Therapy For High Risk Patients
10-20% of patients with advanced stage Hodgkin disease relapse after initial treatment.
|High Risk Hodgkin Lymphoma:|
Advanced stage disease - Stage IIIB and IV
Therapy same as for Intermediate Risk - but all patients are all given involved field RT (21 Gy in 150 cGy fractions).
Chemotherapy - MOPP and ABVD derivatives.
COPP used often instead of MOPP as cyclophosphamide is less myelosuppressive and leukemogenic than mechlorethamine.
C = Cyclophosphamide
O = Vincristine (also used to be called Oncovin)
P = Prednisone
P = Procarbazine
Etoposide is sometimes added to improve treatment response and reduce cumulative doses of alkylating agents.
- Used with multiple agents for a shorter duration.
- MOPP/ABV hybrid regimen is an example.
- Shorter duration of therapy
- Lower cumulative doses of chemotherapy
- Chemotherapy given at weekly intervals for 3 - 5 months - myelosuppressive drugs alternating with non-myelosuppressive. Consolidative RT given to sites of bulky disease.
- Low incidence of fever and neutropenia so G-CSF is not generally used, also some evidence that the use of growth factors with ABDV may increase the risk of bleomycin induced lung toxicity.
Eric Rosen had a second stem cell transplant for Stage IV Hodgkin lymphoma. He created “cNOTE” - a platform to express his synesthetic experience during that time.