Non-Hodgkin's Lymphoma - Chemotherapy

Chemotherapy

Chemotherapy plays a role in the treatment of nearly all patients with lymphoma and has achieved remarkable results, even in late stages. It uses drugs to kill cancer cells. Such drugs are called cytotoxic drugs. Chemotherapy is referred to as systemic therapy because the drugs travel throughout the bloodstream to the entire body.

Chemotherapy may also be used along with radiation.

Chemotherapy Administration

A chemotherapy cycle is usually 21 - 28 days. Patients take the drugs for a few days, then have a period of rest. The drugs may be taken as pills at home or given by injection or infusion in a medical center or doctor’s office. Chemotherapy is injected into the spinal fluid if the cancer has spread to the brain. This approach is called intrathecal chemotherapy. Intrathecal chemotherapy is also used as a preventive measure in patients at high risk for central nervous system involvement. Some patients receiving chemotherapy need to remain in the hospital for several days so the effects of the drug can be monitored.

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Effective Regimens and Drugs

CHOP. The current standard chemotherapy regimen for NHL is CHOP. CHOP is 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 (Rituxan), a biologic drug. (See Biologic Therapy section of this report.) Some studies of this combination in low-grade lymphomas have reported response rates of 70 - 100%.

CVP. This stands for cyclophosphamide, vincristine, and prednisone. It is another common chemotherapy regimen for non-Hodgkin’s lymphoma. It is also used in combination with rituximab.

Fludarabine. Fludarabine (Fludara) is a type of drug called a nucleoside analogue. It is one of the most used drugs for treating low-grade lymphomas. Fludarabine is often used in a chemotherapy regimen called FND (fludarabine, mitoxantrone, and dexamethasone). Other fludarabine regimens for follicular and low-grade lymphomas are FAD (fludarabine, doxorubicin, and dexamethasone) and FMD (fludarabine, mitoxantrone, and dexamethasone). Fludarabine is also being studied in combination with rituximab.