criteria are defined as follows:
CR: Disappearance of all evidence of disease as assessed by computed tomography scanning, positron-emission tomography scanning, history and physical examination, and bone marrow biopsy
Partial response: Achievement of at least a 50% regression in sites of measurable disease and no new sites of disease
Stable disease: Failure to achieve either of the above criteria, but not meeting criteria for progressive disease
Progressive disease: Any new lesion or an increase from a nadir of at least 50% in a measurable lesion if this occurs after a prior CR, it is called relapsed disease
Patients are assessed for response in various ways. Prior to each cycle of therapy, the patient is evaluated by a clinician who performs a history and physical examination. In addition, laboratory studies are usually obtained. In general, a CT scan is performed midway through the planned treatment to assess for response .
Can I Have A Flu Vaccination
Ask your medical team whether they advise that you have the flu vaccination. The vaccine might not work effectively while you are having chemotherapy so it is often better to have the vaccine either before or after completing the course of chemotherapy. After finishing treatment with chemotherapy, it is sensible to have the flu vaccination each year.
Cancer Research UK has more information about flu vaccines and cancer treatment.
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Recurrent Or Relapsed Hodgkin Lymphoma
If HL comes back after treatment, further treatment depends on where the lymphoma comes back, on how long it has been since the initial treatment, and on what the initial treatment was.
If chemotherapy without radiation therapy was used first, and the cancer comes back only in the lymph nodes, radiation to the lymph nodes can be done, with or without more chemo. Chemo with different drugs may be another option.
Radiation usually cannot be repeated in the same area. If, for example, HL in the chest was treated with radiation and it comes back in the chest, it usually can’t be treated with more radiation to the chest. This holds true no matter how long ago the radiation was first given.
If the lymphoma returns after many years, using the same or different chemo drugs might still cure it. On the other hand, HL that recurs soon after treatment may need more intensive treatment. For example, if the HL has returned within a few months of the original treatment, high-dose chemo followed by an autologous stem cell transplant may be recommended.
If the HL still remains after an autologous transplant, an allogeneic stem cell transplant may be an option. Another option, either instead of or after a stem cell transplant, may be treatment with an immunotherapy drug, such as brentuximab vedotin , nivolumab , or pembrolizumab .
Should I Take Exercise
Physical activity can have a positive impact on physical and mental health. It could also shorten your recovery time after treatment.
Speak to your doctor about the type and intensity of exercise thats safe for you. You might be advised to avoid certain types of exercise at times. For example, youll probably be advised to avoid contact sports like rugby if you have a low platelet count , due to the risk of bruising and bleeding. You might also be advised against swimming for a while because of the increased risk of infection from public pools and changing rooms.
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Maintenance Treatment After Asct
For patients with a high risk of relapse after ASCT, maintenance treatment with BV can be considered. In a study investigating BV maintenance, 329 patients with unfavorable risk R/R cHL received either up to 16 cycles of BV maintenance or placebo after ASCT. The study showed improvement in PFS in patients receiving BV maintenance, with a 5-year PFS of 59% vs 41% for placebo. However, there was no difference in OS, probably because 87% of patients who relapsed in the placebo arm received BV at the subsequent relapse. Therefore, the use of BV maintenance after ASCT could potentially be restricted to patients with at least 2 risk factors, or alternatively, its use could be delayed until progression. With the increasing use of BV in the first-line setting, it is also important to investigate whether patients who relapse after BV in combination with chemotherapy will still show advantage of BV maintenance after ASCT. Alternatively, CPI could be used as maintenance treatment a small phase 2 trial in 30 high-risk patients showed high post-ASCT PFS. The combination of CPI and BV maintenance in 59 high-risk patients has also shown promising results, with 5 patients with PR converting to CR during maintenance. Further studies should investigate the role of post-ASCT maintenance in high-risk patients with CPI and/or BV vs reserving these treatments for a subsequent relapse.