Lymphoma is a form of cancer that affects the lymph system. This system includes:
- lymph nodes
- bone marrow
- lymph fluid
While many types of lymphoma exist, doctors divide them into two categories. These are Hodgkin lymphoma and non-Hodgkin lymphoma (NHL).
Patients with Hodgkin lymphoma have cells known as Reed-Sternberg cells. Those with NHL don’t have these cell types. Both lymphoma forms can cause similar symptoms.
Treatments for either lymphoma type depend on the specific cells affected and the cancer type. In addition to radiation treatments to kill cancerous cells and shrink tumors, doctors often prescribe medications to patients to treat the cancerous cells or the lymphoma symptoms.
Chemotherapy drugs are medications used alone or in combination to target lymphoma cells. These drugs kill cancer cells or keep them from multiplying. Chemotherapy medications can treat Hodgkin lymphoma.
Chemotherapy medications often involve combining several drugs together for optimum results. Doctors give the medications via an intravenous (IV) treatment. Special IV lines called a port or port-a-cath are used to deliver these medications. The port provides access to a large vein, usually in the chest. This prevents vein damage from the strong medications.
Three chief chemotherapy regimens for Hodgkin lymphoma exist.
- ABVD: doxorubicin (Adriamycin), bleomycin (Blenoxane), vinblastine (Cytoxan), and dacarbazine (DTIC-Dome)
- BEACOPP: blenoxane, etoposide (Etopophos, Toposar, VePesid, VP-16, Adriamycin, cyclophosphamide (Cytoxan), vincristine (Oncovin), procarbazine (Matulane), and prednisone
- Stanford V: mechlorethamine (Mustargen), adriamycin, cytoxan, oncovin, blenoxane, etoposide, prednisone
Doctors prescribe the Stanford V regimen to patients with advanced lymphoma forms. Doctors are more likely to prescribe the ABVD regimen for earlier stages.
Doctors prescribe chemotherapy to treat NHL. Similar to drugs used for Hodgkin lymphoma treatments, pharmacists mix several chemotherapy medications together. These medication types fall into six categories. Doctors select a medicine based on the lymphoma type and stage.
Alkylating agents keep cells from replicating by destroying DNA. While effective, they are associated with increased risk for leukemia. Examples include:
- cyclophosphamide (Cytotoxan)
- bendamustine (Treanda)
- ifosfamide (Ifex)
Corticosteroids kill cancerous cells, prevent the cancerous cells from growing, and can reduce nausea. Examples of these medications include:
- dexmethasone (Decadron)
Platinum drugs work similarly to alkylating agents without the increased risk for leukemia. Examples of these drugs include:
Purine analogs reduce cell metabolism to keep cancerous cells from reproducing and dividing. Medication examples include:
- cladribine (2-CdA, Leustatin)
- fludarabine (Fludera)
- pentostatin (Nipent)
Antimetabolites prevent DNA and RNA from growing and killing the cancerous cells. Examples include:
- capecitabine (Xeloda)
- cytarabine (ara-C)
- gemcitabine (Gemzar)
- pralatrexate (Folotyn)
Additional medications used to treat lymphoma but don’t fit into a particular category include:
- doxorubicin (Adriamycin)
- etoposide (VP-16)
- vincristine (Oncovin)
According to the American Cancer Society (ACS) , CHOP is a common NHL chemotherapy regimen. Pharmacists combine cyclophosphamide (Cytotxan), doxorubicin (hydroxydoxorubicin), vincristine (Oncovin), and prednisone.
Doctors may add rituximab (Rituxan) to this regimen, which is known as R-CHOP. According to the Leukemia & Lymphoma Society (LLS) , the R-CHOP regimen treats more aggressive forms of non-Hodgkin lymphoma. This method can cure NHL in some patients.
The combination of cyclophosphamide, vincristine, and prednisone (CVP) is another regimen.
Immunotherapy can boost the body’s immune system to fight cancer in NHL patients. In addition to fighting cancer, immunotherapy drugs can minimize some of chemotherapy’s side effects, including nausea and fatigue.
These medications are often called “guided missiles.” They specifically target cancer cells, unlike other chemotherapy medications that can harm healthy cells that multiply quickly, such as hair cells.
Immunotherapy medications that treat NHL include:
- immune modulators, including thalidomide (Thalomid) and lenalidomide (Revlimid)
- monoclonal antibodies, such as rituximab (Rituxan)
- proteasome inhibitors, such as bortezomib (Velcade)
- small molecule treatments, such as panobinostat
A doctor may prescribe these or other treatments, depending upon the patient’s NHL type.