Non-Hodgkin's Lymphoma - Chemotherapy

Highlights	Outlook	Transplantation
Introduction	Staging and Treatment Guidelines	Surgery
Risk Factors	Chemotherapy	Resources
Symptoms	Other Treatments	References
Diagnosis	Radiation Treatments

Chemotherapy

Chemotherapy plays a role in the treatment of nearly all lymphoma patients and has achieved remarkable results, even some in late stages. It uses drugs to killcancer cells. Such drugs are called cytotoxic drugs. Chemotherapyis referred to as bodywide or systemic therapy because the drugstravel throughout the bloodstream to the entire body.

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Studies are now showing that chemotherapy as sole treatment is adequate for most children and young adults in early and perhaps in many advanced stages. (Radiation has been commonly used for these patients but carries particular dangers for children.) It should be pointed out that when a study on a drug reports a complete response rate this does not mean a cure, only that the drug has caused the tumor to completely go away.

Chemotherapy Administration

A chemotherapy cycle is usually 21 to 28 days. Patients take the drugsfor a few days,then have aperiod of rest. The drugs may be taken by mouth or given by injection. Chemotherapy is injected into the spinal fluidif the cancerhas spread to the brain. This is called intrathecal chemotherapy.Intrathecal chemotherapy is also used as a preventive measure in patients at high risk for central nervous system involvement. Chemotherapy may be administered at a medical center or in a doctor's office. Some patients receiving chemotherapy need to remain in the hospital for several days so the effects of the drug can be monitored. Patients withlymphoblastic lymphoma may need long-term maintenance chemotherapy. Such therapy does not seem to benefit patients withsmall-noncleaved-cell and large-cell lymphomas.

Effective Regimens and Drugs

CHOP. The current standard chemotherapy regimen for NHL is CHOP. CHOP standsis a combination of cyclophosphamide, doxorubicin hydrochloride (Adriamycin), vincristine (Oncovin), and prednisone. It is proving to be particularly effective for many stages of lymphoma when used in combination with rituximab, a monoclonal antibody. Some studies of this combination in low-grade lymphomas have reported response rates of 70 - 100%. CHOP alone is still preferred for HIV patients, who tend to have a toxic response to rituximab.

CVP. This stands for cyclophosphamide, vincristine, and prednisone. It may be used with CHOP in certain cases.

Fludarabine and Nucleoside Analogues. Fludarabine (Fludara) is a type of drug calleda nucleoside analogue. It is one of the most active drugs for treating low-grade lymphomas and may be effective for other NHLs, including mantle cell lymphomas. Promising regimens containing fludarabine are under investigation. For example, FND (fludarabine, mitoxantrone, and dexamethasone) may be helpful in combination with rituximab for certain patients, including those with indolent NHL. Other nucleoside analogues include gemcitabine and cladribine. Toxicities and infection rates from high dose nucleoside analogues have been high. Fludarabine also has been associated with a risk for leukemia.