Poly-chemotherapy is applied for all types of nonHodgkin lymphomas and thus for cutaneous lymphomas. Until now, there is no evidence that this toxic approach has any beneficial impact on survival. Therefore, it should not be routinely used (65).
Depending on the drugs used, there are different possibilities to block cell proliferation. The chemotherapy most commonly used is the CHOP therapy. It contains cyclophosphamide, vincristine (oncovin) and adriamycin combined with prednisone. Cyclophosphamide is an alkylating agent requiring metabolism by the liver. Vincris-tine binds to the protein tubulin resulting in an arrest of cells in metaphase with subsequent lysis. Doxorubicin (adriamycin) belongs to the group of anthracyclines, antitumor antibiotics.
Aggressive types of cutaneous lymphomas, especially advanced cases with systemic involvement, can be targeted by this approach.
The patient should be protected from emesis by a serotonin antagonist. The cyto-toxic drugs are given by an experienced treatment team intravenously. The patient's blood counts and cardiac function have to be monitored regularly.
Depending on the subtypes of lymphoma, remissions which are usually shortly lasting can be expected in approximately 50-70% of the cases (66). There is no proven impact on survival (65,67). The immunosuppressive effects of poly-chemotherapy result in infectious complications such as reactivation of herpes or fungal infections in many patients.
Although it is theoretically possible to combine with biological response modifiers or retinoids, these combinations should be avoided due to additional toxicities.
Poly-chemotherapy may rarely be helpful in advanced stages of cutaneous lymphoma in very critical clinical situations. We recommend that these treatment approaches be administered by experienced centers. Due to the limited information available, we urgently recommend treating this patient population in the context of clinical trials.
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