Chemotherapy for lymphoma often combines several treatments into one regimen. Understanding names like R-CHOP, ABVD, and BEACOPP can help you know what your treatment includes and why it may be recommended.
How lymphoma chemotherapy regimens are named
Chemotherapy regimens are often named with acronyms. Each letter usually stands for one treatment in the combination. Sometimes the letter comes from an older treatment or brand name.
Not every treatment in these regimens is chemotherapy. Some combinations also include targeted therapies or steroids. The regimen recommended for you may depend on your lymphoma type, stage, age, and overall health.
R-CHOP: The standard chemotherapy regimen for non-Hodgkin lymphoma
R-CHOP has long been a standard first treatment for several B-cell non-Hodgkin lymphomas, including diffuse large B-cell lymphoma (DLBCL).
R-CHOP includes:
R - rituximab: Rituximab is a targeted therapy that attaches to the CD20 protein on B cells. This helps the immune system find and remove these cells.
C - cyclophosphamide: Cyclophosphamide is a chemotherapy that damages DNA inside lymphoma cells. This makes it harder for the cells to grow and divide.
H - hydroxydaunomycin: Doxorubicin, also called hydroxydaunomycin, is a chemotherapy that damages DNA and blocks processes cells need to grow.
O - Oncovin: Vincristine, previously known as Oncovin, is a chemotherapy that blocks structures cells need to divide.
P - prednisone: Prednisone is a steroid that can help destroy lymphoma cells.
R-CHOP is usually given in cycles. Each cycle includes treatment followed by time for the body to recover.
When is the CHOP chemotherapy regimen used?
CHOP includes cyclophosphamide, doxorubicin, vincristine, and prednisone. It does not include rituximab.
CHOP was a standard treatment for DLBCL before rituximab was added to create R-CHOP. Adding rituximab improved outcomes for many people with B-cell lymphomas.
What are mini-CHOP and R-miniCHOP?
Mini-CHOP uses lower doses of the medicines in CHOP. R-miniCHOP combines lower-dose CHOP with rituximab. R-miniCHOP may be considered for people 80 years or older or those who cannot tolerate full-dose R-CHOP.
Studies have reported lower survival with R-miniCHOP than R-CHOP. However, people receiving R-miniCHOP are often older or have more health problems, which can affect these results. Overall health and the ability to tolerate treatment are important when choosing between these regimens.
Pola-R-CHP: An alternative to R-CHOP for DLBCL
Pola-R-CHP is another first treatment option for certain adults with DLBCL and other large B-cell lymphomas.
It contains polatuzumab vedotin (Polivy, Genentech), rituximab, cyclophosphamide, doxorubicin, and prednisone. Polatuzumab vedotin replaces the vincristine found in R-CHOP. It is an antibody-drug conjugate (ADC), a type of targeted therapy that attaches to a protein called CD79b on B cells and delivers chemotherapy inside them. This helps target lymphoma cells more precisely than traditional chemotherapy.
The Phase 3 POLARIX clinical trial compared Pola-R-CHP with R-CHOP in 879 people. At five years, 64.9% of people receiving Pola-R-CHP were alive without their lymphoma getting worse (progression-free survival), compared with 59.1% receiving R-CHOP. There was no statistically significant difference in overall survival.
These findings show that Pola-R-CHP can delay lymphoma progression compared with R-CHOP. Your lymphoma specialist can explain whether this treatment fits your situation.
ABVD: The standard chemotherapy regimen for Hodgkin lymphoma
ABVD has long been a commonly used treatment for classical Hodgkin lymphoma. It contains:
A: doxorubicin, previously called Adriamycin
B: bleomycin
V: vinblastine
D: dacarbazine
ABVD can be used for early or advanced Hodgkin lymphoma. The amount of treatment can depend on the lymphoma stage, risk factors, and response to treatment.
A PET/CT scan may be used during treatment to see how the lymphoma is responding. These results can sometimes help guide the remaining treatment.
BEACOPP for advanced Hodgkin lymphoma
BEACOPP is a more intensive regimen used for some people with advanced Hodgkin lymphoma. It combines bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone.
An analysis of four clinical trials found that the seven-year progression-free survival was 81.1% with BEACOPP and 71.1% with ABVD. Seven-year overall survival was 87.7% with BEACOPP and 84.3% with ABVD.
However, BEACOPP was linked to a higher risk of secondary cancers, which are new cancers that develop after treatment. These occurred in 6.5% of people receiving BEACOPP, compared with 4% receiving ABVD. This included 13 cases of myelodysplastic syndromes (MDS) or acute myeloid leukemia (AML) in the BEACOPP group, compared with no MDS or AML in the ABVD group.
These findings show why specialists consider both lymphoma control and long-term side effects when choosing treatment.
Other chemotherapy regimens for lymphoma
There are many other different chemotherapy regimens that are used for the different types of lymphoma. These include:
BEACOPDac: BEACOP with dacarbazine instead of procarbazine, used for Hodgkin lymphoma.
