|
|
Lymphomas
Treatment
Patients with early-stage disease can be treated effectively with radiation therapy or chemotherapy or both. The choice of treatment method depends on the tumor bulk (maximum diameter), age and sex of the patient and the subtype of disease. Physicians usually use combinations of drugs to treat late-stage disease. Patients in any stage of the disease who have a large tumor in the chest are typically treated with combinations of drugs and radiation therapy. Patients in any stage of disease who respond quickly to chemotherapy may not need to receive radiation therapy.
Radiation oncologists generally use external beam radiation therapy to treat lymphomas; the radiation is delivered to the lymphoma from a machine known as a linear accelerator. The 30-minute treatment is usually painless and similar to getting an x-ray exam. Targeted radiotherapy, in which a radioactive atom is attached to an antibody (a type of protein) that homes to the lymphoma, is also sometimes used.
Forms of Lymphoma
This list includes the most common and some rare forms of non-Hodgkin and Hodgkin lymphoma, and many of the treatment options for these conditions. These treatment options may be a single drug, a variety of drugs used in different combinations or other therapies, such as surgery, radiation therapy or stem cell transplantation.
|
Aggressive/Rapidly Growing |
|
|
Diffuse large B-cell lymphoma (DLBCL) |
Most common type of non-Hodgkin lymphoma (NHL) in adults (30-40%) and the most common NHL in 15-29 year olds; chemotherapy: cyclophosphamide (Cytoxan), vincristine (Oncovin), doxorubicin (Adriamycin), prednisone (Deltasone, Sterapred), vindesine (Eldisine), bleomycin (Blenoxane), methotrexate (Amethopterin), cytarabine (Cytosar-U), dexamethasone (Decadron), leucovorin, etoposide (VePesid), allopurinol (Lopurin, Zyloprim); monoclonal antibody: rituximab (Rituxan); radiation therapy; stem cell transplantation. |
|
Burkitt lymphoma |
Aggressive B-cell, adults and most common NHL in 5-14 year olds, lymphoma cells in abdominal masses; cyclophosphamide (Cytoxan), vincristine (Oncovin), cytarabine (Cytosar-U), doxorubicin (Adriamycin), methotrexate (Amethopterin); radiation therapy. |
|
Mantle cell lymphoma (MCL) |
B-cell, 6-7% of NHL, can involve numerous organs; chemotherapy: cyclophosphamide (Cytoxan), doxorubicin (Adriamycin), vincristine (Oncovin), prednisone (Deltasone, Sterapred), dexamethasone (Decadron), cytarabine (Cytosar-U), methotrexate (Amethopterin), mitoxantrone (Novantrone), bortezomib (Velcade); monoclonal antibody: rituximab (Rituxan), alemtuzumab (Campath); stem cell transplantation. |
|
Transformed follicular lymphoma (FL) |
FL transforms to aggressive B-cell lymphoma — not unusual; chemotherapy: cyclophosphamide (Cytoxan), vincristine (Oncovin), doxorubicin (Adriamycin), prednisone (Deltasone, Sterapred); monoclonal antibody: rituximab (Rituxan); radioactive monoclonal antibodies: ibritumomab tiuxetan (Zevalin), Iodine 131-tositumomab (Bexar); radiation therapy; stem cell transplantation. |
|
Classical Hodgkin lymphoma (CHL) |
Less common than NHL, Reed-Sternberg cells present, usually B-cell lymphocytes, highly curable; chemotherapy: doxorubicin (Adriamycin), bleomycin (Blenoxane), vinblastine (Velban), dacarbazine (DTIC-Dome), etoposide (VePesid), cyclophosphamide (Cytoxan), vincristine (Oncovin), procarbazine (Matulane), prednisone (Deltasone, Sterapred), mechlorethamine (Mustargen); radiation therapy; stem cell transplantation. |
|
Peripheral T-cell lymphoma (PTCL)(many subtypes) |
Aggressive, difficult to treat, has several subtypes (treat like DLBCL); chemotherapy: cyclophosphamide (Cytoxan), vincristine (Oncovin), doxorubicin (Adriamycin), prednisone (Deltasone, Sterapred), romidepsin (Istodax); targeted therapy: pralatrexate (Folotyn); radiation therapy; stem cell transplantation. Also brentuximab vedotin (Adcetris) for systemic anaplastic large-cell lymphoma (ALCL), a form of PTCL. |
