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We have moved How I Treat articles to a dedicated page.

3 regimens on this page 3 variants on this page

Guidelines

Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.

NCCN

NCCN does not currently have guidelines at this granular level; please see NCCN Guidelines - T-cell Lymphomas.

Initial therapy

Cyclophosphamide monotherapy

Regimen

Study	Evidence
Bareau et al. 2010	Retrospective

Note: These are retrospective series, of which Bareau et al. 2010 is representative. The most common dose reported is 100 mg PO once per day; some authors mentions co-administration of steroids but details are not supplied.

Immunosuppressive therapy

Cyclophosphamide (Cytoxan) 50 to 100 mg PO once per day

Lamy et al. 2011 recommends that patients who are responding are continued on treatment for 6 to 12 months; patients who do not respond within 4 months of therapy are discontinued

References

Retrospective: Go RS, Li CY, Tefferi A, Phyliky RL. Acquired pure red cell aplasia associated with lymphoproliferative disease of granular T lymphocytes. Blood. 2001 Jul 15;98(2):483-5. link to original article PubMed
Retrospective: Bareau B, Rey J, Hamidou M, Donadieu J, Morcet J, Reman O, Schleinitz N, Tournilhac O, Roussel M, Fest T, Lamy T. Analysis of a French cohort of patients with large granular lymphocyte leukemia: a report on 229 cases. Haematologica. 2010 Sep;95(9):1534-41. Epub 2010 Apr 7. link to original article link to PMC article PubMed content property of HemOnc.org
Retrospective: Moignet A, Hasanali Z, Zambello R, Pavan L, Bareau B, Tournilhac O, Roussel M, Fest T, Awwad A, Baab K, Semenzato G, Houot R, Loughran TP Jr, Lamy T. Cyclophosphamide as a first-line therapy in LGL leukemia. Leukemia. 2014 May;28(5):1134-6. Epub 2013 Nov 27. link to original article link to PMC article PubMed

Methotrexate & Prednisone

Regimen

Study	Dates of enrollment	Evidence
Loughran et al. 2014 (ECOG E5998)	1999-07-16 to 2009-03-24	Phase 2

Immunosuppressive therapy

Methotrexate (MTX) 10 mg/m²/day PO in divided doses on days 1, 8, 15, 22
- Details not described in ECOG E5998; Lamy et al. 2011 divides the 10 mg/m² methotrexate dose into 5 mg/m² in the morning and 5 mg/m² in the evening
Prednisone (Sterapred) 1 mg/kg PO once per day for 30 days, then tapered off over 24 days (details not described)

28-day cycles

Subsequent treatment

ECOG E5998, patients with PR: continue up to one year
ECOG E5998, patients with CR: continue for one month past documented CR
ECOG E5998, non-responders: Salvage cyclophosphamide & prednisone

References

ECOG E5998: Loughran TP Jr, Zickl L, Olson TL, Wang V, Zhang D, Rajala HL, Hasanali Z, Bennett JM, Lazarus HM, Litzow MR, Evens AM, Mustjoki S, Tallman MS. Immunosuppressive therapy of LGL leukemia: prospective multicenter phase II study by the Eastern Cooperative Oncology Group (E5998). Leukemia. 2015 Apr;29(4):886-94. Epub 2014 Sep 13. link to original article contains dosing details in manuscript link to PMC article PubMed

Relapsed or refractory

Cyclophosphamide & Prednisone

Regimen

Study	Evidence	Efficacy
Loughran et al. 2014 (ECOG E5998)	Phase 2	ORR: 64% (95% CI, 35-87)

Note: Patients with PR continue up to one year; patients with CR continue for one month past documented CR.

Preceding treatment

Upfront methotrexate & prednisone, with treatment failure

Immunosuppressive therapy

Cyclophosphamide (Cytoxan) 100 mg PO once per day on days 1 to 28
Prednisone (Sterapred) 1 mg/kg PO once per day for 30 days, then tapered off over 24 days (details not described)

28-day cycles (see note)

References

ECOG E5998: Loughran TP Jr, Zickl L, Olson TL, Wang V, Zhang D, Rajala HL, Hasanali Z, Bennett JM, Lazarus HM, Litzow MR, Evens AM, Mustjoki S, Tallman MS. Immunosuppressive therapy of LGL leukemia: prospective multicenter phase II study by the Eastern Cooperative Oncology Group (E5998). Leukemia. 2015 Apr;29(4):886-94. Epub 2014 Sep 13. link to original article contains dosing details in manuscript link to PMC article PubMed

