Lymphoma chemotherapy

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... 

Cytarabine is used in the chemotherapy of acute myelogenous leukemia, usually in combination with anthracyclines, thioguanine, or both. It is less useful in acute lymphoblastic leukemia and lymphomas and has marginal activity against other tumors. Myelosuppres-sion is a major toxicity, as is severe bone marrow hypoplasia nausea and mucositis may also occur. 

Cancer treatment is a multimodality treatment, i.e., surgery is combined with radiotherapy and antineoplastic chemotherapy. The latter treatment mode is used mainly for cancers which have disseminated. Different forms of cancer differ in their sensitivity to chemotherapy with antineoplastic agents. The most responsive include lymphomas, leukemias, choriocarcinoma and testicular carcinoma, while solid tumors such as colorectal, pancreatic and squamous cell bronchial carcinomas generally show a poor response. The clinical use of antineoplastic agents is characterized by the following principles. 

Combinations of drugs displaying distinct effects on cell proliferation/ differentiation and immunomodula-tion (e.g., retinoids and chemotherapy in advanced cutaneous T cell lymphoma). 

To translate this approach into clinical scenarios, the risk-benefit assessment of chemotherapy administration in already immunocompromised patients would favor situations in which cytotoxic drugs are indicated anyhow, such as in AIDS-related lymphomas, where alkylating agents are part of the standard regimens. 

Comorbid conditions can increase the risk of anemia substantially. Anemia is especially common in cancer patients receiving chemotherapy and patients with chronic kidney disease (CKD). The incidence of anemia in cancer patients varies based on tumor type and the level of myelo-suppression the chemotherapy regimen causes. For instance, serious anemia [hemoglobin 7.9 g/dL or less (79 g/L or 4.9 mmol/L)] occurs in at least 75% of patients who receive a common chemotherapy regimen for lymphoma, but serious anemia may occur in only approximately 10% of patients who receive common chemotherapy regimens for... 

Chemotherapy of cancer started in the early 1940s when nitrogen mustard was administered to patients with lymphoma. Since then, numerous agents have been developed for the treatment of different cancers. 

JP is receiving a highly myelosuppressive chemotherapy regimen for the next 3 days for his lymphoma. The chemotherapy orders specify ifosfamide, carboplatin, and etoposide. The goal of this cycle of chemotherapy is to put the cancer into remission so that his lymphoma can be cured with a bone marrow transplant. 

DQ is a 57-year-old man who came to the emergency room because of shortness of breath. A radiographic examination demonstrates a large mass pressing on the bifurcation of the main stem bronchus. A biopsy demonstrates an aggressive lymphoma a five-drug chemotherapy regimen with both intravenous and intrathecal chemotherapy will start today. 

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... 

Coiffer B, Lepage E, Briere J, et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large B-cell lymphoma. New Engl J Med 2002, 346 235-242. 

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... 

Radiation therapy is the treatment of choice for chemotherapy-resistant tumors such as non-small cell lung cancer (NSCLC) or in chemotherapy-refractory patients with SVCS. Between 70% and 90% of patients will experience relief of symptoms. Radiation therapy also may be combined with chemotherapy for chemotherapy-sensitive tumors such as SCLC and lymphoma. In the rare emergency situations of airway obstruction or elevated intracranial pressure, empirical radiotherapy prior to tissue diagnosis should be used. In most patients, symptoms resolve within 1 to 3 weeks. 

Cytotoxic chemotherapy is the treatment of choice for chemotherapy-sensitive tumors such as SCLC and lymphoma. As indicated earlier, chemotherapy also may be combined with radiotherapy, especially in patients with lymphoma who have bulky mediastinal lymphadenopathy. 

Intron A interferon a-2b Schering-Plough Hairy cell leukemia, genital warts, AIDS-related Kaposi s sarcoma, hepatitis C, hepatitis B, malignant melanoma, follicular lymphoma in conjunction with chemotherapy... 

Hurwitz, E., Kashi, R., Burowsky, D., Arnon, R., and Haimovich, J. (1983b) Site-directed chemotherapy with a drug bound to antiidiotypic antibody to a lymphoma cell-surface IgM. Int. J. Cancer 31, 745. 

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

Options for stage I and II follicular lymphoma include locoregional radiation therapy, chemotherapy followed by radiation therapy, and extended-field radiation therapy. 

Rituximab, a chimeric monoclonal antibody directed at the CD20 molecule on B cells, has become one of the most widely used therapies for follicular lymphoma. Rituximab is approved for first-line therapy either alone or combined with chemotherapy and as maintenance therapy for patients with stable disease or with partial or complete response following induction chemotherapy. 

High-dose chemotherapy followed by HSCT is an option for relapsed follicular lymphoma. The recurrence rate is lower after allogeneic than after autologous HSCT, but the benefit is offset by increased treatment-related mortality. The ideal candidate is young and does not have serious comorbidities. 

Diffuse large B-cell lymphomas are the most common lymphoma in patients of all ages but most commonly seen in the seventh decade. Extranodal disease is present at diagnosis in 30% to 40% of patients. The International Prognostic Index score correlates with prognosis. Diffuse aggressive lymphomas are sensitive to chemotherapy with cure achieved in some patients. 

Approximately one-third of patients with aggressive lymphoma will require salvage therapy at some point. Salvage therapy is more likely to induce response if the response to initial chemotherapy was complete (chemosensi-tivity) than if it was primarily or partially resistant to chemotherapy. 

Large amounts of phosphorus can be released from intracellular stores in patients who have rhabdomyolysis and in patients who receive chemotherapy for acute leukemia and lymphoma. 

Hairy cell leukemia Genital warts AIDS-related Kaposi s sarcoma Non-A non-B hepatitis Hepatitis B Malignant melanoma Chronic viral hepatitis C Follicular lymphoma with chemotherapy June 1986 June 1988 Nov. 1988 Feb. 1991 July 1992 Dec. 1995 March 1997 Nov. 1997... 

Chemotherapy-induced neutropenia Neutropenia during bone marrow transplant Severe chronic neutropenia Autologous or allogeneic bone marrow transplantation Mobilization of autologous PBPCs after chemotherapy Persistent or recurrent cutaneous T cell lymphoma Feb. 1991 June 1994 Dec. 1994 Dec. 1995 April 1998 Feb. 1994... 

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