What is the standard treatment approach for patients with lymphoma?

From the Guidelines

The standard treatment approach for lymphoma varies based on the specific type, stage, and individual patient factors, with combination chemotherapy and radiation therapy being primary treatments for Hodgkin lymphoma, and R-CHOP being the standard regimen for aggressive non-Hodgkin lymphomas like diffuse large B-cell lymphoma. For Hodgkin lymphoma, the primary treatment typically involves combination chemotherapy with ABVD (Adriamycin/doxorubicin, Bleomycin, Vinblastine, and Dacarbazine) for 2-6 cycles, often followed by radiation therapy for early-stage disease, as recommended by the European Society for Medical Oncology 1. The treatment of early favorable Hodgkin lymphoma (HL) is a combined chemoradiotherapy consisting of two cycles of ABVD followed by 30 Gy involved field (IF) radiotherapy, which is currently the treatment of choice 1. For aggressive non-Hodgkin lymphomas like diffuse large B-cell lymphoma, R-CHOP (Rituximab, Cyclophosphamide, Hydroxydaunorubicin/doxorubicin, Oncovin/vincristine, and Prednisone) is the standard regimen, typically administered every 21 days for 6 cycles, as supported by evidence from studies such as those published in the Annals of Oncology 1. Some key points to consider in the treatment of lymphoma include:

• The importance of comprehensive staging procedures, including bone marrow biopsy and CT scans of the abdomen and thorax, to determine the extent of disease 1.
• The use of risk factors, such as large mediastinal mass, extranodal disease, and high ESR, to allocate patients to different risk groups and guide treatment decisions 1.
• The potential benefits and risks of different treatment approaches, including chemotherapy, radiation therapy, and targeted therapies, and the need for individualized treatment planning based on patient factors and disease characteristics 1. In terms of specific treatment recommendations, the standard of care for patients with early unfavorable HL is four cycles of ABVD followed by 30 Gy IF radiotherapy, while for advanced HL, multiagent chemotherapy with regimens such as MOPP/ABVD or ABVD is currently under discussion 1. For young good-risk patients with diffuse large B-cell non-Hodgkin's lymphoma, six cycles of combination chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) treatment combined with eight doses of rituximab is the current standard, as recommended by the European Society for Medical Oncology 1. Overall, the treatment of lymphoma requires a comprehensive and individualized approach, taking into account the specific type and stage of disease, as well as patient factors and preferences, with the goal of achieving the best possible outcomes in terms of morbidity, mortality, and quality of life.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Because of the possibility of an anaphylactoid reaction, lymphoma patients should be treated with 2 units or less for the first 2 doses. If no acute reaction occurs, then the regular dosage schedule may be followed. The following dose schedule is recommended: Squamous cell carcinoma, non-Hodgkin's lymphoma, testicular carcinoma - 0.25 to 0. 50 units/kg (10 to 20 units/m2) given intravenously, intramuscularly, or subcutaneously weekly or twice weekly. Hodgkin's Disease - 0.25 to 0. 50 units/kg (10 to 20 units/m2) given intravenously, intramuscularly, or subcutaneously weekly or twice weekly. INDICATIONS AND USAGE Doxorubicin is an anthracycline topoisomerase II inhibitor indicated: ... for the treatment of: ... Hodgkin lymphoma, Non-Hodgkin lymphoma, ...

The standard treatment approach for patients with lymphoma may involve the use of chemotherapy agents such as bleomycin or doxorubicin.

• For Hodgkin's Disease and non-Hodgkin's lymphoma, the recommended dose of bleomycin is 0.25 to 0.50 units/kg (10 to 20 units/m2) given intravenously, intramuscularly, or subcutaneously weekly or twice weekly 2.
• Doxorubicin is indicated for the treatment of Hodgkin lymphoma and Non-Hodgkin lymphoma, with a recommended dose of 60 to 75 mg/m2 given intravenously every 21 days as a single agent, or 40 to 75 mg/m2 given intravenously every 21 to 28 days in combination therapy 3.

From the Research

Treatment Approaches for Lymphoma

• The standard treatment approach for patients with lymphoma depends on the subtype of lymphoma, with non-Hodgkin lymphoma typically treated with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) with or without rituximab (R-CHOP), bendamustine, and lenalidomide 4.
• Hodgkin lymphoma is treated with combined chemotherapy with ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine), Stanford V (a chemotherapy regimen consisting of mechlorethamine, doxorubicin, vinblastine, vincristine, bleomycin, etoposide, and prednisone), or BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) with radiotherapy 4.
• For patients with Hodgkin's lymphoma who are resistant to COPP and ABVD, a salvage chemotherapy regimen consisting of lomustine, etoposide, vindesine, and dexamethasone (CEVD) has been shown to be effective, with an overall response rate of 56% 5.
• Total lymphoid irradiation, high-dose chemotherapy, and autologous bone marrow transplantation have also been used to treat patients with advanced stage Hodgkin's disease who have relapsed or failed to respond to multiple regimens of combination chemotherapy, resulting in a high rate of complete remission and potential for long-term disease-free survival 6.

Chemotherapy Regimens

• The ABVE-PC regimen, which includes doxorubicin, bleomycin, vincristine, etoposide, prednisone, and cyclophosphamide, has been compared to the ABVD regimen in patients with pediatric Hodgkin lymphoma, with similar survival outcomes observed between the two groups 7.
• The use of interim PET-CT scans to guide treatment for patients with advanced Hodgkin's lymphoma has been investigated, with patients who have negative PET findings after two cycles of ABVD chemotherapy being randomly assigned to continue ABVD or omit bleomycin (AVD) in cycles 3 through 6 8.
• The results of this study showed that the omission of bleomycin from the ABVD regimen after negative findings on interim PET resulted in a lower incidence of pulmonary toxic effects than with continued ABVD, but not significantly lower efficacy 8.