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-<span style="font-family:Arial; font-size:300%">&nbsp;Just 8 days left to fill out a survey on how we can make HemOnc.org better and more useful.<br>
+[[#top|Back to Top]]
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+{{#lst:Editorial board transclusions|tcl}}
-|}<br>'''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]]. If this is your first time visiting, we suggest you read the [[tutorial]].'''
+*''We have moved [[How I Treat]] articles to a dedicated page.''
-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]].
 {| class="wikitable" style="float:right; margin-right: 5px;"
 |-
-|<div style="background-color: #fee0d1; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}" align="right"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]]  |?Regimen |limit=10000|format=sum}} regimens on this page</b></font></div>
+|<div style="background-color: #fee0d1; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}" align="right"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]]  |?Regimen |limit=10000|format=sum}} [[Tutorial#Regimens|regimens]] on this page</b></font></div>
-<div style="background-color: #deebf6; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]]  |?Variant |limit=10000|format=sum}} variants on this page</b></font></div>
+<div style="background-color: #deebf6; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]]  |?Variant |limit=10000|format=sum}} [[Tutorial#Variants|variants]] on this page</b></font></div>
 |}
 {{TOC limit|limit=3}}
 =Guidelines=
-==[https://www.nccn.org/ NCCN]==
+'''Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.'''
-*[https://www.nccn.org/professionals/physician_gls/pdf/t-cell.pdf NCCN Guidelines - T-cell Lymphomas] - contains information about T-cell Large Granular Lymphocytic Leukemia
+==NCCN==
+*''NCCN does not currently have guidelines at this granular level; please see [https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1483 NCCN Guidelines - T-cell Lymphomas].''
 =Initial therapy=
 ==Cyclophosphamide monotherapy {{#subobject:464f08|Regimen=1}}==
-{| class="wikitable" style="float:right; margin-left: 5px;"
+<div class="toccolours" style="background-color:#eeeeee">
-|-
-|[[#top|back to top]]
-|}
 ===Regimen {{#subobject:78c71b|Variant=1}}===
-{| class="wikitable" style="width: 100%; text-align:center;"
+{| class="wikitable" style="width: 40%; text-align:center;"
-!Study
+!style="width: 25%"|Study
-![[Levels_of_Evidence#Evidence|Evidence]]
+!style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]]
 |-
 |[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2930955/ Bareau et al. 2010]
@@ Line 36: / Line 28: @@
 |-
 |}
-''These are retrospective series, of which Bareau et al. 2010 is representative. The most common dose reported is 100 mg PO once per day; some authors mentions co-administration of steroids but details are not supplied.''
+''Note: These are retrospective series, of which Bareau et al. 2010 is representative. The most common dose reported is 100 mg PO once per day; some authors mentions co-administration of steroids but details are not supplied.''
-====Chemotherapy====
+<div class="toccolours" style="background-color:#b3e2cd">
+====Immunosuppressive therapy====
 *[[Cyclophosphamide (Cytoxan)]] 50 to 100 mg PO once per day
 '''Lamy et al. 2011 recommends that patients who are responding are continued on treatment for 6 to 12 months; patients who do not respond within 4 months of therapy are discontinued'''
+</div></div>
 ===References===
-# '''Retrospective:''' Go RS, Li CY, Tefferi A, Phyliky RL. Acquired pure red cell aplasia associated with lymphoproliferative disease of granular T lymphocytes. Blood. 2001 Jul 15;98(2):483-5. [http://bloodjournal.hematologylibrary.org/content/98/2/483.long link to original article] [https://www.ncbi.nlm.nih.gov/pubmed?term=11435321 PubMed]
+# '''Retrospective:''' Go RS, Li CY, Tefferi A, Phyliky RL. Acquired pure red cell aplasia associated with lymphoproliferative disease of granular T lymphocytes. Blood. 2001 Jul 15;98(2):483-5. [http://www.bloodjournal.org/content/98/2/483.long link to original article] [https://pubmed.ncbi.nlm.nih.gov?term=11435321/ PubMed]
-# '''Retrospective:''' Bareau B, Rey J, Hamidou M, Donadieu J, Morcet J, Reman O, Schleinitz N, Tournilhac O, Roussel M, Fest T, Lamy T. Analysis of a French cohort of patients with large granular lymphocyte leukemia: a report on 229 cases. Haematologica. 2010 Sep;95(9):1534-41. [http://www.haematologica.org/content/95/9/1534.long link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2930955/ link to PMC article] [https://www.ncbi.nlm.nih.gov/pubmed/20378561 PubMed] content property of [http://hemonc.org HemOnc.org]
