Definition
Non-Hodgkin's lymphoma refers to a serious neoplasm that affects the lymphatic system, and the chances that the diseased cells spread even in extra-lymphatic anatomical sites are very high. The target of Hodgkin's lymphoma is represented by two types of white blood cells, the B lymphocytes (85%) and T (15%), which replicate themselves in a totally uncontrolled and indiscriminate manner, causing damage.
Characteristics of non-Hodgkin's lymphoma that differentiate it from Hodgkin's lymphoma:
- non-Hodgkin's lymphoma tends to easily proliferate even in extra-lymphatic sites
- absence of Reed-Sternberg cells (important parameter for differential diagnosis)
- absence of fever and excessive sweating in the acute phase
Causes
Being a tumor, the precise cause is unknown. Among the risk factors we cannot forget: AIDS, alteration of the integrity of the immune system, prolonged intake of some drugs (eg amphetamines), frequent contact with chemical pollutants, infections, genetic predisposition, radiation.
Symptoms
The symptoms depend on the anatomical site affected by the non-Hodgkin's lymphoma; the most common symptoms are: anorexia, fever (not during the acute phase), difficulty breathing, abdominal and back pain, excessive night sweat (advanced stage), widespread itching, tiredness, cough.
Information on non-Hodgkin's Lymphoma - Drugs for the treatment of non-Hodgkin's lymphoma is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking non-Hodgkin's lymphoma - Drugs for the treatment of non-Hodgkin's lymphoma.
drugs
The choice of a therapeutic treatment for the treatment of non-Hodgkin's lymphoma rather than another, depends on the severity of the condition, the degree of progression of the tumor and the area concerned.
In the past, radiotherapy was the treatment of choice for the treatment of localized non-Hodgkin's lymphoma (limited to a single site), while today radiation therapy is the first-line treatment for treating follicular lymphoma. However, some patients are still treated with X-rays, exclusively to calm the pain, where there was no hope of complete recovery.
Chemotherapy - treatment with antineoplastic drugs, able to act directly against mad cells - is used in the occurrence of severe non-Hodgkin's lymphoma and in elderly patients; the choice of combining multiple drugs or mono-chemotherapy depends on the age of the patient and the severity of the lymphoma.
Among other possible therapeutic opportunities for the treatment of non-Hodgkin's lymphoma, autologous bone marrow transplantation and transplantation of blood cell precursors stand out.
The most widely used therapeutic scheme in treatment for non-Hodgkin's lymphoma is called "CHOP protocol" and consists of the combination of 4 antineoplastic drugs:
- Cyclophosphamide (eg Endoxan Baxter, bottle or tablets): take 10-15 mg / kg every 7-10 days; or 3-5 mg / kg twice a week. The drug can also be taken orally at a dose of 1-8 mg / kg per day (maintenance dose).
- Doxorubicin (eg. Adriblastina, Caelyx, Myocet): when used in combination with other chemotherapy drugs, the indicative dosage for the treatment of non-Hodgkin's lymphoma is 40-60 mg / m2 ev each 21-28 days. Alternatively, take 60-75 mg / m2 ev once every 21 days.
- Vincristine (eg Vincristine, Vincristine PFIZER, Vincristine TEV): the standard dose of this drug is 1.4 mg / m2 intravenously, once a week. However, the dose can range from 0.4 to 1.4 mg / m2. The vincristine dosage depends on the severity of the non-Hodgkin's lymphoma and the patient's response. Do not exceed 2 mg.
- Prednisone (eg. Solprene, Deltamidrina): exponent of synthetic corticosteroids, the drug is used in combination with antineoplastics to relieve non-Hodgkin lymphoma symptoms. The dose should be determined by your doctor.
Other drugs used in therapy for the treatment of non-Hodgkin's lymphoma include:
- Carmustine (eg. Gliadel): alkylating agent also used in monotherapy for the treatment of non-Hodgkin's lymphoma, at a dose of 150-200 mg / m2 ev each week. The aforementioned dose can also be fractionated several times a day. If the drug is used in combination with other active substances, the dose should be carefully changed by the doctor.
- Bleomycin (eg. Bleomycin CRN, Bleomycin VTE): the drug belongs to the class of antibiotics / antineoplastics and can be taken after a trial for anaphylactic reaction. The recommended dose for the treatment of non-Hodgkin's lymphoma is 0.25-0.50 units / kg (or 10-20 units / m2) intravenously, intramuscularly or subcutaneously, to be taken every 7-14 days.
- Fludarabine (eg Fludara, Fludarabine MYL): this antimetabolite drug is used in therapy for the treatment of non-Hodgkin's lymphoma at a dosage of 25mg per square meter of body extension per day, for 5 consecutive days, every 28 days.
In recent years it has been observed that the use of an innovative drug (Rituximab) for the treatment of non-Hodgkin's lymphoma can be very successful in therapy; this drug can be used alone (monotherapy) or in combination (poly-chemotherapy):
- Rituximab (eg. Mabthera): administration of paracetamol associated with an antihistamine is recommended before taking this drug. Then it is possible to proceed with the therapy: start the treatment with a dose of 50 mg / hour to be taken intravenously. In the absence of toxicity, increase the dose by 50 mg / hour (in increments every 30 minutes). Do not exceed 400 mg / hour. For subsequent infusions, it is possible to reach an infusion rate of 100 mg / hour and increase the dosage (in the absence of toxic side effects) from 100 mg / hour (every 30 minutes) up to a maximum of 400 mg / hour. For recurrent / follicular non-Hogdkin B-cell lymphoma forms, take 375 mg / m2 IV once a week for 4 weeks.
Another category of drugs used in therapy for the treatment of non-Hodgkin lymphoma is represented by immunomodulators:
- Alpha interferon (eg. Introna, Pegasys, Pegintron, Viraferonpeg): indicated for mild-to-moderate lymphomas and cutaneous T-cell lymphomas. In general, the first benefits can be seen after about 6 months of treatment. The dosage must be established by the doctor.
Finally, Bortezomib is a proteasome inhibitor, and is one of the innovative molecules studied by researchers as an alternative therapy to standard care.
- Bortezomib (eg Velcade): take 1.3 mg per square meter of body extension by intravenous bolus infusion, twice a week for two weeks; precisely, it is recommended to take the drug on days 1-4-8-11, followed by 9 days of rest. The treatment cycle for non-Hogdkin lymphoma with this drug lasts approximately three weeks.
