Difference between revisions of "T-cell lymphoma"

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=[[Cutaneous T-cell lymphoma|Cutaneous T-cell lymphoma (CTCL)]]=
 
=[[Cutaneous T-cell lymphoma|Cutaneous T-cell lymphoma (CTCL)]]=
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==Relapsed/refractory==
 
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===Belinostat (Beleodaq)===
 
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====Regimen, Pohlman et al. 2009====
 
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border-style:solid;">Phase II</span>
 
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*[[Belinostat (Beleodaq)]] 1000 mg/m2 IV over 30 minutes once per day on days 1 to 5
 
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'''3-week cycles'''
 
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====References====
 
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# '''Abstract:''' Pohlman, Brad, Advani, Ranjana, Duvic, Madeleine, Hymes, Kenneth B., Intragumtornchai, Tanin, Lekhakula, Arnuparp, Shpilberg, Ofer, Lerner, Adam, Ben-Yehuda, Dina, beylot-Barry, Marie, Hillen, Uwe, Fagerberg, Jan, Foss, Francine M. Final Results of a Phase II Trial of Belinostat (PXD101) in Patients with Recurrent or Refractory Peripheral or Cutaneous T-Cell Lymphoma. ASH Annual Meeting Abstracts 2009 114: 920. [http://abstracts.hematologylibrary.org/cgi/content/abstract/114/22/920 link to abstract]
 
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===Bendamustine (Treanda)===
 
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====Regimen, Demaj et al. 2013 (BENTLY)====
 
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*[[Bendamustine (Treanda)]] 120 mg/m2 IV once per day over 30 to 60 minutes on days 1 & 2
 
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'''3-week cycles x 6 cycles'''
 
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====References====
 
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# 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. 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]
 
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===Bexarotene (Targretin)===
 
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====Regimen, Duvic et al. 2001====
 
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''This dose is considered the optimal starting dose by Duvic et al.''
 
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*[[Bexarotene (Targretin)]] 300 mg/m2 PO once per day
 
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'''Duration not specified; presumptively until progression or intolerance'''
 
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====References====
 
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# Duvic M, Hymes K, Heald P, Breneman D, Martin AG, Myskowski P, Crowley C, Yocum RC; Bexarotene Worldwide Study Group. Bexarotene is effective and safe for treatment of refractory advanced-stage cutaneous T-cell lymphoma: multinational phase II-III trial results. J Clin Oncol. 2001 May 1;19(9):2456-71. [http://jco.ascopubs.org/content/19/9/2456.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/11331325 PubMed]
 
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# Duvic M, Martin AG, Kim Y, Olsen E, Wood GS, Crowley CA, Yocum RC; Worldwide Bexarotene Study Group. Phase 2 and 3 clinical trial of oral bexarotene (Targretin capsules) for the treatment of refractory or persistent early-stage cutaneous T-cell lymphoma. Arch Dermatol. 2001 May;137(5):581-93. [http://archderm.jamanetwork.com/article.aspx?articleid=478334 link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/11346336 PubMed]
 
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===Brentuximab vedotin (Adcetris)===
 
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====Regimen, Krathen et al. 2012====
 
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*[[Brentuximab vedotin (Adcetris)]] 1.8 mg/kg IV over 30 minutes on day 1
 
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'''3-week cycles up to 16 infusions'''
 
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====References====
 
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# '''Abstract:''' Michael Krathen, MD, Uma Sundram, MD, PhD, Sameer Bashey, MD, Katherine Sutherland, C-PA, Katrin Salva, MD, Gary S Wood, MD, Ranjana H. Advani, MD, Richard T. Hoppe, MD, Sunil Reddy, MD, Randall Armstrong, Seema Nagpal, MD, Melissa Pulitzer, MD, Steven M. Horwitz, MD and Youn H. Kim, MD. Brentuximab Vedotin Demonstrates Significant Clinical Activity in Relapsed or Refractory Mycosis Fungoides with Variable CD30 Expression. ASH 2012 abstract 797 [https://ash.confex.com/ash/2012/webprogram/Paper49535.html link to abstract] '''contains verified protocol'''
 
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===Denileukin Diftitox (Ontak)===
 
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====Regimen, Olsen et al. 2001 & Prince et al. 2010====
 
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''Dose is that which was recommended by Prince et al. 2010 based on superior response.''
 
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*[[Denileukin diftitox (Ontak)]] 18 mcg/kg IV over 30 to 60 minutes once per day on days 1 to 5
 
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**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.
 
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Supportive medications:
 
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*"Premedication with [[Acetaminophen (Tylenol)]] [≤ 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.
 
