Sunday, February 25, 2024

Hodgkin’s Lymphoma Chemo Regimen

Stem Cell Transplantation For Non

Hodgkin Lymphoma & Non-Hodgkin Lymphoma Treatment

In a stem cell transplant also called a bone marrow transplant a patients blood-forming stem cells are replaced by adding new ones into the bloodstream. Often the goal of a stem cell transplant is either to cure lymphoma that has returned after initial therapy or to allow a patient to live a long time without therapy. Because of the expertise of MSKs transplant team, patients often have excellent results with both autologous and allogeneic stem cell transplantation.

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There Are Three Ways That Cancer Spreads In The Body

Cancer can spread through tissue, the lymph system, and the blood:

  • Tissue. The cancer spreads from where it began by growing into nearby areas.
  • Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
  • Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

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Stages Ia And Iia Favorable

This group includes HL that is only on one side of the diaphragm and that doesnt have any unfavorable factors. For example:

  • HL is in less than 3 different lymph node areas
  • It doesnt cause any of the B symptoms
  • The ESR is not elevated

Treatment for many patients is chemotherapy , followed by radiation to the initial site of the disease . Another option is chemotherapy alone in selected patients.

Doctors often order a PET/CT scan after a few courses of chemo to see how well the treatment is working and to determine how much more treatment is needed.

If a person cant have chemotherapy because of other health issues, radiation therapy alone may be an option.

For those who dont respond to treatment, chemo using different drugs or high-dose chemo followed by a stem cell transplant may be recommended. Treatment with an immunotherapy drug such as brentuximab vedotin , nivolumab , or pembrolizumab might be another option.

Radiation Therapy For Non

Cancer treatment hodgkins lymphoma

Many types of lymphoma are highly sensitive to radiation therapy. These varieties can be treated with much lower doses of radiation on smaller areas of the body than in the past.

At MSK, our radiation oncologists apply the most sophisticated and modern technology to give focused radiation that reduces long-term side effects as well as the risk of damage to healthy cells. Intensity-modulated radiation therapy , which was developed at MSK, uses advanced computer programs to calculate and deliver radiation directly to cancer cells from different angles. A PET-CT simulator helps us plan the treatment. This image gives us real-time information about how active the disease is and where it is in the body. It allows us to determine the radiation treatment position that will be the most accurate and safe. In addition, we are one of the few centers in the country that offer Total Skin Electron Beam radiation, a very effective treatment for patients with lymphoma in their skin.

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How Is Hodgkin’s Lymphoma Treated

People with Hodgkin’s lymphoma are commonly treated with chemotherapy and sometimes with radiation therapy. The chemotherapy regimen, including which drugs and how often theyre taken, varies depending on the stage of the disease. Its standard practice for people with Hodgkin’s lymphoma to receive combination therapy. This means that they get more than one type of chemotherapy drug at a time, rather than receiving a single drug.

After chemotherapy, doctors can use a PET scan or a CAT scan to see if all of the cancer has disappeared if it hasnt, radiation therapy may be given.

For many patients with Hodgkin’s lymphoma, a treatment called ABVD chemotherapy is given intravenously. Some patientsbut not allalso are given radiation therapy after chemotherapy ends.

People with late-stage Hodgkin’s lymphoma may receive:

Newer drugs have been developed for patients with recurrent Hodgkin’s lymphoma, including an immunotherapy called checkpoint inhibitors. These drugs are given intravenously and can alter factors around the tumor cells that contribute to the growth of the cells. This allows the bodys own immune system to fight against the tumor cells. These drugs have been highly effective in patients with Hodgkin’s lymphoma.

In young children, chemotherapy may be favored over radiation therapy, which can have long-term complications and impair muscle and bone growth in those who have not yet reached their full body size.

Patients May Want To Think About Taking Part In A Clinical Trial

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today’s standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

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Hodgkin Lymphoma: Treatment Options

Hodgkin lymphoma is a highly curable form of cancer. Most people with Hodgkin lymphoma will receive combination chemotherapy, some with and some without radiation. Other treatments may include stem cell or bone marrow transplantation.

Chemotherapy

Chemotherapy for Hodgkin lymphoma often consists of giving multiple drugs together, called combination chemotherapy. Chemotherapies used in the treatment of Hodgkin lymphoma include:

  • ABVD: Doxorubicin Bleomycin Vinblastine and Dacarbazine
  • Stanford V: Mechlorethamine Doxorubicin Vinblastine Bleomycin Etoposide Prednisone and Involved Field radiation
  • BEACOPP: Bleomycin Etoposide Doxorubicin Cyclophosphamide Vincristine Procarbazine and Prednisone

Targeted Therapy

Targeted therapy used in the frontline treatment of Hodgkin lymphoma include:

  • Brentuximab vedotin + AVD

Radiation Therapy

Radiation may be combined with chemotherapy. Hodgkin lymphoma generally spreads predictably from one lymph node to another. When the lymphoma is confined to a specific area of the body, for example, the neck, involved-field radiation may be given, meaning the therapy is limited to a small area. When radiation therapy is given more broadly to larger common areas, it is called extended-field radiation.

