Thyroid Lymphoma Medication

  • Author: Fernando Cabanillas, MD; Chief Editor: Emmanuel C Besa, MD   more...
 
Updated: Aug 9, 2011
 

Medication Summary

Managing large-cell lymphoma involves selecting treatment on the basis of prognostic factors. Most investigators treat patients whose IPI result is favorable by using the standard CHOP regimen, followed by irradiation consolidation in patients with Ann Arbor stages I-II. Three to 6 courses of chemotherapy are administered.[14]

Rituximab, a monoclonal antibody directed against CD20 antigen present in B-cell lymphomas, was recently combined with CHOP and compared with CHOP alone in a randomized study of patients aged >60 years with diffuse large-cell lymphoma. The combination of rituximab and CHOP improved rates of complete response, failure-free survival, and survival. The results can be applied to primary thyroid lymphoma. Although the study did not include patients younger than 60 years, younger patients have received rituximab.

Patients who present with Ann Arbor stage I and an IPI of 0 with tumor diameters smaller than 5 cm could be treated with 3 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 6 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.

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Antineoplastic regimens

Class Summary

These agents inhibit cell growth and proliferation.

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Cyclophosphamide (Cytoxan, Neosar)

 

Chemically related to nitrogen mustards. Alkylating agent; mechanism of action of active metabolites may involve cross-linking of DNA, which may interfere with growth of normal and neoplastic cells.

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Doxorubicin (Adriamycin, Rubex)

 

Intercalates DNA and inhibits topoisomerase II; produces free radicals that may cause destruction of DNA and inhibit growth of neoplastic cells.

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Vincristine (Oncovin, Vincasar VFS)

 

Mechanism of action is uncertain. May involve decrease in reticuloendothelial cell function or increase in platelet production.

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Prednisone (Deltasone, Meticorten, Orasone, Sterapred)

 

Immunosuppressant for treatment of autoimmune disorders. May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity.

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Rituximab (Rituxan)

 

Genetically engineered chimeric murine/human monoclonal antibody against CD20 antigen on surface of normal and malignant B-lymphocytes. Antibody is IgG1 kappa immunoglobulin.

Not to be administered as IV bolus.

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Contributor Information and Disclosures
Author

Fernando Cabanillas, MD  Adjunct Professor of Medicine, MD Anderson Cancer Center, University of Texas Medical School at Houston; Adjunct Professor, Moffitt Cancer Center; Medical Director, Auxilio Mutuo Cancer Center, Puerto Rico

Fernando Cabanillas, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Society of Hematology, New York Academy of Sciences, and Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Lodovico Balducci, MD  Professor of Oncology and Medicine, University of South Florida College of Medicine; Division Chief, Senior Adult Oncology Program, H Lee Moffitt Cancer Center and Research Institute

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Wendy Hu, MD  Consulting Staff, Department of Hematology/Oncology and Bone Marrow Transplantation, Huntington Memorial Medical Center

Wendy Hu, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Blood and Marrow Transplantation, American Society of Hematology, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Rajalaxmi McKenna, MD, FACP  Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems

Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis

Disclosure: Nothing to disclose.

Chief Editor

Emmanuel C Besa, MD  Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Clinical Oncology, American Society of Hematology, and New York Academy of Sciences

Disclosure: Nothing to disclose.

References

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