Chemotherapy uses cytotoxic drugs to destroy cancer. These drugs do not only alter the way in which cancer cells grow and divide, but they may also affect normal cells.

Chemotherapy is usually given during as part of a treatment session. Usually, after each session you will have a two-week rest period, which will allow your body to recover from the side effects.

The treatment and rest period make up one treatment cycle. Your specialist will decide how many cycles you will have.

The combinations of cytotoxic drugs most commonly used to treat HL are:

• ABVD Adriamycin, bleomycin, vinblastine, and dacarbazine (every 28 days). This is the standard treatment for almost all stages of the disease. The main drawback is that it causes pulmonary toxicity, although if the necessary precautions are taken, the risk of toxicity is lower than 1%.

• BEACOPP Bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, prednisolone, and G-CSF (every 21 days). This combination has three variants (escalated, standard, and 14-day).

• Stanford V Adriamycin, vinblastine, nitrogen mustard, vincristine, bleomycin, etoposide, prednisolone, and G-CSF (every 28 for a total of 2 or 3 cycles followed by radiotherapy).

Patients who relapse have several treatment options open depending on the chemotherapy that they received at first. Treatment options for relapse following chemotherapy include: local radiotherapy, a new chemotherapy treatment (monoclonal antibodies such as brentuximab vedotin), and bone-marrow transplant.

How is the chemotherapy administered?

Chemotherapy can be given through different intravenous methods. These may give temporary access, which we call placement of a peripheral intravenous line, or it can be permanently inserted. Permanent venous devices are inserted in the hospital by an intravenous-therapy team. The most commonly used devices are:

• Hickman central line

This type of line is usually inserted with the patient under local anesthesia, and it consists of placing a plastic tube (line) in one of the veins of the chest. The line is attached to the skin of the chest using sutures in order to keep it from becoming detached. Once the line is in place and care professionals have checked that it is in the right position, it can be used to administer chemotherapy and blood derivatives; sometimes, the device can also be used to extract blood samples.

This line requires special care to prevent infection and so that blood clots do not form inside of it. Either your nurse or intravenous-therapy team will take care of this.

• PICC line (peripherally inserted central catheter)

This involves inserting a line in one of the veins of the chest, although the veins of the arm are used to reach the chest.

As with the Hickman central line, after care professionals check that it is in the right position, it can be used to administer chemotherapy and blood derivatives and can be used to extract blood samples.

This type of line also requires special care to prevent infection and blood clots inside of the line.

• Port-a-cath

This device is placed below the skin, giving care staff permanent access to the venous system. As with the lines described above, blood samples can be taken using this device. It also requires care and maintenance to prevent infection and complications.