|
Acute adult T-cell lymphoma/leukemia (ATLL) |
Has 4 subtypes -(acute includes elevated calcium levels), aggressive; chemotherapy: cyclophosphamide (Cytoxan), vincristine (Oncovin), doxorubicin (Adriamycin), prednisone (Deltasone, Sterapred), zidovudine (AZT), interferon alpha (Intron A, Roferon-A); stem cell transplantation. |
|
Indolent/Slow Growing |
|
|
Follicular lymphoma (FL) |
Second most common NHL, small abnormal B-cells in lymph nodes; watchful waiting; chemotherapy: cyclophosphamide (Cytoxan), vincristine (Oncovin), prednisone (Deltasone, Sterapred), chlorambucil (Leukeran), monoclonal antibody: rituximab (Rituxan); radioactive monoclonal antibodies: ibritumomab tiuxetan (Zevalin), Iodine 131- tositumomab (BEXXAR); radiation therapy; stem cell transplantation. |
|
Mucosa-associated lymphoid tissue (MALT) lymphoma |
Third most common of all NHL – 7.5%, B-cell; helicobacter pylori association; antibiotic combination; monoclonal antibody: rituximab (Rituxan), Interferon alpha (Intron-A, Roferon-A). |
|
Small cell lymphocytic lymphoma (SLL)/ Chronic lymphocytic leukemia (CLL) |
Fourth most common NHL subtype – 7%, B-cell, very slow progression; watchful waiting; chlorambucil (Leukeran), fludarabine (Fludara), cyclophosphamide (Cytoxan), doxorubicin (Adriamycin), vincristine (Oncovin), prednisone (Deltasone, Sterapred), bendamustine HCI (Treanda), methotrexate (Amethopterin); monoclonal antibody: rituximab (Rituxan). |
|
Lymphoplasmacytic lymphoma (LPL) and Waldenström’s Macroglobulinemia |
Closely related, both show malignant lymphoplasmacytic cells in marrow/spleen, B-cell; chemotherapy: chlorambucil (Leukeran), cyclophosphamide (Cytoxan), melphalan (Alkeran), fludarabine (Fludara), cladribine (Leustatin), pentostatin (Nipent), carmustine (BiCNU), prednisone (Deltasone, Sterapred); monoclonal antibody: rituximab, (Rituxan); radiation therapy; stem cell transplantation. |
|
Nodal marginal zone/Monocytoid B-cell lymphoma |
Marginal zonal subtype, rare, in spleen and blood; watchful waiting; chlorambucil (Leukeran), fludarabine (Fludara), radiation therapy. |
|
Nodular lymphocyte predominant hodgkin lymphoma (NLPHL) |
5% of CHL, few Reed Sternberg B-cells, neck lymph nodes; watchful waiting; radiation therapy. |
|
Cutaneous T-cell lymphoma (Sézary syndrome & mycosis fungoides) (CTCL) |
Involves skin and lymph nodes, folding lymphocyte nuclei in Sézary Syndrome; topical therapy: nitrogen mustard (Mustargen), ultraviolet or electron beam therapy with psoralen, chemotherapy: etoposide (VePesid), cyclophosphamide (Cytoxan), pentostatin (Nipent®), vincristine (Oncovin), doxorubicin (Adriamycin); targeted therapy: vorinostat (Zolinza), romidepsin (Istodax), bexarotene (Targretin), denileukin diftitox (Ontak), interferon alpha (Intron A, Roferon-A), extracorporeal phototherapy, 8- methoxsalen (UVADEX); radiation therapy. |
|
Common Chemotherapy Protocols (combinations of drugs) for Lymphoma* |
|
ABVD |
doxorubicin (Adriamycin), bleomycin, vinblastine, dacarbazine |
|
BEACOPP |
bleomycin, etoposide, doxorubicin (Adriamycin), cyclophosphamide, vincristine (Oncovin), procarbazine, prednisone |
|
CHOP |
cyclophosphamide, doxorubicin, vincristine, prednisone |
|
CNOP |
cyclophosphamide, mitoxantrone, vincristine plus prednisone |
|
EPOCH |
etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin (Adriamycin) |
|
Hyper CVAD |
cyclophosphamide, vincristine, doxorubicin, dexamethasone, doxorubicin (Adriamycin), methotrexate, cytarabine |
|
M-BACOD |
methotrexate, bleomycin, doxorubicin (Adriamycin), cyclophosphamide, vincristine, dexamethasone |
|
MOPP |
mechlorethamine, vincristine, procarbazine, prednisone |
|
*For B-cell lymphomas treatment almost always includes rituximab in addition to drug regimen listed above. |
|
|