Key points
- Hodgkin lymphoma is one of the most curable cancers: up to 9 in every 10 patients are cured with chemotherapy and sometimes radiotherapy [1].
- The backbone of treatment is ABVD chemotherapy, and a PET scan after 2 cycles shows whether treatment can be made lighter or needs to be made stronger [3, 6, 5].
- In advanced disease, adding the immunotherapy drug nivolumab to chemotherapy controlled the disease better than earlier combinations [8, 3].
- If the disease comes back, cure is still possible: more than half of these patients do well with further treatment and a transplant of their own stem cells [1, 3].
- Long follow-up is needed after treatment, because late effects on the heart, lungs and thyroid, and a second cancer, can appear years later; before starting, ask about protecting your fertility [2, 1].
The story of Hodgkin lymphoma: from cure to cure with fewer side effects
Hodgkin lymphoma is a cancer of cells of the lymphatic system that is seen most often in young adults (ages 20 to 39) and then again from age 65 [2]. It usually shows itself with painless, swollen lymph nodes in the neck, armpit or groin, and sometimes with fever, drenching night sweats, weight loss or tiredness [2]; see the symptoms in What are the symptoms of lymphoma?.
Hodgkin lymphoma has been curable with chemotherapy for decades. For nearly 20 years, the standard treatment for advanced disease was a four-drug combination called MOPP [4]. In 1992, a large study showed that the ABVD regimen (doxorubicin, bleomycin, vinblastine and dacarbazine) cleared the disease better than MOPP and was less harmful to the bone marrow [4]. MOPP more often caused infertility and sometimes leukaemia [1]. Since then ABVD has been the backbone of treatment [3].
But success had another side. People treated decades ago with extensive radiotherapy and heavy chemotherapy more often developed a second cancer, heart disease and lung damage years later [11, 1]. In these patients, after 15 to 20 years, deaths from these effects outnumbered deaths from the lymphoma itself [1].
That is why today's treatment has two aims: cure, with as few late side effects as possible. The key is a PET scan after 2 cycles of chemotherapy [3]. In a large study, the PET scan was negative after 2 cycles in more than 8 in every 10 patients with advanced disease; in these patients, leaving the drug bleomycin out of the rest of treatment caused less lung damage and did not make results significantly worse [6]. By contrast, in patients with limited-stage disease whose PET scan stayed positive, making treatment stronger improved results [5]. New drugs also arrived: brentuximab vedotin and the immunotherapy drug nivolumab in advanced disease [7, 8].
Treatment today by stage
- 1
Diagnosis and staging
The diagnosis is made with a biopsy of a lymph node. A PET scan combined with a CT scan shows the stage, and the stage together with a few risk factors decides how intensive treatment should be [3].
- 2
Limited stage (1 and 2)
Usually 2 to 4 cycles of chemotherapy (ABVD, and in some younger patients with risk factors, 2 cycles of a stronger regimen first), often with radiotherapy to the involved area [3]. If the PET scan is still positive after 2 cycles, making chemotherapy stronger lowered the risk of relapse [5]. If it is negative, leaving out radiotherapy slightly increased the risk of relapse [5]; but radiotherapy also has late side effects [1], so weigh this choice with your doctor.
- 3
Advanced stage (3 and 4)
Nivolumab with the three AVD drugs for 6 cycles: in a large study it controlled the disease better than brentuximab with AVD and caused fewer nerve side effects [8]. The European guideline prefers it for patients over 60 and considers it a less intensive option for younger people too [3]. ABVD with a PET scan after 2 cycles is also a standard approach: if the PET scan is negative, treatment continues without bleomycin [6]. Brentuximab vedotin with AVD lengthened patients' lives compared with ABVD [7]. For patients aged 60 or younger, the European guideline recommends the stronger BrECADD regimen; in a large study it controlled the disease better than the previous strong regimen and had fewer side effects [9, 3].
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If the disease comes back
Further treatment that includes an immunotherapy drug (such as nivolumab or pembrolizumab), followed by high-dose chemotherapy and a transplant of the patient's own stem cells [3]. More than half of these patients stay well for a long time with this approach [1]. If a transplant is not possible, or the disease comes back after a transplant, pembrolizumab controlled the disease for longer than brentuximab [10].
