Side Effects

Cancer treatment for Hodgkin lymphoma can produce side effects. The goal of treatment is to kill the cancer cells, but cancer treatments can damage healthy cells too which causes side effects.

Patients react to treatments in different ways. Some patients may have very mild side effects.  For other patients, side effects can be more severe, sometimes requiring hospitalization. For most patients, treatment side effects are temporary and go away once therapy ends.

Before you start treatment, talk with your doctor about potential side effects. There are drugs and other therapies that can prevent or manage many side effects. Always tell your healthcare team about side effects you experience.

Also speak with your doctor about long-term and late effects of treatment and how treatment can affect fertility.

Infections

Hodgkin lymphoma affects the immune system's ability to function properly, making patients more prone to certain types of infections. Because the patient has an increased risk of developing infections, the medical staff, family and friends of the patient need to wash their hands frequently and vigorously and take other precautions to avoid exposing the patient to bacteria, viruses and other infection-causing agents. Caregivers of patients with central lines or ports need to be meticulous in cleaning these devices. Patients at home should seek medical attention right away if any sign of infection develops.

One of the important features of HL is a decrease in immune-system function. The cells of the immune system do not react in normal ways. As a result, patients are susceptible to certain types of infection. Herpes zoster (shingles) is an example of a viral disease that occurs with increased frequency in patients with HL. Chemotherapy and radiation therapy can make patients more susceptible to infections because these treatments lower blood cell counts and weaken immune-system cell function.

HL patients are advised to get certain vaccinations once they have finished their treatment, including vaccinations for pneumococcal pneumonia and influenza. There are two types of pneumococcal vaccines available for adults: a pneumococcal polysaccharide vaccine (PPSV23) and a pneumococcal conjugate vaccine (PCV13). Immunizations using "live" vaccines, such as the herpes zoster or shingles vaccine, should not be administered. Patients who have HL can receive the shingles vaccine Shingrix® because it is an “inactivated” rather than a “live” vaccine. COVID-19 vaccines are also recommended. Speak to your doctor for more information.

To learn more, view, download or order Side-Effect Management: Reducing Your Risk of Infection. 

Low Blood Cell Counts 

Blood cell counts are often low in patients who are treated with chemotherapy. Chemotherapy is toxic to the healthy cells in the bone marrow and may cause a severe deficiency of

  • Red blood cells, resulting in a condition called anemia
  • Platelets, resulting in a conditional called thrombocytopenia
  • White blood cells
    • Neutrophil deficiency results in a condition called neutropenia.
    • Monocyte deficiency results in a condition called monocytopenia.

If the number of white blood cells (particularly the type called “neutrophils”) drops severely and for an extended time, patients may develop infections that require antibiotic treatment and possible hospitalization. In some types of cancer, it is necessary to allow a patient’s blood counts to recover from these side effects before continuing treatment. Sometimes the patient’s chemotherapy dosages or the time between chemotherapy cycles needs to be adjusted. 

However, because HL has a high potential for cure, a low white blood cell count is not a reason to delay treatment or reduce the treatment dosage. It is uncommon for patients to continue to have low blood counts for a long time after the completion of treatment. Patients who undergo stem cell transplantation may continue to be at risk for infection.

Treatment with drugs that are designed to improve white blood cell counts, such as granulocyte-colony stimulating factor (G-CSF), may be considered in patients with some types of cancer. However, in HL regimens that include bleomycin, G-CSF is not typically recommended or necessary because its use may increase the potential for lung complications. G-CSF is commonly recommended for use in regimens that combine brentuximab vedotin with chemotherapy drugs.

To learn more, view, download or order Side-Effect Management: Managing Low Blood Cell Counts.

Fertility

While many treatments for Hodgkin lymphoma have no or little adverse effect on future fertility, some cancer treatments can limit a person’s ability to conceive or have a baby. Adults of childbearing age and parents of children diagnosed with HL should ask their doctors for information that may help lessen the risk of infertility. It may be helpful to speak to a fertility specialist before starting cancer treatment. Download the free LLS booklet Fertility and Cancer for more details.

Other Treatment Side Effects

Side effects from chemotherapy and radiation therapy, vary from person to person. Many side effects appear shortly after the start of treatment but many stop once treatment is completed. The side effects a patient experiences depends on

  • The dose and type of chemotherapy
  • The location of radiation therapy
  • Age
  • Overall health or diagnosis of any chronic health conditions like diabetes or kidney disease

Treatment with chemotherapy drugs may cause 

  • Mouth sores
  • Nausea
  • Vomiting
  • Acid reflux
  • Bloating
  • Constipation
  • Diarrhea
  • Appetite changes 
  • Taste changes
  • Extreme fatigue
  • Neuropathy (numbness and pain, usually in the hands or feet)
  • Muscle or joint pain
  • Fever
  • Cough
  • Shortness of breath 
  • Cognitive issues ("chemo brain")
  • Hair loss
  • Rash or itchiness 

Side effects of radiation therapy depend on the area treated. Fatigue and skin in the treated area that is red, dry, sore or painful are common. Treatment to the head and neck may cause mouth sores, dry mouth or changes in taste. Chest radiation can cause cough or difficulty swallowing. Radiation to the abdomen can cause nausea, vomiting, diarrhea and cramps. 

Allogenic stem cell transplantation can cause Graft versus host disease. 

Click here to read more about the side effects above.

Long-Term and Late Effects

  • Long-term effects are side effects of treatment that may last for months or years after treatment ends. Fatigue is an example.
  • Late effects are side effects of treatment that may not show up until years after treatment ends. Heart disease is an example.

Not everyone who is treated for Hodgkin lymphoma develops long-term or late effects. It depends on the patient's age, overall health and specific treatment. You should talk to your doctors about any long-term or late effects that you think may be related to treatment. To read more about lingering side effects, see the Survivorship Workbooks. 

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