Difference between revisions of "Transplant conditioning regimens"

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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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<!--'''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]].'''-->
  
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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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'''This is an obsolete page; please follow the links below to find the page you're looking for.'''
  
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<big>'''Unlike the other chemotherapy regimen pages, this one is not disease-specific. Rather, this is a gathering point for all transplant conditioning regimens, which will eventually also be available under their respective disease-specific pages. However, this page will remain as a central reference for these types of regimens. Unless otherwise specified, the day of hematopoietic cell re-infusion is by convention day 0.'''</big>
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=[[Stem cell mobilization]]=
  
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{| class="wikitable" style="float:right; margin-right: 5px;"
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=[[Autologous_HSCT|Autologous stem cell transplant]]=
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|<div style="background-color: #66FF66; 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>
 
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<div style="background-color: #66CCFF; 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>
 
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{{TOC limit|limit=3}}
 
  
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=Autologous (auto) stem cell transplant=
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=[[Allogeneic_HSCT|Allogeneic hematopoietic cell transplant, myeloablative]]=
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==BEAC {{#subobject:60921c|Regimen=1}}==
 
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BEAC: '''<u>B</u>'''iCNU (Carmustine), '''<u>E</u>'''toposide, '''<u>A</u>'''ra-C (Cytarabine), '''<u>C</u>'''yclophosphamide
 
  
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===Regimen  {{#subobject:728b1c|Variant=1}}===
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=[[Allogeneic_HSCT|Allogeneic hematopoietic cell transplant, reduced-intensity conditioning (RIC)]]=
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{| border="1" style="text-align:center;" !align="left"
 
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|'''Study'''
 
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|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 
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|'''Comparator'''
 
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|-
 
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|[http://www.nejm.org/doi/full/10.1056/NEJM199512073332305 Philip et al. 1995 (PARMA)]
 
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|<span
 
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style="background:#00CD00;
 
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border-style:solid;">Phase III</span>
 
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|[[Diffuse_large_B-cell_lymphoma#DHAP|DHAP x 4]]
 
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''Treatment in PARMA preceded by [[Diffuse_large_B-cell_lymphoma#DHAP|DHAP x 2]].
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[[Category:Obsolete pages]]
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*[[Carmustine (BiCNU)]] 300 mg/m2 IV once on day -7
 
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*[[Etoposide (Vepesid)]] 800 mg/m2 IV once per day on days -6 to -3
 
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*[[Cytarabine (Cytosar)]] 800 mg/m2 IV once per day on days -6 to -3
 
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*[[Cyclophosphamide (Cytoxan)]] 35 mg/kg IV once per day on days -6 to -3
 
−
 
 
−
Supportive medications:
 
−
*[[Filgrastim (Neupogen)]] 5 mcg/kg SC once per day starting on day +1, continued until there are 3 consecutive days with ANC ≥1000
 
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*Prophylaxis against opportunistic infections and management of febrile neutropenia per "active protocols"
 
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===References===
 
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# Philip T, Guglielmi C, Hagenbeek A, Somers R, Van der Lelie H, Bron D, Sonneveld P, Gisselbrecht C, Cahn JY, Harousseau JL, et al. Autologous bone marrow transplantation as compared with salvage chemotherapy in relapses of chemotherapy-sensitive non-Hodgkin's lymphoma. N Engl J Med. 1995 Dec 7;333(23):1540-5. [http://www.nejm.org/doi/full/10.1056/NEJM199512073332305 link to original article] [http://www.ncbi.nlm.nih.gov/pubmed/7477169 PubMed]
 
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# '''Retrospective:''' Jo JC, Kang BW, Jang G, Sym SJ, Lee SS, Koo JE, Kim JW, Kim S, Huh J, Suh C. BEAC or BEAM high-dose chemotherapy followed by autologous stem cell transplantation in non-Hodgkin's lymphoma patients: comparative analysis of efficacy and toxicity. Ann Hematol. 2008 Jan;87(1):43-8. Epub 2007 Aug 21. [http://www.springerlink.com/content/r764139714772803/ link to original article] '''contains protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/17710401 PubMed]
 
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==BEAM {{#subobject:1e26e2|Regimen=1}}==
 
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BEAM: '''<u>B</u>'''iCNU (Carmustine), '''<u>E</u>'''toposide, '''<u>A</u>'''ra-C (Cytarabine), '''<u>M</u>'''elphalan
 
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===Regimen #1 {{#subobject:fa5ca4|Variant=1}}===
 
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{| border="1" style="text-align:center;" !align="left"
 
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|'''Study'''
 
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|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 
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|'''Comparator'''
 
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|-
 
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|[http://onlinelibrary.wiley.com/doi/10.1002/cncr.27418/full Shimoni et al. 2012]
 
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|<span
 
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border-style:solid;">Randomized Phase II</span>
 
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|[[Transplant_conditioning_regimens#Z-BEAM|Z-BEAM]]
 
