Difference between revisions of "T-cell lymphoma"

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'''Use of this site is subject to you reading and agreeing with the terms set forth in the [[HemOnc.org_-_A_Hematology_Oncology_Wiki:General_disclaimer|disclaimer]].'''
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='''T-cell lymphoma regimens have been moved to their histology-specific subtype pages. Please use the links below and/or update your bookmarks.'''=
  
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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 [[How_to_contribute|invited to contribute to the site]].
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==[[Anaplastic large cell lymphoma|Anaplastic large cell lymphoma (ALCL)]]==
  
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{{TOC limit|limit=3}}
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==[[Cutaneous T-cell lymphoma|Cutaneous T-cell lymphoma (CTCL)]]==
  
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=Extranodal NK/T-cell lymphoma, nasal type=
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==[[Extranodal NK- and T-cell lymphoma, nasal type]]==
  
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==AspaMetDex==
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==[[NK- and T-cell lymphoma]]==
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AspaMetDex: '''<u>Aspa</u>'''raginase, '''<u>Met</u>'''hotrexate, '''<u>Dex</u>'''amethasone
 
  
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===Regimen, Jaccard, et al. 2011===
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==[[Peripheral T-cell lymphoma|Peripheral T-cell Lymphoma (PTCL)]]==
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Level of Evidence:
 
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<span
 
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style="background:#EEEE00;
 
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padding:3px 6px 3px 6px;
 
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border-color:black;
 
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border-width:2px;
 
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border-style:solid;">Phase II</span>
 
  
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*[[Asparaginase (Elspar)]] 6000 units/m2 IM once per day on days 2, 4, 6, 8
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[[Category:Obsolete pages]]
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**Patients who had allergies to Asparaginase (Elspar) received [[Asparaginase Erwinia chrysanthemi (Erwinaze)]] 20,000 units/m2 IM once per day on days 2, 4, 6, 8
 
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*[[Methotrexate (MTX)]] 3000 mg/m2 (route not specified) once on day 1
 
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**Patients >70 years old received [[Methotrexate (MTX)]] 2000 mg/m2 (route not specified) once on day 1
 
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*[[Dexamethasone (Decadron)]] 40 mg PO once per day on days 1 to 4
 
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**Patients >70 years old received [[Dexamethasone (Decadron)]] 20 mg PO once per day on days 1 to 4
 
−
 
 
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'''21-day cycles x 3 cycles'''; see Jaccard, et al. 2011 for details about further treatment
 
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Supportive medications:
 
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*[[Trimethoprim/Sulfamethoxazole (Bactrim DS)]] (dose/route/schedule not specified) prophylaxis, discontinued during methotrexate administration
 
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*[[Valacyclovir (Valtrex)]] (dose/route/schedule not specified) prophylaxis
 
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*For methotrexate: alkaline hydration and [[Folinic acid (Leucovorin)]] rescue (dose/route/schedule not specified)
 
−
 
 
−
===References===
 
−
# Jaccard A, Gachard N, Marin B, Rogez S, Audrain M, Suarez F, Tilly H, Morschhauser F, Thieblemont C, Ysebaert L, Devidas A, Petit B, de Leval L, Gaulard P, Feuillard J, Bordessoule D, Hermine O; GELA and GOELAMS Intergroup. Efficacy of L-asparaginase with methotrexate and dexamethasone (AspaMetDex regimen) in patients with refractory or relapsing extranodal NK/T-cell lymphoma,  a phase 2 study. Blood. 2011 Feb 10;117(6):1834-9. [http://bloodjournal.hematologylibrary.org/content/117/6/1834.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/21123825 PubMed]
 
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==Cisplatin & Concurrent RT -> VIPD==
 
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VIPD: '''<u>V</u>'''P-16, '''<u>I</u>'''fosfamide, '''<u>P</u>'''latinol, '''<u>D</u>'''examethasone
 
−
 
 
−
===Regimen, Kim et al. 2009===
 
−
Level of Evidence:
 
−
<span
 
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style="background:#EEEE00;
 
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padding:3px 6px 3px 6px;
 
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border-color:black;
 
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border-width:2px;
 
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border-style:solid;">Phase II</span>
 
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====Chemoradiation====
 
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*[[Cisplatin (Platinol)]] 30 mg/m2 IV once per week
 
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*Concurrent radiation therapy to the primary tumor, 1.8 to 2 Gy fractions (median total dose: 40 Gy), given 5 times per week.
 
