B-cell lymphoma is one of the most common types of non-Hodgkin's lymphoma, according to the American Cancer Society. It accounts for approximately one out of every three cases (cancer.org). Large B-cell non-Hodgkin's lymphoma (NHL) is the most common intermediate-grade lymphoma (Skeel, 2007). Intermediate-grade lymphomas are aggressive cancers, and used to be fairly deadly when single-agent chemotherapy was used; but with combination chemotherapy regimens, they are curable 40 to 50 percent of the time (Skeel, 2007). Selecting the right regimen depends on various factors, including age and general health, comorbid diseases and the extent of disease.
CHOP
CHOP was one of the first chemotherapy regimens for intermediate-grade NHL, and was the standard of care for these patients until it was found that remission rates were higher when the drug rituximab was added to the regimen (Skeel, 2007; cancer.org). Currently, CHOP plus rituximab is one of the standard approaches to care (Skeel, 2007). The chemotherapy treatment CHOP consists of cyclophosphamide, doxorubicin (brand name Adriamycin), vincristine (brand name Oncovin) and prednisone; and this is administered every 3 weeks (Skeel, 2007). The first three drugs are given on day 1, and prednisone is given on days 1 through 5, according to Skeel.
CHOP plus rituximab is a little different. This regimen involves rituximab on day 1; cyclophosphamide, doxorubicin and vincristine on day 3; and prednisone on days 3 through 7 (Skeel, 2007). Like CHOP, this is given every 21 days.
BACOP
Although CHOP and CHOP plus rituximab are the standard, there are also other combination chemotherapies that are used and that have been shown to have comparable survival rates and effectiveness (Skeel, 2007). BACOP is one of these. This combination includes the drugs bleomycin, doxorubicin, cyclophosphamide, vincristine and prednisone (Skeel, 2007). These medications are given on a very different schedule than CHOP. Doxorubicin, vincristine and cyclophosphamide are given on days 1 and 8; bleomycin is given on days 15 and 22; and prednisone is given on days 15 through 28 (Skeel, 2007). This regimen is administered every 28 days.
m-BACOD
m-BACOD is another combination chemotherapy treatment that has been shown to be effective in treating large B-cell NHL and intermediate-grade lymphomas. m-BACOD consists of the drugs methotrexate, leucovorin, bleomycin, doxorubicin, cyclophosphamide, vincristine and dexamethasone (Skeel, 2007). The schedule for this treatment is: bleomycin, doxorubicin, cyclophosphamide and vincristine on day 1; methotrexate on days 1 and 8; leucovorin starting 24 hours after methorexate and given every 6 hours for eight doses; and dexamethasone on days 1 through 5 (Skeel, 2007).
MACOP-B
This chemotherapy regimen involves the drugs methotrexate, leucovorin, doxorubicin, cyclophosphamide, vincristine, bleomycin and prednisone (Skeel, 2007). This regimen is not like the others mentioned, as it is on a 10- to 12-week cycle, with the medications being given during various weeks in the cycle. For this reason, the specific dosing regimen will not be outlined here.
References
- Non-Hodgkin's Lymphoma
- Handbook of Cancer Chemotherapy; Roland T Skeel; 2007
- Chemotherapy for Non-Hodgkin Lymphoma - American Cancer Society
