Hodgkin's Disease - Staging and Treatment Guidelines

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Later Stages. For stage III disease, chemotherapy, often with radiation, is a standard treatment. For stage IV disease, chemotherapy alone is generally recommended. Newer types of chemotherapy regimens are achieving survival rates that reach 90%.

Relapse. Relapse after treatment occurs in 20 - 35% of patients. Treatments for relapse include chemotherapy, radiation, and bone marrow or blood stem cell transplantation. Many patients respond favorably to such treatments, although another relapse is still possible.

Preparing for Side Effects before Treatment

Preventing Infection. Both the disease and some of the treatments suppress the immune system, increasing the risk for infections. Widespread, life-threatening infection is a particular danger if the spleen has been removed and both radiation and chemotherapy are administered. Patients should be vaccinated against three bacteria: pneumococcus, meningococcus, and Haemophilus influenza before receiving treatment.

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Preserving Fertility. Patients who may wish to have children in the future should discuss the possibility with their doctors options for fertility-preserving treatments. Men with Hodgkin's disease may want to consider sperm freezing and assisted reproductive techniques. Women should ask their doctors about taking hormonal drugs called GnRH analogs before and during chemotherapy.

[For more information on fertility preservation treatments, see In-Depth Report #67: Male infertility and In-Depth Report #22: Female infertility.]

Monitoring after Treatment

Relapse of Hodgkin’s disease is not uncommon, even after treatment for early stages. It can occur a decade or more after treatment. Relapse is more likely to occur in early-stage disease, probably because limited radiation normally used in such cases does not destroy all malignancies. Patients who had large tumors in the chest are also at higher risk for recurrence.

Patients need periodic examinations and imaging tests for years after treatment, both to check for signs of relapse as well as to monitor the long-term effects of treatments. Conditions to watch for include inflammation in the lungs and thyroid disease from radiation in the chest, and heart disease and cancers from combined treatments, chemotherapy and blood stem cell transplantation.