A typical course of CHOP treatment
consists of 6 - 8 cycles, given every 3 weeks (21 days).
For cd20-positive lymphomas, Rituxan
is added (CHOP-R), generally before CHOP.
CHOP consists of
cyclophosphamide, vincristine and doxorubicin as infusions on
the first day of each cycle (day 1). You have Prednisolone
(a steroid) taken at home on days 1 - 5, orally.
About CHOP and Rituxan
 TOPIC
SEARCH: ASCO
| ASH
| Medscape
| ClinicalTrials.gov
| PubMed
There's a growing consensus among
many experts that CHOP + Rituxan (CHOP+R) is the new gold standard for treating transformed
indolent, or
aggressive lymphomas that express CD20. [1,
2]
Is CHOP+R
appropriate as frontline treatment of indolent lymphoma?
This can only be determined in well-controlled clinical
trials. So far, the data is encouraging 4,
but not yet conclusive. Selection of initial treatment for indolent
lymphomas is complex and controversial. We think a head-to-head
study on first line use of CHOP-R versus CVP-R for indolent lymphoma
is needed.
Reports
CHOP
chemotherapy agents
C Cyclophosphamide (Cytoxan®) DNA-Altering
Medline
H Doxorubicin (Adriamycin®) or Rubex® or Hydroxydaunomycin
Antitumor
Antibiotic Medline
O Vincristine
(Oncovin®) Blocks Cell Duplication
Medline
NOTE:
Clearance of Vincristine varies significantly.
Therefore it's important to
report
symptoms associated with vincristine promptly to your doctor.
See for details
P Prednisone (Deltasone®) steroidal:
anti-inflammatory, Immunosuppressant
MedlinePlus
* About CHOP CancerHelp.org.UK
* About Rituxan- a monoclonal antibody (Mab) Lymphomation.org
| rxlist
Abstracts on CHOP + Rituxan
-
Rituximab Plus Chemo More Effective in Elderly Lymphoma Patients.
Updated 02/05/02 Cancer.gov
-
Immunochemotherapy in indolent non-Hodgkin's
lymphoma. Semin Oncol. 2002 Apr;29(2 Suppl 6):11-7. Review.
PMID: 12040529 PubMed
-
Histological conversion of
follicular lymphoma with structural alterations of t(14;18) and
immunoglobin genes. Leukemia. 1995 Oct;9(10):1748-55. PMID:
7564520 PubMed
-
Immunochemotherapy in indolent NHL. Semin Oncol. 2002 Apr;29(2 Suppl 6):11-7. Review.
PMID:
12040529 | Related
abstracts
-
Patients with Low-Grade NHL Treated with Rituximab
+ CHOP Experience Prolonged Clinical and Molecular Remission.
Session Type: Poster Session 605-I abstracts2view.com/
Rituxan plus CHOP extends survival in advanced follicular
lymphoma
oncolink.upenn.edu
Jan 2005
See also:
Regarding Risks and Toxicities of CHOP-R
.gif) |
The therapy-limiting toxicity for
doxorubicin is cardiomyopathy,
which may lead to congestive heart failure and death. Approximately 2%
of patients who have received a cumulative (lifetime)
doxorubicin dose of 450-500 mg?m(2) will experience
this condition.
The liposomal formulation of doxorubicin.
Methods Enzymol. 2005;391:71-97. PMID: 15721375
|
|
|
Late-onset neutropenia (LON) following RCHOP
chemotherapy in diffuse large B-cell lymphoma
Lai GG, Lim ST, Tao M, Chan A, Li H, Quek R. Am
J Hematol. 2009 Mar 31. PMID:
19415727
... it is reassuring that LON is self-limiting
and unassociated with life-threatening infection. A watchful waiting
approach is appropriate in majority of patients who develop LON
following RCHOP. |
Dose-dense CHOP: Decreasing the Time between Dose Cycles?
When your receive chemotherapy, your
white cell counts will typically drop, and the next round of therapy
cannot begin until your counts have come back to normal or near-normal
levels. During this time of low counts you are more susceptible to
infection. Long delays between treatment cycles may allow
malignant cells to recover and adapt to treatment.
Based on the results described below for breast cancer, and the
rational theory that supports it, we ask treating physicians to
consider the use of Neupogen (Filgrastim) for their lymphoma patients in
order to raise neutrophil counts when needed so that treatments are
not delayed unnecessarily. We also ask that studies be initiated
as soon as possible to determine if "dose density" can
improve outcomes for NHL patients as it has apparently done for breast cancer
patients.
Aggressive lymphomas:
|
|
Incidence and Predictors of Low Chemotherapy Dose-Intensity
in Aggressive Non-Hodgkin's Lymphoma: A Nationwide Study. J Clin
Oncol. 2004 Sep 20
PMID:
15381684 |
Related
articles |
|
|
Two-weekly or 3-weekly CHOP chemotherapy with or without
etoposide for the treatment of YOUNG patients with good-prognosis
(normal LDH) aggressive lymphomas: results of the NHL-B1 trial of
the DSHNHL. Blood. 2004 Aug 1;104(3):626-33. Epub 2004 Feb 24.
PMID:
14982884 |
Related
articles |
|
|
Two-weekly or 3-weekly CHOP chemotherapy with
or without etoposide for the treatment of ELDERLY patients with
aggressive lymphomas: results of the NHL-B2 trial of the DSHNHL.
Blood. 2004 Aug 1;104(3):634-41. Epub 2004 Mar 11.
PMID:
15016643 |
Related
articles |
|
|
Feasibility and preliminary efficacy of R-CHOP-14 in patients with diffuse large B-Cell lymphoma (DLBCL).
