Chemotherapy Hodgkin

Despite dramatic advances in the treatment of several human malignancies including Hodgkin s lymphomas and leukemias, dmg resistance remains a pressing issue in cancer chemotherapy. Acquired or induced dmg resistance afflicts practically all classes of cancer agents. It usually is manifested clinically... 

Mustard gas, used in chemical warfare in World War I, has been found to be an effective agent in the chemotherapy of Hodgkins disease. It can be produced according to the following reaction ... 

The recombinant monoclonal antibody rituximab is an effective treatment option for some patients with non-Hodgkin s lymphoma as a single agent and enhances the efficacy of combination chemotherapy regimens. 

The clinical course varies widely among these histologies of HL and NHL. Most lymphoma subtypes are highly proliferating tumor cells that require aggressive therapeutic intervention with chemotherapy, radiation therapy, or both. By contrast, certain subtypes of non-Hodgkin s lymphoma... 

Canellos GP, Anderson JR, Propert KJ, et al. Chemotherapy of advanced Hodgkin s disease with MOPP, ABVD, or MOPP alternating with ABVD. New Engl J Med 1992 327 ... 

Fisher RI, et al. Comparison of standard regimen (CHOP) with three intensive chemotherapy regimens for advanced non-Hodgkins lymphoma. New Engl J Med 1993 328 1002-1006. 

Miller TP, Dahlberg S, Cassady JR, et al. Chemotherapy alone compared with chemotherapy plus radiotherapy for localized intermediate- and high-grade non-Hodgkin s lymphoma. New Engl J Med 1998 339 21-26... 

JM is a 32-year-old woman who was recently diagnosed with stage IIIB Hodgkin s disease. She comes to the clinic to receive her first dose of ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) chemotherapy. She currently does not have a central access device therefore, she will receive her chemotherapy via peripheral vein. 

Combination Chemotherapy Regimens for Hodgkin s Lymphoma (Continued)... 

Multicentre studies have demonstrated the efficacy of rituximab, a chimeric IgG-1 directed against CD20, in the treatment of relapsed low-grade and follicular non-Hodgkin lymphoma. In 166 patients, receiving 375 mg rituximab in four weekly doses, the overall response rate was 50% in 161 evaluable patients who had previously received chemotherapy... 

Hodgkin s disease accounts for 1% of all new cancers diagnosed in Western countries and for 15% of all malignant lymphomas. In patients with early stage lA-IIA disease without B-symptoms or bulky adenopathy, therapy consists of either extended field radiotherapy or limited duration chemotherapy, e.g. ABVD (anthracycline, bleomycin, vinblastine, dacarbazine) for 3-4 cycles followed by involved field radiotherapy. Radiation alone results in a 10-year relapse free survival of 70-75% and, because of the efficacy of salvage chemotherapy for those who relapse, an overall survival of 80-85%. The combined modality approach results in fewer relapses but overall survival is similar. In order to reduce the long term morbidity of radiation current trials are exploring combined modality treatment with lower radiation doses versus chemotherapy alone. 

Diehl V, Eranklin J, Pfreundschuh M, Lathan B, Panins U, Hansenclever D et al. Standard and increased-dose BEACOPP chemotherapy compared to COPP-ABVD for advanced Hodgkin s disease. N Engl J Med 2003 348 2386-95. 

The chemotherapy of advanced Hodgkin s disease is one of the best examples of successful combination chemotherapy. Combination therapy with the MOPP regimen (mechlorethamine, Oncovin [vincristine sulfate], procarbazine, prednisone), alternating with ABVD (Adriamycin [doxorubicin hydrochloride], bleomycin, vinblastine, dacarbazine), has resulted in cure rates of 50 to 60%. 

The treatment of Hodgkin s disease also illustrates the use of combined modalities, that is, radiation plus chemotherapy. The combined modality approach to several childhood tumors (e.g., Ewing s sarcoma, Wilms tumor, and rhabdomyosarcoma) has dramatically increased the cure rates for these diseases. 

Carmustine and lomustine can produce remissions that last from 3 to 6 months in 40 to 50% of patients with primary brain tumors. Both drugs also are used as secondary treatment of Hodgkin s disease and in experimental combination chemotherapy for various types of lung cancer. Other tumors in which remission rates of 10 to 30% have been obtained are non-Hodgkin s lymphomas, multiple myeloma, melanoma, renal cell carcinoma, and colorectal cancer. 

Bleomycin, in combination with cisplatin or etopo-side, is important as part of the potentially curative combination chemotherapy of advanced testicular carcinomas. Bleomycin is used in some standard regimens for the treatment of Hodgkin s and non-Hodgkin s lymphomas, and it is useful against squamous cell carcinomas of the head and neck, cervix, and skin. 

N.G. Mikhaeel, M. Hutchings, P.A. Fields, M.J. O Doherty, A.R. Timothy, FDG-PET after two to three cycles of chemotherapy predicts progression-free and overall survival in high-grade non-Hodgkin lymphoma, Ann. Oncol. 16(9) (2005) 1514-1523. 

M. Hutchings, A. Loft, M. Hansen, L.M. Pedersen, T. Buhl, J. Jurlander, S. Buus, S. Keiding, F. D Amore, A.M. Boesen, A.K. Berthelsen, L. Specht, FDG-PET after two cycles of chemotherapy predicts treatment failure and progression-free survival in Hodgkin lymphoma. Blood 107(1) (2006) 52-59. 

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