From the Guidelines
The most effective treatment for lymphoma involves a combination of therapies tailored to the specific type and stage of the disease, with chemotherapy being the primary treatment, and regimens like ABVD commonly used for Hodgkin lymphoma. The treatment approach depends on various factors, including the type of lymphoma, stage, and individual patient factors.
Treatment Options
- Chemotherapy is the primary treatment, with regimens like ABVD (Adriamycin, Bleomycin, Vinblastine, Dacarbazine) commonly used for Hodgkin lymphoma and R-CHOP (Rituximab, Cyclophosphamide, Hydroxydaunorubicin, Oncovin, Prednisone) for many non-Hodgkin lymphomas, as supported by studies such as 1.
- Radiation therapy may be added for localized disease, targeting specific lymph node regions with daily treatments over 3-4 weeks.
- Immunotherapy with monoclonal antibodies like rituximab has revolutionized treatment by targeting CD20 proteins on B-cell lymphomas.
- For aggressive or relapsed cases, stem cell transplantation may be necessary, while some indolent lymphomas may be managed with watchful waiting.
Specific Treatment Regimens
- For early favorable Hodgkin lymphoma, two cycles of ABVD followed by 30 Gy involved field radiotherapy is currently the treatment of choice, as shown in studies such as 2.
- For early unfavorable Hodgkin lymphoma, four cycles of ABVD followed by 30 Gy IF radiotherapy is the standard of care, with tumor control and overall survival in excess of 85% or 90% at 5 years, as reported in 3.
- For advanced-stage Hodgkin lymphoma, eight cycles of ABVD or eight cycles of BEACOPP escalated followed by 30 Gy radiotherapy of residual lymphoma larger than 1.5 cm is recommended for patients up to age 60 years, while patients older than 60 years should undergo ABVD chemotherapy due to higher toxicity, as stated in 1.
Key Considerations
- Treatment success depends on early diagnosis, proper staging, and adherence to the complete treatment regimen.
- Side effects vary by treatment type but can include fatigue, nausea, hair loss, and increased infection risk, which can be managed with supportive medications and regular monitoring.
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 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)
- Combination therapies, such as: + Doxorubicin, vinblastine, and dacarbazine for previously untreated Stage III or IV cHL + Cyclophosphamide, doxorubicin, and prednisone for previously untreated sALCL or PTCL + Lenalidomide and a rituximab product for relapsed or refractory LBCL 4
From the Research
Treatment Options for Lymphoma
The treatment options for lymphoma vary depending on the type and stage of the disease.
- For early-stage Hodgkin lymphoma, combined-modality therapy with chemotherapy, such as ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine), followed by consolidation radiation therapy is the most effective treatment program 5.
- For non-Hodgkin lymphoma, chemotherapy treatment plans differ between subtypes, with options including CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) with or without rituximab (R-CHOP), bendamustine, and lenalidomide 6.
- For advanced-stage Hodgkin lymphoma, treatment options include combined chemotherapy with ABVD, Stanford V, or BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) with radiotherapy 6, 7, 8, 9.
- The choice of treatment also depends on the patient's overall health, age, and other factors, with the goal of maintaining high cure rates while minimizing risks 5, 8.
- In some cases, treatment may involve a combination of chemotherapy, radiation therapy, and immunotherapy, such as brentuximab vedotin or PD-1 inhibitors 8, 9.
Chemotherapy Regimens
Common chemotherapy regimens for lymphoma include:
- ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) 5, 6, 7, 9
- BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) 6, 7, 8, 9
- CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) with or without rituximab (R-CHOP) 6
- Stanford V (a chemotherapy regimen consisting of mechlorethamine, doxorubicin, vinblastine, vincristine, bleomycin, etoposide, and prednisone) 6, 7
Radiation Therapy
Radiation therapy may be used in combination with chemotherapy to treat lymphoma, particularly in early-stage disease 5, 6, 8.