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Chemotherapy is a treatment in which powerful chemicals are used to kill fast-growing cells by causing DNA damage. Since cancer cells tend to grow and multiply much faster than normal cells, chemotherapy is an attractive treatment strategy for many cancer types. Many different chemotherapeutic drugs are available, and these agents can be used alone, or in combination with other chemotherapeutic agents, or other drugs (e.g., steroids, monoclonal antibodies, targeted drugs, immunotherapy, etc.).

In addition to their role as ‘cancer cell killing therapy’, chemotherapy is also used to prepare patients for a stem cell transplantation. In this setting, the chemotherapy targets the quickly dividing stem cells in the bone marrow.

Chemotherapy is usually given intravenously, although some chemotherapeutic agents also come as a pill. In addition to this, chemotherapy can be given through an injection in the cerebrospinal fluid (intrathecal chemotherapy). The latter is done to treat or prevent spreading of the malignancy into the brain or spinal cord.

Chemotherapy uses very toxic agents and, as a result, this treatment comes with an important set of side effects. The nature and severity of these side effects depends on the agent that is used, but often includes nausea, vomiting, diarrhea, hair loss, fatigue, fever, and a loss of appetite. Apart from these immediate side effects, chemotherapy can also cause long-lasting damage to the lungs, heart or kidneys and can lead to nerve damage (neuropathy), or infertility. In addition to this, chemotherapy can increase the risk for a second cancer.

Some of the more frequently used chemotherapy combinations in hematological malignancies consist of ABVD and R-CHOP. The ABVD regimen is classically used for the treatment of classical Hodgkin lymphoma (cHL) and consists of doxorubicin (adriamycin), bleomycin, vinblastine and dacarbazine. This regimen is given in cycles that last for 28 days during which chemotherapy is administered on days 1 and 15. R-CHOP is the most commonly used chemotherapy combination in patients with non-hodgkin lymphoma (NHL). In this regimen, three chemotherapy drugs (cyclophosphamide, doxorubicin, and vincristine) are combined with a steroid (prednisone) and the monoclonal antibody rituximab, which targets the CD20 protein. Usually, R-CHOP is given in cycles of three weeks.

The chemotherapy combinations listed above are intensive and come with an important set of side effects. As a result, it may not be feasible to use these regimens in in older, frail patients. A popular, more tolerable alternative for intensive chemotherapy combinations in hematology consists of bendamustine. This is an alkylating agent, which means that it induces cell death in cancer cells by damaging the DNA. Another chemotherapy agent that is often used as monotherapy consists of cytarabine. This agent is used in the treatment of acute leukemias and also has a place in the treatment of certain lymphomas. Cytarabine is an antimetabolite, which means that it joins with the DNA of cancer cells, stopping them from making and repairing their DNA. This stops the cell growth and induces cell death in cancer cells.

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