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|-
 
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*[[Carmustine (BiCNU)]] 300 mg/m2 IV once on day -6
 
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*[[Etoposide (Vepesid)]] 200 mg/m2 IV once per day on days -5 to -2
 
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*[[Cytarabine (Cytosar)]] 200 mg/m2 IV Q12H on days -5 to -2
 
−
*[[Melphalan (Alkeran)]] 140 mg/m2 IV once on day -1
 
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−
Supportive medications:
 
−
*[[Filgrastim (Neupogen)]] 5 mcg/kg SC once per day starting on day +4 "until engraftment"
 
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*[[Valacyclovir (Valtrex)]] (dose not specified) for one month
 
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*[[Trimethoprim/Sulfamethoxazole (Bactrim DS)]] (dose/frequency not specified) for six months
 
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===Regimen #2, Stewart et al. 2006 {{#subobject:16f7a3|Variant=1}}===
 
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<span
 
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border-style:solid;">Phase II</span>
 
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*[[Carmustine (BiCNU)]] 300 mg/m2 IV once on day -6
 
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*[[Etoposide (Vepesid)]] 100 mg/m2 IV Q12H on days -5 to -2 (8 total doses)
 
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*[[Cytarabine (Cytosar)]] 200 mg/m2 IV Q12H on days -5 to -2 (8 total doses)
 
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*[[Melphalan (Alkeran)]] 140 mg/m2 IV once on day -1
 
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Supportive medications:
 
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*Patients <70 kg: [[Filgrastim (Neupogen)]] 300 mcg SC once per day starting on day +7 after stem cell transplant
 
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*Patients >70 kg (reference did not clarify which dosage to use for patients who are exactly 70 kg): [[Filgrastim (Neupogen)]] 480 mcg SC once per day starting on day +7 after stem cell transplant
 
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*[[Trimethoprim/Sulfamethoxazole (Bactrim DS)]] (160/800 mg) PO BID on Monday and Thursdays, until 6 months after BEAM
 
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''While ANC <500:''
 
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*[[Ciprofloxacin (Cipro)]] 500 mg PO BID
 
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*[[Fluconazole (Diflucan)]] 100 mg PO once per day or mycostatin 500,000 units swish & swallow QID
 
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*[[Acyclovir (Zovirax)]] 400 mg PO TID
 
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===Regimen #3, Josting et al. 2005 {{#subobject:5e3c75|Variant=1}}===
 
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<span
 
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border-style:solid;">Phase II</span>
 
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''Paper did not specify which day peripheral blood stem cells were administered.''
 
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*[[Carmustine (BiCNU)]] 300 mg/m2 IV once on day 1
 
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*[[Etoposide (Vepesid)]] 150 mg/m2 IV Q12H on days 2 to 5 (8 total doses)
 
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*[[Cytarabine (Cytosar)]] 200 mg/m2 IV Q12H on days 2 to 5 (8 total doses)
 
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*[[Melphalan (Alkeran)]] 140 mg/m2 IV once on day 1
 
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===Regimen #4, Gisselbrecht et al. 2010 {{#subobject:c92668|Variant=1}}===
 
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<span
 
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border-style:solid;">Non-randomized</span>
 
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''This study randomized patients to R-ICE or R-DHAP, but all patients undergoing autologous transplant received BEAM''
 
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''Autologous blood stem cells are infused on day 0, at least 24 hours after completion of BEAM.''
 
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*[[Carmustine (BiCNU)]] 300 mg/m2 IV once on day -6
 
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*[[Etoposide (Vepesid)]] 200 mg/m2 IV once per day on days -5 to -2
 
−
*[[Cytarabine (Cytosar)]] 200 mg/m2 IV once per day on days -5 to -2
 
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*[[Melphalan (Alkeran)]] 140 mg/m2 IV once on day -1
 
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===Regimen #5, Zinzani et al. 2003 {{#subobject:75447a|Variant=1}}===
 
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<span
 
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style="background:#ff0000;
 
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border-style:solid;">Retrospective</span>
 
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*[[Carmustine (BiCNU)]] 300 mg/m2 IV once on day -7
 
−
*[[Etoposide (Vepesid)]] 200 mg/m2 IV BID on days -6 to -3
 
−
*[[Cytarabine (Cytosar)]] 200 mg/m2 IV BID on days -6 to -3
 
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*[[Melphalan (Alkeran)]] 140 mg/m2 IV once on day -2
 
−
 
 
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===Regimen #6, Jo et al. 2008 {{#subobject:d7b00a|Variant=1}}===
 
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<span
 
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style="background:#ff0000;
 
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padding:3px 6px 3px 6px;
 
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border-style:solid;">Retrospective</span>
 
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''Autologous blood stem cells are infused on day 0.''
 
