Understanding Lymphoma

and Chemotherapy

Chemotherapy drugs work against one of the primary characteristics of cancer cells: their tendency
to grow and multiply very quickly. Chemotherapy halts cell growth to prevent cancer cells from
making more and more cancer cells. However, chemotherapy drugs also affect normal cells in the
body that divide rapidly, such as those found in the hair follicles, blood, and mouth. This can cause
side effects.
The purpose of chemotherapy is to kill cancer cells. It is commonly used to treat cancer that is systemic, meaning that
the cancer may be in more than one location or has spread throughout the body. Lymphoma is caused by uncontrolled
growth in one of two types of white blood cells, called T cells and B cells, both of which travel through the bloodstream.
T cells and B cells are important elements of the immune system. One advantage of chemotherapy is that it can also
travel in the bloodstream to kill lymphoma cells throughout the body.
Many patients who are treated for lymphoma are given two or more medications together, called combination
chemotherapy. These chemotherapy drugs are combined to create a treatment regimen, which is a specific schedule
that the drugs are given during certain days of each treatment cycle. The reason for using a combination of drugs is to
increase how effectively the drugs kill or damage cancer cells. Since cancer cells divide more rapidly than normal cells,
they are more sensitive to chemotherapy.
Oncology nurses are usually responsible for administering the chemotherapy regimen prescribed by the doctor.
Most patients receive their chemotherapy in an outpatient clinic, hospital outpatient department, or physician’s office,
but sometimes patients need to stay in the hospital to receive their treatment. The decision to do treatment on an
inpatient basis may be made due to factors such as prolonged chemotherapy infusions, or the need to monitor for
certain side effects.

COMMON CHEMOTHERAPY REGIMENS Bendamustine (Treanda) is an alkylating agent in a class

of drugs that causes damage to a cell’s DNA. Pralatrexate
FOR HODGKIN LYMPHOMA (HL) AND (Folotyn) is an antimetabolite in a class of drugs that interferes
NON-HODGKIN LYMPHOMA (NHL) with normal DNA production by eliminating folate, which is
needed for the creation of DNA. Brentuximab vedotin (Adcetris)
Many chemotherapy regimens for B-cell NHL include binds to the antigen (target) CD30, which is found on the cells of
the monoclonal antibody rituximab (Rituxan), which is an some forms of lymphoma and delivers the chemotherapy drug
immunotherapy. Rituximab is usually abbreviated with that kills cancer cells.
the letter R and placed at the beginning or end of the
chemotherapy regimen abbreviation, such as R-CHOP Brentuximab vedotin (Adcetris) is a type of antibody-drug
or CHOP-R (cyclophosphamide [Cytoxan], doxorubicin/ conjugate approved for the treatment for HL and anaplastic
large cell lymphoma. An antibody-drug conjugate is a
hydroxydaunorubicin [Adriamycin], vincristine [Oncovin], and
monoclonal antibody that is linked to a toxin, in this case a
prednisone [Deltasone]). Most of the chemotherapy drugs
chemotherapy agent called monomethyl auristatin E (MMAE).
used in lymphoma treatment have been used for decades,
Loncastuximab tesirine (Zynlonta), another example of an
but bendamustine (Treanda) and pralatrexate (Folotyn) were
antibody-drug conjugate, is approved to treat diffuse large
approved in the last few years, along with brentuximab vedotin
B-cell lymphoma. In this case, the monoclonal antibody targets
(Adcetris), loncastuximab tesirine (Zynlonta) and polatuzumab
the antigen CD19 (which is expressed at the surface of some
vedotin (Polivy) which are monoclonal antibodies attached
B-cell lymphomas) and is attached to an alkylating agent called
to a toxin.

Understanding Lymphoma Series Helpline: 800 500 9976 | [email protected]

