Difference between revisions of "Transformed lymphoma"

From HemOnc.org - A Hematology Oncology Wiki
Jump to navigation Jump to search
Line 36: Line 36:
 
====Chemotherapy====
 
====Chemotherapy====
 
''Note: these infusion instructions are for the Treanda formulation, which was discontinued on 3/31/2016.''
 
''Note: these infusion instructions are for the Treanda formulation, which was discontinued on 3/31/2016.''
−
*[[Bendamustine]] 120 mg/m2 IV over 60 to 120 minutes once per day on days 1 & 2
+
*[[Bendamustine]] 120 mg/m<sup>2</sup> IV over 60 to 120 minutes once per day on days 1 & 2
  
 
'''21-day cycle x up to 12 cycles'''
 
'''21-day cycle x up to 12 cycles'''
Line 50: Line 50:
 
|}
 
|}
  
−
===Regimen, Wiernik et al. 2008 (NHL-002); Witzig et al. 2011 (NHL-003) {{#subobject:87163f|Variant=1}}===
+
===Regimen {{#subobject:87163f|Variant=1}}===
−
 
+
{| border="1" style="text-align:center;" !align="left"
−
<span  
+
|'''Study'''
 +
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 +
|-
 +
|[http://jco.ascopubs.org/content/26/30/4952.long Wiernik et al. 2008 (NHL-002)]
 +
|<span
 +
style="background:#EEEE00;
 +
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Phase II</span>
 +
|-
 +
|[http://annonc.oxfordjournals.org/content/22/7/1622.long Witzig et al. 2011 (NHL-003]
 +
|<span  
 
style="background:#EEEE00;
 
style="background:#EEEE00;
 
padding:3px 6px 3px 6px;
 
padding:3px 6px 3px 6px;
Line 58: Line 70:
 
border-width:2px;
 
border-width:2px;
 
border-style:solid;">Phase II</span>
 
border-style:solid;">Phase II</span>
−
 
+
|-
 +
|}
 +
====Chemotherapy====
 
*[[Lenalidomide (Revlimid)]] 25 mg PO once per day on days 1 to 21
 
*[[Lenalidomide (Revlimid)]] 25 mg PO once per day on days 1 to 21
  
Line 72: Line 86:
 
|[[#toc|back to top]]
 
|[[#toc|back to top]]
 
|}
 
|}
−
===Regimen, Wang et al. 2013 {{#subobject:8347d9|Variant=1}}===
+
===Regimen {{#subobject:8347d9|Variant=1}}===
−
 
+
{| border="1" style="text-align:center;" !align="left"
−
<span  
+
|'''Study'''
 +
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 +
|-
 +
|[http://www.nature.com/leu/journal/v27/n9/full/leu201395a.html Wang et al. 2013]
 +
|<span  
 
style="background:#ff0000;
 
style="background:#ff0000;
 
padding:3px 6px 3px 6px;
 
padding:3px 6px 3px 6px;
 
border-color:black;
 
border-color:black;
 
border-width:2px;
 
border-width:2px;
−
border-style:solid;">Phase II, <20 patients reported</span>
+
border-style:solid;">Phase II, <20 pts</span>
 +
|-
 +
|}
  
 +
====Chemotherapy====
 
*[[Lenalidomide (Revlimid)]] 20 mg PO once per day on days 1 to 21
 
*[[Lenalidomide (Revlimid)]] 20 mg PO once per day on days 1 to 21
−
*[[Rituximab (Rituxan)]] 375 mg/m2 IV once per week on weeks 1 to 4 of cycle 1, only
+
*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once per week on weeks 1 to 4 of cycle 1, only
  
 
'''28-day cycles'''
 
