Classical Hodgkin lymphoma (cHL) is a curable type of lymphoma that achieves long-term survival with standard first-line chemotherapy. So, what are the precautions for cHL patients during and after chemotherapy? Professor Song Yuqin of Peking University Cancer Hospital was invited to give a detailed explanation to everyone.
Expert Profiles
Professor Song Yuqin
Deputy Director, Chief Physician and Doctoral Supervisor of the Department of Lymphoma, Peking University Cancer Hospital
Director of the Chinese Society of Clinical Oncology (CSCO).
Secretary General of the Anti-Lymphoma Alliance of the Chinese Society of Clinical Oncology (CSCO).
Chairman of the Lymphatic Hematology And Tumor Professional Committee of Beijing Anti-Cancer Association
Vice Chairman of the Lymphohematology Oncology Professional Committee of the Chinese Geriatric Oncology Society
Member of the Standing Committee and Secretary of the Oncology Committee of the Beijing Medical Association
How do people with classic Hodgkin lymphoma survive? Is it possible to be completely cured after suffering from classic Hodgkin lymphoma?
Professor Song Yuqin: The overall cure rate of cHL is high. For both young and elderly patients, first-line treatment with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) regimens has a cure rate of up to 80% and is not very side effect. Only a small number of patients, especially those with advanced stages, poor prognostic factors, or particular drug resistance, will relapse. After recurrence, half of patients are cured by a second-line salvage chemotherapy regimen plus autologous hematopoietic stem cell transplantation. It can be seen that the cure rate of cHL can reach 90%, and the lowest can reach 80%. Therefore, the survival of patients with cHL is very optimistic, and the cost of treatment is not high, and it is a hematologic tumor with the highest cure rate of all malignancies except acute promyelocytic leukemia (M3 leukemia, APL).
At present, drugs such as PD-1 monoclonal antibody and vibutuximab can give patients who cannot be cured a chance to be relieved again and even survive for a long time.
< h1 toutiao-origin="h2" > Medicine Pulse: What are the precautions for patients with classical Hodgkin lymphoma during chemotherapy? </h1>
Professor Song Yuqin: cHL is highly occurring in children, adolescents, and young adults, and rarely in elderly patients, and the cure rate is high. Therefore, treatment mainly considers how to strike a balance between cure rate and long-term survival of the quality of life. The following points require special attention during chemotherapy.
First, reproductive protection. After the young patient is diagnosed with cHL, it is recommended that the patient receive reproductive protection, hoping that the patient can also form a family like a normal person after being cured, get married and have children. AbVD programs have little impact on reproduction, but they still need to be prepared for eugenics.
Second, pay attention to lung damage. The ABVD regimen is weaker and has fewer side effects, so there are fewer long-term adverse events for patients, including cardiac toxicity and reproductive toxicity. However, the bleomycin in this regimen may cause lung damage, so if the patient has a cough, breath holding, fever, do not treat it as a cold, contact the doctor and then do a lung CT scan. If this lung injury occurs, the doctor will replace bleomycin with dexamethasone, and the effect is still very satisfactory.
Third, the dose cannot be reduced or treatment postponed. All chemotherapy will have abnormal blood picture, other tumors after chemotherapy leukocytes decreased, will first raise leukocytes (white injection), chemotherapy can be postponed or reduced. But cHL is different because the treatment goal is higher, so the intensity of chemotherapy cannot be reduced or delayed because of low white blood cells. Chemotherapy can be given first, followed by a white injection. In addition, patients may occasionally experience side effects such as cardiotoxicity or hair loss, which are acceptable compared to the therapeutic effect.
Fourth, actively cooperate with PET-CT examination. PET-CT is very important for patients with cHL, whether it is from the initial diagnosis for disease staging or evaluation of efficacy after treatment, and the current price has been reduced, so it is recommended that patients actively cooperate with the examination.
Fifth, patients with relapse and refractory treatment should first consider autologous hematopoietic stem cell transplantation. For patients with relapsed refractory cHL, the current new drugs PD-1 antibody and vibutuximab are relatively efficient, the price is more reasonable, and the side effects are lower, but they cannot cure the disease, so it is still inevitable to carry out autologous hematopoietic stem cell transplantation.
Medical Pulse: What are the matters that need to be paid attention to in the daily life of patients with classical Hodgkin lymphoma after completing chemotherapy?
Professor Song Yuqin: cHL patients are relatively young, and the first-line chemotherapy regimen is light, and many patients go to work while chemotherapy. But after all, it is still chemotherapy, so I have a few suggestions for this part of the patient:
suggestion
First, rest well, don't stay up late, and avoid exertion. Generally speaking, after 3 months of chemotherapy, immune function can be restored.
Second, eat a normal diet without deliberately making up for it.
Third, the vaccine is given three months after the end of chemotherapy. Immune function is reduced after chemotherapy, vaccination may affect the effect of vaccination, so it is recommended that patients be vaccinated after three months of chemotherapy. In the case of patients after transplantation, a longer interval is required.
Fourth, relax.
Fifth, proper exercise can be done. Strength training, endurance training is no problem. However, chemotherapy drugs have a certain effect on the heart and lungs, so do not exercise too strong cardiopulmonary function.
Sixth, three years after chemotherapy, there will be another child. cHL patients are younger, may be parents in the future, generally after the end of chemotherapy for about three years of rest can have normal fertility, before giving birth can consult another fertility doctor.
Seventh, pay attention to follow-up. After all, a small number of patients will relapse and progress, so they are generally followed up every three months for two years after the end of treatment, and the risk of recurrence after two years is greatly reduced, and it can be changed to every six months. If there is no recurrence for five years, it can be reviewed annually.