In 2009 in the United States, there will be approximately 8,510 new diagnoses of Hodgkin lymphoma and 65,980 new diagnoses of non-Hodgkin lymphoma. Chemotherapy is one of the main treatments for both kinds of lymphoma. Due to the large scope of the topic, this article will focus on adult lymphoma. There are myriad drugs used in treating the disease, depending on the type and the course of the cancer, but the following are commonly used chemotherapy regimens in lymphoma.
Hodgkin Lymphoma
There are various regimens of chemotherapy for Hodgkin lymphoma, and you and your treatment team will choose one that best suits how the lymphoma looks under the microscope, the symptoms you have presented with and individual characteristics. An old regimen is called MOPP and contains the drugs nitrogen mustard, vincristine, procarbazine and prednisone. This treatment has been found to be less effective to a newer combination, ABVD. The ABVD treatment contains the drugs doxorubicin, bleomycin, vinblastine and dacarbazine. While this treatment is effective in many patients, for advanced-stage Hodgkin lymphoma, a regimen called escalated BEACOPP may be used. This regimen contains more chemotherapy drugs and consists of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone, and a drug called Neupogen, which helps build the immune system. This regimen has increased survival rates, but it causes sterility in almost all patients, and has a higher risk of later secondary leukemia.
Complications of these chemotherapy regimens can include nausea and vomiting, pulmonary toxicity and hair loss. The older treatment MOPP was related to treatment-related leukemia, but since this combination is not used as frequently, the rate of this complication has gone down.
Non-Hodgkin Lymphoma
Non-Hodgkin lymphoma can be classified as indolent, or slow-growing, or aggressive. Within these groups are many different kinds of non-Hodgkin lymphomas, but general chemotherapy options will be discussed here. For indolent early-stage lymphomas, a single-agent regimen like the drug rituximab may be used, as well as a combination of rituximab and another chemotherapy regimen, with or without directed radiation therapy. For later stage indolent non-Hodgkin lymphomas, standard treatment is rituximab (R) and another chemotherapeutic regimen. Some combined chemotherapy regimens for these lymphomas include R-CVP (rituximab and cyclophosphamide, vincristine, and prednisone) and R-CHOP (rituximab and cyclophosphamide, doxorubicin, vincristine and prednisone).
For aggressive non-Hodgkin lymphomas, in stages I and II, the standard of care at the present time is three cycles of R-CHOP (mentioned above) followed by directed radiation therapy. For stages III and IV, R-CHOP is used. There are clinical trials that are experimenting with different chemotherapy regimens for these lymphomas, and if you would like to know more about clinical trials, it is best to ask your physician, who would know the latest options.
Complications and toxicities of these chemotherapeutic drugs can include hair loss, fever, nausea and vomiting, chills and low white blood cell count, which can increase risk of infection.
Other Options
Clinical trials are studies in which new treatments and drugs are investigated to evaluate their benefits and efficacy in fighting disease. In order to see if you qualify to participate in a clinical trial, or to find out if a clinical trial would benefit you, it is best to talk to your doctor about your options and to learn more.
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