+# '''Retrospective:''' Bareau B, Rey J, Hamidou M, Donadieu J, Morcet J, Reman O, Schleinitz N, Tournilhac O, Roussel M, Fest T, Lamy T. Analysis of a French cohort of patients with large granular lymphocyte leukemia: a report on 229 cases. Haematologica. 2010 Sep;95(9):1534-41. Epub 2010 Apr 7. [http://www.haematologica.org/content/95/9/1534.long link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2930955/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/20378561/ PubMed] content property of [https://hemonc.org HemOnc.org]
-# '''Review:''' Lamy T, Loughran TP Jr. How I treat LGL leukemia. Blood. 2011 Mar 10;117(10):2764-74. [http://bloodjournal.hematologylibrary.org/content/117/10/2764.long link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3062292/ link to PMC article] [https://www.ncbi.nlm.nih.gov/pubmed/21190991 PubMed]
+# '''Retrospective:''' Moignet A, Hasanali Z, Zambello R, Pavan L, Bareau B, Tournilhac O, Roussel M, Fest T, Awwad A, Baab K, Semenzato G, Houot R, Loughran TP Jr, Lamy T. Cyclophosphamide as a first-line therapy in LGL leukemia. Leukemia. 2014 May;28(5):1134-6. Epub 2013 Nov 27. [https://doi.org/10.1038/leu.2013.359 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017255/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/24280867/ PubMed]
-# '''Retrospective:''' Moignet A, Hasanali Z, Zambello R, Pavan L, Bareau B, Tournilhac O, Roussel M, Fest T, Awwad A, Baab K, Semenzato G, Houot R, Loughran TP Jr, Lamy T. Cyclophosphamide as a first-line therapy in LGL leukemia. Leukemia. 2014 May;28(5):1134-6. Epub 2013 Nov 27. [http://www.nature.com/leu/journal/v28/n5/full/leu2013359a.html link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017255/ link to PMC article] [https://www.ncbi.nlm.nih.gov/pubmed/24280867 PubMed]
 ==Methotrexate & Prednisone {{#subobject:9c0e17|Regimen=1}}==
-{| class="wikitable" style="float:right; margin-left: 5px;"
+<div class="toccolours" style="background-color:#eeeeee">
-|-
-|[[#top|back to top]]
-|}
 ===Regimen {{#subobject:3bbb5|Variant=1}}===
-{| class="wikitable" style="width: 100%; text-align:center;"
+{| class="wikitable sortable" style="width: 60%; text-align:center;"
-!Study
+!style="width: 33%"|Study
-![[Levels_of_Evidence#Evidence|Evidence]]
+!style="width: 33%"|Dates of enrollment
+!style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]]
 |-
 |[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4377298/ Loughran et al. 2014 (ECOG E5998)]
-|style="background-color:#91cf61"|Phase II
+|1999-07-16 to 2009-03-24
+|style="background-color:#91cf61"|Phase 2
 |-
 |}
-====Chemotherapy====
+<div class="toccolours" style="background-color:#b3e2cd">
-*[[Methotrexate (MTX)]] 10 mg/m<sup>2</sup> PO "in divided doses" once per week
+====Immunosuppressive therapy====
+*[[Methotrexate (MTX)]] 10 mg/m<sup>2</sup>/day PO in divided doses on days 1, 8, 15, 22
 **Details not described in ECOG E5998; Lamy et al. 2011 divides the 10 mg/m<sup>2</sup> methotrexate dose into 5 mg/m<sup>2</sup> in the morning and 5 mg/m<sup>2</sup> in the evening
 *[[Prednisone (Sterapred)]] 1 mg/kg PO once per day for 30 days, then tapered off over 24 days (details not described)
 '''28-day cycles'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
-''Patients with PR continue up to one year; patients with CR continue for one month past documented CR. Non-responders were transitioned to [[#Cyclophosphamide_.26_Prednisone|cyclophosphamide & prednisone]].''
+====Subsequent treatment====
+*ECOG E5998, patients with PR: continue up to one year
+*ECOG E5998, patients with CR: continue for one month past documented CR
+*ECOG E5998, non-responders: Salvage [[#Cyclophosphamide_.26_Prednisone|cyclophosphamide & prednisone]]
+</div></div>
 ===References===
-# '''Review:''' Lamy T, Loughran TP Jr. How I treat LGL leukemia. Blood. 2011 Mar 10;117(10):2764-74. [http://bloodjournal.hematologylibrary.org/content/117/10/2764.long link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3062292/ link to PMC article] [https://www.ncbi.nlm.nih.gov/pubmed/21190991 PubMed]
