Healthy Living

What You Need to Know About Stage IV Hodgkin Lymphoma

Survival rates tell you what portion of people with the same type and stage of cancer are still alive a certain amount of time (usually 5 years) after they were diagnosed. They can’t tell you how long you will live, but they may help give you a better understanding about how likely it is that your treatment will be successful.

Hodgkin Lymphoma Stages

After someone is diagnosed with Hodgkin lymphoma, doctors will try to figure out if it has spread. This process is called staging. The stage of a cancer describes how much cancer is in the body. It helps determine how serious the cancer is and what is the best way to treat it. Doctors also use a cancer's stage when talking about survival statistics.

Hodgkin lymphoma generally starts in the lymph nodes. If it spreads, it is usually to another set of nearby lymph nodes. It can invade nearby organs as well. Rarely, Hodgkin lymphoma will start in an organ other than lymph nodes, such as a lung.

The stage is based on:

  • Your medical history
  • The physical exam
  • Biopsies
  • Imaging tests, which typically include a chest x-ray, CT, scan of the chest/abdomen/pelvis, and PET (positron emission tomography) scan
  • Bone marrow aspiration and biopsy (sometimes but not always done)

Symptoms of stage 4 lymphoma

Stage 4 Hodgkin’s lymphoma and NHL have similar symptoms. Your symptoms will depend on the type of lymphoma you have and the organs affected. Your symptoms may include:

Survival rates for Hodgkin lymphoma

  • The 5-year survival rate for people with stage I Hodgkin lymphoma is about 90%. 
  • For stage II Hodgkin lymphoma, the 5-year survival rate is about 90%.
  • The 5-year survival rate for stage III Hodgkin lymphoma is about 80%.
  • Stage IV Hodgkin lymphoma has a 5-year survival rate of about 65%.

Remember, these survival rates are only estimates – they can’t predict what will happen to any individual person. These statistics can be confusing and may lead you to have more questions. Talk to your doctor to better understand your specific situation.

Treatment for stage 4 lymphoma

Your recommended treatment plan will greatly vary. It will depend on the type of lymphoma you have, the organs affected, and your health and medical history.

Hodgkin’s lymphoma

To treat Hodgkin’s lymphoma, your doctor may recommend chemotherapy. For example, they may recommend:

  • six or more cycles of ABVD, a chemotherapy regimen that includes the drugs doxorubicin, bleomycin, vinblastine, and dacarbazine
  • 12 weeks of the Stanford V protocol, a combination of the drugs mechlorethamine, doxorubicin, vinblastine, vincristine, bleomycin, etoposide, and prednisone, followed by radiation
  • the BEACOPP regimen, which includes the drugs bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone

If your condition doesn’t respond to initial treatment, your doctor may recommend other drug combinations, higher doses of drugs, or a stem cell transplant.


To treat stage 4 DLBCL, your doctor will likely recommend chemotherapy. For example, they may recommend the R-CHOP chemotherapy regimen. This involves a combination of the drugs cyclophosphamide, doxorubicin, vincristine, and prednisone, with the addition of rituximab, a monoclonal antibody. Treatment usually lasts about six months in most cases. To treat slow-growing follicular lymphoma, your doctor may start by prescribing rituximab and chemotherapy drugs.

The progress that has been made in the treatment of advanced stage Hodgkin's lymphoma has resulted from the development of multi-drug combination chemotherapy regimens and the performance of clinical trials. Future progress will result from continued participation in appropriate clinical trials. Currently, there are several areas of active exploration aimed at improving the treatment of advanced Hodgkin's lymphoma.