'''28-day cycles'''
Line 110: Line 131:
 
|-
 
|-
 
|}
 
|}
−
 
+
====Chemotherapy====
−
*[[Oxaliplatin (Eloxatin)]] 25 mg/m2 IV over 2 hours once per day on days 1 to 4
+
*[[Oxaliplatin (Eloxatin)]] 25 mg/m<sup>2</sup> IV over 2 hours once per day on days 1 to 4
−
*[[Fludarabine (Fludara)]] 30 mg/m2 IV once per day on days 2 & 3, adminstered within 30 minutes of completion of [[Oxaliplatin (Eloxatin)]]
+
*[[Fludarabine (Fludara)]] 30 mg/m<sup>2</sup> IV once per day on days 2 & 3, adminstered within 30 minutes of completion of [[Oxaliplatin (Eloxatin)]]
−
*[[Cytarabine (Cytosar)]] 1000 mg/m2 IV over 2 hours once per day on days 2 & 3, 4 hours after [[Fludarabine (Fludara)]] started
+
*[[Cytarabine (Cytosar)]] 1000 mg/m<sup>2</sup> IV over 2 hours once per day on days 2 & 3, 4 hours after [[Fludarabine (Fludara)]] started
 
*[[Rituximab (Rituxan)]] as follows:
 
*[[Rituximab (Rituxan)]] as follows:
−
**Cycle 1: 375 mg/m2 IV over 4 to 6 hours once on day 3  
+
**Cycle 1: 375 mg/m<sup>2</sup> IV over 4 to 6 hours once on day 3  
−
**Cycles 2 to 6: 375 mg/m2 IV over 4 to 6 hours once on day 1
+
**Cycles 2 to 6: 375 mg/m<sup>2</sup> IV over 4 to 6 hours once on day 1
  
−
Supportive medications:
+
====Supportive medications====
 
*[[Pegfilgrastim (Neulasta)]] 6 mg SC once on day 6
 
*[[Pegfilgrastim (Neulasta)]] 6 mg SC once on day 6
 
*Herpes zoster and PCP (Pneumocystis jiroveci pneumonia) prophylaxis used
 
*Herpes zoster and PCP (Pneumocystis jiroveci pneumonia) prophylaxis used
  
−
'''28-day cycles x up to 6 cycles'''
+
'''28-day cycle x up to 6 cycles'''
  
 
===References===
 
===References===
Line 150: Line 171:
 
|-
 
|-
 
|}
 
|}
−
 
+
====Chemotherapy====
−
*[[Rituximab (Rituxan)]] 375 mg/m2 IV once on day 1
+
*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once on day 1
 
*[[Dexamethasone (Decadron)]] 40 mg PO once per day on days 1 to 4
 
*[[Dexamethasone (Decadron)]] 40 mg PO once per day on days 1 to 4
−
*[[Cytarabine (Cytosar)]] 2000 mg/m2 IV over 3 hours Q12H x 2 doses on day 2 (total of 2 doses)
+
*[[Cytarabine (Cytosar)]] 2000 mg/m<sup>2</sup> IV over 3 hours Q12H x 2 doses on day 2 (total of 2 doses)
−
*[[Cisplatin (Platinol)]] 100 mg/m2 IV continuous infusion over 24 hours on day 1
+
*[[Cisplatin (Platinol)]] 100 mg/m<sup>2</sup> IV continuous infusion over 24 hours on day 1
  
 
'''21-day cycles x up to 3 cycles'''
 
'''21-day cycles x up to 3 cycles'''
Line 185: Line 206:
 
|}
 
|}
 
''Note: this is not the dose-adjusted R-EPOCH regimen''
 
''Note: this is not the dose-adjusted R-EPOCH regimen''
 +
====Chemotherapy====
 +
*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV on day 1
 +
*[[Etoposide (Vepesid)]] 65 mg/m<sup>2</sup>/day (total dose of 195 mg/m<sup>2</sup>) IV continuous infusion on days 2 to 4
 +
*[[Prednisone (Sterapred)]] 60 mg/m<sup>2</sup>/day PO on days 1 to 14
 +
*[[Vincristine (Oncovin)]] 0.5 mg/m<sup>2</sup>/day (total dose of 1.5 mg/m<sup>2</sup>) IV continuous infusion on days 2 to 4
 +
*[[Cyclophosphamide (Cytoxan)]] 750 mg/m<sup>2</sup> IV once on day 5
 +
*[[Doxorubicin (Adriamycin)]] 15 mg/m<sup>2</sup>/day (total dose of 45 mg/m<sup>2</sup>) IV continuous infusion on days 2 to 4
  
