Adult T-cell leukemia-lymphoma

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5 regimens on this page 5 variants on this page

Guidelines

NCCN

• NCCN Guidelines - T-cell Lymphomas

Untreated

CHOP-14

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CHOP: Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Oncovin (Vincristine), Prednisone

Synonyms: CHOP-DI, I-CHOP

Structured Concept: none

Regimen

Study	Evidence	Comparator	Efficacy
Tsukasaki et al. 2007 (JCOG 9801)	Phase III	mLSG15	Seems to have inferior CR rate

Chemotherapy

• Cyclophosphamide (Cytoxan) 750 mg/m² IV once on day 1
• Doxorubicin (Adriamycin) 50 mg/m² IV once on day 1
• Vincristine (Oncovin) 1.4 mg/m² (max dose 2 mg) IV once on day 1
• Prednisone (Sterapred) 100 mg PO once per day on days 1 to 5

Supportive medications

• Filgrastim (Neupogen) given once neutrophil count decreased to less than 1 × 10^9/L and continued once per day until count increased to greater than 5 for 10^9/L

14-day cycle for 8 cycles

Intrathecal component

Intrathecal triple-therapy was given during recovery phase of cycles 1, 3, and 5 after platelet count was > 70k.

• Cytarabine (Cytosar) 40 mg IT
• Methotrexate (MTX) 15 mg IT
• Prednisone (Sterapred) 10 mg IT

3 doses, total

References

1. Tsukasaki K, Utsunomiya A, Fukuda H, Shibata T, Fukushima T, Takatsuka Y, Ikeda S, Masuda M, Nagoshi H, Ueda R, Tamura K, Sano M, Momita S, Yamaguchi K, Kawano F, Hanada S, Tobinai K, Shimoyama M, Hotta T, Tomonaga M; Japan Clinical Oncology Group Study JCOG9801. VCAP-AMP-VECP compared with biweekly CHOP for adult T-cell leukemia-lymphoma: Japan Clinical Oncology Group Study JCOG9801. J Clin Oncol. 2007 Dec 1;25(34):5458-64. Epub 2007 Oct 29. link to original article contains verified protocol PubMed

LSG15

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Regimen

Study	Evidence
Yamada et al. 2001 (JCOG 9303)	Phase II

Ranimustine is not available in the United States and is approved only in Japan. This regimen was notable for excess CNS relapses and was subsequently replaced by mLSG15.

Chemotherapy

• Vincristine (Oncovin) 1 mg/m² (maximum dose = 2 mg) IV once on day 1
• Cyclophosphamide (Cytoxan) 350 mg/m² IV once on day 1
• Doxorubicin (Adriamycin) 40 mg/m² IV once on day 1, then 30 mg/m² IV once on day 8
• Prednisone (Sterapred) 40 mg/m² PO once per day on days 1, 8, 15 to 17
• Ranimustine (Cymerin) 60 mg/m² IV once on day 8
• Vindesine (Eldisine) 2.4 mg/m² IV once on day 15
• Etoposide (Vepesid) 100 mg/m² IV once per day on days 15 to 17
• Carboplatin (Paraplatin) 250 mg/m² IV once on day 15

28-day cycle for 7 cycles

References

1. Yamada Y, Tomonaga M, Fukuda H, Hanada S, Utsunomiya A, Tara M, Sano M, Ikeda S, Takatsuki K, Kozuru M, Araki K, Kawano F, Niimi M, Tobinai K, Hotta T, Shimoyama M. A new G-CSF-supported combination chemotherapy, LSG15, for adult T-cell leukaemia-lymphoma: Japan Clinical Oncology Group Study 9303. Br J Haematol. 2001 May;113(2):375-82. link to original article PubMed

mLSG15

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Regimen

Study	Evidence	Comparator	Efficacy
Tsukasaki et al. 2007 (JCOG 9801)	Phase III	CHOP-14	Seems to have superior CR rate
Ishida et al. 2015	Randomized Phase II	mLSG15 & mogamulizumab	Seems not superior

Ranimustine is not available in the United States and is approved only in Japan.

