Chemotherapy for Non-Hodgkin’s Lymphoma

Get information about the success rate, drugs used, types of chemo along with our detailed guide about chemotherapy for the treatment of non-Hodgkin’s lymphoma! 

Chemotherapy (chemo) for non-Hodgkin’s lymphoma is the use of anti-cancer drugs that are usually injected into a vein (IV) or taken by mouth. These drugs enter the bloodstream and reach almost all areas of the body, making this treatment very useful for lymphoma. 

Why Is Chemotherapy Used to Treat Lymphoma?   

Chemo is the main treatment for most people with non-Hodgkin’s lymphoma (NHL). Depending on the type and the stage of the lymphoma, chemo may be used alone or combined with other treatments, such as immunotherapy drugs or radiation therapy. 

An important part of the immune system is its ability to keep itself from attacking normal cells in the body. To do this, it uses “checkpoint” proteins on immune cells, which act like switches that need to be turned on (or off) to start an immune response. Cancer cells sometimes use these checkpoints to avoid being attacked by the immune system.  

Drugs called immune checkpoint inhibitors target these checkpoint proteins, which can help restore the immune response against esophagus cancer cells.  

Immunotherapy for esophageal cancer is being utilized to reduce recurrence, as a first-line treatment, and in novel combinations for advanced-stage cancer.  

What Are the Types of Non-Hodgkin’s Lymphoma Chemotherapy?  

You normally have several chemotherapy drugs together during a course of treatment. Some chemotherapy combinations include a course of steroids. 

Limited (early) stage 

You might have 2 to 4 cycles of ABVD chemotherapy, which contains the drugs: 

• adriamycin (doxorubicin) 
• bleomycin 
• vinblastine 
• dacarbazine 

Advanced stage 

You may have ABVD for 6 to 8 cycles. Or you might have: 

• ChlvPP – chlorambucil, vinblastine, procarbazine and prednisolone 
• Escalated BEACOPP – bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisolone 
• GemP – gemcitabine, cisplatin and prednisolone 
• ESHAP – etoposide, prednisolone, cytarabine and cisplatin (more likely for Hodgkin lymphoma that has come back) 

High dose treatment 

You might have BEAM or LEAM chemotherapy with a stem cell transplant, if chemotherapy doesn’t work well or your lymphoma comes back. 

These combinations include the drugs: 

• Carmustine (BiCNU) or lomustine (CCNU) 
• Etoposide 
• Cytarabine (Ara-C, cytosine arabinoside) 
• Melphalan 

Which Drugs Are Used in Non-Hodgkin’s Lymphoma Chemotherapy Treatment?  

Many chemo drugs are useful in treating lymphoma. Often, several drugs are combined. The number of drugs, their doses, and the length of treatment depend on the type and stage of the lymphoma. Here are some of the drugs more commonly used to treat lymphoma: 

Alkylating agents  

• Cyclophosphamide 
• Chlorambucil 
• Bendamustine 
• Ifosfamide  

Corticosteroids 

• Prednisone  
• Dexamethasone 

Platinum drugs 

• Cisplatin 
• Carboplatin 
• Oxaliplatin 

Purine analogs  

• Fludarabine 
• Pentostatin 
• Cladribine (2-CdA) 

Anti-metabolites  

• Cytarabine (ara-C) 
• Gemcitabine 
• Methotrexate 
• Pralatrexate 

Anthracyclines 

• Doxorubicin (Adriamycin) 
• Liposomal doxorubicin (Caelyx) 

Others 

• Vincristine 
• Mitoxantrone 
• Etoposide (VP-16) 
• Bleomycin 

Often drugs from different groups are combined. One of the most common combinations is called CHOP. This includes the drugs cyclophosphamide, doxorubicin (also known as hydroxydaunorubicin), vincristine (Oncovin) and prednisone. Another common combination leaves out doxorubicin and is called CVP.  

Chemo is often combined with an immunotherapy drug, especially rituximab (Rituxan). 

What Are the Side Effects of Non-Hodgkin’s Lymphoma Chemotherapy Treatment?  

Chemo drugs can cause side effects. These depend on the type and dose of drugs given and how long treatment lasts. Common side effects can include: 

• Hair loss 
• Mouth sores 
• Loss of appetite 
• Nausea and vomiting 
• Diarrhea or constipation 
• Increased chance of infection (from a shortage of white blood cells) 
• Bleeding or bruising after minor cuts or injuries (from a shortage of platelets) 
• Fatigue and shortness of breath (from too few red blood cells) 

These side effects usually go away after treatment is finished. If serious side effects occur, the dose of chemo may be reduced, or treatment may be delayed. 

There are often ways to lessen these side effects. For example, drugs can be given to prevent or reduce nausea and vomiting. 

Certain chemo drugs can have other possible side effects. For example: 

• Platinum drugs such as cisplatin can cause nerve damage (neuropathy), leading to numbness, tingling, or even pain in the hands and feet.  
• Ifosfamide can damage the bladder. The risk of this can be lowered by giving it along with a drug called mesna.  
• Doxorubicin can damage the heart. Your doctor may order a test of your heart function (like a MUGA scan or echocardiogram) before starting you on this drug.  
• Bleomycin can damage lungs. Doctors often test lung function before starting someone on this drug.  
• Many chemo drugs can affect fertility (the ability to have children). 
• Some chemo drugs can raise your risk of developing leukemia several years later. 

How Long Is Chemotherapy for Lymphoma? 

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream. 

A course of chemotherapy is made up of several cycles. You have treatment, usually over 1 to 3 days, depending on the combination of drugs. Then you have a break of a few weeks to allow your body to recover from the effects of the particular chemotherapy. Then, another cycle begins. The number of cycles you have depends on: 

• Which drugs you are having 
• The stage and type of your Hodgkin’s lymphoma 
• Results of any tests 
• How well your lymphoma responds to treatment  

Clinical Trials for Non-Hodgkin’s Lymphoma  

Lymphoma clinical trials offer access to new, innovative treatments that are not widely available but go through strict, FDA-approved regulatory processes before being approved for use. Massive Bio guides patients through the most comprehensive clinical trial matching process using our AI-Powered system. Participating in a clinical trial provides patients with new studies they would otherwise not have access to.   

New drugs are continually being researched and developed for non-Hodgkin’s lymphoma. These must be shown to be safe and effective before doctors can prescribe them to patients. Following a strict protocol and using carefully controlled conditions, researchers evaluate the investigational drugs under development and measure the ability of the new drug to treat non-Hodgkin’s lymphoma, its safety, and any possible side effects. 

If you’ve been diagnosed with any of the following lymphoma subtypes, we’re here to help.    

• Marginal Zone Lymphoma (MZL) 
• Follicular Lymphoma 
• Burkitt Lymphoma 
• T-Cell Large B-cell Lymphoma 
• High-grade B-cell Lymphoma 
• Primary Mediastinal (thymic) Large B-cell Lymphoma 

If you don’t know which type of Lymphoma you have that’s okay. Additional testing can help you determine your exact diagnosis.  

To learn more about Non-Hodgkin’s Lymphoma, read our ultimate guide: Non-Hodgkin’s Lymphoma Ultimate Guide

Sources:  

https://www.cancerresearchuk.org

https://www.webmd.com

https://www.cancer.org