−
*[[Rituximab (Rituxan)]] 375 mg/m2 IV on day 1
+
'''21-day cycle x 4 to 6 cycles'''
−
*[[Etoposide (Vepesid)]] 65 mg/m2/day (total dose of 195 mg/m2) IV continuous infusion on days 2 to 4
 
−
*[[Prednisone (Sterapred)]] 60 mg/m2/day PO on days 1 to 14
 
−
*[[Vincristine (Oncovin)]] 0.5 mg/m2/day (total dose of 1.5 mg/m2) IV continuous infusion on days 2 to 4
 
−
*[[Cyclophosphamide (Cytoxan)]] 750 mg/m2 IV once on day 5
 
−
*[[Doxorubicin (Adriamycin)]] 15 mg/m2/day (total dose of 45 mg/m2) IV continuous infusion on days 2 to 4
 
−
 
 
−
'''21-day cycles x 4 to 6 cycles'''
 
  
 
===References===
 
===References===
Line 221: Line 242:
 
|-
 
|-
 
|}
 
|}
−
*[[Rituximab (Rituxan)]] 375 mg/m2 IV once on day 1
+
====Chemotherapy====
−
*[[Gemcitabine (Gemzar)]] 1000 mg/m2 IV once per day on days 1 & 8
+
*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once on day 1
 +
*[[Gemcitabine (Gemzar)]] 1000 mg/m<sup>2</sup> IV once per day on days 1 & 8
 
*[[Dexamethasone (Decadron)]] 40 mg PO once per day on days 1 to 4
 
*[[Dexamethasone (Decadron)]] 40 mg PO once per day on days 1 to 4
−
*[[Cisplatin (Platinol)]] 75 mg/m2 IV once on day 1
+
*[[Cisplatin (Platinol)]] 75 mg/m<sup>2</sup> IV once on day 1
  
−
'''21-day cycles x up to 3 cycles'''
+
'''21-day cycle x up to 3 cycles'''
  
 
''Responders proceeded to undergo autologous stem cell transplant.''
 
''Responders proceeded to undergo autologous stem cell transplant.''

Revision as of 02:59, 26 June 2016

Use of this site is subject to you reading and agreeing with the terms set forth in the disclaimer.

Is there a regimen missing from this list? Would you like to share a different dosage/schedule or an additional reference for a regimen? Have you noticed an error? Do you have an idea that will help the site grow to better meet your needs and the needs of many others? You are invited to contribute to the site.

18 regimens on this page
18 variants on this page


Transformed lymphoma, often referred to as Richter's transformation, most commonly arises from a preceding indolent lymphoma - usually follicular lymphoma or chronic lymphocytic leukemia. It is typically treated as per the histologic subtype, which is usually DLBCL. However, some regimens specific to transformed lymphoma have been developed and are included here.

All lines of therapy

Bendamustine

back to top

Regimen

Study Evidence
Friedberg et al. 2008 Phase II, <20 pts

Chemotherapy

Note: these infusion instructions are for the Treanda formulation, which was discontinued on 3/31/2016.

