Difference between revisions of "Primary mediastinal B-cell lymphoma"

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DA-R-EPOCH: '''<u>D</u>'''ose '''<u>A</u>'''djusted '''<u>R</u>'''ituximab, '''<u>E</u>'''toposide, '''<u>P</u>'''rednisone, '''<u>O</u>'''ncovin (vincristine), '''<u>C</u>'''yclophosphamide, '''<u>H</u>'''ydroxydaunorubicin (doxorubicin)
 
DA-R-EPOCH: '''<u>D</u>'''ose '''<u>A</u>'''djusted '''<u>R</u>'''ituximab, '''<u>E</u>'''toposide, '''<u>P</u>'''rednisone, '''<u>O</u>'''ncovin (vincristine), '''<u>C</u>'''yclophosphamide, '''<u>H</u>'''ydroxydaunorubicin (doxorubicin)
  
−
===Regimen, Dunleavy et al. 2013 {{#subobject:98dcb9|Variant=1}}===
+
===Regimen {{#subobject:98dcb9|Variant=1}}===
−
<span  
+
{| border="1" style="text-align:center;" !align="left"
−
style="background:#EEEE00;
+
|'''Study'''
 +
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 +
|-
 +
|[http://www.nejm.org/doi/full/10.1056/NEJMoa1214561 Dunleavy et al. 2013]
 +
|<span
 +
style="background:#eeee00;
 +
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Phase II</span>
 +
|-
 +
|[http://onlinelibrary.wiley.com/doi/10.1111/bjh.13273/full Purroy et al. 2014]
 +
|<span  
 +
style="background:#eeee00;
 
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</span>
 
border-style:solid;">Phase II</span>
 +
|-
 +
|}
 +
====Chemotherapy====
 +
*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV over 3 hours once on day 1
 +
*[[Etoposide (Vepesid)]] 50 mg/m<sup>2</sup>/day IV continuous infusion over 96 hours on days 1 to 4 (total dose per cycle: 200 mg/m2)
 +
*[[Prednisone (Sterapred)]] 60 mg/m<sup>2</sup> PO BID on days 1 to 5
 +
*[[Vincristine (Oncovin)]] 0.4 mg/m<sup>2</sup>/day IV continuous infusion over 96 hours on days 1 to 4 (total dose per cycle: 1.6 mg/m2; dose was not capped)
 +
*[[Cyclophosphamide (Cytoxan)]] 750 mg/m<sup>2</sup> IV over 2 hours once on day 5
 +
*[[Doxorubicin (Adriamycin)]] 10 mg/m<sup>2</sup>/day IV continuous infusion over 96 hours on days 1 to 4 (total dose per cycle: 40 mg/m2)
  
−
*[[Rituximab (Rituxan)]] 375 mg/m2 IV over 3 hours once on day 1
+
====Supportive medications====
−
*[[Etoposide (Vepesid)]] 50 mg/m2/day IV continuous infusion over 96 hours on days 1 to 4 (total dose per cycle: 200 mg/m2)
 
−
*[[Prednisone (Sterapred)]] 60 mg/m2 PO BID on days 1 to 5
 
−
*[[Vincristine (Oncovin)]] 0.4 mg/m2/day IV continuous infusion over 96 hours on days 1 to 4 (total dose per cycle: 1.6 mg/m2; dose was not capped)
 
−
*[[Cyclophosphamide (Cytoxan)]] 750 mg/m2 IV over 2 hours once on day 5
 
−
*[[Doxorubicin (Adriamycin)]] 10 mg/m2/day IV continuous infusion over 96 hours on days 1 to 4 (total dose per cycle: 40 mg/m2)
 
−
 
 
−
Supportive medications:
 
 
*[[Filgrastim (Neupogen)]] 300 mcg SQ once per day, starting on day 6 and continuing until ANC >5,000/uL past nadir
 
*[[Filgrastim (Neupogen)]] 300 mcg SQ once per day, starting on day 6 and continuing until ANC >5,000/uL past nadir
 
*[[Trimethoprim/Sulfamethoxazole (Bactrim DS)]] 160/800 mg (or equivalent if allergic) PO once per day on 3 days per week
 
*[[Trimethoprim/Sulfamethoxazole (Bactrim DS)]] 160/800 mg (or equivalent if allergic) PO once per day on 3 days per week
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*Hepatitis B surface antigen positive patients received daily antiviral therapy until 8 weeks after completion of chemotherapy
 
*Hepatitis B surface antigen positive patients received daily antiviral therapy until 8 weeks after completion of chemotherapy
  
−
'''21-day cycles x 6 to 8 cycles'''
+
'''21-day cycle for 6 to 8 cycles'''
  
−
Dose adjustments:
+
====Dose adjustments====
 
*Start cycle 1 as described above.
 