To learn more about treatment options for HL, download our Hodgkin Lymphoma booklet.

Hodgkin Lymphoma During The First Trimester Of Pregnancy

Hodgkinâs lymphoma | Hodgkinâs Disease | Reed-Sternberg Cell

When Hodgkin lymphoma is diagnosed in the first trimester of pregnancy, it does not necessarily mean that the woman will be advised to end the pregnancy. Each woman’s treatment will depend on the stage of the lymphoma, how fast it is growing, and her wishes. Treatment of Hodgkin lymphoma during the first trimester of pregnancy may include the following:

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What Is The Outlook For People With Hodgkin’s Lymphoma

Hodgkin’s lymphoma is treatable. About 90% of people with early-stage Hodgkin’s lymphoma are cured. Among people with more advanced disease, the cure rate is lower. Younger people respond to treatment better than older adults, and females tend to respond to treatment more successfully than males.

Sometimes, the treatments that cure Hodgkin’s lymphoma may cause health problems later in life, including an underactive thyroid, lung problems, heart disease, or other types of cancer, such as melanoma or breast cancer. Therefore, people whove had this type of cancer are advised to continue regular monitoring throughout the rest of their lives.

What Can I Expect During Abvd Chemotherapy

With ABVD chemotherapy, the four chemotherapy drugs are given through an IV on days 1 and 15 of your treatment 28-day cycle. This process takes about 3 to 4 hours. Your doctors will recommend a certain amount of cycles based on factors such as your overall health and the stage of your cancer.

The has provided estimates of the amount of cycles you may need based on different factors. One factor is favorability, which means the cancer is:

  • found in less than three lymph node areas
  • does not cause B symptoms
  • your erythrocyte sedimentation rate is not elevated

The estimated number of cycles based on these factors are:

  • favorable early stage cancer: 2 to 4 cycles
  • unfavorable early stage cancer: 4 to 6 cycles
  • advanced stage cancer: at least 6 cycles or more

At the same time you receive the chemotherapy drugs, most patients receive premedications with corticosteroids and antihistamines to prevent side effects.

Your doctor may also recommend that you take prescription anti-nausea pills to prevent vomiting and nausea. Its often recommended that you take these drugs before and after receiving chemotherapy.

Youll also have a blood test done either before the first day of your cycle or on the first day to check your white blood cell count.

The drugs administered during ABVD, and other types of chemotherapy, can damage healthy cells and cause many types of side effects. While not everyone will experience all of these side effects, most people will have some. These can include:

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Acronyms For Chemotherapy Regimens Sometimes Used To Treat Lymphoma

ABVD doxorubicin , bleomycin, vinblastine and dacarbazine

BEACOPP bleomycin, etoposide, doxorubicin , cyclophosphamide, vincristine , procarbazine and prednisolone a higher-dose regimen is sometimes called BEACOPPesc

BEAM carmustine , etoposide, cytarabine and melphalan

CHEOP cyclophosmamide, doxorubicin , etoposide, vincristine and prednisolone

ChlVPP chlorambucil, vinblastine, procarbazine and prednisolone

CHOP cyclophosphamide, doxorubicin , vincristine and prednisolone

CHVPi cyclophosphamide, doxorubicin , etoposide , prednisolone and interferon-alpha

CODOX-M cyclophosphamide, vincristine , doxorubicin and methotrexate

COPDAC cyclophosphamide, vincristine , prednisolone and dacarbazine

CVP cyclophosphamide, vincristine and prednisolone

DA-EPOCH dose-adjusted etoposide, prednisolone, vincristine , cyclophosphamide and doxorubicin

DHAP dexamethasone, high-dose cytarabine and cisplatin

ESHAP etoposide, methylprednisolone , high-dose cytarabine and cisplatin

GCVP gemcitabine, cyclophosphamide, vincristine and prednisolone

GDP gemcitabine, dexamethasone and cisplatin

GEMOX gemcitabine and oxaliplatin

GEM-P gemcitabine, cisplatin and methylprednisolone

Hyper-CVAD cyclophosphamide, vincristine, doxorubicin and dexamethasone hyper is short for hyperfractionated, which means that you have the same drug more than once in a day

ICE ifosfamide, carboplatin and etoposide

IGEV ifosfamide, gemcitabine and vinorelbine

How Is Hodgkin Lymphoma Treated

How I Beat Hodgkin

Treatment depends mainly on the stage, or extent of disease in your body. Other factors that are considered include the exact type of Hodgkin lymphoma you have, your age and general health. These days, most people treated for Hodgkin lymphoma can be cured. Many others who are treated remain disease-free and well for a long time. Treatment usually involves chemotherapy or radiotherapy or a combination of both. In selected cases, a stem cell transplant may be used.

Early-stage disease

The great majority of people with early-stage Hodgkin lymphoma are cured. There are often several options available for your treatment, which your doctor should discuss with you. Early-stage disease is usually treated with a combination of chemotherapy and radiotherapy. The decision regarding which of these options should be used will depend on your disease stage and which side effects of treatment are important to you.

Advanced-stage disease

Advanced-stage disease is usually treated with a longer course of chemotherapy. In most patients, the chemotherapy will continue for six months or even longer. Occasionally radiotherapy is also used in this stage.

