Initial work-up and therapy for patients with Hodgkin's Disease is done at centres associated with the BC Cancer Agency. Staging of Hodgkin's Disease (HD) - Stage I to IV - often determines the type of treatment that a patient will receive.
Patients with stage III or IV HD almost always receive chemotherapy. Patients with stage I or II disease are treated with a short course of chemotherapy combined with radiotherapy.
An autologous (using patient's own cells) BMT is necessary for HD patients if they have to undergo high-dose therapy. Patients are considered for high dose therapy if disease recurs after standard chemotherapy or is not responding completely to multi-drug chemotherapy.
The administration of high-dose therapy severely damages the bone marrow. Therefore patients must first have their stem cells collected and frozen so that they can be transplanted back to the patient afterwards. One or two cycles of standard multi-drug chemotherapy may be given during this time period to keep the Hodgkin's Disease controlled while the various arrangements are being made for the BMT. Patients are then admitted for high-dose chemotherapy. Note that radiation is NOT part of the high-dose treatment. This is followed by an autologous stem cell transplant.
Stem cells from a donor is rarely used in HD, since in most circumstances this approach does not improve results and is associated with more complications. In individual patients, once recovery from the bone marrow transplant is complete, radiation may be given to specific sites where the HD has recurred.
For HD patients treated at first recurrence after multi-drug chemotherapy, 60% will be cured with high-dose therapy and a blood and marrow transplant. When a BMT is performed for HD that has recurred multiple times, or for HD that has never completely responded to chemotherapy, the BMT has about a 30% cure rate.