−
 
 
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====Chemotherapy====
 
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''Chemotherapy starts 3 to 5 weeks after the last dose of cisplatin''
 
−
*[[Etoposide (Vepesid)]] 100 mg/m2 IV over 90 minutes once per day on days 1 to 3
 
−
*[[Ifosfamide (Ifex)]] 1200 mg/m2 IV over 1 hour once per day on days 1 to 3
 
−
*[[Mesna (Mesnex)]] 240 mg/m2 IV over 15 minutes once per day on days 1 to 3
 
−
*[[Cisplatin (Platinol)]] 33 mg/m2 IV over 1 hour once per day on days 1 to 3
 
−
*[[Dexamethasone (Decadron)]] 40 mg PO/IV once per day on days 1 to 4
 
−
 
 
−
'''21-day cycles x up to 3 cycles'''
 
−
 
 
−
Supportive medications:
 
−
*[[Filgrastim (Neupogen)|G-CSF]] given for grade 3 or 4 neutropenia
 
−
 
 
−
===References===
 
−
# Kim SJ, Kim K, Kim BS, Kim CY, Suh C, Huh J, Lee SW, Kim JS, Cho J, Lee GW, Kang KM, Eom HS, Pyo HR, Ahn YC, Ko YH, Kim WS. Phase II trial of concurrent radiation and weekly cisplatin followed by VIPD chemotherapy in newly diagnosed,  stage IE to IIE, nasal, extranodal NK/T-Cell Lymphoma: Consortium for Improving Survival of Lymphoma study. J Clin Oncol. 2009 Dec 10;27(35):6027-32. [http://jco.ascopubs.org/content/27/35/6027.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/19884539 PubMed]
 
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==DeVIC & Concurrent RT==
 
−
DeVIC: '''<u>De</u>'''xamethasone, '''<u>V</u>'''P-16, '''<u>I</u>'''fosfamide, '''<u>C</u>'''arboplatin
 
−
 
 
−
===Regimen, Yamaguchi et al. 2009 (JCOG0211)===
 
−
Level of Evidence:
 
−
<span
 
−
style="background:#EEEE00;
 
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padding:3px 6px 3px 6px;
 
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border-color:black;
 
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border-width:2px;
 
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border-style:solid;">Phase II</span>
 
−
 
 
−
====Dose Level I====
 
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*[[Dexamethasone (Decadron)]] 40 mg IV once per day on days 1 to 3
 
−
*[[Etoposide (Vepesid)]] 67 mg/m2 IV over 2 hours once per day on days 1 to 3
 
−
*[[Ifosfamide (Ifex)]] 1000 mg/m2 IV over 3 hours once per day on days 1 to 3
 
−
*[[Carboplatin (Paraplatin)]] 200 mg/m2 IV over 30 minutes once on day 1
 
−
 
 
−
====Dose Level II====
 
−
*[[Dexamethasone (Decadron)]] 40 mg IV once per day on days 1 to 3
 
−
*[[Etoposide (Vepesid)]] 100 mg/m2 IV over 2 hours once per day on days 1 to 3
 
−
*[[Ifosfamide (Ifex)]] 1500 mg/m2 IV over 3 hours once per day on days 1 to 3
 
−
*[[Carboplatin (Paraplatin)]] 300 mg/m2 IV over 30 minutes once on day 1
 
−
 
 
−
'''21-day cycles x 3 cycles'''
 
−
 
 
−
Supportive medications:
 
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*[[Filgrastim (Neupogen)]] (dose/route/schedule not specified) started for leukocyte count <2,000/μL or ANC <1,000/μL; discontinued if leukocyte count >5,000/μL.
 
−
 
 
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====Concurrent radiation therapy====
 
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''Started simultaneously with the beginning of cycle 1 of chemotherapy''
 
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*Stage IE disease: Concurrent radiation therapy, 2 Gy fractions x 25 fractions (total dose: 50 Gy) over 5 weeks
 
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*Stage IIE disease: Concurrent radiation therapy, 1.8 Gy fractions x 28 fractions (total dose: 50.4 Gy) over 6 weeks
 
−
 
 
−
===References===
 
−
# Yamaguchi M, Tobinai K, Oguchi M, Ishizuka N, Kobayashi Y, Isobe Y, Ishizawa K, Maseki N, Itoh K, Usui N, Wasada I, Kinoshita T, Ohshima K, Matsuno Y, Terauchi T, Nawano S, Ishikura S, Kagami Y, Hotta T, Oshimi K. Phase I/II study of concurrent chemoradiotherapy for localized nasal natural killer/T-cell lymphoma: Japan Clinical Oncology Group Study JCOG0211. J Clin Oncol. 2009 Nov 20;27(33):5594-600. [http://jco.ascopubs.org/content/27/33/5594.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/19805668 PubMed]
 
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# '''Update:''' Yamaguchi M, Tobinai K, Oguchi M, Ishizuka N, Kobayashi Y, Isobe Y, Ishizawa K, Maseki N, Itoh K, Usui N, Wasada I, Kinoshita T, Hotta T, Tsukasaki K, Oshimi K. Concurrent chemoradiotherapy for localized nasal natural killer/T-cell lymphoma: an updated analysis of the Japan clinical oncology group study JCOG0211. J Clin Oncol. 2012 Nov 10;30(32):4044-6. doi: 10.1200/JCO.2012.45.6541. Epub 2012 Oct 8. [http://jco.ascopubs.org/content/30/32/4044.2.long link to original article] [http://www.ncbi.nlm.nih.gov/pubmed/23045573 PubMed]
 
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==GELOX==
 
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GELOX: '''<u>G</u>'''emcitabine, '''<u>L</u>'''-asparaginase, '''<u>O</u>'''xaliplatin
 
