I. Basic treatment plan
The treatment of NHL is similar to that of Hodgkin’s disease, and the main methods are radiotherapy, chemotherapy and other adjuvant treatments or all three. NHL is relatively sensitive to radiotherapy and chemotherapy, and some patients can be cured, but the overall efficacy is still quite different from that of HD, so the treatment plan for each case should be specifically formulated according to different pathological typing and clinical stages.
The treatment principles for NHL are basically similar to those for HD, with radiotherapy being the mainstay for localized lesions (stages I and II) and chemotherapy for systemic lesions (stages III and IV). However, compared with HD, although the systemic symptoms of NHL are less common, the lesion invasion is more extensive, organs other than lymph nodes are more likely to be invaded, and the bone marrow is more likely to be invaded, therefore, systemic treatment is more important in the application of NHL.
II. Radiotherapy
It is mainly applied to stage I and II, i.e. early stage NHL, especially the group with better prognosis, and most patients can be cured by radiotherapy. It has been recognized that radiotherapy is the main means of local tumor treatment. The scope of radiotherapy is usually the invasion site plus whole body lymph node irradiation. It may or may not be used in combination with chemotherapy. The dose of radiotherapy is related to the efficacy. The commonly used dose of 20-35Gy (2000-3500rad) can significantly reduce the size of the mass. However, to achieve a cure, a high dose is often required, such as a total dose of 44 Gy (4400 rad).
The efficacy of radiotherapy for stage I patients has a very high 5-year survival rate. For diffuse large cell type with stage I pathological stage, the radiation dose often needs to be increased appropriately (44-50Gy), which can improve the efficacy. The 5-year survival rate of stage II patients should be decreased, mainly due to the increase of recurrence, which is more often seen in the areas outside the radiation field. Therefore, it is sometimes meaningful to add chemotherapy in stage II patients. In stage III and IV NHL cases, even if the malignancy is low, radiotherapy alone cannot achieve a cure, and chemotherapy must be used as the main treatment and small-dose systemic radiotherapy.
Chemotherapy
Chemotherapy is the main method of treatment for NHL and is applicable to stage III and IV cases. For stage Ib and IIb1 cases, the addition of chemotherapy treatment along with radiotherapy can improve the efficacy.
Among chemotherapy drugs, almost all drugs effective for HD are also effective for NHL, but the sensitivity of HD as well as various types of NHL to the same drug is not exactly the same.
IV. Interferon therapy
Interferon therapy for NHL has been proven to be effective. The effective rate for low-grade malignant NHL is 40% to 70%, and the remission time is about 6-8 months, and the effective rate for moderate and highly malignant NHL is about 33%. We have experienced better efficacy of interferon with combination chemotherapy for primary NHL cases. The frequent dose is 3 million units of intramuscular injection daily for 10 days. Toxic side effects of interferon: mild lack of malaise, hypothermia, pruritus, occasional chills and hyperthermia may occur, leukopenia and thrombocytopenia may also occur, and febrile reactions to agents may occur in individual patients. Minor toxic reactions can be treated without treatment, and patients with high fever can be treated with antipyretic agents.
V. Surgical treatment
NHL originating in organs other than lymph nodes is more common, such as the stomach, intestines, kidneys and other organs. In these cases, surgical resection should be performed first, followed by radiotherapy and chemotherapy, which can often lead to long-term survival.
Sixth, Chinese medicine treatment
Hodgkin’s disease (HD) and non-Hodgkin’s disease (NHL) are both malignant lymphomas, which are related to “stone gangrene”, “malignant nucleus”, “loss of glory” and “phlegmatic nucleus” in Chinese medicine. The pathogenesis and treatment are closely related to the above mentioned pathologies. In terms of TCM treatment, HD is the same as NHL, so we will discuss them together here.
According to Chinese medicine, HD is caused by the weakness of the vital energy, which is caused by the external evil of the six sexes and the internal injury of the seven emotions, resulting in the deficiency of the function of the internal organs, the deficiency of Qi and blood stasis, the weakness of the spleen and stomach, and the stagnation of phlegm and stagnation. The treatment is to warm the Yang and support the righteousness, strengthen the spleen and stomach, invigorate the blood and remove blood stasis, and benefit the Qi and disperse the knots.
(I) Treatment by diagnosis and treatment
Luo Juqing et al. reported using oyster, xuan shen, dabei mu, tian quai zi, huang yao zi, shan ci mu, xia ku cao, stiff jelly, pine tulip, and danpi as the basic formula, together with taking xi huang wan 2-3g, or homemade tapping and eliminating tumor pill (composed of niu huang, musk, snail, xiong huang, and toad puff) 5-10g; qi and yin deficiency plus yang shen wan 2-4 pills; fire prosperity plus liushen wan 10-30 pills; deficiency fire prosperity plus zhi bai di huang wan 8-10 pills; blood in phlegm plus zhi bai di huang wan 8-10 pills. For blood in sputum, add Yunnan Baiyao 1 to 3 pills; for dry stool, add Niuhuang detoxification tablets 10 tablets. A total of six cases were treated and all of them were clinically cured, with the longest survival time reaching 27 years.