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*[[Carmustine (BiCNU)]] 300 mg/m2 IV once on day -6
 
−
*[[Etoposide (Vepesid)]] 200 mg/m2 IV once per day on days -5 to -2
 
−
*[[Cytarabine (Cytosar)]] 400 mg/m2 IV once per day on days -5 to -2
 
−
*[[Melphalan (Alkeran)]] 140 mg/m2 IV once on day -1
 
−
 
 
−
Supportive medications:
 
−
*[[Filgrastim (Neupogen)]] 5 mcg/kg SC once per day starting on day +1, continued until there are 3 consecutive days with ANC =1000
 
−
*Prophylaxis against opportunistic infections and management of febrile neutropenia per "active protocols"
 
−
 
 
−
===References===
 
−
# '''Retrospective:''' Zinzani PL, Tani M, Gabriele A, Gherlinzoni F, de Vivo A, Ricci P, Bandini G, Lemoli RM, Motta MR, Rizzi S, Giudice V, Zompatori M, Stefoni V, Alinari L, Musuraca G, Bassi S, Conte R, Pileri S, Tura S, Baccarani M. High-dose therapy with autologous transplantation for Hodgkin's disease: the Bologna experience. Haematologica. 2003 May;88(5):522-8. [http://www.haematologica.org/content/88/5/522.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/12745271 PubMed]
 
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# Zinzani PL, Tani M, Gabriele A, Gherlinzoni F, De Vivo A, Ricci P, Bandini G, Lemoli RM, Motta MR, Rizzi S, Guidice V, Zompatori M, Stefoni V, Alinari L, Musuraca G, Marchi E, Bassi S, Conte R, Pileri S, Tura S, Baccarani M. High-dose therapy with autologous transplantation for aggressive non-Hodgkin's lymphoma: the Bologna experience. Leuk Lymphoma. 2004 Feb;45(2):321-6. [http://www.ncbi.nlm.nih.gov/pubmed/15101718 PubMed]
 
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# Josting A, Sieniawski M, Glossmann JP, Staak O, Nogova L, Peters N, Mapara M, Dörken B, Ko Y, Metzner B, Kisro J, Diehl V, Engert A. High-dose sequential chemotherapy followed by autologous stem cell transplantation in relapsed and refractory aggressive non-Hodgkin's lymphoma: results of a multicenter phase II study. Ann Oncol. 2005 Aug;16(8):1359-65. Epub 2005 Jun 6. [http://annonc.oxfordjournals.org/content/16/8/1359.long link to original article] '''contains protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/15939712 PubMed]
 
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# Stewart DA, Bahlis N, Valentine K, Balogh A, Savoie L, Morris DG, Jones A, Brown C, Russell JA. Upfront double high-dose chemotherapy with DICEP followed by BEAM and autologous stem cell transplantation for poor-prognosis aggressive non-Hodgkin lymphoma. Blood. 2006 Jun 15;107(12):4623-7. Epub 2006 Feb 7. [http://bloodjournal.hematologylibrary.org/content/107/12/4623.long link to original article] '''contains protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/16467197 PubMed] content property of [http://hemonc.org HemOnc.org]
 
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# '''Retrospective:''' Jo JC, Kang BW, Jang G, Sym SJ, Lee SS, Koo JE, Kim JW, Kim S, Huh J, Suh C. BEAC or BEAM high-dose chemotherapy followed by autologous stem cell transplantation in non-Hodgkin's lymphoma patients: comparative analysis of efficacy and toxicity. Ann Hematol. 2008 Jan;87(1):43-8. Epub 2007 Aug 21. [http://www.springerlink.com/content/r764139714772803/ link to original article] '''contains protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/17710401 PubMed]
 
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<!--
 
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Presented at the 45th Annual Meeting of the American Society of Clinical Oncology, May 29-June 2, 2009, Orlando, FL, and at the 51st Annual Meeting of the American Society of Hematology, December 5-8, 2009, New Orleans, LA. -->
 
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# Gisselbrecht C, Glass B, Mounier N, Singh Gill D, Linch DC, Trneny M, Bosly A, Ketterer N, Shpilberg O, Hagberg H, Ma D, Brière J, Moskowitz CH, Schmitz N. Salvage regimens with autologous transplantation for relapsed large B-cell lymphoma in the rituximab era. J Clin Oncol. 2010 Sep 20;28(27):4184-90. Epub 2010 Jul 26. Erratum in: J Clin Oncol. 2012 May 20;30(15):1896. [http://jco.ascopubs.org/content/28/27/4184.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/20660832 PubMed]
 
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# Shimoni A, Avivi I, Rowe JM, Yeshurun M, Levi I, Or R, Patachenko P, Avigdor A, Zwas T, Nagler A. A randomized study comparing yttrium-90 ibritumomab tiuxetan (Zevalin) and high-dose BEAM chemotherapy versus BEAM alone as the conditioning regimen before autologous stem cell transplantation in patients with aggressive lymphoma. Cancer. 2012 Oct 1;118(19):4706-14. Epub 2012 Jan 17. [http://onlinelibrary.wiley.com/doi/10.1002/cncr.27418/full link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/22252613 PubMed]
 