−
 
 
−
===Regimen===
 
−
Level of Evidence:
 
−
<span
 
−
style="background:#EEEE00;
 
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padding:3px 6px 3px 6px;
 
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border-color:black;
 
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border-width:2px;
 
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border-style:solid;">Phase II</span>
 
−
 
 
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*[[Gemcitabine (Gemzar)]] 1000 mg/m2 IV once per day on days 1 & 8
 
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*[[Asparaginase (Elspar)]] 6000 units/m2 IV once per day on days 1 to 7
 
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*[[Oxaliplatin (Eloxatin)]] 130 mg/m2 once on day 1
 
−
 
 
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'''3-weeks cycles for at least 2 cycles, then:'''
 
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*Involved field radiation to 56 grays (Gy) in 28 fractions, 5 fractions per week
 
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'''Followed by more chemotherapy within one week of radiation completion, up to 6 total cycles'''
 
−
 
 
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===References===
 
−
# Wang L, Wang ZH, Chen XQ, Li YJ, Wang KF, Xia YF, Xia ZJ. First-line combination of gemcitabine, oxaliplatin, and L-asparaginase (GELOX) followed by involved-field radiation therapy for patients with stage IE/IIE extranodal natural killer/T-cell lymphoma. Cancer. 2013 Jan 15;119(2):348-55. doi:10.1002/cncr.27752. Epub 2012 Jul 18. [http://onlinelibrary.wiley.com/doi/10.1002/cncr.27752/full link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/22811078 PubMed]
 
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==LVP==
 
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LVP: '''<u>L</u>'''-asparaginase, '''<u>V</u>'''incristine, '''<u>P</u>'''rednisolone
 
−
 
 
−
===Regimen===
 
−
Level of Evidence:
 
−
<span
 
−
style="background:#ff0000;
 
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padding:3px 6px 3px 6px;
 
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border-color:black;
 
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border-width:2px;
 
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border-style:solid;">Phase II, <20 patients reported</span>
 
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''Regimen details are from a review article; original article is not available through PubMed''
 
−
 
 
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*[[Asparaginase (Elspar)]] 6000 units/m2 IV once per day on days 1 to 5
 
−
*[[Vincristine (Oncovin)]] 1.4 mg/m2 IV once on day 1
 
−
*[[Prednisolone (Millipred)]] 100 mg PO once per day on days to 5
 
−
 
 
−
===References===
 
−
# Yong W, Zheng W, Zhang Y, Zhu J, Wei Y, Zhu D, Li J. L-asparaginase-based regimen in the treatment of refractory midline nasal/nasal-type T/NK-cell lymphoma. Int J Hematol. 2003 Aug;78(2):163-7. [http://www.ncbi.nlm.nih.gov/pubmed/12953813 PubMed]
 
−
 
 
−
==LVP "Sandwich"==
 
−
LVP: '''<u>L</u>'''-asparaginase, '''<u>V</u>'''incristine, '''<u>P</u>'''rednisolone
 
−
 
 
−
===Regimen===
 
−
Level of Evidence:
 
−
<span
 
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
−
 
 
−
*[[Asparaginase (Elspar)]] 6000 units/m2 IV once per day on days 1 to 5
 
−
*[[Vincristine (Oncovin)]] 1.4 mg/m2 IV once on day 1
 
−
*[[Prednisolone (Millipred)]] 100 mg PO once per day on days to 5
 
−
 
 
−
'''3-week cycles x 2 cycles, then'''
 
−
 
 
−
*Radiation to the nasal cavity and surrounding sinuses, 56 Gy in 28 fractions, once per day, five days per week
 
−
 
 
−
'''Resume chemotherapy one week after completion of radiation, up to 6 total cycles'''
 
−
 
 
−
===References===
 
−
# Jiang M, Zhang H, Jiang Y, Yang Q, Xie L, Liu W, Zhang W, Ji X, Li P, Chen N, Zhao S, Wang F, Zou L. Phase 2 trial of "sandwich" L-asparaginase, vincristine, and prednisone chemotherapy with radiotherapy in newly diagnosed, stage IE to IIE, nasal type, extranodal natural killer/T-cell lymphoma. Cancer. 2012 Jul 1;118(13):3294-301. doi: 10.1002/cncr.26629. Epub 2011 Dec 2. [http://onlinelibrary.wiley.com/doi/10.1002/cncr.26629/full link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/22139825 PubMed]
 
−
 
 
−
==SMILE==
 
−
SMILE: '''<u>S</u>'''teroid (dexamethasone), '''<u>M</u>'''ethotrexate, '''<u>I</u>'''fosfamide, '''<u>L</u>'''-asparaginase, '''<u>E</u>'''toposide
 
−
 
 
−
===Regimen===
 
−
Level of Evidence:
 