+# '''ECOG E5998:''' Loughran TP Jr, Zickl L, Olson TL, Wang V, Zhang D, Rajala HL, Hasanali Z, Bennett JM, Lazarus HM, Litzow MR, Evens AM, Mustjoki S, Tallman MS. Immunosuppressive therapy of LGL leukemia: prospective multicenter phase II study by the Eastern Cooperative Oncology Group (E5998). Leukemia. 2015 Apr;29(4):886-94. Epub 2014 Sep 13. [https://doi.org/10.1038/leu.2014.298 link to original article]  '''contains dosing details in manuscript''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4377298/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/25306898/ PubMed]
-# Loughran TP Jr, Zickl L, Olson TL, Wang V, Zhang D, Rajala HL, Hasanali Z, Bennett JM, Lazarus HM, Litzow MR, Evens AM, Mustjoki S, Tallman MS. Immunosuppressive therapy of LGL leukemia: prospective multicenter phase II study by the Eastern Cooperative Oncology Group (E5998). Leukemia. 2015 Apr;29(4):886-94. Epub 2014 Sep 13. [http://www.nature.com/leu/journal/vaop/naam/pdf/leu2014298a.pdf link to original article]  '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4377298/ link to PMC article] [https://www.ncbi.nlm.nih.gov/pubmed/25306898 PubMed]
 =Relapsed or refractory=
 ==Cyclophosphamide & Prednisone {{#subobject:3cfd6b|Regimen=1}}==
-{| class="wikitable" style="float:right; margin-left: 5px;"
+<div class="toccolours" style="background-color:#eeeeee">
-|-
-|[[#top|back to top]]
-|}
 ===Regimen {{#subobject:c27546|Variant=1}}===
-{| class="wikitable" style="width: 100%; text-align:center;"
+{| class="wikitable" style="width: 60%; text-align:center;"
-!Study
+!style="width: 33%"|Study
-![[Levels_of_Evidence#Evidence|Evidence]]
+!style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]]
-|'''ORR'''
+!style="width: 33%"|[[Levels_of_Evidence#Efficacy|Efficacy]]
 |-
 |[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4377298/ Loughran et al. 2014 (ECOG E5998)]
-|style="background-color:#91cf61"|Phase II
+|style="background-color:#91cf61"|Phase 2
-|64% (95% CI, 35-87)
+|ORR: 64% (95% CI, 35-87)
 |-
 |}
-''Preceded by treatment failure on [[#Methotrexate_.26_Prednisone|methotrexate & prednisone]].''
+''Note: Patients with PR continue up to one year; patients with CR continue for one month past documented CR.''
-====Chemotherapy====
+<div class="toccolours" style="background-color:#cbd5e8">
-*[[Cyclophosphamide (Cytoxan)]] 100 mg PO once per day
+====Preceding treatment====
+*Upfront [[#Methotrexate_.26_Prednisone|methotrexate & prednisone]], with treatment failure
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
+====Immunosuppressive therapy====
+*[[Cyclophosphamide (Cytoxan)]] 100 mg PO once per day on days 1 to 28
 *[[Prednisone (Sterapred)]] 1 mg/kg PO once per day for 30 days, then tapered off over 24 days (details not described)
+'''28-day cycles (see note)'''
-'''28-day cycles'''
+</div></div>
-''Patients with PR continue up to one year; patients with CR continue for one month past documented CR.''
 ===References===
-# Loughran TP Jr, Zickl L, Olson TL, Wang V, Zhang D, Rajala HL, Hasanali Z, Bennett JM, Lazarus HM, Litzow MR, Evens AM, Mustjoki S, Tallman MS. Immunosuppressive therapy of LGL leukemia: prospective multicenter phase II study by the Eastern Cooperative Oncology Group (E5998). Leukemia. 2015 Apr;29(4):886-94. Epub 2014 Sep 13. [http://www.nature.com/leu/journal/vaop/naam/pdf/leu2014298a.pdf link to original article]  '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4377298/ link to PMC article] [https://www.ncbi.nlm.nih.gov/pubmed/25306898 PubMed]
+# '''ECOG E5998:''' Loughran TP Jr, Zickl L, Olson TL, Wang V, Zhang D, Rajala HL, Hasanali Z, Bennett JM, Lazarus HM, Litzow MR, Evens AM, Mustjoki S, Tallman MS. Immunosuppressive therapy of LGL leukemia: prospective multicenter phase II study by the Eastern Cooperative Oncology Group (E5998). Leukemia. 2015 Apr;29(4):886-94. Epub 2014 Sep 13. [https://doi.org/10.1038/leu.2014.298 link to original article]  '''contains dosing details in manuscript''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4377298/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/25306898/ PubMed]
 [[Category:Large granular lymphocytic leukemia regimens]]
 [[Category:Disease-specific pages]]
 [[Category:T-cell lymphomas]]

Difference between revisions of "Large granular lymphocytic leukemia"

Revision as of 19:26, 23 June 2024

Contents

Guidelines

NCCN

Initial therapy

Cyclophosphamide monotherapy

Regimen

Immunosuppressive therapy

References

Methotrexate & Prednisone

Regimen

Immunosuppressive therapy

Subsequent treatment

References

Relapsed or refractory

Cyclophosphamide & Prednisone

Regimen

Preceding treatment

Immunosuppressive therapy

References

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