Chang Zhen Fang reported the use of ginseng, Radix et Rhizoma Ginseng, Poria, Licorice, Atractylodes Macrocephala, Radix Angelicae Sinensis, Radix Paeoniae Alba, Rhizoma Ligustici Chuanxiong, Radix Rehmanniae Sinensis, Radix Cinnamomum Tuberosa, Radix Aromaticum, Pericarpium Citri Reticulatae, Radix Angelicae Sinensis, Radix Angelicae Sinensis, Myrrh, Dandelion, and Centipede as the basic formula, and add and subtract with the evidence, together with the method of cutting off the root of meridian points. The liver, gall bladder and diaphragm points of the foot solar meridian were taken. First, the acupuncture points were routinely disinfected and injected with procaine local anesthesia, and then the incision was made on the acupuncture points with a scalpel, the incision was about 1 cm long, and then about 5-6 white fibrous glandular tissues were cut with a single claw hook hanging out of the incision subcutaneously, and after compressing with cotton balls of iodine tincture to stop bleeding, it was protected with sterile gauze dressing. Course of treatment: 3 times as a course of treatment, each time 7 days apart. The total effective rate of treatment reached 64% in 55 cases, which improved the survival rate, of which 32 cases were still alive and in good condition.
(B) Identification and classification of treatment
1.Qi stagnation and phlegm knot type
Symptoms: chest tightness, pain in the ribs, swollen neck, axillary and inguinal lymph nodes in bunches, unchanging skin color, occasional pressure pain, abdominal lumps, pale face, enlarged liver and spleen, puffy face, fever and sweating, occasional itching of the skin, light red tongue, white or yellow fur, sunken and slippery pulse.
Treatment: To regulate Qi, resolve phlegm, soften hardness and disperse nodules.
Herbs: Chai Hu 9g, Qing Pi 9g, Xia Ku Cao 15g, Bai Shao 10g, Shan Cixi Mushroom 12g, Curcuma Longa 12g, Rhizoma Alba 30g, Tian Men Dong 15g, Astragalus Membranaceus 15g, Poria Cocos 10g, Astragalus Astragalus 9g.
2.Cold phlegm stagnation type
Symptoms: superficial lymph nodes swollen, tough, in bunches, of different sizes, without pain or heat, occasionally with low fever, sweating, pale face, light red tongue, thin white fur, sunken and thin pulse.
Treatment: Warming and resolving cold phlegm.
Formula: Yang He Tang with addition and subtraction. Radix Rehmanniae Praeparata 15g, Deer Antler Gum 15g, White Mustard Seed 9g, Ephedra 1.5g, Cinnamon 3g, Xia Ku Cao 15g, Tian Nan Xing 15g, Curcuma Longa 10g, Gui Zhi 6g, Poria 10g, Licorice 3g.
3.Yin deficiency of liver and kidney
Symptoms: enlarged lymph nodes, afternoon hot flashes, sweating, palpitations and insomnia, poor appetite, dry mouth and drinking, light red or red-red tongue, thin white tongue coating or no coating, thin and weak pulse.
Treatment: Nourish Yin and generate fluid, nourish liver and kidney.
Remedy: Sancai Fengmao Dan with added flavor. Asparagus 30g, Radix Rehmanniae 12g, Radix et Rhizoma Ginseng 6g, Radix et Rhizoma Prince 15g, Radix Salviae Miltiorrhiza 12g, Radix et Rhizoma Pseudostellariae 30g, Rhizoma Macrocephalae 9g, Poria 12g, Rhizoma Rotunda 10g, Radix et Rhizoma Bupleurum 15g, Rhizoma Polygonati 12g, Radix Lycii 10g, Rhizoma Polygonati 12g, Rhizoma Atractylodes 10g.
4.Phlegm and fire type
Symptoms: Neck swelling with unchanging skin color, hard when pressed, fever that does not resolve, sweating, itching of the skin, dry mouth and tongue, dry stools or dry knots, red or purple dull tongue, yellow greasy moss or light vivid without moss, thin pulse or thin strings.
Treatment: Clearing heat and detoxifying toxins, resolving phlegm and dispersing nodules.
Remedy: Self-designed Detoxification and Dispersion Pill with addition and subtraction. Dandelion 30g, Semen Nelumbo 15g, Xia Ku Cao 30g, Tu Fu Ling 15g, Tian Zhu Huang 15g, Chai Hu 12g, Dan Shen 30g, Nan Xing 12g, Bei Mu 15g, Qing Pores 20.
(C) proprietary Chinese medicine
1. Xiaojin Dan is composed of white gum incense, grass wool, five lingzhi, ground dragon, wood turtle seeds, made frankincense, made myrrh, angelica, musk, fragrant ink charcoal. The above medicines are finely powdered and made of glutinous rice powder into pills as big as gravy. Take 1 pill for each dose, and take it down with Chen wine to cover the sweat.
Recent animal experiments have proved that it can inhibit the growth of spindle cell sarcoma and S180 in mice.