−
<span
 
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
−
 
 
−
*[[Dexamethasone (Decadron)]] 40 mg PO/IV once per day on days 2 to 4
 
−
*[[Methotrexate (MTX)]] 2000 mg/m2 IV over 6 hours once on day 1
 
−
*[[Folinic acid (Leucovorin)]] 15 mg PO/IV Q6H x 4 doses per day on days 2 to 4, beginning 30 hours after completion of methotrexate
 
−
*[[Ifosfamide (Ifex)]] 1500 mg/m2 IV once per day on days 2 to 4
 
−
*[[Mesna (Mesnex)]] 300 mg/m2 IV three times per day on days 2 to 4; first dose given together with ifosfamide, second dose given at 4 hours after start of ifosfamide, and third dose given 8 hours after start of ifosfamide
 
−
*[[Asparaginase (Elspar)]] 6000 units/m2 IV once per day on days 8, 10, 12, 14, 16, 18, 20
 
−
*[[Etoposide (Vepesid)]] 100 mg/m2 IV once per day on days 2 to 4
 
−
 
 
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'''28-day cycles x 2 cycles'''; after 2 cycles, patients could receive additional treatment with SMILE and/or other chemotherapy, with or without autologous/allogeneic stem cell transplant.
 
−
 
 
−
Supportive medications:
 
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*[[Filgrastim (Neupogen)]] (dose not specified) SC/IV once per day starting on day 6, given until WBC >5 x 10<sup>9</sup>/L
 
−
*[[Trimethoprim/Sulfamethoxazole (Bactrim DS)]] prophylaxis recommended
 
−
 
 
−
===References===
 
−
# Yamaguchi M, Suzuki R, Kwong YL, Kim WS, Hasegawa Y, Izutsu K, Suzumiya J, Okamura T, Nakamura S, Kawa K, Oshimi K. Phase I study of dexamethasone, methotrexate, ifosfamide, L-asparaginase, and etoposide (SMILE) chemotherapy for advanced-stage, relapsed or refractory extranodal natural killer (NK)/T-cell lymphoma and leukemia. Cancer Sci. 2008 May;99(5):1016-20. doi:10.1111/j.1349-7006.2008.00768.x. Epub 2008 Feb 19. [http://onlinelibrary.wiley.com/doi/10.1111/j.1349-7006.2008.00768.x/full link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/18294294 PubMed] content property of [http://hemonc.org HemOnc.org]
 
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# Yamaguchi M, Kwong YL, Kim WS, Maeda Y, Hashimoto C, Suh C, Izutsu K, Ishida F, Isobe Y, Sueoka E, Suzumiya J, Kodama T, Kimura H, Hyo R, Nakamura S, Oshimi K, Suzuki R. Phase II study of SMILE chemotherapy for newly diagnosed stage IV, relapsed, or refractory extranodal natural killer (NK)/T-cell lymphoma, nasal type: the NK-Cell Tumor Study Group study. J Clin Oncol. 2011 Nov 20;29(33):4410-6. doi: 10.1200/JCO.2011.35.6287. Epub 2011 Oct 11. [http://jco.ascopubs.org/content/29/33/4410.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/21990393 PubMed]
 
−
 
 
−
=NK/T-cell lymphoma, untreated=
 
−
 
 
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==SMILE==
 
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SMILE: '''<u>S</u>'''teroid (dexamethasone), '''<u>M</u>'''ethotrexate, '''<u>I</u>'''fosfamide, '''<u>L</u>'''-asparaginase, '''<u>E</u>'''toposide
 
−
 
 
−
===Regimen===
 
−
Level of Evidence:
 
−
<span
 
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
−
 
 
−
*[[Dexamethasone (Decadron)]] 40 mg PO once per day on days 2 to 4
 
−
*[[Methotrexate (MTX)]] 2000 mg/m2 in 500 mL normal saline IV over 6 hours once on day 1
 
−
**Methotrexate levels checked at 24, 48, and 72 hours after methotrexate is given, or until methotrexate levels fall below toxic range.  Folinic acid should be continued until methotrexate levels are below toxic range.
 
−
*[[Folinic acid (Leucovorin)]] 45 mg PO Q6H x 4 doses per day on days 2 to 4 (or until methotrexate is below the toxic range), starting 24 hours after completion of methotrexate
 
−
*[[Ifosfamide (Ifex)]] 1500 mg/m2 in 1 liter normal saline IV over 6 hours once per day on days 2 to 4, given together with mesna
 
−
*[[Mesna (Mesnex)]] 900 mg/m2 IV over 6 hours once per day on days 2 to 4, given together with ifosfamide
 
−
*[[Asparaginase (Elspar)]] 6000 units/m2 in 250 mL normal saline IV over 2 hours once per day on days 8, 10, 12, 14, 16, 18, 20
 
−
**Skin test done for asparaginase before each dose; [[Asparaginase Erwinia chrysanthemi (Erwinaze)]] used for patients who developed sensitivity to L-asparaginase from E. coli
 
−
*[[Etoposide (Vepesid)]] 100 mg/m2 in 500 mL normal saline IV over 2 hours once per day on days 2 to 4
 
−
 
 
−
'''up to 6 cycles given'''; paper and supplement did not specify the length of each cycle, but other SMILE regimens, e.g. Yamaguchi, et al. 2011 above, describe 28-day cycles
 