After treatment: late effects and fertility
Treatment for Hodgkin lymphoma can have effects years later: a second cancer (such as breast, lung or thyroid cancer), heart disease, lung problems, an underactive thyroid, long-lasting tiredness and infertility [2]. These risks depend on the type of treatment and age at the time of treatment [2]. In a large study of patients treated decades ago, the risk of a second cancer was still higher than in other people even 35 years later [11]. The risk of breast cancer is higher in women who had chest radiotherapy before the age of 30, and it rises after 15 years [1]. This is why regular, long-term follow-up with a doctor who knows these effects is important [2].
Fertility: the ABVD regimen usually does not cause lasting harm to the ovaries or testes; infertility mostly happens after stronger regimens such as BEACOPP [1]. In a large study, after 6 to 8 cycles of BEACOPP, periods came back in most women under 30, but in fewer than half of women aged 30 or over [12]. The best way to protect fertility is to freeze sperm or eggs before treatment starts [1]. See: Fertility and sex during cancer treatment
When should I call my doctor?
During chemotherapy: report a temperature of 38 °C or higher, chills or any sign of infection straight away; infection during this time can be dangerous [15]. See: Low blood counts and preventing infection. Report a new cough or breathlessness early; bleomycin can damage the lungs [6]. With brentuximab vedotin: report numbness or tingling in the hands or feet, muscle weakness, severe stomach pain, or changes in behaviour, memory, vision or walking straight away [13]. With nivolumab or pembrolizumab: report a new cough or chest pain, diarrhoea or severe stomach pain, yellowing of the skin or eyes, a skin rash, and signs of thyroid or blood sugar problems straight away [14]. If you have severe breathlessness, call your local emergency number.
Frequently asked questions
Can Hodgkin lymphoma be cured?
Yes. Up to 9 in every 10 patients are cured [1]. Even if the disease comes back, more than half of patients stay well for a long time with further treatment and a stem cell transplant [1]. See: Lymphoma: a complete guide
How many sessions of ABVD chemotherapy are there?
Each ABVD cycle lasts four weeks, and the drugs are given by drip on day 1 and day 15; that is once every 2 weeks [6]. In limited-stage disease there are usually 2 to 4 cycles, and in advanced disease 6 cycles [3, 6]. See: The ABVD regimen and How many sessions of chemotherapy are there?
Why is a PET scan done halfway through treatment?
Can I have children after treatment?
What role does nivolumab play in treating Hodgkin lymphoma?
Nivolumab is an immunotherapy drug that takes the brakes off the immune system [14]. In advanced disease, adding it to the three AVD drugs controlled the disease better than brentuximab with AVD [8]. See: What is cancer immunotherapy? and Nivolumab
What follow-up is needed after treatment ends?
For physicians
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Background: Canellos 1992 (361 patients with advanced disease): complete response 82% with ABVD versus 67% with MOPP, 5-year failure-free survival 61% versus 50% and overall survival 73% versus 66% (P=0.28), with less bone marrow toxicity [4]. After 15 to 20 years, cumulative mortality from a second malignancy, cardiovascular disease or pulmonary fibrosis exceeds mortality from Hodgkin lymphoma [1]. Schaapveld (3,905 five-year survivors treated 1965 to 2000): SIR for a second cancer 4.6 and 40-year cumulative incidence 48.5%, with no lower risk of solid tumours in the 1989 to 2000 period [11].
Limited stage: EORTC/LYSA/FIL H10 (1,950 patients with stage I–II disease): ePET positive after 2 cycles of ABVD in 18.8%; escalation to BEACOPPesc + INRT raised 5-year PFS from 77.4% to 90.6% (HR 0.42; P=0.002); in ePET-negative patients, omitting INRT gave 87.1% versus 99.0% in the favourable group and 89.6% versus 92.1% in the unfavourable group, and non-inferiority of ABVD alone was not shown [5]. EHA 2026: favourable, 2 cycles of ABVD and 20 Gy IS-RT (1A); unfavourable aged 60 or younger, 2 cycles of eBEACOPP and 2 cycles of ABVD with 30 Gy IS-RT only if PET is positive at the end of chemotherapy (1A), or with a less intensive approach 4 cycles of ABVD and 30 Gy IS-RT (1A) [3].
