Hodgkin's Disease - Other Treatments

Side Effects and Complications

Side effects and complications of any chemotherapeutic regimen are common, are more severe with higher doses, and increase over the course of treatment, though some trials suggest that toxicities can be reduced by administering the drugs for shorter duration without loss of cancer-killing effects.

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Common Side Effects. Common side effects include the following:

Nausea and vomiting -- drugs known as serotonin antagonists, including ondansetron (Zofran) or granisteron (Kyril), can relieve these side effects in nearly all patients given moderate drugs and most patients who take more powerful drugs. In one study, nearly all patients who took a combination of dexamethasone (a steroid) in combination with ondansetron within 24 hours of chemotherapy experienced either a significant or complete reduction in nausea and vomiting.
Diarrhea
Hair loss
Weight loss
Anemia --studies are investigating the use of epoetin (Procrit), which increases production of red blood cells, to reduce this effect and improve quality of life.
Depression

These side effects are nearly always temporary. Most patients are able to continue with normal activities for all but perhaps one or two days a month.

Serious Side Effects. Serious side effects can also occur and may vary depending on the specific drugs used. They include the following:

Increased chance for infection from suppression of the immune system and severe drops in white blood cells (neutropenia) -- white blood cell count may be improved with the addition of granulocyte colony-stimulating factor drugs such as filgrastim, pegfilgrastim, and lenograstim. There is no evidence that these drugs have any effect on survival or cancer recurrence.
Liver and kidney damage
Abnormal blood clotting (thrombocytopenia)
Allergic reaction

The drug BCNU (carmustine) carries a significant risk for life-threatening pneumonia, particularly in women.

Long-Term Complications.

Fatigue and general aches and pains are calledsomatic symptoms. Fatigue is especially common after chemotherapy and can even last for years.
There is a high risk of leukemia with MOPP, particularly combined with radiation therapy.
Many women stop menstruating after chemotherapy. The risk for infertilityis highest for women with advanced stage Hodgkin?s disease who are treated after age 30. Taking oral contraceptives during chemotherapy may reduce the risk. For specific chemotherapy regimens, studies indicate that the risk for infertility is highest with MOPP and BEACOPP and less so with ABVD. Investigators are testing a drug called a gonadotropin-releasing hormone analogue that puts women in a temporary pre-pubescent state during chemotherapy and which may preserve fertility in many women.
Bone injury may be related to steroid treatments.
Heart failure may occur with the use ofanthracyclines (such as doxorubicin) and similar drugs called anthracenediones (e.g., mitoxantrone).
Bleomycin (Blenoxane), an antibiotic used in some regimens, is particularly toxic to the lungs. Vinblastine and methotrexate may also pose a risk when used in combination with radiation therapy.