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47

NCCN Guidelines for Patients

®

Hodgkin Lymphoma, Version 1.2015

Chart 4.3

maps the treatment path for refractory

cancer. A biopsy is needed before treatment to

confirm refractory disease. Which second-line

treatment you will have partly depends on your prior

treatment. Options include:

C-MOPP

(cyclophosphamide, vincristine, procarbazine,

prednisone),

DHAP

(dexamethasone, cisplatin, high-dose

cytarabine),

ESHAP

(etoposide, methylprednisolone, high-dose

cytarabine and cisplatin),

GCD

(gemcitabine, carboplatin, dexamethasone),

GVD

(gemcitabine, vinorelbine, liposomal

doxorubicin),

ICE

(ifosfamide, carboplatin, etoposide),

GEV

(ifosfamide, gemcitabine, vinorelbine),

Mini-BEAM

(carmustine, cytarabine, etoposide,

melphalan),

MINE

(etoposide, ifosfamide, mesna, mitoxantrone),

and

Brentuximab vedotin.

You will receive tests to check how well treatment is

working. Treatment may appear to be working well,

less than wanted, or working poorly.

If second-line treatment appears to be working well,

you have three options. The first option is a stem cell

transplant. If you can’t have a transplant, radiation

therapy or observation are options. Observation or

“watch-and-wait” is a period of testing to see if the

cancer grows.

If you’ll receive a transplant, do not take

chemotherapy with mechlorethamine, procarbazine,

carmustine, or melphalan. These drugs may

result in a poor collection of stem cells. With the

transplant, you may receive radiation therapy if not

received before. TLI (

t

otal

l

ymphoid

i

rradiation) is

radiation given to all lymphatic tissue. It is used with

chemotherapy to kill cancer cells so that the stem cell

transplant is more likely to cure the cancer.

If the transplant fails, you may receive brentuximab

vedotin if you have primary refractory disease.

Primary refractory disease is cancer growth during

first-time treatment or cancer that somewhat responds

but is not cured by first-time treatment. Brentuximab

is given for one year.

There are three treatment options if second-line

treatment is working less than wanted. A transplant

with or without radiation therapy is an option.

Radiation therapy alone is a second option. The third

option is a chemotherapy regimen not used before,

brentuximab vedotin, bendamustine, lenalidomide, or

everolimus. Radiation therapy may be added.

If second-line treatment appears to be working

poorly, there are two options. Radiation therapy is

one option. The other is a chemotherapy regimen not

used before, brentuximab vedotin, bendamustine,

lenalidomide, or everolimus. Radiation therapy may

be added.

4

Treatment guide: Classical Hodgkin lymphoma Treatment for refractory cancer