Hodgkin Lymphoma

What is Hodgkin lymphoma?

Lymphoma is cancer that starts in white blood cells (lymphocytes) that are part of the body’s infection-fighting immune system.

There are 2 main types:

They differ in how they:

  • Spread
  • Affect the body
  • Respond to treatment

Lymphoma can start anywhere in the lymph system and can spread to other parts of the body. Doctors do not know what causes Hodgkin lymphoma. There is no known way to prevent it.

Hodgkin Lymphoma at Seattle Children’s

To have the best chance of a cure, you need a team experienced in treating Hodgkin lymphoma in children, teens and young adults. Each year our Leukemia and Lymphoma Program team cares for many families who have a child with this cancer. Some are just starting treatment. Others have refractory or relapsed disease. Our entire focus is on helping you beat this disease and thrive. 

If you would like an appointment, ask your primary care provider to refer you to Seattle Children’s Cancer and Blood Disorders Center.

If you have a referral or would like a second opinion, contact the center at 206-987-2106 or by email.

Providers, see how to refer a patient.

  • Among the nation’s best cancer programs, with better survival
    • 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.
  • Advanced therapies and clinical trials
    • 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.
  • Complete care from birth to young adulthood
    • 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.
  • Support for your whole family
    • 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.

Symptoms of Hodgkin Lymphoma

These symptoms may be caused by Hodgkin lymphoma or by another condition. Check with a doctor if you have any of these:

  • Shortness of breath, breathing trouble, wheezing or high-pitched breathing.
  • Swelling in the head, neck, upper arms or chest.
  • Trouble swallowing.
  • Swollen lymph nodes in the neck, underarm, chest, abdomen, pelvis or groin. Most often, lymph node symptoms appear slowly over a long period. Symptoms can be present for a year before doctors diagnose the disease.
  • Unexplained fever, weight loss or drenching night sweats. These are sometimes called B symptoms and may be signs of a more advanced form of disease.
  • Itching all over.

Diagnosing Hodgkin Lymphoma

To find out whether you have Hodgkin lymphoma, the doctor will:

  • Do an exam to look for signs of the disease.
  • Ask about your health.
  • Test your blood. We check how many cells of each type are moving through the bloodstream. Another test looks for chemicals in the blood that may be signs of cancer.
  • Have a surgeon take a sample of tissue (biopsy).

Your doctor will want to take pictures of the inside of your body (imaging studies). These help show enlarged lymph nodes, tumors or areas where cancer is active. Imaging studies may include:

  • X-ray of the chest
  • CT (computed tomography) scan
  • PET (positron emission tomography) scan

Stages of Hodgkin Lymphoma

It is important to find out how far cancer has spread and what body parts it affects. This process is called staging.

Knowing the stage of your cancer helps your doctor plan the right treatment. There are 4 stages of Hodgkin lymphoma. Your doctor will explain the stage of your disease and the best treatment for it.

Treating Hodgkin Lymphoma

Our goal of treatment is to give you the best chance of a long and healthy life. We offer the most advanced treatments for Hodgkin lymphoma in our region, including clinical trials of promising new therapies.

Your healthcare team will suggest a treatment plan based on:

  • Whether you have classic Hodgkin lymphoma or nodular lymphocyte-predominant Hodgkin lymphoma.
  • The stage of the disease.
  • The size of tumors. If tumors are large, the condition is called “bulky disease.”
  • Number of red blood cells and white blood cells.
  • Your age and overall health.
  • Your family’s preferences.
  • How well cancer responds to early treatment with chemotherapy.

Hodgkin lymphoma may need more intense treatment if:

  • It is later stage
  • Tumors are larger (bulky disease)
  • You have fever, weight loss or night sweats (B symptoms)
  • Classic 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

    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.

Treatment Options for Hodgkin Lymphoma

We are experienced with all treatment options for Hodgkin lymphoma, including using your immune system to fight cancer (immunotherapy). The goal of this approach is to improve cure rates while reducing the harsh effects of traditional treatments like chemotherapy or radiation therapy. As leaders in pediatric cancer research, we can offer options that are not available at all centers.

  • Immunotherapy

    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.
  • Clinical trials for Hodgkin lymphoma

    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

  • Chemotherapy

    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.

  • Radiation therapy

    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.

  • Surgery

    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.

  • High-dose chemotherapy and stem cell transplant

    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.

Follow-up Care

Follow-up care is important after treatment ends — no matter what type of treatment you had. The follow-up routine will depend on your cancer and treatments.

Most of our patients visit Seattle Children’s for follow-up care. If you live far from Seattle, you may get some follow-up care from a cancer doctor closer to where you live.

During follow-up visits at Seattle Children’s, your team will:

  • Look for any signs that cancer is returning
  • Check for effects that may happen months or years after treatment
  • Tell you about any risk for other cancers and signs to watch for

Our Cancer Survivor Program provides long-term follow-up care to help young people stay healthy after being treated for cancer in childhood. 

Contact Us

If you would like an appointment, ask your primary care provider to refer you.

If you have a referral or would like a second opinion, contact the Cancer and Blood Disorders Center at 206-987-2106 or by email.

Providers, see how to refer a patient.

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