2.The main drugs of Xihuangwan are Niuhuang, musk, frankincense, myrrh, yellow rice and so on. It can activate blood circulation and remove blood stasis, detoxify and fight against cancer. It is suitable for phlegm and fire accumulation type. Usage: 6g heavy honey pills, 1 pill each time, 2 times a day, served with rice vinegar. Or use 1 pill, dissolve it with 30ml of water and keep it in enema, once a day.
3. The main drugs of scrofula are 60g of white silkworm, 60g of cicada, 6g of spotted cypress (remove the head, foot, wing and chest, respectively, incorporate into 6 pitted red dates, roast and grind finely). It is finely powdered and divided into 12 portions in capsules, 1 portion each time, taken orally twice daily.
Other products, such as Zijin Ingot, Pingxiao Tablets, Dahuang Shuwai Pill, Huachansu Injection, Eleutherococcus Injection, etc., can be used as appropriate.
VII. Combination of Chinese and Western medicine treatment
There were 22 cases of malignant lymphoma treated with Danshen injection together with chemotherapy, and the efficacy was satisfactory compared with 13 cases treated with chemotherapy alone. The patients were randomly grouped according to the RichardDoLi method. One group received COP regimen and the other group was treated with Danshen-COP regimen. COP regimen group: CTX 400 mg/m2, intravenous injection, twice a week; VCR 1 mg/m2, intravenous injection, once a week; PDN 5 mg, oral, 3 times a day; 3 weeks of continuous medication and 1 week of rest followed by one more course of medication. There were 13 cases in this group. Danshen-COP regimen group: 10ml of Danshen injection was administered intravenously daily during the period of medication according to the COP regimen. 22 cases in this group. Results: In the COP program group, there was 1 case of complete remission, 8 cases of partial remission, and 3 cases of ineffectiveness; in the Danshen-COP program group, there was 1 case of complete remission, 8 cases of partial remission, and 3 cases of ineffectiveness; in the Danshen-COP program group, there was 4 cases of complete remission and 18 cases of partial remission; the efficacy of the latter group was better than that of the former group, and the difference in efficacy between the two groups was significant (P < 0.05.
Twenty-four cases of malignant lymphoma were treated with a combination of Chinese and Western medicine. For the type with cold phlegm stagnation, Astragalus, Radix Rehmanniae, Deer Antler Gum and Xia Ku Cao were used: 1 g each, Tennant’s Star, Curcuma and Poria: 10 g each, Cinnamomum Cassia: 6 g, Glycyrrhiza glabra: 3 g. For the type with qi stagnation and phlegm stagnation, Xia Ku Cao, Tennant’s Winter and Panax notoginseng: 15 g each, Paeonia lactiflora, Radix Astragali and Poria: 10 g each, Qing Pi, Radix Angelicae Sinensis and Scutellariae: 8 g each, Chai Hu: 9 g, Cyperus rotundus and Curcuma: 12 g each, Rhizoma alba: 30 g. For the type with blood heat and stagnation of toxins, Jin Yin Hua, Dang Pi, Mai Men Dong and Sheng Hua were used. For blood heat and stasis toxicity, 10g each of Salvia miltiorrhiza, Semen Aegypti, Radix et Rhizoma Macrocephalae, 30g each of Radix et Rhizoma Bupleurum, Radix asparagus, Radix asparagus, Radix asparagus, Radix et Rhizoma, Radix et Rhizoma Bupleurum, Radix et Rhizoma Bupleurum, 25g each of Dried Guadua. Radix et Rhizoma Polygonatum, Radix et Rhizoma Gynostemma, Radix et Rhizoma Polygonatum, Radix et Rhizoma Gynostemma, 6g. Take 1 dose of decoction daily. In the control group, 22 cases were treated with topical chemotherapy, vitamin B1, vitamin B6, and supportive therapy, blood transfusion and antibiotics as appropriate. In the control group, 22 cases were treated with topical Chinese medicine and other treatments were the same. RESULTS: There were 14 and 7 cases with significant effect, 6 and 8 cases with effective effect, and 4 and 7 cases with ineffective effect in the two groups, respectively, with a total effective rate of 85% and 67.8%. The completion of chemotherapy, systemic reaction, peripheral white blood cell count and immune function in this group were all better than those in the control group (P < 0.01 or 0.05.
The formula was formulated to warm yang and benefit qi, invigorate blood circulation, resolve blood stasis and disperse phlegm, using prince’s ginseng, astragalus, lady’s mantle, deer horn slices, Xianmao, bacopa monniera, Xianling spleen, cinnamon stick, conpoy, dried ginger, parasite, geranium, anti-hexis, roasted licorice, angelica and wolfberry. According to the patient’s concurrent evidence, it should be added and reduced according to the evidence, one dose daily with water decoction. In order to increase the efficacy of warming Yang, invigorating Qi, activating blood circulation and resolving blood stasis, we also applied Ginseng Injection and Compound Salvia Injection. The efficacy of the treatment was significantly higher compared with that of single chemotherapy, and no toxic side effects were found.