Advanced stage: RATHL (1,214 patients): PET negative after 2 cycles of ABVD in 937 of 1,119 (83.7%); 3-year PFS with ABVD versus AVD 85.7% versus 84.4% (difference 1.6 percentage points; 95% CI −3.2 to 5.3; just outside the non-inferiority margin) and OS 97.2% versus 97.6%; grade 3–4 pulmonary adverse events 3% versus 1% [6]. ECHELON-1 (1,334 patients with stage III–IV disease; median follow-up 73 months): 6-year OS 93.9% with BV-AVD versus 89.4% with ABVD (HR 0.59; P=0.009), HR for progression 0.68 [7]. SWOG S1826 (994 patients aged 12 and older, stage III–IV): 2-year PFS 92% with N-AVD versus 83% with BV-AVD (HR 0.45); immune-related adverse events uncommon, and neuropathy and treatment discontinuation more frequent with BV [8]. GHSG HD21 (1,500 patients aged 60 or younger): 4-year PFS 94.3% with BrECADD versus 90.9% with eBEACOPP (HR 0.66), treatment-related morbidity 42% versus 59% [9]. EHA 2026: aged 60 or younger, BrECADD for four or six cycles according to PET after 2 cycles (1A), six cycles of N-AVD as a less intensive alternative (1A) and the preferred approach over 60 (2A); bleomycin over 60 limited to 2 cycles and omitted over 70 (3A) [3]. IPS: IPS calculator. Doses: N-AVD · ABVD and AVD after a negative PET · BV-AVD · BrECADD.
Relapse and late effects: EHA: salvage containing a PD-1 inhibitor with chemotherapy (concurrent or sequential) (3B), then HDCT and autologous transplant (2A) [3]. KEYNOTE-204 (304 patients ineligible for transplant or relapsing after it): median PFS 13.2 months with pembrolizumab versus 8.3 months with brentuximab vedotin (HR 0.65) [10]. Dose: Pembrolizumab. GHSG HD13 to HD15 (1,323 survivors): after 6 to 8 cycles of BEACOPP, menstrual activity in women under 30 was 82% versus 45% in women aged 30 or over; a regular cycle after limited-stage treatment in more than 90%; testosterone in men within the normal range [12]. ABVD largely preserves long-term gonadal function, and oocyte or sperm cryopreservation is the first choice for fertility preservation [1]; see Fertility preservation before cancer treatment. BV: blood counts before each dose, peripheral neuropathy, and concurrent use with bleomycin contraindicated [13].
Scientific evidence
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Scientific evidence
6 itemsAdapted Treatment Guided by Interim PET-CT Scan in Advanced Hodgkin’s Lymphoma
Nivolumab+AVD in Advanced-Stage Classic Hodgkin's Lymphoma
Assessing the efficacy and tolerability of PET-guided BrECADD versus eBEACOPP in advanced-stage, classical Hodgkin lymphoma (HD21): a randomised, multicentre, parallel, open-label, phase 3 trial
Hodgkin lymphoma: EHA Clinical Practice Guidelines for diagnosis, treatment, and follow-up.
Pembrolizumab versus brentuximab vedotin in relapsed or refractory classical Hodgkin lymphoma (KEYNOTE-204): an interim analysis of a multicentre, randomised, open-label, phase 3 study
Overall Survival with Brentuximab Vedotin in Stage III or IV Hodgkin's Lymphoma
Read more
Related cancer types
References
15 referencesShow all references, 6 with a study cardClose the reference list
Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
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- 9Assessing the efficacy and tolerability of PET-guided BrECADD versus eBEACOPP in advanced-stage, classical Hodgkin lymphoma (HD21): a randomised, multicentre, parallel, open-label, phase 3 trial
- 10Pembrolizumab versus brentuximab vedotin in relapsed or refractory classical Hodgkin lymphoma (KEYNOTE-204): an interim analysis of a multicentre, randomised, open-label, phase 3 study
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- 15Infection and Neutropenia during Cancer Treatment
This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.
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