−
 
 
−
Supportive medications:
 
−
*Hydration with normal saline (no volume specified) Q8H x 1 day prior to methotrexate
 
−
*Patients told to drink at least 2 liters of fluid per day on days 1 to 4; target urine output of ≥3 liters per day on days 1 to 4
 
−
*[[Filgrastim (Neupogen)]] 300 mcg SC once per day, starting on day 6, given until ANC >1 x 10<sup>9</sup>/L
 
−
*[[Trimethoprim/Sulfamethoxazole (Bactrim DS)|Cotrimoxazole]] or [[Pentamidine (Nebupent)]] for PJP prophylaxis
 
−
*Famotidine (Pepcid) and potassium slow release tablets (no dose specified) "for dexamethasone" on days 2 to 4
 
−
*Chlorpheniramine (note: was spelled in the protocol as "chlorphenarime") 10 mg PO once prior to L-asparaginase infusions on days 8, 10, 12, 14, 16, 18, 20
 
−
*Hydrocortisone (Cortef) 100 mg IV once prior to L-asparaginase infusions on days 8, 10, 12, 14, 16, 18, 20
 
−
 
 
−
===References===
 
−
# Kwong YL, Kim WS, Lim ST, Kim SJ, Tang T, Tse E, Leung AY, Chim CS. SMILE for natural killer/T-cell lymphoma: analysis of safety and efficacy from the Asia Lymphoma Study Group. Blood. 2012 Oct 11;120(15):2973-80. doi:10.1182/blood-2012-05-431460. Epub 2012 Aug 23. [http://bloodjournal.hematologylibrary.org/content/120/15/2973.long link to original article] [http://bloodjournal.hematologylibrary.org/content/120/15/2973/suppl/DC1 supplemental materials] '''supplemental materials contain verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/22919026 PubMed]
 
−
 
 
−
=NK/T-cell lymphoma, relapsed/refractory=
 
−
 
 
−
==SMILE==
 
−
SMILE: '''<u>S</u>'''teroid (dexamethasone), '''<u>M</u>'''ethotrexate, '''<u>I</u>'''fosfamide, '''<u>L</u>'''-asparaginase, '''<u>E</u>'''toposide
 
−
 
 
−
===Regimen===
 
−
Level of Evidence:
 
−
<span
 
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
−
 
 
−
*[[Dexamethasone (Decadron)]] 40 mg PO once per day on days 2 to 4
 
−
*[[Methotrexate (MTX)]] 2000 mg/m2 in 500 mL normal saline IV over 6 hours once on day 1
 
−
**Methotrexate levels checked at 24, 48, and 72 hours after methotrexate is given, or until methotrexate levels fall below toxic range.  Folinic acid should be continued until methotrexate levels are below toxic range.
 
−
*[[Folinic acid (Leucovorin)]] 45 mg PO Q6H x 4 doses per day on days 2 to 4 (or until methotrexate is below the toxic range), starting 24 hours after completion of methotrexate
 
−
*[[Ifosfamide (Ifex)]] 1500 mg/m2 in 1 liter normal saline IV over 6 hours once per day on days 2 to 4, given together with mesna
 
−
*[[Mesna (Mesnex)]] 900 mg/m2 IV over 6 hours once per day on days 2 to 4, given together with ifosfamide
 
−
*[[Asparaginase (Elspar)]] 6000 units/m2 in 250 mL normal saline IV over 2 hours once per day on days 8, 10, 12, 14, 16, 18, 20
 
−
**Skin test done for asparaginase before each dose; [[Asparaginase Erwinia chrysanthemi (Erwinaze)]] used for patients who developed sensitivity to L-asparaginase from E. coli
 
−
*[[Etoposide (Vepesid)]] 100 mg/m2 in 500 mL normal saline IV over 2 hours once per day on days 2 to 4
 
−
 
 
−
'''up to 6 cycles given'''; paper and supplement did not specify the length of each cycle, but other SMILE regimens, e.g. Yamaguchi, et al. 2011 above, describe 28-day cycles
 
−
 
 
−
Supportive medications:
 
−
*Hydration with normal saline (no volume specified) Q8H x 1 day prior to methotrexate
 
−
*Patients told to drink at least 2 liters of fluid per day on days 1 to 4; target urine output of ≥3 liters per day on days 1 to 4
 
−
*[[Filgrastim (Neupogen)]] 300 mcg SC once per day, starting on day 6, given until ANC >1 x 10<sup>9</sup>/L
 
−
*[[Trimethoprim/Sulfamethoxazole (Bactrim DS)|Cotrimoxazole]] or [[Pentamidine (Nebupent)]] for PJP prophylaxis
 
−
*Famotidine (Pepcid) and potassium slow release tablets (no dose specified) "for dexamethasone" on days 2 to 4
 
−
*Chlorpheniramine (note: was spelled in the protocol as "chlorphenarime") 10 mg PO once prior to L-asparaginase infusions on days 8, 10, 12, 14, 16, 18, 20
 