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# Pardal E, Coronado M, Martín A, Grande C, Marín-Niebla A, Panizo C, Bello JL, Conde E, Hernández MT, Arranz R, Bargay J, González-Barca E, Pérez-Ceballos E, Montes-Moreno S, Caballero MD. Intensification treatment based on early FDG-PET in patients with high-risk diffuse large B-cell lymphoma: a phase II GELTAMO trial. Br J Haematol. 2014 Nov;167(3):327-36. Epub 2014 Jul 28. [http://onlinelibrary.wiley.com/doi/10.1111/bjh.13036/full link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/25066542 PubMed]
 
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==BeEAM {{#subobject:dee72f|Regimen=1}}==
 
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{| class="wikitable" style="float:right; margin-left: 5px;"
 
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|-
 
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|[[#toc|back to top]]
 
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|}
 
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BeEAM: '''<u>Be</u>'''ndamustine, '''<u>E</u>'''toposide, '''<u>A</u>'''ra-C (Cytarabine), '''<u>M</u>'''elphalan
 
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===Regimen {{#subobject:81ff2e|Variant=1}}===
 
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{| border="1" style="text-align:center;" !align="left"
 
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|'''Study'''
 
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|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 
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|-
 
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|[http://www.bloodjournal.org/content/118/12/3419.long Visani et al. 2011]
 
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|<span
 
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style="background:#eeee00;
 
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border-style:solid;">Phase II</span>
 
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|-
 
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|}
 
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To be completed
 
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===References===
 
−
# Visani G, Malerba L, Stefani PM, Capria S, Galieni P, Gaudio F, Specchia G, Meloni G, Gherlinzoni F, Giardini C, Falcioni S, Cuberli F, Gobbi M, Sarina B, Santoro A, Ferrara F, Rocchi M, Ocio EM, Caballero MD, Isidori A. BeEAM (bendamustine, etoposide, cytarabine, melphalan) before autologous stem cell transplantation is safe and effective for resistant/relapsed lymphoma patients. Blood. 2011 Sep 22;118(12):3419-25. Epub 2011 Aug 3. [http://www.bloodjournal.org/content/118/12/3419.long link to original article] [http://www.ncbi.nlm.nih.gov/pubmed/21816830 PubMed]
 
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==Bor-HDM {{#subobject:9c28bc|Regimen=1}}==
 
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{| class="wikitable" style="float:right; margin-left: 5px;"
 
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|[[#toc|back to top]]
 
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|}
 
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Bor-HDM: '''<u>Bor</u>'''tezomib, '''<u>H</u>'''igh '''<u>D</u>'''ose '''<u>M</u>'''elphalan
 
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===Regimen {{#subobject:93cb47|Variant=1}}===
 
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<span
 
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border-style:solid;">Phase II</span>
 
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''Autologous hematopoetic stem cell transplant on day 0.''
 
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*[[Bortezomib (Velcade)]] 1 mg/m2 IV once per day on days -6, -3, 1, 4
 
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*[[Melphalan (Alkeran)]] 200 mg/m2 IV once on day -2
 
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Supportive medications:
 
−
*"All patients received standard supportive care measures"
 
−
 
 
−
===References===
 
−
# Roussel M, Moreau P, Huynh A, Mary JY, Danho C, Caillot D, Hulin C, Fruchart C, Marit G, Pégourié B, Lenain P, Araujo C, Kolb B, Randriamalala E, Royer B, Stoppa AM, Dib M, Dorvaux V, Garderet L, Mathiot C, Avet-Loiseau H, Harousseau JL, Attal M; Intergroupe Francophone du Myélome (IFM). Bortezomib and high-dose melphalan as conditioning regimen before autologous stem cell transplantation in patients with de novo multiple myeloma: a phase 2 study of the Intergroupe Francophone du Myelome (IFM). Blood. 2010 Jan 7;115(1):32-7. Epub 2009 Nov 2. [http://bloodjournal.hematologylibrary.org/content/115/1/32.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/19884643 PubMed]
 
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==Busulfan & Melphalan {{#subobject:484436|Regimen=1}}==
 
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{| class="wikitable" style="float:right; margin-left: 5px;"
 
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|-
 
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|[[#toc|back to top]]
 
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|}
 
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===Regimen {{#subobject:c5fc8f|Variant=1}}===
 
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<span
 
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style="background:#EEEE00;
 
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border-style:solid;">Phase II</span>
 
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''Day 0 is the day of transplantation.''
 
