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Chemotherapy - Other NHL Types

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Central Nervous System NHL
There has been a growing interest in the use of systemic (whole-body) chemotherapy for the treatment of NHL of the central nervous system. Primary central nervous system lymphoma (PCNSL) can be difficult to treat, because many drugs do not pass through the blood-brain barrier of the CNS. In spite of this, some fat-penetrating drugs and drugs with very small molecules are able to cross the barrier and destroy the tumor cells. These drugs include ethotrexate, cytarabine, the nitrosoureas, procarbazine, and 5-fluorouracil. In addition, chemotherapy medications like cyclophosphamide (Neosar®) and vincristine show some activity against PCNSL, perhaps through areas that the blood-brain barrier has broken down.

• Option 1: Chemotherapy with methotrexate (3.5 g/m2x 3, with leucovorin rescue) after radiation therapy.
• Option 2: Chemotherapy with methotrexate (1.5 g/m2) and cyclophosphamide (15–30 mg/kg), plus Procarbazine (100–150 mg/day) and dexamethasone (24 mg/day), plus whole-brain radiation therapy, if needed.
• Option 3: Chemotherapy with methotrexate (1.0 g/m2) IV and intrathecally (12 mg x 6), plus Cytarabine (high dose), plus whole-brain radiation therapy and tumor boost.

Gastric NHL
Gastric, or stomach, NHL that is not successfully treated with antibiotic therapy may require surgical removal of the tumor, chemotherapy, or chemotherapy plus radiotherapy. If surgery is not possible, many experts rely on combination chemotherapy using doxorubicin-based therapy (e.g., CHOP) followed by radiation.

• Option 1: Combination chemotherapy with cyclophosphamide (Neosar®), hydroxydaunomycin, vincristine sulfate (Oncovin®), and prednisone; also called "CHOP"

Cutaneous (skin) NHL
The cutaneous, or skin, NHL mycosis fungoides is best treated by methods other than systemic chemotherapy, which affects the whole body and is not confined to the skin. But if systemic chemotherapy is required, the physician may recommend treatment with a combination of drugs. The most widely tested drug combinations have included cyclophosphamide, vincristine sulfate (Oncovin®), and prednisone, with or without doxorubicin (Adriamycin®); however, the results of these treatments have not been outstanding. By contrast, patients with Sézary syndrome often are successfully relieved of symptoms by systemic chemotherapy. One common plan combines oral chlorambucil and prednisone.

The nucleoside drugs fludarabine and pentostatin have showed some promise in early clinical trials of cutaneous NHL, including mycosis fungoides.

• Option 1: Combination chemotherapy with cyclophosphamide (Neosar®), vincristine sulfate (Oncovin®), and prednisone, with/without doxorubicin (Adriamycin®)
• Option 2: Combination chemotherapy with chlorambucil (Leukeran®) and prednisone
• Option 3: Chemotherapy with a single nucleoside (e.g., fludarabine phosphate [FDA], or pentostatin [2'-deoxycoformycin])

For more information on therapies for the Non-Hodgkin's Lymphomas, please speak with your physician. Open communication, asking questions, and becoming more informed about your condition can lead to improved care. Participation in your health care is essential; become an informed consumer.

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