ASCO 2004 Abstract No: 6584
|
|
|
Is more better? Two
parallel trials suggest that intensified CHOP is
superior to standard CHOP in the management of
aggressive NHL. "The authors of these papers conclude that
they have defined new "preferred therapies"
for histologically aggressive NHL, but the standard
therapy today (although not when these trials were
started) is not CHOP-21, it is CHOP-21 plus rituximab. Although
rituximab may add further to the benefits of CHOP-14 or
CHOEP-21 (CHOP plus etoposide), it is possible that the use
of
rituximab may negate any benefits due to dose intensification.
In the rituximab era, it remains unclear whether "more
is better," and further trials are required."
bloodjournal.org
|
|
|
Two-weekly CHOP with G-CSF: New Standard Regimens for Elderly Patients with Aggressive Non-Hodgkin's
Lymphoma
mednet.ca
"Finally, it appears that improvements on CHOP21 for the elderly are
emerging from different directions. One approach involves the delivery of
CHOP cycles over the shorter period of 14 days with granulocyte-colony
stimulating factor (G-CSF) support (CHOP14G), while the other adds the
anti-CD20 monoclonal antibody rituximab to CHOP21 (R-CHOP21)."
|
General:
|
|
THE Case for Caution: Dose Intensive and Dose Dense CHOP Regimens - Abstracts
and Commentary CTCLconsult.com 02_01_03
"Even if these dose-dense or intense regimens were to show
some advantage they would not be appropriate for a large
proportion of patients who are either older or have significant
comorbid illness."
|
|
|
|
|
|
High-dose intensity cyclophosphamide,
epidoxorubicin, vincristine and prednisone by shortened intervals
and granulocyte colony-stimulating factor in non-Hodgkin's
lymphoma: a phase II study. Br J Cancer. 1998 Sep;78(6):777-80.
PMID: 9743300 PubMed
|
Alternative Agents for Elderly Patients or
Patients with Other (co-morbid) Conditions?
|
|
Pegylated liposomal doxorubicin in combination
chemotherapy in the treatment of previously untreated aggressive
diffuse large-B-cell lymphoma.
Med Oncol. 2002;19(1):55-8. PMID: 12025891
PubMed
|
|
|
Cyclophosphamide, pegylated liposomal doxorubicin
(Caelyx"), vincristine and prednisone (CCOP) in elderly
patients with diffuse large B-cell lymphoma: results from a
prospective phase II study. Haematologica. 2002 Aug;87(8):822-7.
PMID: 12161358
PubMed
|
|
|
Targeted delivery and triggered release of
liposomal doxorubicin enhances cytotoxicity against human B
lymphoma cells. Biochim Biophys Acta. 2001 Dec 1;1515(2):144-58.
PMID: 11718670
PubMed
|
|
|
LIPOSOMAL DOXORUBICIN: A phase I/II trial of liposomal
doxorubicin (TLC D-99, Myocet) with cyclophosphamide, vincristine,
and prednisone in newly diagnosed aggressive non-Hodgkins lymphoma
(NHL) Year: 2002 Abstract No:
1133
|
|
|
Liposomal encapsulated anthracyclines: new
therapeutic horizons.
Curr Oncol Rep. 2001 Mar;3(2):156-62. Review. PMID: 11177748
PubMed
|
|
|
Pixantrone
- clinical trials - Might have similar activity
against aggressive lymphomas as doxorubicin, with less cardio toxicity
redorbit
|
Dexrazoxane (Zinecard) as
a cardio-protectant
Under investigation for treatment of childhood
leukemias and lymphomas to see if it can prevent damage to the heart
caused by doxorubicin, a drug commonly used to treat childhood
leukemia and lymphoma. Results from this part of the study are not yet
available. nih.gov
|
|
|
|
|
Use of dexrazoxane as a cardioprotectant in patients
receiving doxorubicin or epirubicin chemotherapy for the treatment
of cancer guideline.gov
|
Continuous infusion doxorubicin,
instead of bolus
|
|
Reduction of doxorubicin cardiotoxicity by prolonged
continuous intravenous infusion. Ann Intern Med. 1982
Feb;96(2):133-9.
PMID: 7059060 PubMed
|
|
|
Adriamycin (doxorubicin) Gan To Kagaku Ryoho. 2001
Oct;28(10):1331-8. Review. Japanese. PMID: 11681238 PubMed
|
What's Next?
Your treating physicians can also
adjust treatments, add or remove agents in response to changing
circumstances. Treatment responses can also be consolidated
(maintained) with
additional treatments, such as
Related abstracts:
|
|
Combined therapy in advanced stages (III
and IV) of follicular lymphoma increases the possibility of cure:
results of a large controlled clinical trial. Eur J Haematol. 2002
Mar;68(3):144-9. PMID: 12068794 PubMed
|
|
|
Durable Remissions Obtained with Zevalin in Recurrent Follicular Lymphoma
CancerConsultants.com Nov_8_02
|
Research News
-
Rituximab Plus Chemo More Effective in Elderly Lymphoma Patients.
Updated 02/05/02 Cancer.gov
-
Immunochemotherapy in indolent non-Hodgkin's
lymphoma. Semin Oncol. 2002 Apr;29(2 Suppl 6):11-7. Review.
PMID: 12040529 PubMed
-
Monitoring of minimal residual disease after CHOP
and rituximab in previously untreated patients with follicular
lymphoma.
Blood. 2002 Feb 1;99(3):856-62. PMID: 11806987 PubMed
-
Successful autologous peripheral blood stem cell
transplantation in transformed follicular lymphoma previously
treated with radioimmunotherapy (iodine (131)I tositumomab). Bone
Marrow Transplant. 2002 Mar;29(6):523-5.
PMID: 11960274 PubMed
|