−
*Hydrocortisone (Cortef) 100 mg IV once prior to L-asparaginase infusions on days 8, 10, 12, 14, 16, 18, 20
 
−
 
 
−
===References===
 
−
# Kwong YL, Kim WS, Lim ST, Kim SJ, Tang T, Tse E, Leung AY, Chim CS. SMILE for natural killer/T-cell lymphoma: analysis of safety and efficacy from the Asia Lymphoma Study Group. Blood. 2012 Oct 11;120(15):2973-80. doi:10.1182/blood-2012-05-431460. Epub 2012 Aug 23. [http://bloodjournal.hematologylibrary.org/content/120/15/2973.long link to original article] [http://bloodjournal.hematologylibrary.org/content/120/15/2973/suppl/DC1 supplemental materials] '''supplemental materials contain verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/22919026 PubMed]
 
−
 
 
−
=Peripheral T-cell Lymphoma (PTCL)=
 
−
 
 
−
==Bendamustine (Treanda)==
 
−
 
 
−
===Regimen, Demaj, et al. 2013 (BENTLY)===
 
−
Level of Evidence:
 
−
<span
 
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
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−
border-style:solid;">Phase II</span>
 
−
 
 
−
*[[Bendamustine (Treanda)]] 120 mg/m2 IV once per day over 30 to 60 minutes on days 1 & 2
 
−
 
 
−
'''3-week cycles x 6 cycles'''
 
−
 
 
−
===References===
 
−
# Damaj G, Gressin R, Bouabdallah K, Cartron G, Choufi B, Gyan E, Banos A, Jaccard A, Park S, Tournilhac O, Schiano-de Collela JM, Voillat L, Joly B, Le Gouill S, Saad A, Cony-Makhoul P, Vilque JP, Sanhes L, Schmidt-Tanguy A, Bubenheim M, Houot R, Diouf M, Marolleau JP, Béné MC, Martin A, Lamy T. Results from a prospective, open-label, phase II trial of bendamustine in refractory or relapsed T-cell lymphomas: the BENTLY trial. J Clin Oncol. 2013 Jan 1;31(1):104-10. doi: 10.1200/JCO.2012.43.7285. Epub 2012 Oct 29. [http://jco.ascopubs.org/content/31/1/104.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/23109692 PubMed]
 
−
 
 
−
==Lenalidomide (Revlimid)==
 
−
 
 
−
===Regimen, Morschhauser, et al. 2013 (EXPECT)===
 
−
Level of Evidence:
 
−
<span
 
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
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−
border-style:solid;">Phase II</span>
 
−
 
 
−
*[[Lenalidomide (Revlimid)]] 25 mg PO per day on days 1 to 21
 
−
 
 
−
'''28-day cycles, up to 2 years'''
 
−
 
 
−
===References===
 
−
# Morschhauser F, Fitoussi O, Haioun C, Thieblemont C, Quach H, Delarue R, Glaisner S, Gabarre J, Bosly A, Lister J, Li J, Coiffier B. A phase 2, multicentre, single-arm, open-label study to evaluate the safety and efficacy of single-agent lenalidomide (Revlimid®) in subjects with relapsed or refractory peripheral T-cell non-Hodgkin lymphoma: The EXPECT trial. Eur J Cancer. 2013 May 31. doi:pii: S0959-8049(13)00363-8. 10.1016/j.ejca.2013.04.029. [Epub ahead of print] [http://www.ejcancer.com/article/S0959-8049%2813%2900363-8/fulltext link to original article] '''contains protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/23731832 PubMed]
 
−
 
 
−
==Pralatrexate (Folotyn)==
 
−
 
 
−
===Example orders===
 
−
*[[Example orders for Pralatrexate (Folotyn) in peripheral T-cell lymphoma]]
 
−
 
 
−
===Regimen, O'Connor, et al. 2011 (PROPEL)===
 
−
Level of Evidence:
 
−
<span
 
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
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−
border-style:solid;">Phase II</span>
 
−
 
 
−
*[[Pralatrexate (Folotyn)]] 30 mg/m2 IV push over 3 to 5 minutes once per day on days 1, 8, 15, 22, 29, 36
 
−
 
 
−
'''7-week cycles,  given until progression of disease, unacceptable toxicity, or patient/physician preference'''
 
−
 
 
−
Supportive medications:
 
−
*[[Cyanocobalamin (Vitamin B12)]] 1 mg IM once every 8 to 10 weeks
 
−
*Folic acid 1 to 1.25 mg PO once per day
 
−
*"Elevated methylmalonic acid (>200 nmol/L) and/or homocysteine (>10 μmol/L) at screening required initiation of vitamins ≥ 10 days before the first dose of pralatrexate."
 