  • Bendamustine 120 mg/m2 IV over 60 to 120 minutes once per day on days 1 & 2

21-day cycle x up to 12 cycles

References

  1. Friedberg JW, Cohen P, Chen L, Robinson KS, Forero-Torres A, La Casce AS, Fayad LE, Bessudo A, Camacho ES, Williams ME, van der Jagt RH, Oliver JW, Cheson BD. Bendamustine in patients with rituximab-refractory indolent and transformed non-Hodgkin's lymphoma: results from a phase II multicenter, single-agent study. J Clin Oncol. 2008 Jan 10;26(2):204-10. Erratum in: J Clin Oncol. 2008 Apr 10;26(11) 1911. link to original article contains verified protocol PubMed

Lenalidomide (Revlimid)

back to top

Regimen

Study Evidence
Wiernik et al. 2008 (NHL-002) Phase II
Witzig et al. 2011 (NHL-003 Phase II

Chemotherapy

28-day cycles until disease progression or unacceptable toxicity

References

  1. Wiernik PH, Lossos IS, Tuscano JM, Justice G, Vose JM, Cole CE, Lam W, McBride K, Wride K, Pietronigro D, Takeshita K, Ervin-Haynes A, Zeldis JB, Habermann TM. Lenalidomide monotherapy in relapsed or refractory aggressive non-Hodgkin's lymphoma. J Clin Oncol. 2008 Oct 20;26(30):4952-7. Epub 2008 Jul 7. link to original article contains verified protocol PubMed
  2. Witzig TE, Vose JM, Zinzani PL, Reeder CB, Buckstein R, Polikoff JA, Bouabdallah R, Haioun C, Tilly H, Guo P, Pietronigro D, Ervin-Haynes AL, Czuczman MS. An international phase II trial of single-agent lenalidomide for relapsed or refractory aggressive B-cell non-Hodgkin's lymphoma. Ann Oncol. 2011 Jul;22(7):1622-7. Epub 2011 Jan 12. link to original article contains verified protocol PubMed

Lenalidomide & Rituximab

back to top

Regimen

Study Evidence
Wang et al. 2013 Phase II, <20 pts

Chemotherapy

28-day cycles

References

  1. Wang M, Fowler N, Wagner-Bartak N, Feng L, Romaguera J, Neelapu SS, Hagemeister F, Fanale M, Oki Y, Pro B, Shah J, Thomas S, Younes A, Hosing C, Zhang L, Newberry KJ, Desai M, Cheng N, Badillo M, Bejarano M, Chen Y, Young KH, Champlin R, Kwak L, Fayad L. Oral lenalidomide with rituximab in relapsed or refractory diffuse large cell, follicular and transformed lymphoma: a phase II clinical trial. Leukemia. 2013 Sep;27(9):1902-9. Epub 2013 Apr 2. link to original article contains verified protocol PubMed

OFAR

back to top

OFAR: Oxaliplatin, Fludarabine, Ara-C (Cytarabine), Rituximab

Regimen

Study Evidence
Tsimberidou et al. 2008 Phase II

Chemotherapy

Supportive medications

28-day cycle x up to 6 cycles

References

  1. Tsimberidou AM, Wierda WG, Plunkett W, Kurzrock R, O'Brien S, Wen S, Ferrajoli A, Ravandi-Kashani F, Garcia-Manero G, Estrov Z, Kipps TJ, Brown JR, Fiorentino A, Lerner S, Kantarjian HM, Keating MJ. Phase I-II study of oxaliplatin, fludarabine, cytarabine, and rituximab combination therapy in patients with Richter's syndrome or fludarabine-refractory chronic lymphocytic leukemia. J Clin Oncol. 2008 Jan 10;26(2):196-203. link to original article contains protocol PubMed

R-DHAP

back to top

R-DHAP: Rituximab, Dexamethasone, High-dose Ara-C (Cytarabine), Platinol (Cisplatin)

