Thyroid Lymphoma Medication
- Author: Fernando Cabanillas, MD; Chief Editor: Emmanuel C Besa, MD more...
Treatment for large-cell lymphoma is selected on the basis of prognostic factors. Most investigators treat patients whose International Prognostic Index (IPI) result is favorable by using the standard CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) regimen, followed by irradiation consolidation in patients with Ann Arbor stages I-II. Three to six courses of chemotherapy are administered.
Patients who present with Ann Arbor stage I and an IPI of 0 with tumor diameters smaller than 5 cm could be treated with three courses of CHOP followed by local irradiation. The role of rituximab in patients with these favorable presentations has not been explored, but most clinicians include it in the treatment regimen. All other patients receive six courses of CHOP and radiotherapy. Consider investigational regimens in patients with IPI scores greater than 0.
In general, the addition of rituximab provides benefit in survival and disease-free survival rates, and the results are also assumed to apply to primary thyroid large-cell lymphomas.
Antineoplastic agents inhibit cell growth and proliferation.
Cyclophosphamide is chemically related to nitrogen mustards. It is an alkylating agent; the mechanism of action of active metabolites may involve cross-linking of DNA, which may interfere with growth of normal and neoplastic cells.
Doxorubicin intercalates DNA and inhibits topoisomerase II; it produces free radicals that may cause destruction of DNA and inhibit growth of neoplastic cells.
Vincristine's mechanism of action is uncertain; it may involve a decrease in reticuloendothelial cell function or an increase in platelet production.
Antineoplastics, Monoclonal Antibody
Monoclonal antibodies are genetically engineered chimeric murine-human immunoglobulins directed against proteins involved in cell cycle initiation.
Rituximab is a genetically engineered chimeric murine/human monoclonal antibody (immunoglobulin G1 [IgG1] kappa) against CD20 antigen on the surface of normal and malignant B cells. It is not to be administered as an intravenous bolus.
These agents have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.
Prednisone is an immunosuppressant used for treatment of autoimmune disorders. It may decrease inflammation by reversing increased capillary permeability and suppressing polymorphonuclear leukocyte (PMN) activity.
Prednisone is useful for treating inflammatory and allergic reactions; it may decrease inflammation by reversing increased capillary permeability and suppressing polymorphonuclear leukocyte (PMN) activity. It decreases autoimmune reactions, possibly by suppressing key components of immune system.
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