*Start cycle 1 as described above.
 
*Obtain CBCs twice per week for nadir measurements.
 
*Obtain CBCs twice per week for nadir measurements.
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===References===
 
===References===
 
# Dunleavy K, Pittaluga S, Maeda LS, Advani R, Chen CC, Hessler J, Steinberg SM, Grant C, Wright G, Varma G, Staudt LM, Jaffe ES, Wilson WH. Dose-adjusted EPOCH-rituximab therapy in primary mediastinal B-cell lymphoma. N Engl J Med. 2013 Apr 11;368(15):1408-16. [http://www.nejm.org/doi/full/10.1056/NEJMoa1214561 link to original article] [http://www.nejm.org/doi/suppl/10.1056/NEJMoa1214561/suppl_file/nejmoa1214561_appendix.pdf link to supplementary appendix] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/23574119 PubMed]
 
# Dunleavy K, Pittaluga S, Maeda LS, Advani R, Chen CC, Hessler J, Steinberg SM, Grant C, Wright G, Varma G, Staudt LM, Jaffe ES, Wilson WH. Dose-adjusted EPOCH-rituximab therapy in primary mediastinal B-cell lymphoma. N Engl J Med. 2013 Apr 11;368(15):1408-16. [http://www.nejm.org/doi/full/10.1056/NEJMoa1214561 link to original article] [http://www.nejm.org/doi/suppl/10.1056/NEJMoa1214561/suppl_file/nejmoa1214561_appendix.pdf link to supplementary appendix] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/23574119 PubMed]
−
# Purroy N, Bergua J, Gallur L, Prieto J, Lopez LA, Sancho JM, García-Marco JA, Castellví J, Montes-Moreno S, Batlle A, de Villambrosia SG, Carnicero F, Ferrando-Lamana L, Piris MA, Lopez A. Long-term follow-up of dose-adjusted EPOCH plus rituximab (DA-EPOCH-R) in untreated patients with poor prognosis large B-cell lymphoma. A phase II study conducted by the Spanish PETHEMA Group. Br J Haematol. 2014 Dec 18. [Epub ahead of print] [http://onlinelibrary.wiley.com/doi/10.1111/bjh.13273/full link to original article] [http://www.ncbi.nlm.nih.gov/pubmed/25521006 PubMed]
+
# Purroy N, Bergua J, Gallur L, Prieto J, Lopez LA, Sancho JM, García-Marco JA, Castellví J, Montes-Moreno S, Batlle A, de Villambrosia SG, Carnicero F, Ferrando-Lamana L, Piris MA, Lopez A. Long-term follow-up of dose-adjusted EPOCH plus rituximab (DA-EPOCH-R) in untreated patients with poor prognosis large B-cell lymphoma. A phase II study conducted by the Spanish PETHEMA Group. Br J Haematol. 2015 Apr;169(2):188-98. Epub 2014 Dec 18. [http://onlinelibrary.wiley.com/doi/10.1111/bjh.13273/full link to original article] [http://www.ncbi.nlm.nih.gov/pubmed/25521006 PubMed]
  
 
==R-CHOP {{#subobject:796753|Regimen=1}}==
 
==R-CHOP {{#subobject:796753|Regimen=1}}==
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|-
 
|-
 
|}
 
|}
−
*[[Rituximab (Rituxan)]] 375 mg/m2 IV once on day 1
+
====Chemotherapy====
−
*[[Cyclophosphamide (Cytoxan)]] 750 mg/m2 IV once on day 1
+
*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once on day 1
−
*[[Doxorubicin (Adriamycin)]] 50 mg/m2 IV once on day 1
+
*[[Cyclophosphamide (Cytoxan)]] 750 mg/m<sup>2</sup> IV once on day 1
 +
*[[Doxorubicin (Adriamycin)]] 50 mg/m<sup>2</sup> IV once on day 1
 