BEAM and mini-BEAM: BEAM is given before an autologous stem cell transplant. After mini-BEAM, some people go on to have a stem cell transplant. Used for Hodgkin and non-Hodgkin lymphoma.
ChlVPP: For Hodgkin lymphoma.
CODOX-M: For high-grade lymphomas, including Burkitt lymphoma and some diffuse large B-cell lymphomas (DLBCL).
COPDAC: For Hodgkin lymphoma in children.
CVP and R-CVP: For non-Hodgkin lymphoma.
DA-EPOCH and DA-EPOCH-R: An intensive treatment for different types of lymphoma.
DHAP and R-DHAP: For lymphoma.
ESHAP: For Hodgkin lymphoma, non-Hodgkin lymphoma, and myeloma.
FCR: For some types of non-Hodgkin lymphoma.
Hyper-CVAD: For non-Hodgkin lymphoma.
ICE: Used for lymphoma.
IVAC: For some types of high-grade lymphoma.
MATRix: For CNS lymphoma.
R-GDP: For Hodgkin and non-Hodgkin lymphoma.
Common side effects of chemotherapy for lymphoma
Chemotherapy can affect healthy cells that divide quickly, including cells in the bone marrow, digestive system, and hair follicles. Side effects vary by regimen, but many can be prevented or managed.
Low white blood cell counts: This can increase infection risk. Growth factors may help your body make white blood cells. Antibiotics or treatment changes may also be needed. Contact your care team right away if you have a body temperature of 100.4 °F (38°C) or higher.
Heart problems: Doxorubicin can weaken the heart muscle, especially at higher doses. Your care team may check your heart before and during treatment.
Lung problems: Bleomycin can affect the lungs. Tell your care team if you develop a new cough, shortness of breath, or chest pain.
Hepatitis B: You will usually be tested for hepatitis B before starting rituximab. Rituximab can cause a past hepatitis B infection to become active again.
Nausea and vomiting: Prescribed anti-nausea medicines can help prevent or control these symptoms.
Fatigue: Physical activity and healthy sleep habits may help reduce fatigue.
Mouth sores: Good mouth care, staying hydrated, and mouth rinses recommended by your healthcare team may reduce discomfort.
Diarrhea or constipation: Certain medicines prescribed by your doctor may help manage these symptoms.
Peripheral neuropathy: Certain cancer treatments may damage nerves, causing numbness, tingling, or pain in the hands or feet. Report these symptoms because your treatment may need to be adjusted.
Hair loss: Some chemotherapy medicines cause temporary hair thinning or hair loss. Hair usually grows back after treatment.
Fertility problems: Some regimens can affect your ability to have children. Ask about fertility preservation before treatment if having children in the future is important to you.
Report new or worsening symptoms to your care team. This can help them manage side effects and decide whether treatment changes are needed.
Are lymphoma specialists moving away from chemotherapy?
Chemotherapy remains an important part of lymphoma care, but treatment is changing. Specialists are studying ways to reduce chemotherapy or combine it with newer targeted and immune-based treatments.
For Hodgkin lymphoma, newer options include brentuximab vedotin (Adcetris, Pfizer) and checkpoint inhibitors such as nivolumab (Opdivo, Bristol Myers Squibb) and pembrolizumab (Keytruda, Merck). Checkpoint inhibitors are immunotherapies that help the immune system recognize and attack lymphoma cells. There is also interest in alternatives to intensive regimens such as BEACOPP because of their short- and long-term side effects. One newer regimen, called BrECADD, includes brentuximab vedotin and is used in some places instead of BEACOPP.
For non-Hodgkin lymphoma, some treatment options do not require traditional chemotherapy. These include targeted therapies such as CAR T-cell therapy and bispecific antibodies. CAR-T uses modified immune cells to recognize cancer cells, while bispecific antibodies help immune cells find and remove lymphoma cells.
Many newer treatment plans still include chemotherapy. The goal is to maintain effective lymphoma treatment while reducing side effects when possible.
What to know about lymphoma chemotherapy
Chemotherapy often remains part of many lymphoma treatment plans, while newer targeted and immune-based therapies are changing some options. Understanding what your regimen includes can help you discuss its benefits, side effects, and alternatives with your lymphoma specialist.
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Sources:
Impact of Rituximab (Rituxan) on the Treatment of B-Cell Non-Hodgkin’s Lymphoma
R-miniCHOP May Be Effective in DLBCL Care, but Survival Is Inferior to R-CHOP
Neutropenia and Neutropenic Complications in ABVD Chemotherapy for Hodgkin Lymphoma
BEACOPP: a new regimen for advanced Hodgkin's disease. German Hodgkin's Lymphoma Study Group
Is escalated BEACOPP dead? Rethinking standards in Hodgkin lymphoma treatment
Minimizing the Toxicities of First-Line Hodgkin Lymphoma Treatment in the Modern Era