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*[[Busulfan (Myleran)]] 1 mg/kg PO q6h on days -6 to -4
 
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*[[Melphalan (Alkeran)]] 70 mg/m2 IV bolus once per day on days -3 & -2
 
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−
===References===
 
−
# Yanada M, Tsuzuki M, Fujita H, Fujimaki K, Fujisawa S, Sunami K, Taniwaki M, Ohwada A, Tsuboi K, Maeda A, Takeshita A, Ohtake S, Miyazaki Y, Atsuta Y, Kobayashi Y, Naoe T, Emi N; Japan Adult Leukemia Study Group. Phase 2 study of arsenic trioxide followed by autologous hematopoietic cell transplantation for relapsed acute promyelocytic leukemia. Blood. 2013 Apr 18;121(16):3095-102. Epub 2013 Feb 14. [http://bloodjournal.hematologylibrary.org/content/121/16/3095.long link to original article] '''Contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/23412094 PubMed]
 
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==C-VAMP -> high-dose Melphalan (Alkeran) {{#subobject:248c43|Regimen=1}}==
 
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{| class="wikitable" style="float:right; margin-left: 5px;"
 
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|[[#toc|back to top]]
 
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C-VAMP: '''<u>C</u>'''yclophosphamide, '''<u>V</u>'''incristine, '''<u>A</u>'''driamycin, '''<u>M</u>'''ethyl'''<u>P</u>'''rednisolone
 
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===Regimen - multiple myeloma high-dose therapy {{#subobject:e6ae33|Variant=1}}===
 
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<span
 
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border-style:solid;">Phase III</span>
 
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====Induction therapy====
 
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*[[Cyclophosphamide (Cytoxan)]] 500 mg IV once per day on days 1, 8, 15
 
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**Cyclophosphamide was omitted in patients with a serum creatinine >3.4 mg/dL
 
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*[[Vincristine (Oncovin)]] 0.4 mg IV once per day on days 1 to 4 (total dose per cycle: 1.6 mg)
 
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*[[Doxorubicin (Adriamycin)]] 9 mg/m2/day IV continuous infusion over 4 days (total dose per cycle: 36 mg/m2) on days 1 to 4
 
−
*[[Methylprednisolone (Solumedrol)]] 1000 mg/m2 (maximum dose per cycle of 1500 mg) PO/IV once per day on days 1 to 5
 
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−
'''21-day cycles, given until maximal response was achieved. A minimum of 3 cycles given before stem cell harvest.'''
 
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−
*Stem cell mobilization was performed with administration of [[Cyclophosphamide (Cytoxan)]] 2000 to 4000 mg/m2 IV with hydration and [[Filgrastim (Neupogen)|G-CSF]] on days 5 to 12
 
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====Melphalan (Alkeran) & transplant====
 
−
*[[Melphalan (Alkeran)]] 200 mg/m2 IV (no additional details given)
 
−
*Peripheral blood stem cells infused on day 0, 24 hours after melphalan
 
−
*[[Methylprednisolone (Solumedrol)]] 1500 mg IV once per day on days 0 to 3
 
−
 
 
−
An alternative to the above melphalan option was:
 
−
*Bone marrow autograft
 
−
*Total body irradiation (TBI)
 
−
*[[Melphalan (Alkeran)]] 140 mg/m2 IV (no additional details given)
 
−
*[[Methylprednisolone (Solumedrol)]] 1500 mg IV once per day on days 0 to 3
 
−
 
 
−
====Interferon alfa maintenance therapy====
 
−
*[[Interferon alfa-2a (Roferon-A)]] 3 million units SC three times per week
 
−
 
 
−
===References===
 
−
# Child JA, Morgan GJ, Davies FE, Owen RG, Bell SE, Hawkins K, Brown J, Drayson MT, Selby PJ; Medical Research Council Adult Leukaemia Working Party. High-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma. N Engl J Med. 2003 May 8;348(19):1875-83. [http://www.nejm.org/doi/full/10.1056/NEJMoa022340#t=abstract link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/12736280 PubMed]
 
−
 
 
−
==CBV {{#subobject:935235|Regimen=1}}==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#toc|back to top]]
 
−
|}
 
−
CBV: '''<u>C</u>'''yclophosphamide, '''<u>B</u>'''iCNU, '''<u>V</u>'''P-16
 
−
 
 
−
===Regimen #1, Stiff et al. 1998; Damon et al. 2009 {{#subobject:35a696|Variant=1}}===
 
−
<span
 
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
−
 
 
−
*[[Carmustine (BiCNU)]] 15 mg/kg (maximum dose of 550 mg/m2) IV over 1 hour once on day -6
 
−
*[[Etoposide (Vepesid)]] 60 mg/kg IV over 4 hours once on day -4
 
−
*[[Cyclophosphamide (Cytoxan)]] 100 mg/kg IV over 2 hours once on day -2
 
−
*Autologous blood stem cells infused on day 0.
 