*[[Vincristine (Oncovin)]] 2 mg IV once on day 1
 
*[[Vincristine (Oncovin)]] 2 mg IV once on day 1
 
*[[Prednisone (Sterapred)]] 100 mg PO once per day on days 1 to 5
 
*[[Prednisone (Sterapred)]] 100 mg PO once per day on days 1 to 5
 
*Radiation therapy: 30 to 40 Gy given to sites of primary bulky disease; 30 to 40 Gy to primary extranodal disease at physician discretion
 
*Radiation therapy: 30 to 40 Gy given to sites of primary bulky disease; 30 to 40 Gy to primary extranodal disease at physician discretion
  
−
Supportive medications:
+
====Supportive medications====
 
*[[Filgrastim (Neupogen)]] or [[Lenograstim (Granocyte)]] used at physician discretion for neutropenia
 
*[[Filgrastim (Neupogen)]] or [[Lenograstim (Granocyte)]] used at physician discretion for neutropenia
  
−
'''21-day cycles x 6 cycles'''
+
'''21-day cycle for 6 cycles'''
  
 
===References===
 
===References===
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|}
 
|}
  
−
===Regimen, Bartlett et al. 2013 {{#subobject:52bebf|Variant=1}}===
+
===Regimen {{#subobject:52bebf|Variant=1}}===
−
<span  
+
{| border="1" style="text-align:center;" !align="left"
 +
|'''Study'''
 +
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 +
|-
 +
|[https://ash.confex.com/ash/2013/webprogram/Paper59695.html Bartlett 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>
−
 
+
|-
 +
|}
 
''This regimen was evaluated in patients with CD30+ non-Hodgkin lymphoma, as determined by immunohistochemistry.''
 
''This regimen was evaluated in patients with CD30+ non-Hodgkin lymphoma, as determined by immunohistochemistry.''
−
 
+
====Chemotherapy====
 
*[[Brentuximab vedotin (Adcetris)]] 1.8 mg/kg IV over 30 minutes on day 1
 
*[[Brentuximab vedotin (Adcetris)]] 1.8 mg/kg IV over 30 minutes on day 1
  
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|-
 
|-
 
|}
 
|}
−
*[[Rituximab (Rituxan)]] 375 mg/m2 IV once on day 1
+
====Chemotherapy====
 +
*[[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 cycle x up to 3 cycles'''
+
'''21-day cycle for up to 3 cycles'''
  
 
===References===
 
===References===
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R-GDP: '''<u>R</u>'''ituximab, '''<u>G</u>'''emcitabine, '''<u>D</u>'''examethasone, '''<u>P</u>'''latinol (Cisplatin)
 
R-GDP: '''<u>R</u>'''ituximab, '''<u>G</u>'''emcitabine, '''<u>D</u>'''examethasone, '''<u>P</u>'''latinol (Cisplatin)
  
−
===Regimen #1 {{#subobject:8091c0|Variant=1}}===
+
===Regimen {{#subobject:8091c0|Variant=1}}===
 
{| border="1" style="text-align:center;" !align="left"  
 
{| border="1" style="text-align:center;" !align="left"  
 
|'''Study'''
 
|'''Study'''
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|-
 
|-
 
|}
 
|}
−
 
+
====Chemotherapy====
−
*[[Rituximab (Rituxan)]] 375 mg/m2 IV once on day 1
+
*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once on day 1
−
*[[Gemcitabine (Gemzar)]] 1000 mg/m2 IV once per day on days 1 & 8
+
*[[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 cycle x up to 3 cycles'''
+
'''21-day cycle for up to 3 cycles'''
  
 
===References===
 
===References===

Revision as of 18:28, 1 July 2016

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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.