Relapsed and resistant disease

Palliative care

Radiotherapy

Before radiotherapy begins, the radiotherapist will carefully calculate the correct dose of radiation therapy for you. The areas of your body that need to be treated will be marked with tiny ink dots on your skin using a special pen.

Chemotherapy

Stem cell transplant

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Clinical Trials And Consultations

Because of the limited number of patients with Hodgkin lymphoma and the importance of the clinical questions that remain about optimal disease management, patient involvement in clinical trials is strongly encouraged. It is also recommended that clinicians seek the following consultations in cases of Hodgkin lymphoma:

  • Hematologist/oncologist
  • Tertiary care center for consideration of clinical trial enrollment

Patients With Hodgkin Lymphoma Should Have Their Treatment Planned By A Team Of Health Care Providers With Expertise In Treating Lymphomas

Treatment will be overseen by a medical oncologist, a doctor who specializes in treating cancer. The medical oncologist may refer you to other health care providers who have experience and expertise in treating adult Hodgkin lymphoma and who specialize in certain areas of medicine. These may include the following specialists:

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Hematopoietic Stem Cell Transplantation

High-dose chemotherapy at doses that ablate the bone marrow is feasible with reinfusion of the patient’s previously collected hematopoietic stem cells or infusion of stem cells from a donor source . Patients with refractory or relapsed Hodgkin lymphoma should be promptly referred to centers capable of HDC with hematopoietic stem cell support.

Historically, hematopoietic stem cells have been obtained from bone marrow, but they are now typically obtained by pheresis of peripheral blood lymphocytes. A validated and relatively safe conditioning regimen for autologous transplantation is the BEAM regimen . In addition, Gayoso et al reported success with unmanipulated haploidentical related-donor transplant with a busulfan-based reduced conditioning regimen and post-transplant cyclophosphamide as prophylaxis against graft versus host disease.

Which Regimen Will I Have

Non-Hodgkin Lymphoma: Symptoms & Treatment | Stanford

The regimen you have depends on a number of factors including:

  • the type of lymphoma you have
  • how quickly the lymphoma is growing whether its fast-growing or slow-growing
  • where in your body the lymphoma is
  • the symptoms or problems your lymphoma is causing
  • whether you have previously had other treatments for lymphoma
  • whether or not you have other health conditions and whether youre on other medication
  • your age, general health and fitness.

Your medical team will talk to you about the best treatment for you based on your individual circumstances.

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Treatment Regimen And Side Effects Of Abvd Chemotherapy

Doru Paul, MD, is triple board-certified in medical oncology, hematology, and internal medicine. He is an associate professor of clinical medicine at Weill Cornell Medical College and attending physician in the Department of Hematology and Oncology at the New York Presbyterian Weill Cornell Medical Center.

If ABVD chemotherapy is recommended for your cancer, you probably have a thousand questions. How is this given? How often? What are the side effects? Are there any long term consequences? Let’s look at some of those questions.

Treatment For Adult Hodgkin Lymphoma May Cause Side Effects

For information about side effects that begin during treatment for cancer, see our Side Effects page.

Side effects from cancer treatment that begin after treatment and continue for months or years are called late effects. Treatment with chemotherapy and/or radiation therapy for Hodgkin lymphoma may increase the risk of second cancers and other health problems for many months or years after treatment. These late effects depend on the type of treatment and the patient’s age when treated, and may include the following:

  • Second cancers.
  • Heart disease, such as heart attack.
  • Lung problems, such as trouble breathing.
  • Avascular necrosis of bone .
  • Regular follow-up by doctors who are experts in finding and treating late effects is important for the long-term health of patients treated for Hodgkin lymphoma.

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    New Treatments For Relapsed Hodgkin Lymphoma

    If you can’t have a stem cell transplant, or if your lymphoma comes back after the transplant, there are other drug options available.

    If you relapse after a stem cell transplant

    You may be able to have:

    • Brentuximab vedotin, if you’ve already had a stem cell transplant
    • Nivolumab, if you’ve already had a stem cell transplant and brentuximab vedotin

    If you can’t have a stem cell transplant

    You may be able to have:

    • Brentuximab vedotin, if you’ve already had two other treatments and a stem cell transplant isn’t an option
    • Pembrolizumab, if you’ve already had brentuximab vedotin and a stem cell transplant isn’t an option

    Brentuximab vedotin is whats known as an antibody drug conjugate – a combination of an antibody and a chemotherapy drug. ADCs deliver chemotherapy in a way thats much more targeted than usual, and may cause fewer side effects.

    Nivolumab and pembrolizumab are whats known as immunotherapy drugs. They help activate your immune system so its more effective at fighting the cancer.

    If you’re treated during thecoronavirus pandemic and you have refractory disease, you may be given brentuximab vedotin followed by nivolumab, instead of the standard treatment for refractory Hodgkin lymphoma .

    Having this less intensive treatment means you won’t need to stay in hospital for as long and it also reduces the risk ofneutropenia– a possible side effect of stronger treatments. Speak to your healthcare team if you have any questions about your treatment options.

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