Prednisone lymphomas

Nitrogen mustard is clinically used for the treatment of lymphomas and some forms of lung cancer. The major indication for mechlorethamine is Hodgkin s disease as a part of the MOPP regimen (mechlorethamine + vincristine (oncovin) + procarbazine + prednisone). The usual dose consists of 6 mg/m2 on days 1 and 8. This drug has pronounced hematological toxicity (myelo-suppression). 

Prednisone 20-40 mg enterally daily or equivalent if lymphoma or granulomatous disease-related... 

LL, a 47-year-old man, was diagnosed with high-risk diffuse large cell B-cell non-Hodgkin s lymphoma (NHL) 12 months ago. LL had a complete response to his initial treatment of six cycles of RCHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). LL is participating in a clinical trial and is randomized to receive a myeloablative autologous HCT TBI days 8 to 5, etoposide day 4, rest day 3, cyclophosphamide day 2, rest day 1, with infusion of autologous PBPC on day 0. 

MACOP-B Methotrexate, daunomycin, cyclophosphamide, vincristine, prednisone, bleomycin Lymphoma... 

In addition, combination therapy trials of rituximab with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) in refractory and newly diagnosed patients suggests that rituximab may also have a role in the eradication of residual disease. This combination appears to be a viable treatment option for relapsed low-grade non-Hodgkin lymphoma... 

Corticosteroids suppress proliferation of lymphocytic cells, thus they are useful at combating acute lymphoblastic or undifferentiated leukemia of childhood, chronic lymphocytic leukemia, Hodgkin s lymphoma, other lymphomas. Therapy is often initiated with a steroid in combination with other agents. There is no evidence of cross resistance to unrelated agents. Mostly prednison is used however at appropriate dosages similar effects can be obtained with other glucocorticosteroids. 

The major indication for mechlorethamine is Hodgkin s disease the drug is given in the MOPP regimen (mechlorethamine, vincristine, procarbazine, prednisone see Chapter 55). Other less reactive nitrogen mustards are now preferred for the treatment of non-Hodgkin s lymphomas, leukemias, and various solid tumors. 

Vincristine has been effectively combined with prednisone for remission induction in acute lymphoblastic leukemia in children. It is also active in various hematologicmalignancies such as Hodgkin s and non-Hodgkin s lymphomas, and multiple myeloma, and in several pediatric tumors including rhabdomyosarcoma, neuroblastoma, Ewing s sarcoma, and Wilms tumor. 

CHOP Cyclophosphamide (Cytoxan), doxorubicin, vincristine (Oncovin), prednisone Non-Hodgkin lymphoma... 

This is present in mechlorethamine (Mustargen), which is used in patients with Hodgkin s disease and other lymphomas, usually in combination with other drugs, such as in MOPP therapy (mechlorethamine, Oncovin [vincristine], procarbazine, and prednisone). It may cause bone marrow depression. 

Cyclophosphamide (Cytoxan and Endoxan) is used in the treatment of Hodgkin s disease, lymphosarcoma, and other lymphomas. It is employed as a secondary drug in patients with acute leukemia and in combination with doxorubicin in women with breast cancer. A drug combination effective in the treatment of breast cancer is cyclophosphamide, methotrexate, fluorouracil, and prednisone (CMFP). Cyclophosphamide is also an immunosuppressive agent. The toxicity of cyclophosphamide causes alopecia, bone marrow depression, nausea and vomiting, and hemorrhagic cystitis. 

Nodular lymphoma Cyclophosphamide, Oncovin (vincristine), and prednisone (CVP). 

Diffuse histiocytic lymphoma Cyclophosphamide, Adriamycin (doxorubicin), vincristine, and prednisone (CHOP) bleomycin, Adriamycin (doxorubicin), cyclophosphamide, Oncovin (vincristine), and prednisone (BACOP) or cyclophosphamide, Oncovin (vincristine), methotrexate, and cytarabine (COMA). 

Most steroid-sensitive cancers express specific cell surface receptors. Prednisone-sensitive lymphomas, estrogen-sensitive breast cancers, and prostatic cancers express specific receptors for corticosteroids, estrogens, and androgens, respectively. It is now possible to assay tumor specimens for steroid receptor content and to identify which individual patients are likely to benefit from hormonal therapy. Measurement of the estrogen receptor (ER) and progesterone receptor (PR) proteins in breast cancer tissue is now standard clinical practice. ER or PR positivity predicts response to hormonal therapy, whereas patients whose tumors are ER-negative generally fail to respond to such treatment. 

Non-Hodgkin s lymphoma Combination chemotherapy cyclophosphamide, doxorubicin, vincristine, prednisone Bleomycin, lomustine, carmustine, etoposide, interferon, mitoxantrone, ifosfamide, rituximab... 

