Hodgkin's Disease

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Questions to Ask Your Doctor about Hodgkin’s Disease
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Chemotherapy

Chemotherapy is a general term that is used to describe cancer-killing drugs. Such drugs can be given: intravenously, through a vein; orally, by mouth; subcutaneously, injected under the skin; intramuscularly, injected into a muscle; or intrathecally, injected into the cerebrospinal fluid (CSF).

Chemotherapy for lymphoma is varied, because there are so many different forms of this disease. Treatment may rely on a single anticancer medication - that is, single agent chemotherapy - or it may involve combination chemotherapy with a number of different anticancer drugs. Such drugs destroy cancer cells by preventing them from growing and dividing rapidly. Unfortunately, a number of the body's normal, noncancerous cells also divide rapidly and therefore are harmed by chemotherapy. Specifically, the hair follicles, red and white blood cells, platelets (blood particles responsible for clotting), and cells that line the gastrointestinal system may be damaged or destroyed, causing side effects. Such side effects depend upon the type and dose of drugs taken, as well as the length of time that they are used.

Side Effects
Chemotherapeutic side effects may include temporary hair loss, mouth sores, anemia (decreased numbers of red blood cells, which may cause fatigue, dizziness, and shortness of breath), leukopenia (decreased numbers of white blood cells, which may lower resistance to infection), thrombocytopenia (decreased numbers of platelets, which may lead to easy bleeding or bruising), and gastrointestinal symptoms like nausea, vomiting, and diarrhea.

Hodgkin's Disease (HD)
Although many different chemotherapeutic plans are available for the treatment of HD, two regimens are employed most frequently: MOPP, an abbreviation for mechlorethamine, vincristine (Oncovin®), procarbazine, and prednisone; and ABVD, an abbreviation for doxorubicin (Adriamycin®), bleomycin, vinblastine, and dacarbazine. These therapies are used primarily for patients who have advanced disease or high-risk localized HD.

MOPP is the oldest standard therapy for HD. Although it has a respectable cure rate of roughly 50%, leukemia is a long-term side effect of this therapy in about 7% of all patients. By contrast, ABVD offers a higher probability of long-term disease-free survival.

MOPP: Chemotherapy with mechlorethamine hydrochloride (Mustargen®), vincristine sulfate (Oncovin®), procarbazine hydrohloride (Matulane®), and prednisone; also called "MOPP"

• How are the drugs given:
  • Mechlorethamine: intravenously (IV)
  • Vincristine: IV
  • Procarbazine: orally
  • Prednisone: orally in three divided doses
• What is the duration of time for the drugs:
  Mechlorethamine and vincristine are given on days 1 and 8; procarbazine and prednisone are given on days 1 through 14.
• What are the side effects:
  • Mechlorethamine - myelosuppression (impaired bone marrow function), immune system effects, kidney and liver malfunction, painful inflammation at injection site
  • Vincristine - hair loss, nervous system effects, drug allergy, gastrointestinal effects, urinary changes, blood pressure effects
  • Procarbazine - pancytopenia (lack of all types of blood cells), bleeding tendency, liver malfunction, nervous system effects
  • prednisone - immune system effects.
  • Long-term effects of MOPP: sterility, secondary myelodysplasia (abnormal bone marrow cells)/leukemia

ABVD: Chemotherapy with doxorubicin (Adriamycin®), bleomycin sulfate (Blenoxane®), vinblastine sulfate (Velban®), and dacarbazine (DTIC-Dome®); also called "ABVD"

• How are the drugs given:
  • Doxorubicin intravenously (IV)
  • Bleomycin: IV
  • Vinblastine: IV
  • Dacarbazine: IV
• What is the duration of time:
  All drugs are given on days 1 and 15 (treatment may be repeated every 15 days)
• What are the side effects:
  • Doxorubicin - cardiotoxicity (heart damage), worsening of symptoms caused by other drugs
  • Bleomycin - pulmonary fibrosis, idiosyncratic reaction
  • Vinblastine - hair loss, leukopenia (decreased numbers of white blood cells), nervous system effects, worsening of symptoms caused by other drugs
  • Dacarbazine -nausea, vomiting, flu-like symptoms

Additional Treatment Options
Other treatment options have been used for HD with varying degrees of success. Some of these options are equivalent to MOPP, but do not produce the side effects of hair loss, nausea, and vomiting:

LOPP
Chemotherapy with chlorambucil (Leukeran®), vincristine sulfate (Oncovin®), procarbazine hydrohloride (Matulane®), and prednisone; also called "LOPP"

ChlVPP
Chemotherapy with chlorambucil (Leukeran®), vinblastine sulfate (Velban®), procarbazine hydrohloride (Matulane®), and prednisone; also called "ChlVPP"

EVAP
Chemotherapy with etoposide (VP-16; VePesid®), vinblastine sulfate (Velban®), doxorubicin (Adriamycin®), and prednisone; also called "EVAP"

Alternative Chemotherapies
The chemotherapeutic agent bleomycin, which is part of the combination drug plan ABVD, poses a potential threat to lung function in patients who have received previous radiation therapy or who have respiratory disease such as emphysema or pulmonary fibrosis. In such cases, a number of alternative treatments are available.These non-bleomycin-based treatments include:

• EVA - etoposide, vinblastine, and doxorubicin;
• EVAP - etoposide, vinblastine, doxorubicin, and prednisone;
• VEEP - vincristine, epirubicin, etoposide, and prednisolone; and
• NOVP - mitoxantrone (Novantrone®), vincristine (Oncovin®), vinblastine, and prednisone

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