Regimen

Study Evidence Comparator
Crump et al. 2014 (NCIC-CTG LY.12) Phase III R-GDP

Chemotherapy

21-day cycles x up to 3 cycles

References

  1. Crump M, Kuruvilla J, Couban S, MacDonald DA, Kukreti V, Kouroukis CT, Rubinger M, Buckstein R, Imrie KR, Federico M, Di Renzo N, Howson-Jan K, Baetz T, Kaizer L, Voralia M, Olney HJ, Turner AR, Sussman J, Hay AE, Djurfeldt MS, Meyer RM, Chen BE, Shepherd LE. Randomized Comparison of Gemcitabine, Dexamethasone, and Cisplatin Versus Dexamethasone, Cytarabine, and Cisplatin Chemotherapy Before Autologous Stem-Cell Transplantation for Relapsed and Refractory Aggressive Lymphomas: NCIC-CTG LY.12. J Clin Oncol. 2014 Nov 1;32(31):3490-6. Epub 2014 Sep 29. link to original article contains verified protocol PubMed
    1. Subgroup Analysis: Kuruvilla J, MacDonald DA, Kouroukis CT, Cheung M, Olney HJ, Turner AR, Anglin P, Seftel M, Ismail WS, Luminari S, Couban S, Baetz T, Meyer RM, Hay AE, Shepherd L, Djurfeldt MS, Alamoudi S, Chen BE, Crump M. Salvage chemotherapy and autologous stem cell transplantation for transformed indolent lymphoma: a subset analysis of NCIC CTG LY12. Blood. 2015 Aug 6;126(6):733-8. Epub 2015 Jun 24. link to original article contains verified protocol PubMed

R-EPOCH

back to top

R-EPOCH: Rituximab, Etoposide, Prednisone, Oncovin (Vincristine), Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin)

Regimen

Study Evidence
Jermann et al. 2004 Phase II, <20 patients reported

Note: this is not the dose-adjusted R-EPOCH regimen

Chemotherapy

21-day cycle x 4 to 6 cycles

References

  1. Jermann M, Jost LM, Taverna Ch, Jacky E, Honegger HP, Betticher DC, Egli F, Kroner T, Stahel RA. Rituximab-EPOCH, an effective salvage therapy for relapsed, refractory or transformed B-cell lymphomas: results of a phase II study. Ann Oncol. 2004 Mar;15(3):511-6. link to original article contains verified protocol PubMed

R-GDP

back to top

R-GDP: Rituximab, Gemcitabine, Dexamethasone, Platinol (Cisplatin)

Regimen

Study Evidence Comparator
Crump et al. 2014 (NCIC-CTG LY.12) Phase III R-DHAP

Chemotherapy

21-day cycle x up to 3 cycles

Responders proceeded to undergo autologous stem cell transplant.

References

  1. Crump M, Kuruvilla J, Couban S, MacDonald DA, Kukreti V, Kouroukis CT, Rubinger M, Buckstein R, Imrie KR, Federico M, Di Renzo N, Howson-Jan K, Baetz T, Kaizer L, Voralia M, Olney HJ, Turner AR, Sussman J, Hay AE, Djurfeldt MS, Meyer RM, Chen BE, Shepherd LE. Randomized Comparison of Gemcitabine, Dexamethasone, and Cisplatin Versus Dexamethasone, Cytarabine, and Cisplatin Chemotherapy Before Autologous Stem-Cell Transplantation for Relapsed and Refractory Aggressive Lymphomas: NCIC-CTG LY.12. J Clin Oncol. 2014 Nov 1;32(31):3490-6. Epub 2014 Sep 29. link to original article contains verified protocol PubMed
    1. Subgroup Analysis: Kuruvilla J, MacDonald DA, Kouroukis CT, Cheung M, Olney HJ, Turner AR, Anglin P, Seftel M, Ismail WS, Luminari S, Couban S, Baetz T, Meyer RM, Hay AE, Shepherd L, Djurfeldt MS, Alamoudi S, Chen BE, Crump M. Salvage chemotherapy and autologous stem cell transplantation for transformed indolent lymphoma: a subset analysis of NCIC CTG LY12. Blood. 2015 Aug 6;126(6):733-8. Epub 2015 Jun 24. link to original article contains verified protocol PubMed
Retrieved from "https://hemonc.org/w/index.php?title=Transformed_lymphoma&oldid=11258"