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*Olsen et al. 2001 used [[Promethazine (Phenergan)]] 25 mg or [[Prochlorperazine (Compazine)]] 10 mg (route/schedule not specified) as needed for nausea.
 
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*Corticosteroid use was not allowed.
 
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'''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'''
 
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====References====
 
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# 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]
 
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<!-- Presented in part at the 43rd Annual Meeting of the American Society of Clinical Oncology, June 1-5, 2007, Chicago, IL; and the 44th Annual Meeting of the American Society of Clinical Oncology, May 30-June 3, 2008, Chicago, IL. -->
 
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# 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. 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]
 
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# 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. 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]
 
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<!-- Presented in part at the 46th Annual Meeting of the American Society of Clinical Oncology in Chicago, IL, June 4-8, 2010 -->
 
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# '''Meta-analysis:''' Duvic M, Geskin L, Prince HM. Duration of response in cutaneous T-cell lymphoma patients treated with denileukin diftitox: results from 3 phase III studies. Clin Lymphoma Myeloma Leuk. 2013 Aug;13(4):377-84. Epub 2013 Jun 14. [http://www.sciencedirect.com/science/article/pii/S2152265013000955 link to original article] [http://www.ncbi.nlm.nih.gov/pubmed/23770157 PubMed]
 
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===Lenalidomide (Revlimid)===
 
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====Regimen====
 
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*[[Lenalidomide (Revlimid)]] 10 mg PO once per day on days 1 to 21, increased by 5 mg per day with each cycle to a maximum of 25 mg PO once per day, as tolerated
 
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'''28-day cycles, up to 2 years or until disease progression'''
 
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====References====
 
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# Querfeld C, Rosen ST, Guitart J, Duvic M, Kim YH, Dusza SW, Kuzel TM. Results of an open-label multicenter phase II trial of lenalidomide monotherapy in refractory mycosis fungoides and Sezary syndrome. Blood. 2014 Feb 20;123(8):1159-66. Epub 2013 Dec 11. [http://bloodjournal.hematologylibrary.org/content/123/8/1159.full link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/24335103 PubMed]
 
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===Pralatrexate (Folotyn)===
 
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====Regimen====
 
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''Dose is that identified as recommended based on de-escalation strategy.''
 
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*[[Pralatrexate (Folotyn)]] 15 mg/m2 IV push once per day on days 1, 8, 15
 
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Supportive medications:
 
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*[[Cyanocobalamin (Vitamin B12)]] 1 mg IM once every 8 to 10 weeks, within 10 weeks of treatment initiation
 
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*[[Folic acid (Folate)]] 1 mg PO once per day, starting at least 10 days prior to treatment initiation
 
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'''4-week cycles,  given until progression of disease, unacceptable toxicity, or patient/physician preference'''
 
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====References====
 
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# 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. 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]
 
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===Romidepsin (Istodax)===
 
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====Regimen, Whittaker et al. 2010====
 
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*[[Romidepsin (Istodax)]] 14 mg/m2 IV over 4 hours once per day on days 1, 8, 15
 
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'''28-day cycles, up to 6 cycles, with optional extension of treatment for patients with stable disease or response'''
 
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====References====
 
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# 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. 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]
 
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===Vorinostat (Zolinza)===
 
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====Regimen, Olsen et al. 2007====
 
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*[[Vorinostat (Zolinza)]] 400 mg PO once per day
 
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'''Continued on drug until disease progression or intolerable toxicity'''
 
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====References====
 
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# 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]
 
  
 
=Extranodal NK/T-cell lymphoma (ENKTCL), nasal type=
 
=Extranodal NK/T-cell lymphoma (ENKTCL), nasal type=

Revision as of 23:49, 26 November 2014

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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.


Anaplastic large-cell lymphoma (ALCL)

Relapsed/refractory

Brentuximab vedotin (Adcetris)

Regimen, Pro et al. 2012

Phase II

3-week cycles up to 16 infusions

References

  1. Pro B, Advani R, Brice P, Bartlett NL, Rosenblatt JD, Illidge T, Matous J, Ramchandren R, Fanale M, Connors JM, Yang Y, Sievers EL, Kennedy DA, Shustov A. Brentuximab vedotin (SGN-35) in patients with relapsed or refractory systemic anaplastic large-cell lymphoma: results of a phase II study. J Clin Oncol. 2012 Jun 20;30(18):2190-6. Epub 2012 May 21. link to original article contains verified protocol PubMed

Cutaneous T-cell lymphoma (CTCL)

Extranodal NK/T-cell lymphoma (ENKTCL), nasal type

Untreated

Cisplatin & Concurrent RT -> VIPD

VIPD: VP-16, Ifosfamide, Platinol, Dexamethasone

Regimen, Kim et al. 2009

Phase II

Chemoradiation
  • Cisplatin (Platinol) 30 mg/m2 IV once per week
  • Concurrent radiation therapy to the primary tumor, 1.8 to 2 Gy fractions (median total dose: 40 Gy), given 5 times per week.
Chemotherapy