SG3199 (which kills cancer cells). Polatuzumab vedotin (Polivy), HOW IS CHEMOTHERAPY GIVEN?
also an antibody-drug conjugate, is approved in certain patients
with diffuse large B-cell lymphoma. This therapy uses the Most chemotherapy drugs are given orally (pill taken by
chemotherapy agent MMAE linked to a monoclonal antibody that mouth), intravenously (IV; injection directly into the vein), or
targets CD79b, another B-cell surface protein. Each of these subcutaneously (injected under the skin). A few chemotherapy
drugs is also being investigated for other uses. drugs are injected into the space around the spinal cord, called
The individual and combination chemotherapy regimens listed a lumbar puncture (spinal tap). In this process, a doctor inserts
in Table 1 below are either currently recommended by the a thin needle into the lower back after it has been numbed
National Comprehensive Cancer Network or not yet approved by with a local anesthetic. The medications are administered one
the U.S. Food and Drug Administration (FDA) for the treatment or more times a week for one or more weeks, followed by a
of lymphoma. Nearly all the progress in treating HL and NHL rest period. This regular treatment schedule is called a cycle.
has been gained from information learned from clinical trials. The length of the rest period and the number of cycles vary
Some of the combinations listed are used in relapsed (disease depending on the disease and the type of drug(s) used. For
returns after treatment) or refractory (disease does not more information on oral chemotherapy agents, please view
respond to treatment) lymphoma, referred to as second line the Lymphoma Research Foundation’s (LRF’s) Oral Agents in
therapy because they are given after frontline (initial) therapy. Lymphoma fact sheet at lymphoma.org/publications.
To make it easier to give and receive multiple cycles of IV
chemotherapy into the veins, a doctor or another healthcare
team member may insert or implant a central venous access
device— sometimes called a catheter, port, or central line—into
a large blood vessel in the patient’s chest or upper extremity.
The device may stay in place for a few weeks, for the duration of
the chemotherapy treatment, or for several months beyond the
duration of chemotherapy. Patients should discuss with their
physician which type of venous access device, if any, would be
best for their particular situation.

TABLE 1. CHEMOTHERAPY REGIMEN ABBREVIATIONS

REGIMENS HL NHL MEDICATION(S)

ABBREVIATIONS
Doxorubicin/hydroxydaunorubicin (Adriamycin, Rubex), Bleomycin (Blenoxane), Vinblastine (Velban,
ABVD X*
Velsar), Dacarbazine (DTIC-Dome)
Doxyorubicin (Adriamycin), Bleomycin (Blenoxane), Vinblastine (Velban, Velsar), Etoposide (Vepesid),
ABVE-PC X
Prednisone (Deltasone), Cyclophosphamide (Clafen, Cytoxan, Neosar)
B X* X Bendamustine (Treanda)
Bleomycin (Blenoxane), Etoposide/VP16 (Etopophos, Toposar, Vepesid), Doxorubicin/hydroxydaunorubicin
BEACOP X (Adriamycin, Rubex), Cyclophosphamide (Clafen, Cytoxan, Neosar), Vincristine (Oncovin, Vincasar PFS),
Procarbazine (Matulane)
Bleomycin (Blenoxane), Etoposide/VP16 (Etopophos, Toposar, Vepesid), Doxorubicin/hydroxydaunorubicin
BEACOPP X (Adriamycin, Rubex), Cyclophosphamide (Clafen, Cytoxan, Neosar), Vincristine (Oncovin, Vincasar PFS),
Procarbazine (Matulane), Prednisone (Deltasone)
BV X X Brentuximab vedotin (Adcetris)

C X* Cyclophosphamide (Clafen, Cytoxan, Neosar)

Chl X X* Chlorambucil (Leukeran)

ChlVPP X X Chlorambucil (Leukeran), Vinblastine (Velban, Velsar), Procarbazine (Matulane), Prednisone (Deltasone)
Cyclophosphamide (Clafen, Cytoxan, Neosar), Doxorubicin/hydroxydaunorubicin (Adriamycin, Rubex),
CHOP X* X*
Vincristine (Oncovin, Vincasar PFS), Prednisone (Deltasone)
Cyclophosphamide (Clafen, Cytoxan, Neosar), Vincristine (Oncovin, Vincasar PFS), Liposomal doxorubicin
CODOXM-IVAC X (Doxil), Cytarabine/high-dose Ara-C (Cytosar-U, Tarabine PFS), Methotrexate (Otrexup, Rheumatrex,
Trexall), Ifosfamide (Ifex), Etoposide/VP16 (Etopophos, Toposar, Vepesid)
CVP (COP) X X* Cyclophosphamide (Clafen, Cytoxan, Neosar), Vincristine (Oncovin, Vincasar PFS), Prednisone (Deltasone)
Dexamethasone (Decadron, Dexasone), Cytarabine/high-dose Ara-C (Cytosar-U, Tarabine PFS), Cisplatin
DHAP X* X*
(Platinol, Platinol-AQ)
Dexamethasone (Decadron, Dexasone), Ifosfamide (Ifex), Cisplatin (Platinol, Platinol-AQ), Etoposide/VP16
DICE X* X
(Etopophos, Toposar, Vepesid)

*Rituximab (Rituxan) or other CD20 antibodies may be added.