−
 
 
−
Supportive medications:
 
−
*[[Filgrastim (Neupogen)]] 5 mcg/kg SC once per day starting on day +4, to continue until ANC >5000 once or >1500 twice
 
−
*[[Levofloxacin (Levaquin)]] 500 mg PO once per day, starting on day +2, to continue until ANC =500
 
−
*[[Fluconazole (Diflucan)]] 200 mg PO once per day, starting on day +1, to continue until ANC =500
 
−
*[[Acyclovir (Zovirax)]] 200 mg PO TID, starting on day -2, to continue until 1 year after ASCT
 
−
*[[Trimethoprim/Sulfamethoxazole (Bactrim DS)]] 160/800 mg PO BID on Saturday and Sunday, to continue until 3 months after ASCT
 
−
 
 
−
===Regimen #2, Zinzani et al. 2003 (CVB) {{#subobject:1ba6d|Variant=1}}===
 
−
*[[Cyclophosphamide (Cytoxan)]] 1500 mg/m2 IV once per day on days -6 to -3
 
−
*[[Etoposide (Vepesid)]] 250 mg/m2 IV once per day on days -6 to -4
 
−
*[[Carmustine (BiCNU)]] 300 mg/m2 IV once on day -6
 
−
 
 
−
===References===
 
−
# Reece DE, Connors JM, Spinelli JJ, Barnett MJ, Fairey RN, Klingemann HG, Nantel SH, O'Reilly S, Shepherd JD, Sutherland HJ, et al. Intensive therapy with cyclophosphamide, carmustine, etoposide +/- cisplatin, and autologous bone marrow transplantation for Hodgkin's disease in first relapse after combination chemotherapy. Blood. 1994 Mar 1;83(5):1193-9. [http://www.bloodjournal.org/content/83/5/1193.long link to original article] [http://www.ncbi.nlm.nih.gov/pubmed/8118023 PubMed]
 
−
# Stiff PJ, Dahlberg S, Forman SJ, McCall AR, Horning SJ, Nademanee AP, Blume KG, LeBlanc M, Fisher RI. Autologous bone marrow transplantation for patients with relapsed or refractory diffuse aggressive non-Hodgkin's lymphoma: value of augmented preparative regimens--a Southwest Oncology Group trial. J Clin Oncol. 1998 Jan;16(1):48-55. [http://jco.ascopubs.org/content/16/1/48.full.pdf+html link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/9440722 PubMed]
 
−
# '''Retrospective:''' Zinzani PL, Tani M, Gabriele A, Gherlinzoni F, de Vivo A, Ricci P, Bandini G, Lemoli RM, Motta MR, Rizzi S, Giudice V, Zompatori M, Stefoni V, Alinari L, Musuraca G, Bassi S, Conte R, Pileri S, Tura S, Baccarani M. High-dose therapy with autologous transplantation for Hodgkin's disease: the Bologna experience. Haematologica. 2003 May;88(5):522-8. [http://www.haematologica.org/content/88/5/522.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/12745271 PubMed]
 
−
# Damon LE, Johnson JL, Niedzwiecki D, Cheson BD, Hurd DD, Bartlett NL, Lacasce AS, Blum KA, Byrd JC, Kelly M, Stock W, Linker CA, Canellos GP. Immunochemotherapy and autologous stem-cell transplantation for untreated patients with mantle-cell lymphoma: CALGB 59909. J Clin Oncol. 2009 Dec 20;27(36):6101-8. Epub 2009 Nov 16. [http://jco.ascopubs.org/content/27/36/6101.long link to original article] '''contains protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/19917845 PubMed]
 
−
 
 
−
==Cyclophosphamide (Cytoxan), Etoposide (Vepesid), TBI {{#subobject:1fcca8|Regimen=1}}==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#toc|back to top]]
 
−
|}
 
−
===Regimen {{#subobject:a79295|Variant=1}}===
 
−
 
 
−
<span
 
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
−
 
 
−
''Autologous hematopoetic stem cell transplant on day 0.''
 
−
*[[Cyclophosphamide (Cytoxan)]] 100 mg/kg IV over 1 to 2 hours once on day -2
 
−
*[[Etoposide (Vepesid)]] 60 mg/kg IV over 4 hours once on day -4
 
−
*Total body irradiation (TBI) with 150 cGy fractions given twice per day (fractions are at least 5 hours apart) x 8 fractions (total dose: 1200 cGy) over 4 days on days -8 to -5, with lung shielding for the final 600 Gy
 
−
**Note: Table 1 of Stiff et al. 1998 lists the dosage of each fraction as being 120 cGy, in contrast to the body text under "treatment regimen" saying each fraction is 150 cGy.  It is believed that the 150 cGy dose is correct since 8 fractions of this results in the correct total dose of 1200 cGy.
 