−
 
 
−
===References===
 
−
# O'Connor OA, Pro B, Pinter-Brown L, Bartlett N, Popplewell L, Coiffier B, Lechowicz MJ, Savage KJ, Shustov AR, Gisselbrecht C, Jacobsen E, Zinzani PL, Furman R, Goy A, Haioun C, Crump M, Zain JM, Hsi E, Boyd A, Horwitz S. Pralatrexate in patients with relapsed or refractory peripheral T-cell lymphoma: results from the pivotal PROPEL study. J Clin Oncol. 2011 Mar 20;29(9):1182-9. [http://jco.ascopubs.org/content/29/9/1182.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/21245435 PubMed]
 
−
 
 
−
==Romidepsin (Istodax)==
 
−
 
 
−
===Regimen, Coiffier, et al. 2012===
 
−
Level of Evidence:
 
−
<span
 
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
−
 
 
−
*[[Romidepsin (Istodax)]] 14 mg/m2 IV over 4 hours once per day on days 1, 8, 15
 
−
 
 
−
'''28-day cycles, up to 6 cycles, with optional extension of treatment for patients with stable disease or response'''
 
−
 
 
−
===References===
 
−
# Coiffier B, Pro B, Prince HM, Foss F, Sokol L, Greenwood M, Caballero D, Borchmann P, Morschhauser F, Wilhelm M, Pinter-Brown L, Padmanabhan S, Shustov A, Nichols J, Carroll S, Balser J, Balser B, Horwitz S. Results from a pivotal, open-label, phase II study of romidepsin in relapsed or refractory peripheral T-cell lymphoma after prior systemic therapy. J Clin Oncol. 2012 Feb 20;30(6):631-6. doi: 10.1200/JCO.2011.37.4223. Epub 2012 Jan 23. [http://jco.ascopubs.org/content/30/6/631.full link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/22271479 PubMed]
 
−
 
 
−
=Cutaneous T-cell Lymphoma (CTCL), relapsed/refractory=
 
−
 
 
−
==Bendamustine (Treanda)==
 
−
 
 
−
===Regimen, Demaj, et al. 2013 (BENTLY)===
 
−
Level of Evidence:
 
−
<span
 
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
−
 
 
−
*[[Bendamustine (Treanda)]] 120 mg/m2 IV once per day over 30 to 60 minutes on days 1 & 2
 
−
 
 
−
'''3-week cycles x 6 cycles'''
 
−
 
 
−
===References===
 
−
# Damaj G, Gressin R, Bouabdallah K, Cartron G, Choufi B, Gyan E, Banos A, Jaccard A, Park S, Tournilhac O, Schiano-de Collela JM, Voillat L, Joly B, Le Gouill S, Saad A, Cony-Makhoul P, Vilque JP, Sanhes L, Schmidt-Tanguy A, Bubenheim M, Houot R, Diouf M, Marolleau JP, Béné MC, Martin A, Lamy T. Results from a prospective, open-label, phase II trial of bendamustine in refractory or relapsed T-cell lymphomas: the BENTLY trial. J Clin Oncol. 2013 Jan 1;31(1):104-10. doi: 10.1200/JCO.2012.43.7285. Epub 2012 Oct 29. [http://jco.ascopubs.org/content/31/1/104.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/23109692 PubMed]
 
−
 
 
−
==Denileukin Diftitox (Ontak)==
 
−
 
 
−
===Regimen, Olsen, et al. 2001 & Prince, et al. 2010===
 
−
Level of Evidence:
 
−
<span
 
−
style="background:#00CD00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase III</span>
 
−
 
 
−
''Dose is that which was recommended by Prince, et al. 2010 based on superior response.''
 
−
 
 
−
*[[Denileukin diftitox (Ontak)]] 18 mcg/kg IV over 30 to 60 minutes once per day on days 1 to 5
 
−
**Olsen, et al. 2001 & Prince, et al. 2010 also investigated [[Denileukin diftitox (Ontak)]] 9 mcg/kg IV once per day on days 1 to 5.  Olsen, et al. 2001's [[Denileukin diftitox (Ontak)]] was given over 15 to 60 minutes.
 
−
 
 
−
'''21-day cycles x up to 8 cycles; up to 3 additional cycles allowed in the Olsen, et al. 2001 trial for patients who had ongoing response'''
 
−
 
 
−
Supportive medications:
 
−
*"Premedication with acetaminophen [≤ 650 mg in Olsen, et al. 2001] and an antihistamine was required 30 to 60 minutes before each infusion" and could be used after infusions as needed.
 
−
*Olsen, et al. 2001 used Promethazine (Phenergan) 25 mg or Prochlorperazine (Compazine) 10 mg (route/schedule not specified) as needed for nausea.
 
−
*Corticosteroid use was not allowed.
 