Combination chemotherapy is the treatment standard for patients with diffuse non-Hodgkin s lymphoma. The anthracycline-containing regimen CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) has been considered the best treatment in terms of initial therapy. Recently, randomized phase III clinical studies have shown that the combination of CHOP with the anti-CD20 monoclonal antibody rituximab results in improved response rates, disease-free survival, and overall survival compared with CHOP chemotherapy alone. 

To further support the use of a 6-mg fixed dose of pegfilgrastim, a Phase II study was conducted in 29 patients with non-Hodgkirfs lymphoma who received a single SC 6-mg dose of pegfilgrastim approximately 24 h after the start of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy [42]. No relationship between the duration of grade 4 neutropenia and body weight was seen, and no unexpected adverse events were reported. 

Tumors that are steroid hormone-sensitive may be either (1) hormone-responsive, where the tumor regresses following treatment with a specific hormone (2) hormone-dependent, where removal of a hormonal stimulus causes tumor regression or (3) both. Hormone treatment of responsive tumors is usually only palliative, except in the case of the cytotoxic effect of glucocorticoids (for example, prednisone) on lymphomas. Removal of hormonal stimuli from hormone-dependent tumors can be accomplished by surgery, for example, in the case of orchiectomy for patients with advanced prostate cancer, or by drugs, for example in the case of breast cancer, treatment with the antiestrogen... 

Prednisone [PRED ni sone] is a potent synthetic anti-inflammatory corticosteroid with less mineralocorticoid activity than cortisol (see p. 272). The use of this compound in the treatment of lymphomas arose when it was observed that patients with Cushing s syndrome (a syndrome associated with hypersecretion of cortisol) have lymphocytopenia and decreased lymphoid mass. These result from corticosteroid action on lymphocyte formation and distribution, that is, movement of these cells from the circulation to lymphoid tissue. 

Therapeutic applications Prednisone is primarily employed to induce remission in patients with acute lymphocytic leukemia, and in the treatment of both Hodgkin s and non-Hodgkin s lymphomas. 

Available data suggest that the antitumor therapeutic response of older patients is optimal when exposure to appropriate chemotherapy is the same as for younger patients. For example, the treatment of non-HodgkiiVs lymphoma with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or etoposide, mitoxantrone, and prednimustine (VMP) is less effective in older patients when dose reductions are made (73, 74). Similarly, treatment of metastatic breast cancer in younger and older patients with the same dose intensity of doxorubicin-based chemotherapy resulted in similar outcomes as measured by time to progression of disease and overall survival (75). 

An 80-year-old woman with a small B cell extranodal lymphoma was initially given chlorambucil for 10 months, with complete remission for 2 years. When she developed recurrent lymph node sweUing she was given ibritumomab tiuxetan, with near-complete remission. When she developed progressive disease 14 months later, she received cyclophosphamide, vincristine, and prednisone for one cycle. She had persistent pancytopenia, and a bone marrow biopsy showed extensive infiltration by acnte myelogenons lenkemia. 

A 55-year-old man with chronic lymphocytic leukemia and rheumatoid arthritis took methotrexate for 4 years and developed a B cell non-Hodgkin s lymphoma in the shoulder and axillary lymph nodes he had Epstein-Barr viral antigens in the serum. After radiation and chemotherapy had failed, complete remission was achieved with a combination of rituximab and EPOCH (etoposide -I- prednisone -I- vincristine -I-cyclophosphamide + doxorubicin). 

Wolfe F. Inflammatory activity, but not methotrexate or prednisone use predicts non-Hodgkin s lymphoma in rheumatoid arthritis a 25-year study of 1767 RA patients. Arthritis Rheum 1998 41(Suppl) S188. 

A 26-year-old woman with a diffuse large B cell lymphoma received CHOP (cyclophosphamide, hydroxy-daunomycin, Oncovin, and prednisone), ritnximab, and radiotherapy (14). She developed a transfnsion-dependent anemia. Bone marrow biopsy confirmed pure red cell aplasia and parvovirus infection. She had no antibodies to parvovirus, suggesting that she never had a previous exposure. Intravenous immunoglobulin resulted in a reticulocytosis and recovery of her hemoglobin. 

Because of its ability to cross the blood-brain barrier, carmustine is used against brain tumors and other tumors (e.g.. leukemias) that have metastasized to the brain. It also is used as secondary therapy in combination with other agents for Hodgkin s di.sease and other lymphoma.s. Multiple myeloma responds to a combination of carmustine and prednisone. Delayed myelosuppression is the most frequent and serious toxicity. ITiis condition u.sually develops 4 to 6 weeks after treatment. Thrombtxtytopcnia is the most pronounced effect, followed by leukopenia. Nausea and vomiting frequently occur about 2 hours after treatment. 

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