 REGIMENS HL NHL MEDICATION(S)
ABBREVIATIONS
Etoposide/VP16 (Etopophos, Toposar, Vepesid), Prednisone (Deltasone), Vincristine (Oncovin, Vincasar
EPOCH X* PFS), Cyclophosphamide (Clafen, Cytoxan, Neosar), Doxorubicin/hydroxydaunorubicin (Adriamycin,
Rubex)
Etoposide/VP16 (Etopophos, Toposar, Vepesid), Methylprednisolone (Solu-Medrol), Cytarabine/high-dose
ESHAP X* X*
Ara-C (Cytosar-U, Tarabine PFS), Cisplatin (Platinol, Platinol-AQ)
FC X* Fludarabine (Fludara), Cyclophosphamide (Clafen, Cytoxan, Neosar)

FND X* Fludarabine (Fludara), Mitoxantrone (Novantrone), Dexamethasone (Decadron, Dexasone)

GCD X* Gemcitabine (Gemzar), Carboplatin (Paraplatin), Dexamethasone (Decadron, Dexasone)

GDP X* X* Gemcitabine (Gemzar), Dexamethasone (Decadron, Dexasone), Cisplatin (Platinol, Platinol-AQ)

GemOX X* X* Gemcitabine (Gemzar), Oxaliplatin (Eloxatin)

GVD X* Gemcitabine (Gemzar), Vinorelbine (Navelbine), Liposomal doxorubicin (Doxil)

High-dose methotrexate (Otrexup, Rheumatrex, Trexall), Cytarabine/high-dose Ara-C (Cytosar-U,
HD MTX and HD Ara-C X
Tarabine PFS)
Cyclophosphamide (Clafen, Cytoxan, Neosar), Vincristine (Oncovin, Vincasar PFS), Doxorubicin/
HyperCVAD/MTX-Ara-C X* hydroxydaunorubicin (Adriamycin, Rubex), Dexamethasone (Decadron, Dexasone), Methotrexate
(Otrexup, Rheumatrex, Trexall), Cytarabine/high-dose Ara-C (Cytosar-U, Tarabine PFS)
ICE X X* Ifosfamide (Ifex), Carboplatin (Paraplatin), Etoposide/VP16 (Etopophos, Toposar, Vepesid)

Loncastuximab tesirine X Loncastuximab tesirine (Zynlonta)

Mesna (Mesnex), Ifosfamide (Ifex), Mitoxantrone (Novantrone), Etoposide/VP16 (Etopophos, Toposar,
MINE X X*
Vepesid)
MTR X Methotrexate (Otrexup, Rheumatrex, Trexall), Temozolomide (Temodar), Rituximab (Rituxan)

P X Pralatrexate (Folotyn)

Pola-BR X Polatuzumab vedotin (Polivy), Bendamustine (Treanda), Rituximab (Rituxan)

Methotrexate (Otrexup, Rheumatrex, Trexall), Leucovorin (Wellcovorin, Citrovorum Factor, Folinic Acid),
SMILE X Ifosfamide (Ifex), Mesna (Mesnex), Dexamethasone (Decadron, Dexasone), Etoposide/VP16 (Etopophos,
Toposar, Vepesid), Pegaspargase (Oncaspar)
Doxorubicin/hydroxydaunorubicin (Adriamycin, Rubex), Vinblastine (Velban, Velsar), Mechlorethamine
Stanford V X (Mustargen), Vincristine (Oncovin, Vincasar PFS), Bleomycin (Blenoxane), Etoposide/VP16 (Etopophos,
Toposar, Vepesid), Prednisone (Deltasone)

*Rituximab (Rituxan) or other CD20 antibodies may be added.

