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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.
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.
Treatment of Pregnant Women
Because Hodgkin's disease often occurs in young adults, treatment for pregnant women is of particular concern. Therapy must be effective enough to protect the mother without hurting the fetus. Chemotherapy is rarely used early in the term, because it poses a risk for birth defects. Treatment choice must be individualized, taking into consideration the mother's wishes, the severity and pace of the disease, and the remaining length of the pregnancy. The treatment plan may need to be changed as the pregnancy progresses. If the disease develops in the second half of the pregnancy, it may be possible to postpone chemotherapy or radiation therapy until after an early induced delivery.
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Review Date: 01/27/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine,
Harvard Medical School; Physician, Massachusetts General Hospital.
Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M.,
Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)