−
 
 
−
===References===
 
−
# Olsen E, Duvic M, Frankel A, Kim Y, Martin A, Vonderheid E, Jegasothy B, Wood G, Gordon M, Heald P, Oseroff A, Pinter-Brown L, Bowen G, Kuzel T, Fivenson D, Foss F, Glode M, Molina A, Knobler E, Stewart S, Cooper K, Stevens S, Craig F, Reuben J, Bacha P, Nichols J. Pivotal phase III trial of two dose levels of denileukin diftitox for the treatment of cutaneous T-cell lymphoma. J Clin Oncol. 2001 Jan 15;19(2):376-88. [http://jco.ascopubs.org/content/19/2/376.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/11208829 PubMed]
 
−
# Prince HM, Duvic M, Martin A, Sterry W, Assaf C, Sun Y, Straus D, Acosta M, Negro-Vilar A. Phase III placebo-controlled trial of denileukin diftitox for patients with cutaneous T-cell lymphoma. J Clin Oncol. 2010 Apr 10;28(11):1870-7. doi: 10.1200/JCO.2009.26.2386. Epub 2010 Mar 8. [http://jco.ascopubs.org/content/28/11/1870.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/20212249 PubMed]
 
−
# Duvic M, Martin AG, Olsen EA, Fivenson DP, Prince HM. Efficacy and safety of denileukin diftitox retreatment in patients with relapsed cutaneous T-cell lymphoma. Leuk Lymphoma. 2013 Mar;54(3):514-9. doi: 10.3109/10428194.2012.720372. Epub 2012 Sep 3. [http://informahealthcare.com/doi/abs/10.3109/10428194.2012.720372 link to original article] [http://www.ncbi.nlm.nih.gov/pubmed/22891708 PubMed]
 
−
 
 
−
==Pralatrexate (Folotyn)==
 
−
 
 
−
===Regimen===
 
−
Level of Evidence:
 
−
<span
 
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
−
 
 
−
''Dose is that identified as recommended based on de-escalation strategy.''
 
−
 
 
−
*[[Pralatrexate (Folotyn)]] 15 mg/m2 IV push once per day on days 1, 8, 15
 
−
 
 
−
'''4-week cycles,  given until progression of disease, unacceptable toxicity, or patient/physician preference'''
 
−
 
 
−
Supportive medications:
 
−
*[[Cyanocobalamin (Vitamin B12)]] 1 mg IM once every 8 to 10 weeks, within 10 weeks of treatment initiation
 
−
*Folic acid 1 mg PO once per day, starting at least 10 days prior to treatment initiation
 
−
 
 
−
===References===
 
−
# Horwitz SM, Kim YH, Foss F, Zain JM, Myskowski PL, Lechowicz MJ, Fisher DC, Shustov AR, Bartlett NL, Delioukina ML, Koutsoukos T, Saunders ME, O'Connor OA, Duvic M. Identification of an active, well-tolerated dose of pralatrexate in patients with relapsed or refractory cutaneous T-cell lymphoma. Blood. 2012 May 3;119(18):4115-22. doi: 10.1182/blood-2011-11-390211. Epub 2012 Mar 6. [http://bloodjournal.hematologylibrary.org/content/119/18/4115.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/22394596 PubMed]
 
−
 
 
−
==Romidepsin (Istodax)==
 
−
Level of Evidence:
 
−
<span
 
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
−
 
 
−
===Regimen, Whittaker, et al. 2010===
 
−
 
 
−
*[[Romidepsin (Istodax)]] 14 mg/m2 IV over 4 hours once per day on days 1, 8, 15
 
−
 
 
−
'''28-day cycles, up to 6 cycles, with optional extension of treatment for patients with stable disease or response'''
 
−
 
 
−
===References===
 
−
# Whittaker SJ, Demierre MF, Kim EJ, Rook AH, Lerner A, Duvic M, Scarisbrick J, Reddy S, Robak T, Becker JC, Samtsov A, McCulloch W, Kim YH. Final results from a multicenter, international, pivotal study of romidepsin in refractory cutaneous T-cell lymphoma. J Clin Oncol. 2010 Oct 10;28(29):4485-91. doi: 10.1200/JCO.2010.28.9066. Epub 2010 Aug 9. [http://jco.ascopubs.org/content/28/29/4485.full link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/20697094 PubMed]
 
−
 
 
−
==Vorinostat (Zolinza)==
 
−
 
 
−
===Regimen, Olsen, et al. 2007===
 
−
Level of Evidence:
 
−
<span
 
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
−
 
 
−
*[[Vorinostat (Zolinza)]] 400 mg PO once per day
 
−
 
 
−
'''Continued on drug until disease progression or intolerable toxicity'''
 
−
 
 
−
===References===
 
−
# Olsen EA, Kim YH, Kuzel TM, Pacheco TR, Foss FM, Parker S, Frankel SR, Chen C, Ricker JL, Arduino JM, Duvic M. Phase IIb multicenter trial of vorinostat in patients with persistent, progressive, or treatment refractory cutaneous T-cell lymphoma. J Clin Oncol. 2007 Jul 20;25(21):3109-15. [http://jco.ascopubs.org/content/25/21/3109.full link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/17577020 PubMed]
 

Latest revision as of 16:50, 23 November 2019

T-cell lymphoma regimens have been moved to their histology-specific subtype pages. Please use the links below and/or update your bookmarks.

Anaplastic large cell lymphoma (ALCL)

Cutaneous T-cell lymphoma (CTCL)

Extranodal NK- and T-cell lymphoma, nasal type

NK- and T-cell lymphoma

Peripheral T-cell Lymphoma (PTCL)

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