11 regimens on this page
11 variants on this page


Untreated

DA-R-EPOCH

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DA-R-EPOCH: Dose Adjusted Rituximab, Etoposide, Prednisone, Oncovin (vincristine), Cyclophosphamide, Hydroxydaunorubicin (doxorubicin)

Regimen

Study Evidence
Dunleavy et al. 2013 Phase II
Purroy et al. 2014 Phase II

Chemotherapy

Supportive medications

  • Filgrastim (Neupogen) 300 mcg SQ once per day, starting on day 6 and continuing until ANC >5,000/uL past nadir
  • Trimethoprim/Sulfamethoxazole (Bactrim DS) 160/800 mg (or equivalent if allergic) PO once per day on 3 days per week
    • Note: It's assumed this is what the supplement for Dunleavy et al. 2013 meant by "Baxtrim (sulphametoxazole and trimethoprim)"
  • Omeprazole (Prilosec) 20 mg (or equivalent) PO once per day
  • Docusate (Colace) (dose not specified) and Sennosides (Senna) 2 tablets PO BID as needed for constipation
  • Lactulose 20 g PO Q6H as needed for constipation
  • Hepatitis B surface antigen positive patients received daily antiviral therapy until 8 weeks after completion of chemotherapy

21-day cycle for 6 to 8 cycles

Dose adjustments

  • Start cycle 1 as described above.
  • Obtain CBCs twice per week for nadir measurements.
  • If nadir ANC >500, increase etoposide, doxorubicin, and cyclophosphamide by one level (20%) compared to previous cycle.
  • If nadir ANC <500, use same doses as last cycle.
  • If nadir platelet count <25,000, decrease etoposide, doxorubicin, and cyclophosphamide by 20% compared to the previous cycle.

References

  1. Dunleavy K, Pittaluga S, Maeda LS, Advani R, Chen CC, Hessler J, Steinberg SM, Grant C, Wright G, Varma G, Staudt LM, Jaffe ES, Wilson WH. Dose-adjusted EPOCH-rituximab therapy in primary mediastinal B-cell lymphoma. N Engl J Med. 2013 Apr 11;368(15):1408-16. link to original article link to supplementary appendix contains verified protocol PubMed
  2. Purroy N, Bergua J, Gallur L, Prieto J, Lopez LA, Sancho JM, García-Marco JA, Castellví J, Montes-Moreno S, Batlle A, de Villambrosia SG, Carnicero F, Ferrando-Lamana L, Piris MA, Lopez A. Long-term follow-up of dose-adjusted EPOCH plus rituximab (DA-EPOCH-R) in untreated patients with poor prognosis large B-cell lymphoma. A phase II study conducted by the Spanish PETHEMA Group. Br J Haematol. 2015 Apr;169(2):188-98. Epub 2014 Dec 18. link to original article PubMed

R-CHOP

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

Synonyms: R-CHOP-21, CHOP-R

Structured Concept: C9760 (NCI-T), C0393023 (NCI-MT/UMLS)

Regimen

Study Evidence Comparator Efficacy
Pfreundschuh et al. 2006 (MInT) Phase III CHOP Seems to have superior EFS

Chemotherapy

Supportive medications

21-day cycle for 6 cycles

References

  1. Rieger M, Osterborg A, Pettengell R, White D, Gill D, Walewski J, Kuhnt E, Loeffler M, Pfreundschuh M, Ho AD; MabThera International Trial (MInT) Group. Primary mediastinal B-cell lymphoma treated with CHOP-like chemotherapy with or without rituximab: results of the Mabthera International Trial Group study. Ann Oncol. 2011 Mar;22(3):664-70. Epub 2010 Aug 19. link to original article refers to protocol in PMID 16648042 PubMed

Relapsed/Refractory

Brentuximab vedotin (Adcetris)

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Regimen

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

This regimen was evaluated in patients with CD30+ non-Hodgkin lymphoma, as determined by immunohistochemistry.

Chemotherapy

21-day cycles, given until progression or unacceptable toxicity

References

  1. Abstract: Nancy L. Bartlett, MD, Jeff P. Sharman, MD, Yasuhiro Oki, MD, Ranjana H. Advani, MD, Celeste M. Bello, MD, Jane N. Winter, MD, Yin Yang, MS, Dana A. Kennedy, PharmD and Eric D. Jacobsen, MD. A Phase 2 Study Of Brentuximab Vedotin In Patients With Relapsed Or Refractory CD30-Positive Non-Hodgkin Lymphomas: Interim Results In Patients With DLBCL and Other B-Cell Lymphomas. ASH Abstract 848. link to abstract

R-DHAP

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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, <20 in this subgroup R-GDP

Chemotherapy

21-day cycle for 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

R-GDP

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

Regimen

Study Evidence Comparator
Crump et al. 2014 (NCIC-CTG LY.12) Phase III, <20 in this subgroup R-DHAP

Chemotherapy

21-day cycle for 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
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