−
 
 
−
Supportive medications:
 
−
*[[Diphenhydramine (Benadryl)]] 25 mg (route not specified) once 2 hours before [[Etoposide (Vepesid)]] to prevent allergic reaction
 
−
*[[Hydrocortisone (Cortef)]] 100 mg (route not specified) once 2 hours before [[Etoposide (Vepesid)]] to prevent allergic reaction
 
−
*"Continuous bladder irrigation and vigorous hydration were used" to protect against hemorrhagic cystitis
 
−
 
 
−
===References===
 
−
# Stiff PJ, Dahlberg S, Forman SJ, McCall AR, Horning SJ, Nademanee AP, Blume KG, LeBlanc M, Fisher RI. Autologous bone marrow transplantation for patients with relapsed or refractory diffuse aggressive non-Hodgkin's lymphoma: value of augmented preparative regimens--a Southwest Oncology Group trial. J Clin Oncol. 1998 Jan;16(1):48-55. [http://jco.ascopubs.org/content/16/1/48.full.pdf+html link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/9440722 PubMed]
 
−
 
 
−
==DHAP -> BEAC {{#subobject:6c3b36|Regimen=1}}==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#toc|back to top]]
 
−
|}
 
−
DHAP: '''<u>D</u>'''examethasone, '''<u>H</u>'''igh-dose '''<u>A</u>'''ra-C (cytarabine), cis'''<u>P</u>'''latin
 
−
<br>BEAC: '''<u>B</u>'''iCNU, '''<u>E</u>'''toposide, '''<u>A</u>'''ra-C, '''<u>C</u>'''yclophosphamide
 
−
===Regimen, Velasquez, et al. 1988 (DHAP) & Philip, et al. 1991 {{#subobject:a5ff49|Variant=1}}===
 
−
 
 
−
<span
 
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
−
 
 
−
====DHAP Induction Therapy====
 
−
''In Velasquez, et al. 1988, Ara-C/Cytarabine was originally administered "on the third day," but the regimen was subsequently modified so that it was given on day 2 after cisplatin.''
 
−
*[[Dexamethasone (Decadron)]] 40 mg PO/IV over 15 minutes once per day on days 1 to 4
 
−
*[[Cytarabine (Cytosar)]] 2000 mg/m2 IV over 3 hours on day 2, starting when cisplatin infusion is complete; a second dose of [[Cytarabine (Cytosar)]] 2000 mg/m2 IV over 3 hours is given after the first one
 
−
*[[Cisplatin (Platinol)]] 100 mg/m2 IV continuous infusion over 24 hours on day 1, starting after 6 hours of prehydration
 
−
 
 
−
Supportive Medications:
 
−
*Normal saline solution with mannitol, 50 g/L, at 250 mL/hour IV over 36 hours starting on day 1 prior to cisplatin
 
−
*[[Metoclopramide (Reglan)]] 1 mg/kg "given routinely as antiemetics"
 
−
*[[Diphenhydramine (Benadryl)]] 25 mg IV "given routinely as antiemetics"
 
−
 
 
−
'''21 to 28 day cycles, depending on degree of myelosuppression, for a total of 2 cycles as follows:''' After 1 course of DHAP, if they did not have "clearly progressive disease," patients underwent bone marrow harvest. A second course of DHAP was administered starting 1 day after bone marrow harvest.  At day 20 after the second course of DHAP, patients were restaged. Patients who showed a response and had bulky disease at initial relapse then started involved field radiotherapy on day 20 after the second course of DHAP for 5 days per week x 2 weeks.  In the original Velasquez, et al. 1988 paper where DHAP was used on its own, treatment continued for 6 to 10 cycles in patient who responded to treatment.
 
−
 
 
−
====BEAC conditioning & transplant====
 
−
''BEAC starts on day 35 after the second course of DHAP.  Autologous blood stem cells are infused on day 0.''
 
−
*[[Carmustine (BiCNU)]] 300 mg/m2 IV over 30 minutes once on day -13
 
−
*[[Etoposide (Vepesid)]] 100 mg/m2 IV twice per day on days -12 to -7
 
−
*[[Cytarabine (Cytosar)]] 100 mg/m2 IV twice per day on days -12 to -9
 
−
*[[Cyclophosphamide (Cytoxan)]] 35 mg/kg IV over 60 minutes once per day on days -12 to -9
 
−
*[[Mesna (Mesnex)]] 50 mg/kg IV every day on days -12 to -9 (optional)
 
−
 
 
−
===References===
 
−
# '''DHAP portion:''' Velasquez WS, Cabanillas F, Salvador P, McLaughlin P, Fridrik M, Tucker S, Jagannath S, Hagemeister FB, Redman JR, Swan F, et al. Effective salvage therapy for lymphoma with cisplatin in combination with high-dose Ara-C and dexamethasone (DHAP). Blood. 1988 Jan;71(1):117-22. [http://www.bloodjournal.org/content/71/1/117.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/3334893 PubMed]
 
−
# '''BEAC portion:''' Philip T, Chauvin F, Armitage J, Bron D, Hagenbeek A, Biron P, Spitzer G, Velasquez W, Weisenburger DD, Fernandez-Ranada J, et al. Parma international protocol: pilot study of DHAP followed by involved-field radiotherapy and BEAC with autologous bone marrow transplantation. Blood. 1991 Apr 1;77(7):1587-92. [http://www.bloodjournal.org/content/77/7/1587.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/2009374 PubMed]
 
