Currently, medical treatment for lymphoma revolves around the following therapies:
- Stem cell therapy
A discussion of how chemotherapy and radiotherapy agents kill blood cancers, and the use of stem cell therapy, is available in the Leukemia protocol.
The standard chemotherapy regimen for NHL, known as CHOP, combines four agents: cyclophosphamide, doxorubicin, vincristine, and prednisone (Canellos GP 2004; Escalon MP et al 2005; Younes A 2004). Although CHOP has been the accepted “gold standard” for NHL chemotherapy treatment for the past 30 years, its delivery was recently optimized with a change to a 14-day dose-dense schedule, which increased clinical responses compared to the traditional 21-day schedule (Younes A 2004). A recent study showed the effectiveness of another chemotherapy combination (carmustine, doxorubicin, etoposide, vincristine, and cyclophosphamide, plus mitoxantrone, cytarabine and methotrexate with a factor known as BAVEC-MiMA) for NHL treatment (Rigacci L et al 2005).
The standard chemotherapy combination for HD is known as ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) (Canellos GP 2004).
The use of these chemotherapy agents is often combined with radiotherapy (Mukai HY et al 2003) and stem cell therapy (Lavoie JC et al 2005).
Side Effects of Conventional Therapy
Chemotherapy often has a side effect of reducing white blood cell count to very low levels, thereby leaving the patient vulnerable to infections (Lyman GH 2000). As with other cancers, the risk of developing lymphoma increases sharply with increasing age (Holmes FF et al 1991). Changes in the aging body reduce the patient’s ability to tolerate standard chemotherapy and radiotherapy regimens that are often better suited to the relatively more robust immune systems of young adults.
In particular, the aging body experiences a decline in its ability to make new white blood cells (Chatta GS et al 1996). The use of chemotherapy in elderly patients therefore aggravates this problem because it destroys patients’ normal white blood cells, leaving them prone to infections. Readers should refer to the Cancer Chemotherapy protocol for a range of prescription drugs that can be taken to reduce this negative side effect of chemotherapy. Readers should also refer to the protocol on Blood Disorders: Anemia, Leukopenia, and Thrombocytopenia for other practical guidelines on dealing with reduced white and red blood cells.
Heart disease (cardiomyopathy) is the most important long-term toxicity of Adriamycin® (doxorubicin) administration, which is used to treat both NHL and HD. Several clinical studies suggest that some changes in the heart’s electrical activity caused by Adriamycin® may be prevented by coenzyme Q10 supplementation (Tajima M 1984; Tsubaki K et al 1984). Coenzyme Q10 supplementation has a protective effect on cardiac function during therapy with Adriamycin® in lymphoma patients (Iarussi D et al 1994; Wang SQ 1991). Some investigators believe that simultaneous coenzyme Q10 and vitamin E supplementation is indicated during Adriamycin® therapy in order to reduce its toxicity and prevent fatal congestive heart failure (Wang SQ 1991).