Chemotherapy starts 3 to 5 weeks after the last dose of cisplatin

Supportive medications:

  • Mesna (Mesnex) 240 mg/m2 IV over 15 minutes once per day on days 1 to 3
  • G-CSF given for grade 3 or 4 neutropenia

21-day cycles x up to 3 cycles

References

  1. 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. link to original article contains verified protocol PubMed

DeVIC & Concurrent RT

DeVIC: Dexamethasone, VP-16, Ifosfamide, Carboplatin

Regimen, Yamaguchi et al. 2009 (JCOG0211)

Phase II

Dose Level I
Dose Level II

Supportive medications:

  • 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.

21-day cycles x 3 cycles

Concurrent radiation therapy

Started simultaneously with the beginning of cycle 1 of chemotherapy

  • Stage IE disease: Concurrent radiation therapy, 2 Gy fractions x 25 fractions (total dose: 50 Gy) over 5 weeks
  • Stage IIE disease: Concurrent radiation therapy, 1.8 Gy fractions x 28 fractions (total dose: 50.4 Gy) over 6 weeks

References

  1. 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. link to original article contains verified protocol PubMed
  2. 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. Epub 2012 Oct 8. link to original article PubMed

GELOX

GELOX: Gemcitabine, L-asparaginase, Oxaliplatin

Regimen

Phase II

3-weeks cycles for at least 2 cycles, then:

  • Involved field radiation to 56 grays (Gy) in 28 fractions, 5 fractions per week

Followed by more chemotherapy within one week of radiation completion, up to 6 total cycles

References

  1. 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. Epub 2012 Jul 18. link to original article contains verified protocol PubMed

LVP "Sandwich"

LVP: L-asparaginase, Vincristine, Prednisolone

Regimen

Phase II

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

  1. 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. Epub 2011 Dec 2. link to original article contains verified protocol PubMed

SMILE

SMILE: Steroid (dexamethasone), Methotrexate, Ifosfamide, L-asparaginase, Etoposide

Regimen

Phase II

Supportive medications:

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.

References

  1. 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. Epub 2008 Feb 19. link to original article contains verified protocol PubMed content property of HemOnc.org
  2. 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. Epub 2011 Oct 11. link to original article contains verified protocol PubMed

Relapsed/refractory

AspaMetDex

AspaMetDex: Asparaginase, Methotrexate, Dexamethasone

Regimen, Jaccard et al. 2011

Phase II

Supportive medications:

21-day cycles x 3 cycles; see Jaccard et al. 2011 for details about further treatment

References

  1. 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. link to original article contains verified protocol PubMed

LVP

LVP: L-asparaginase, Vincristine, Prednisolone

Regimen

Phase II, <20 patients reported

Regimen details are from a review article; original article is not available through PubMed

References

  1. 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. PubMed

SMILE

SMILE: Steroid (dexamethasone), Methotrexate, Ifosfamide, L-asparaginase, Etoposide

Regimen

Phase II

Supportive medications:

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.

References

  1. 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. Epub 2008 Feb 19. link to original article contains verified protocol PubMed content property of HemOnc.org
  2. 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. Epub 2011 Oct 11. link to original article contains verified protocol PubMed

NK/T-cell lymphoma

Untreated

SMILE

SMILE: Steroid (dexamethasone), Methotrexate, Ifosfamide, L-asparaginase, Etoposide

Regimen

Phase II

  • 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.
  • 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
  • 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
  • Etoposide (Vepesid) 100 mg/m2 in 500 mL normal saline IV over 2 hours once per day on days 2 to 4

Supportive medications:

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

References

  1. 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. Epub 2008 Feb 19. link to original article contains verified protocol PubMed content property of HemOnc.org
  2. 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. Epub 2012 Aug 23. link to original article supplemental materials supplemental materials contain verified protocol PubMed

Relapsed/refractory

SMILE

SMILE: Steroid (dexamethasone), Methotrexate, Ifosfamide, L-asparaginase, Etoposide

Regimen

Phase II

  • 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.
  • 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
  • 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
  • Etoposide (Vepesid) 100 mg/m2 in 500 mL normal saline IV over 2 hours once per day on days 2 to 4

Supportive medications:

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

References

  1. 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. Epub 2008 Feb 19. link to original article contains verified protocol PubMed content property of HemOnc.org
  2. 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. Epub 2012 Aug 23. link to original article supplemental materials supplemental materials contain verified protocol PubMed

Peripheral T-cell Lymphoma (PTCL)

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