Chemotherapy regimens for lymphoma

What is a chemotherapy regimen?

A chemotherapy regimen is a treatment plan that usually involves more than one drug. The regimen sets out:

• the name of the drugs
• the dose of each drug
• how often you take the drugs
• how the drugs are given
• how long you take each drug for.

Most regimens are given as a block of chemotherapy followed by a rest period to allow your body to recover. This is known as a ‘cycle’. Cycles often last between 2 and 4 weeks. A whole course of treatment can vary from several of weeks to a number of months.

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Why is more than one chemotherapy drug often given?

Chemotherapy drugs are sometimes given on their own. Examples include pixantrone and bendamustine. 

More often, however, a combination of chemotherapy drugs is given to treat lymphoma. Each drug works in a slightly different way to kill the lymphoma cells. You might be interested in our animation that explains how chemotherapy works.

In some cases, giving a combination of drugs:

• allows the chemotherapy to target cells at different stages of their cycle, meaning that the drugs are able to kill more of the lymphoma
• reduces the chance of resistance developing by using drugs that work in different ways
• balances the toxicity of treatment by using drugs with different side effects.

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Which chemotherapy regimens are used for lymphoma?

There are lots of different chemotherapy regimens. Below, we list regimens that are most commonly used for lymphoma. Don’t worry if your regimen isn’t listed here; your doctors plan the best treatment for you and new regimens become available as they are approved.

The names of chemotherapy regimens are usually acronyms, made up of the first letters of each of the drugs they contain, although this isn’t always the case. Using acronyms can make them easier to say.

Sometimes, a regimen uses a drug’s ‘trade’ or brand name (the name the pharmaceutical company gives the drug). Trade names start with a capital letter and sometimes have a registered trademark (®).

For some types of lymphoma, other drugs can be given together with chemotherapy. This is sometimes the case with:

• targeted drugs, such as ibrutinib
• antibody therapies, such as rituximab or obinutuzumab. When rituximab is given with chemotherapy, the regimen name includes ‘R’ for rituximab, for example R-CHOP. When obinutuzumab is given with chemotherapy, the regimen name is similarly changed to include ‘O’ (or sometimes ‘G’ because of the trade name Gazyvaro®)
• antibody-drug conjugates, such as polatuzumab vedotin. When polatuzumab vedotin is given with chemotherapy, the regimen name often includes ‘pola’, for example pola-R-CHP.

Acronyms for chemotherapy regimens sometimes used to treat lymphoma

ABD - doxorubicin (Adriamycin®), bleomycin and dacarbazine

ABVD – doxorubicin (Adriamycin®), bleomycin, vinblastine and dacarbazine

BEACOPP – bleomycin, etoposide, doxorubicin (Adriamycin®), cyclophosphamide, vincristine (Oncovin®), procarbazine and prednisolone; a higher-dose regimen is sometimes called BEACOPPesc (escalated dose)

escBEACOPP – escalated dose bleomycin, etoposide, doxorubicin (Adriamycin®), cyclophosphamide, vincristine (Oncovin®), procarbazine and prednisolone

escBEACOPDac – escalated dose bleomycin, etoposide, doxorubicin (Adriamycin®), cyclophosphamide, vincristine (Oncovin®), prednisolone and dacarbazine

BEAM – carmustine (BiCNU®), etoposide, cytarabine (Ara-C) and melphalan

BeGeV – bendamustine, gemcitabine and vinorelbine

CHEOP – cyclophosmamide, doxorubicin (or hydroxydaunorubicin), etoposide, vincristine (Oncovin®) and prednisolone

ChlVPP – chlorambucil, vinblastine, procarbazine and prednisolone

CHOP – cyclophosphamide, doxorubicin (or hydroxydaunorubicin), vincristine (Oncovin®) and prednisolone

CHP - cyclophosphamide, doxorubicin (or hydroxydaunorubicin) and prednisolone

CODOX-M – cyclophosphamide, vincristine (Oncovin®), doxorubicin and methotrexate

COPDAC – cyclophosphamide, vincristine (Oncovin®), prednisolone and dacarbazine

CVP – cyclophosphamide, vincristine and prednisolone

DA-EPOCH – dose-adjusted etoposide, prednisolone, vincristine (Oncovin®), cyclophosphamide and doxorubicin (or hydroxydaunorubicin)

DHAP – dexamethasone, high-dose cytarabine (Ara-C) and cisplatin (Platinol®)

ESHAP – etoposide, methylprednisolone (Solu-Medrone®), high-dose cytarabine
(Ara-C) and cisplatin (Platinol®)

FC – fludarabine and cyclophosphamide

GCVP – gemcitabine, cyclophosphamide, vincristine and prednisolone

GDP – gemcitabine, dexamethasone and cisplatin (Platinol®)

GEMOX – gemcitabine and oxaliplatin

GEM-P – gemcitabine, cisplatin and methylprednisolone

Hyper-CVAD – cyclophosphamide, vincristine, doxorubicin (Adriamycin®) and dexamethasone; ‘hyper’ is short for ‘hyperfractionated’, which means that you have the same drug more than once in a day

ICE – ifosfamide, carboplatin and etoposide

IGEV – ifosfamide, gemcitabine and vinorelbine

IVAC – ifosfamide, etoposide (VP-16) and cytarabine (Ara-C)

IVE – ifosfamide, etoposide (VP-16) and epirubicin

MATRix – methotrexate, cytarabine (also known as Ara-C), thiotepa and rituximab

OEPA – vincristine (Oncovin®), etoposide, prednisolone and doxorubicin (Adriamycin®)

P-MitCEBO – prednisolone, mitoxantrone, cyclophosphamide, etoposide, bleomycin and vincristine (Oncovin®)

Pola-R-CHP – polatuzumab vedotin, rituximab, cyclophosphamide, doxorubicin (or hydroxydaunorubicin) and prednisolone

Macmillan Cancer Support has an online tool where you can search for a chemotherapy regimen and find out more about it.

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Which regimen will I have?

The regimen you have depends on a number of factors including:

• the type of lymphoma you have
• how quickly the lymphoma is growing – whether it’s fast-growing (high-grade) or slow-growing (low-grade)
• where in your body the lymphoma is
• the symptoms or problems your lymphoma is causing
• whether you have previously had other treatments for lymphoma
• whether or not you have other health conditions and whether you’re on other medication
• your age, general health and fitness.

Your medical team will talk to you about the best treatment for you based on your individual circumstances. Your preferences are an important part of making the decision about which regimen to use. If you have any questions, ask your medical team.

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What side effects will I have?

Treatment affects each person differently – even if you have the same treatment as someone else, you might experience different side effects. Your doctor, clinical nurse specialist or chemotherapy nurse should speak to you about any side effects and late effects you might expect from your chemotherapy regimen.

Macmillan Cancer Support’s online tool  lists common side effects of different chemotherapy regimens.

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