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Non-Hodgkin lymphoma

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Chemotherapy for non-Hodgkin lymphoma

Chemotherapy is one of the main treatments for non-Hodgkin lymphoma (NHL).

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to treat cancer. It is a systemic therapy that circulates throughout the body and destroys cancer cells, including those that may have broken away from the primary tumour.

Chemotherapy may be used:

  • as the primary treatment, with or without radiation therapy, to destroy cancer cells
    • Chemotherapy may be used alone or along with biological therapy or radiation therapy, depending on the type and stage of NHL.
    • Early stage, slow-growing (indolent) lymphomas may be treated with radiation therapy by itself or with chemotherapy (single drugs or a combination of drugs) or biological therapy, if the person has symptoms.
    • Fast-growing (aggressive) lymphomas are usually treated immediately with combination chemotherapy and biological therapy (with or without radiation therapy). This treatment offers the best chance of success.
  • in people with a lymphoma that tends to spread to the brain and spinal cord (central nervous system or CNS)
    • Certain chemotherapy drugs are used to prevent the spread of the lymphoma to the CNS.
  • in combination with biological therapy or radiation therapy to treat recurrent or relapsed lymphoma
  • to relieve pain or to control the symptoms of advanced NHL (palliative chemotherapy)

Drugs, doses and schedules vary from person to person. Chemotherapy is usually given in cycles. The number of cycles and how much time in between them depends on the type, stage and grade of NHL a person has and the types of chemotherapy drugs being given.

Types of chemotherapy

The chemotherapy drugs that are used depend on the type, stage and grade of NHL being treated.

Single chemotherapy drugs are generally used for slow-growing (indolent) NHLs. The most common single chemotherapy drugs used to treat NHL are:

  • chlorambucil (Leukeran) – on its own or with prednisone (Deltasone)
  • fludarabine (Fludara)
  • cyclophosphamide (Cytoxan, Procytox)

Combinations of chemotherapy drugs are usually used to treat NHLs. The most common chemotherapy combinations used to treat NHL are:

  • CHOP – most widely used combination
    • cyclophosphamide
    • doxorubicin (Adriamycin)
    • vincristine (Oncovin)
    • prednisone
  • CVP
    • cyclophosphamide
    • vincristine
    • prednisone

CHOP and CVP are usually given for 6–8 cycles, depending on the stage of the lymphoma and how it responds to treatment. A cycle is generally given every 21 days.

There are several other combinations of chemotherapy drugs that can be used to treat NHL. Different types of combinations may be used to treat certain types of NHL. Some other combinations of chemotherapy drugs that may be used include:

  • FND
    • fludarabine
    • mitoxantrone (Novantrone)
    • dexamethasone (Decadron, Dexasone)
  • Hyper-CVAD – may be used for some very aggressive lymphomas, such as Burkitt lymphoma or lymphoblastic lymphomas
    • cyclophosphamide
    • vincristine
    • doxorubicin
    • dexamethasone
    • in combination with methotrexate and cytarabine (Cytosar, Ara-C)
    • methotrexate
      • Leucovorin (folinic acid) is a drug given to protect normal cells from damage and decrease the severity of side effects from methotrexate.
    • doxorubicin
    • cyclophosphamide
    • vincristine
    • prednisone
    • bleomycin (Blenoxane)

Salvage chemotherapy

Sometimes a person's NHL recurs or relapses after being treated with chemotherapy or doesn't respond very well to initial chemotherapy treatment. In these cases, different chemotherapy drugs or more intensive chemotherapy may be given. This is sometimes referred to as salvage chemotherapy. Higher doses of drugs may be used or the schedule over which the drugs are given is shortened to make the chemotherapy more intense.

Some salvage chemotherapy regimens for NHL include:

  • DHAP
    • dexamethasone
    • cytarabine
    • cisplatin (Platinol AQ)
    • etoposide (Vepesid, VP-16)
    • prednisone
    • vincristine
    • cyclophosphamide
    • doxorubicin
    • etoposide
    • methylprednisolone (Medrol, Solu-medrol)
    • cytarabine
    • cisplatin
  • GDP
    • gemcitabine (Gemzar)
    • dexamethasone
    • cisplatin
  • ICE
    • ifosfamide (Ifex)
      • Mesna (Uromitexan) is a drug given to prevent urinary tract problems and protect the bladder from damage caused by ifosfamide.
    • carboplatin (Paraplatin, Paraplatin AQ) or cisplatin
    • etoposide
    • If dexamethasone is added to this combination, it is called DICE.
  • mini-BEAM
    • carmustine (BiCNU, BCNU)
    • etoposide
    • cytarabine
    • melphalan (Alkeran, L-PAM)

Intrathecal chemotherapy

Intrathecal chemotherapy is given directly into the cerebrospinal fluid that surrounds the brain and spinal cord through a lumbar puncture. Chemotherapy may also be given through a special device under the scalp called an Ommaya reservoir (intraventricular chemotherapy). These types of chemotherapy are given to people whose lymphoma has spread to the central nervous system (CNS). Sometimes such chemotherapy is given to certain people to prevent the spread of the lymphoma to the CNS (CNS prophylaxis).

  • Methotrexate is most commonly given for intrathecal therapy. It can also be given into the vein (intravenously) in high doses to treat CNS lymphoma.
  • Cytarabine is another drug that can be used for intrathecal chemotherapy.


CorticosteroidCorticosteroidAny steroid hormone that acts as an anti-inflammatory by reducing swelling and lowering the body’s immune response (the immune system’s reaction to the presence of foreign substances). drugs like prednisone are often given with chemotherapy to treat NHL.

Biological therapy

Rituximab (Rituxan) is a biological therapy drug that is used to treat many different types of B-cell lymphomas. It may be added to chemotherapy combinations like CHOP (CHOP-R or R-CHOP), CVP (CVP-R or R-CVP), or given with single drugs like fludarabine (fludarabine-R).

For more detailed information on specific drugs, go to sources of drug information.

See a list of questions to ask your doctor about chemotherapy.


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