Chemotherapy

• Vincristine (Oncovin) 1 mg/m² (maximum dose = 2 mg) IV once on day 1
• Cyclophosphamide (Cytoxan) 350 mg/m² IV once on day 1
• Doxorubicin (Adriamycin) 40 mg/m² IV once on day 1, then 30 mg/m² IV once on day 8
• Prednisone (Sterapred) 40 mg/m² PO once per day on days 1, 8, 15 to 17
• Ranimustine (Cymerin) 60 mg/m² IV once on day 8
• Vindesine (Eldisine) 2.4 mg/m² IV once on day 15
• Etoposide (Vepesid) 100 mg/m² IV once per day on days 15 to 17
• Carboplatin (Paraplatin) 250 mg/m² IV once on day 15

28-day cycle for 6 cycles

CNS prophylaxis

• Cytarabine (Cytosar) 40 mg mixed with Methotrexate (MTX) 15 mg and Prednisone (Sterapred) 10 mg IT

Given after cycles 1, 3, and 5 after platelets > 70 × 10⁹/L and within 2 days before the next cycle

References

1. Tsukasaki K, Utsunomiya A, Fukuda H, Shibata T, Fukushima T, Takatsuka Y, Ikeda S, Masuda M, Nagoshi H, Ueda R, Tamura K, Sano M, Momita S, Yamaguchi K, Kawano F, Hanada S, Tobinai K, Shimoyama M, Hotta T, Tomonaga M; Japan Clinical Oncology Group Study JCOG9801. VCAP-AMP-VECP compared with biweekly CHOP for adult T-cell leukemia-lymphoma: Japan Clinical Oncology Group Study JCOG9801. J Clin Oncol. 2007 Dec 1;25(34):5458-64. Epub 2007 Oct 29. link to original article contains verified protocol PubMed
2. Ishida T, Jo T, Takemoto S, Suzushima H, Uozumi K, Yamamoto K, Uike N, Saburi Y, Nosaka K, Utsunomiya A, Tobinai K, Fujiwara H, Ishitsuka K, Yoshida S, Taira N, Moriuchi Y, Imada K, Miyamoto T, Akinaga S, Tomonaga M, Ueda R. Dose-intensified chemotherapy alone or in combination with mogamulizumab in newly diagnosed aggressive adult T-cell leukaemia-lymphoma: a randomized phase II study. Br J Haematol. 2015 Jun;169(5):672-82. Epub 2015 Mar 2. link to original article PubMed

Relapsed/Refractory

Alemtuzumab (Campath)

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Regimen

Study	Evidence
Sharma et al. 2016	Phase II

Chemotherapy

• Alemtuzumab (Campath) 30 mg IV TIW (three times per week)

Up to 12-week course

References

1. Sharma K, Janik JE, O'Mahony D, Stewart D, Pittaluga S, Stetler-Stevenson M, Jaffe ES, Raffeld M, Fleisher TA, Lee CC, Steinberg SM, Waldmann TA, Morris JC. Phase II Study of Alemtuzumab (CAMPATH-1) in Patients with HTLV-1-Associated Adult T-cell Leukemia/lymphoma. Clin Cancer Res. 2017 Jan 1;23(1):35-42. Epub 2016 Aug 2. link to original article contain protocol PubMed

Lenalidomide (Revlimid)

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Regimen

Study	Evidence
Ishida et al. 2016 (ATLL-002)	Phase II

Chemotherapy

• Lenalidomide (Revlimid) 25 mg PO once per day

Continued until progression

References

1. Ishida T, Fujiwara H, Nosaka K, Taira N, Abe Y, Imaizumi Y, Moriuchi Y, Jo T, Ishizawa K, Tobinai K, Tsukasaki K, Ito S, Yoshimitsu M, Otsuka M, Ogura M, Midorikawa S, Ruiz W, Ohtsu T. Multicenter Phase II Study of Lenalidomide in Relapsed or Recurrent Adult T-Cell Leukemia/Lymphoma: ATLL-002. J Clin Oncol. 2016 Dec;34(34):4086-4093. link to original article PubMed