From the Guidelines
The most effective treatment for lymphoma depends on the type and stage of the disease, with chemotherapy regimens like ABVD for Hodgkin lymphoma and R-CHOP for non-Hodgkin lymphoma being standard approaches. The treatment of lymphoma is complex and involves various modalities, including chemotherapy, radiation therapy, immunotherapy, and stem cell transplantation.
Treatment Approaches
- Chemotherapy: This is a primary treatment for many types of lymphoma. For Hodgkin lymphoma, the ABVD regimen (adriamycin, bleomycin, vinblastine, dacarbazine) is commonly used, as supported by studies such as 1. For non-Hodgkin lymphoma, R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) is a standard treatment, especially for CD20+ large-cell non-Hodgkin’s lymphoma, as indicated in 1.
- Radiation Therapy: This can be used alone for early-stage disease or in combination with chemotherapy for more advanced stages. The use of involved field radiotherapy (IFRT) with a dose of 30 Gy is recommended for certain cases of Hodgkin lymphoma, as discussed in 1.
- Immunotherapy: Options include rituximab for B-cell lymphomas and checkpoint inhibitors like pembrolizumab for certain types of lymphoma. Brentuximab vedotin is approved for patients with Hodgkin lymphoma who have failed autologous stem cell transplantation (ASCT) or have multiple relapses, as mentioned in 1.
- Stem Cell Transplantation: This is considered for aggressive or relapsed disease, with high-dose chemotherapy followed by autologous stem cell transplantation (ASCT) being a standard approach for patients with disease recurrence after first-line treatment, as outlined in 1.
Considerations
- The intensity of treatment depends on the patient’s risk profile, with factors such as age, stage of disease, and presence of clinical risk factors influencing treatment decisions.
- Follow-up care is crucial to detect disease recurrence and therapy-related late effects, with regular monitoring of thyroid function, testosterone and oestrogen levels, and surveillance for secondary malignancies, as recommended in 1.
- Treatment selection must balance efficacy against potential side effects, which can include fatigue, nausea, hair loss, and immune suppression requiring infection precautions.
Recent Guidelines
The most recent guidelines, such as those from 1, emphasize the importance of treating patients within clinical trial protocols whenever possible and highlight the role of newer therapies like brentuximab vedotin in the management of relapsed or refractory Hodgkin lymphoma. Overall, the choice of treatment for lymphoma should be individualized based on the specific characteristics of the patient and their disease, with a focus on maximizing efficacy while minimizing toxicity.
From the FDA Drug Label
INDICATIONS AND USAGE ADCETRIS is a CD30-directed antibody and microtubule inhibitor conjugate indicated for treatment of: • Adult patients with previously untreated Stage III or IV classical Hodgkin lymphoma (cHL), in combination with doxorubicin, vinblastine, and dacarbazine (1. 1). • Pediatric patients 2 years and older with previously untreated high risk classical Hodgkin lymphoma (cHL), in combination with doxorubicin, vincristine, etoposide, prednisone, and cyclophosphamide (1.2). • Adult patients with classical Hodgkin lymphoma (cHL) at high risk of relapse or progression as post-autologous hematopoietic stem cell transplantation (auto-HSCT) consolidation (1. 3). • Adult patients with classical Hodgkin lymphoma (cHL) after failure of auto-HSCT or after failure of at least two prior multi-agent chemotherapy regimens in patients who are not auto-HSCT candidates (1. 4). • Adult patients with previously untreated systemic anaplastic large cell lymphoma (sALCL) or other CD30-expressing peripheral T-cell lymphomas (PTCL), including angioimmunoblastic T-cell lymphoma and PTCL not otherwise specified (NOS), in combination with cyclophosphamide, doxorubicin, and prednisone (1. 5). • Adult patients with systemic anaplastic large cell lymphoma (sALCL) after failure of at least one prior multi-agent chemotherapy regimen (1.6). • Adult patients with primary cutaneous anaplastic large cell lymphoma (pcALCL) or CD30-expressing mycosis fungoides (MF) who have received prior systemic therapy (1. 7). • Adult patients with relapsed or refractory large B-cell lymphoma (LBCL), including diffuse large B-cell lymphoma (DLBCL) NOS, DLBCL arising from indolent lymphoma, or high-grade B-cell lymphoma (HGBL), after two or more lines of systemic therapy who are not eligible for auto-HSCT or CAR T-cell therapy, in combination with lenalidomide and a rituximab product (1. 8).
The treatment options for lymphoma include:
- Brentuximab vedotin (ADCETRIS) in combination with other chemotherapy agents for various types of lymphoma, including:
- Classical Hodgkin lymphoma (cHL)
- Systemic anaplastic large cell lymphoma (sALCL)
- Peripheral T-cell lymphomas (PTCL)
- Large B-cell lymphoma (LBCL)
- The specific treatment regimen and dosage may vary depending on the type and stage of lymphoma, as well as the patient's overall health and medical history 2.
From the Research
Treatment Options for Lymphoma
The treatment options for lymphoma vary depending on the subtype and stage of the disease.
- Non-Hodgkin lymphoma is typically treated with chemotherapy regimens such as CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) with or without rituximab (R-CHOP), bendamustine, and lenalidomide 3.
- Hodgkin lymphoma is treated with combined chemotherapy regimens such as ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine), Stanford V, or BEACOPP, often in combination with radiotherapy 3.
Advanced Stages of Classical Hodgkin Lymphoma
For advanced stages of classical Hodgkin lymphoma, treatment options include:
- ABVD chemotherapy 4
- Escalated BEACOPP chemotherapy 4
- Brentuximab vedotin in combination with chemotherapy 4, 5, 6
- Nivolumab in combination with brentuximab vedotin, doxorubicin, and dacarbazine (AN+AD) 6
Limited-Stage Classical Hodgkin Lymphoma
For limited-stage classical Hodgkin lymphoma, treatment options include:
Historical Treatment Options
Historically, treatment options for advanced-stage classical Hodgkin lymphoma have included:
- Doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapy with interferon (IABVD) 7