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Chemotherapy - Indolent NHL & Aggressive NHL

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Slow-Growing NHL
For patients diagnosed with slow-growing (indolent) NHL (Stage 1 or 2), treatment options may include single nucleosides (fludarabine, cladribine, pentostatin), single alkylating agents (chlorambucil, cyclophosphamide [Neosar®]), or an alkylating agent plus prednisone. It is important to note that these treatments also are used for patients with recurrent slow-growing NHL.

Option 1: Chemotherapy with a single nucleoside (e.g., fludarabine phosphate [FDA], or cladribine [2-CDA; 2-chloro-2'-deoxyadenosine])

• Fludarabine or cladribine are administered intravenously (through a vein; IV).
• Fludarabine is given every day for 5 days and cladribine is given every day for 7 days.
• Fludarabine side effects include nervous system effects, stomatitis (mouth inflammation), hepatitis (liver inflammation); cladribine side effects include immune system suppression.

Option 2: Chemotherapy with a single alkylating agent (e.g., chlorambucil [Leukeran®], or cyclophosphamide [Neosar®])

• Chlorambucil administered orally; cyclophosphamide (Neosar®) administered intravenously.
• Chlorambucil is taken in pill form every day and cyclophosphamide is administered every 3 to 4 weeks.
• Chlorambucil side effecs include leukemia; cyclophosphamide side effects include bladder infection (cystitis), lung fibrosis, water retention.

There are several approaches to the management of patients with advanced (Stage 3 or 4) low-grade NHL. Treatment options include single-agent chemotherapy (e.g., with an alkylating agent or nucleoside) or aggressive combination chemotherapy (e.g., cyclophosphamide [Neosar®], vincristine, and prednisone ["CVP"]) with or without total nodal irradiation.

Options include the following:

• Option 1: Chemotherapy with a single alkylating agent (e.g., chlorambucil [Leukeran®], or cyclophosphamide [Neosar®])
• Option 2: Chemotherapy with a single nucleoside (e.g., fludarabine phosphate [FDA], or cladribine [2-CDA; 2-chloro-2'-deoxyadenosine])
• Option 3: Combination chemotherapy (e.g., cyclophosphamide [Neosar®], vincristine sulfate [Oncovin®], and prednisone; also called "CVP") with/without total nodal irradiation (TDI)

Fast-Growing NHL
Fast-growing, early stage (Stage 1 or 2) NHL is treated with aggressive, combination chemotherapy plans such as:

• CHOP—cyclophosphamide (Neosar®), hydroxydaunomycin, vincristine (Oncovin®), prednisone
• BACOD—bleomycin, doxorubicin (Adriamycin®), cyclophosphamide (Neosar®), vincristine (Oncovin®), dexamethasone
• MACOP-B—methotrexate, doxorubicin (Adriamycin®), cyclophosphamide, vincristine (Oncovin®), prednisone, bleomycin
• Pro-MACE-CytaBOM—prednisone, methotrexate (with leucovorin rescue), doxorubicin (Adriamycin®), cyclophosphamide (Neosar®), etoposide, cytarabine, bleomycin, vincristine (Oncovin®)
• EPOCH—etoposide, prednisone, vincristine (Oncovin®), cyclophosphamide (Neosar®), fluoxymesterone (Halotestin®)

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