This page discusses the use of chemotherapy for the treatment of non-Hodgkin’s lymphoma. For a thorough review of chemotherapy, please see the chemotherapy treatment monograph .

Cancer chemotherapy is the use of drugs to kill cancer cells. Unlike radiation and surgery, which are localized treatments, chemotherapy is a systemic treatment, meaning the drugs travel throughout the whole body. This means chemotherapy can reach cancer cells that may have spread, or metastasized, to other areas.

Chemotherapy for non-Hodgkin’s lymphoma depends on the type of cancer cells present. The drugs may be given alone or in combination. The drugs are given in cycles on multiple days. You may receive six to eight cycles of therapy. Between cycles the doctor will likely check your tumor status. This may involve a physical exam and x-rays or other tests. If the tumor continues to grow the doctor will make changes to your treatment plan.

Chemotherapy is most often ordered before radiation treatment or if the disease recurs. Doctors are investigating using regimens that combine chemotherapy and radiation.

Successful initial treatment provides the best chance of survival. Receiving the optimal dose increases the odds of success. But side effects may prevent giving as much drug as possible.

Chemotherapy Drugs Used for non-Hodgkin’s Lymphoma

  • Chlorambucil (Leukeran)
  • Cladribine (Leustatin)
  • Cyclophosphamide (Cytoxan)
  • Fludarabine (Fludara)
  • Methotrexate
  • Prednisone
  • Vincristine (Oncovin)
  • Doxorubicin (Adriamycin)
  • Etoposide (VP-16)
  • Mitoxantrone

Single Agent Regimens

  • Chlorambucil (Leukeran) – taken by mouth daily, or for a number of days during a four- to six-week cycle. This is taken at home.
  • Cyclophosphamide (Cytoxan) – given intravenously (by IV) and taken by mouth. This is given on an outpatient basis.
  • Adriamycin – given intravenously on an outpatient basis
  • Etoposide – given intravenously on an outpatient basis
  • Mitoxantrone – given intravenously on an outpatient basis
  • Fludarabine (Fludara) – given by IV on days one through five during a four-week cycle
  • Cladribine (Leustatin) – given by IV on days one through five
  • Pentostatin (Nipent) – given intravenously on an outpatient basis
  • Rituximab (Rituxan) – given intravenously on an outpatient basis
  • Zevalin – given intravenously on an outpatient basis
  • ONTAK – given intravenously on an outpatient basis
  • Bexarotene (ONTAK) – given orally

Combination Therapies

The combination of drugs recommended by your doctor will depend on the known side effects, your general health and age, and his or her familiarity with the regimens.

Combination options include the following:

  • CVP, a three-week cycle
  • Cyclophosphamide, taken by mouth on days one through five
  • Vincristine (Oncovin), given by IV on day one
  • Prednisone, taken by mouth on days one through five
  • CHOP, three-week cycle; the number of cycles depends on the extent of the disease
  • Cyclophosphamide, given by IV on day one
  • Prednisone, taken by mouth on days one through five
  • R-CHOP, three-week cycle; the number of cycles depends on the extent of the disease
  • Cyclophosphamide, given by IV on day one
  • Doxorubicin (Adriamycin), given by IV on day one; Vincristine, given by IV on day one
  • Prednisone, taken by mouth on days one through five
  • Rituxan- given intravenously before each dose of CHOP
  • EPOCH- three week cycles
    • Doxorubicin given by intravenous infusion for 4 days
    • Vincristine given by intravenous infusion for 4 days
    • Etoposide given by intravenous infusion for 4 days
    • Decadron given daily by mouth
    • Cyclophosphamide given IV on day 6.
  • Hyper CVAD- four week cycles
    • Cyclophosphamide given twice a day for 3 days
    • Adriamycin given intravenously on day 4
    • Vincristine given intravenously on day 4
    • Alternating with Ara-c given intravenously or methotrexate given intravenously

Effectiveness

Most low-grade non-Hodgkin’s lymphomas initially respond well to chemotherapy; between 30% and 60% of patients respond. But the remission only lasts about 2.5 years. In almost all cases, the disease recurs—only 20% to 25% of patients remain free of disease four years after treatment. When the disease recurs, doctors typically try different drugs.

For aggressive lymphomas, chemotherapy often produces only short-term results. Better results in some aggressive lymphomas have been seen with combination therapy.

For a thorough review of chemotherapy, please see the chemotherapy treatment monograph .