WHY IS IT IMPORTANT TO the body endure the side effects of treatment and may limit the
need to modify therapy choices. Patients can speak with their
ADHERE TO THE CHEMOTHERAPY healthcare team regarding these issues. For detailed information
TREATMENT SCHEDULE? on nutrition during lymphoma treatment, view LRF’s Nutrition
fact sheet at lymphoma.org/publications.
Patients should adhere to their chemotherapy treatment
schedule because the timing of a full course of chemotherapy
often works best in the treatment of their disease. In clinical
studies, doctors have found that reducing the dose or delaying CLINICAL TRIALS
cycles of chemotherapy to reduce short-term side effects can
decrease the treatment benefit for patients with certain types of Clinical trials are crucial in identifying effective drugs and
lymphoma. Some side effects may be unpleasant but tolerable; determining optimal doses for patients with lymphoma. Patients
other side effects may be more serious, but they can often be interested in participating in a clinical trial should view the
anticipated and prevented. It is very important that chemotherapy Understanding Clinical Trials fact sheet on LRF’s website at
schedules be maintained to the greatest extent possible. lymphoma.org/publications, talk to their physician, or contact the
LRF Helpline for an individualized clinical trial search by calling
A healthy diet is also essential for helping a patient’s body heal (800) 500-9976 or emailing [email protected].
from both lymphoma and its treatments. A healthy diet may help
 FOLLOW-UP Network. This program connects patients and caregivers with
volunteers who have experience with lymphomas, similar
Patients with lymphoma should have regular visits with a treatments, or challenges, for mutual emotional support and
physician who is familiar with their medical history and the encouragement. You may find this useful whether you or a loved
treatments they have received. Medical tests (such as blood one is newly diagnosed, in treatment, or in remission.
tests, computed tomography [CT] scans, and positron emission
tomography [PET] scans) may be required at various times
during remission (disappearance of signs and symptoms) to LRF FOCUS ON LYMPHOMA MOBILE APP
evaluate the need for additional treatment.
Some treatments can cause long-term side effects or late side Focus on Lymphoma is the first app to provide patients
effects, which can vary based on the duration and frequency of and their caregivers with tailored content based on lymphoma
treatments, age, gender, and the overall health of each patient subtype, and actionable tools to better manage diagnosis
at the time of treatment. A physician will check for these side and treatment. Comprehensive lymphoma management,
effects during follow-up care. Visits may become less frequent conveniently in one secure and easy-to-navigate app, no matter
the longer the disease remains in remission. where you are on the care continuum. Get the right information,
first, with resources from the entire Lymphoma Research
Patients and their caregivers are encouraged to keep copies of
Foundation content library, use unique tracking and reminder
all medical records and test results as well as information on
tools, and connect with a community of specialists and
the types, amounts, and duration of all treatments received.
patients. To learn more this resource, visit our website at
This documentation will be important for keeping track of
lymphoma.org/mobileapp, or contact the LRF Helpline
any side effects resulting from treatment or potential disease
at 800-500-9976 or [email protected].
recurrences. LRF’s award-winning Focus on Lymphoma mobile
application (app, www.FocusOnLymphoma.org) can help
patients manage this documentation.
Resources
LRF offers a wide range of resources that address
LRF’S HELPLINE treatment options, the latest research advances, and
AND LYMPHOMA SUPPORT NETWORK ways to cope with all aspects of lymphoma and CLL/
SLL including our award-winning mobile app. LRF also
provides many educational activities, including our in-
A lymphoma diagnosis often triggers a range of feelings and
person meetings, webinars for people with lymphoma,
concerns. In addition, cancer treatment can cause physical
as well as patient guides and e-Updates that provide
discomfort. The LRF Helpline staff members are available to
the latest disease-specific news and treatment options.
answer your general questions about a lymphoma diagnosis
To learn more about any of these resources, visit our
and treatment information, as well as provide individual support website at www.lymphoma.org or contact the Helpline
and referrals to you and your loved ones. Callers may request at (800) 500-9976 or [email protected].
the services of a language interpreter. A part of the Helpline is
LRF’s one-to-one peer support program, Lymphoma Support

Medical reviewer:
Juan P. Alderuccio, MD
University of Miami

LRF appreciates the expertise and John Allan Manali Kamdar, MD Contact LRF:
review of our Editorial Committee: Weill Cornell Medicine University of Colorado
Helpline: (800) 500-9976
Leo I. Gordon, MD, FACP Jennifer E. Amengual, MD Peter Martin, MD,
Columbia University Weill Cornell Medicine Email: [email protected]
Co-Chair
Robert H. Lurie Comprehensive Cancer Jonathon Cohen www.lymphoma.org
Center of Northwestern University Emory University School of Medicine
Neha Mehta-Shah, MD, MSCI
Kristie A. Blum, MD Lorenzo Falchi, MD Washington University School
Co-Chair Memorial Sloan Kettering Cancer Center of Medicine in St. Louis
Emory University School of Medicine Alex Herrera, MD Pierluigi Porcu, MD
City of Hope Thomas Jefferson University
Shana Jacobs, MD
Children’s National Hospital

Supported through grants from:

The Understanding Lymphoma fact sheet series is published by the Lymphoma Research Foundation (LRF) for the purpose of informing and educating readers. Facts and
statistics were obtained using published information, including data from the Surveillance, Epidemiology, and End Results (SEER) Program. Because each person’s body
and response to treatment is different, no individual should self-diagnose or embark upon any course of medical treatment without first consulting with his or her physician.
The medical reviewer, the medical reviewer’s institution, and LRF are not responsible for the medical care or treatment of any individual.
© 2022 Lymphoma Research Foundation

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