−
 
 
−
==High-dose Melphalan (Alkeran) {{#subobject:404662|Regimen=1}}==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#toc|back to top]]
 
−
|}
 
−
===Regimen - immunoglobulin light-chain (AL) amyloidosis {{#subobject:e63043|Variant=1}}===
 
−
{| border="1" style="text-align:center;" !align="left"
 
−
|'''Study'''
 
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 
−
|-
 
−
|[http://annals.org/article.aspx?articleid=717091 Skinner et al. 2004]
 
−
|<span
 
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
−
|-
 
−
|}
 
−
 
 
−
''Eligibility criteria: Biopsy-proven amyloid disease and =1 major organ involved, evidence of plasma cell dyscrasia, no heart failure or arrhythmia that cannot be medically managed, cardiac ejection fraction =40%, no pleural effusions, supine systolic blood pressure =90 mmHg, O2 saturation =95% on room air, lung diffusing capacity =50% predicted, SWOG performance status =2 unless due to neuropathy.''
 
−
 
 
−
*Patients who fulfilled all of these criteria--=65 years old, cardiac ejection fraction =45%, and =2.5 x 10<sup>6</sup> CD34+ cells/kg collected--received [[Melphalan (Alkeran)]] 200 mg/m2 total dose IV divided over two consecutive days
 
−
*Patients with at least one of these criteria-->65 years old, cardiac ejection fraction 40-44%, or with 2.0-2.5 x 10<sup>6</sup> CD34+ cells/kg collected received [[Melphalan (Alkeran)]] 140 mg/m2 total dose IV divided over two consecutive days
 
−
*Autologous stem cell infusion occurs 24 to 72 hours after the last dose of melphalan
 
−
 
 
−
===References===
 
−
# Barlogie B, Hall R, Zander A, Dicke K, Alexanian R. High-dose melphalan with autologous bone marrow transplantation for multiple myeloma. Blood. 1986 May;67(5):1298-301. [http://www.bloodjournal.org/content/67/5/1298 link to original article] [http://www.ncbi.nlm.nih.gov/pubmed/3516252 PubMed]
 
−
# Skinner M, Sanchorawala V, Seldin DC, Dember LM, Falk RH, Berk JL, Anderson JJ, O'Hara C, Finn KT, Libbey CA, Wiesman J, Quillen K, Swan N, Wright DG. High-dose melphalan and autologous stem-cell transplantation in patients with AL amyloidosis: an 8-year study. Ann Intern Med. 2004 Jan 20;140(2):85-93. [http://annals.org/article.aspx?articleid=717091 link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/14734330 PubMed]
 
−
 
 
−
==R-BEAM {{#subobject:8b88db|Regimen=1}}==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#toc|back to top]]
 
−
|}
 
−
R-BEAM: '''<u>R</u>'''ituximab, '''<u>B</u>'''iCNU (Carmustine), '''<u>E</u>'''toposide, '''<u>A</u>'''ra-C (Cytarabine), '''<u>M</u>'''elphalan
 
−
 
 
−
===Regimen {{#subobject:77f5a0|Variant=1}}===
 
−
{| border="1" style="text-align:center;" !align="left"
 
−
|'''Study'''
 
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 
−
|-
 
−
|[http://onlinelibrary.wiley.com/doi/10.1111/bjh.13234/full Kirschey et al. 2014]
 
−
|<span
 
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
−
|-
 
−
|}
 
−
 
 
−
''A minimum number of 2 × 10^6/kg bw CD34-positive cells were required to proceed.''
 
−
 
 
−
*[[Rituximab (Rituxan)]] 375 mg/m2 IV once on days -8 & -2
 
−
*[[Carmustine (BiCNU)]] 300 mg/m2 IV once on day -7
 
−
*[[Etoposide (Vepesid)]] 200 mg/m2 IV BID on days -6 to -3
 
−
*[[Cytarabine (Cytosar)]] 400 mg/m2 IV BID on days -6 to -3
 
−
*[[Melphalan (Alkeran)]] 140 mg/m2 IV once on day -2
 
−
 
 
−
'''Autologous blood stem cells are infused on day 0.'''
 
−
 
 
−
''Patients in the LyMa trial were randomized to [[Mantle_cell_lymphoma#Rituximab_.28Rituxan.29|rituximab maintenance]] versus [[Mantle_cell_lymphoma#Observation_2|observation]].''
 
−
 
 
−
===References===
 
−
# Kirschey S, Flohr T, Wolf HH, Frickhofen N, Gramatzki M, Link H, Basara N, Peter N, Meyer RG, Schmitz N, Weidmann E, Banat A, Schulz A, Kolbe K, Derigs G, Theobald M, Hess G. Rituximab combined with DexaBEAM followed by high dose therapy as salvage therapy in patients with relapsed or refractory B-cell lymphoma: mature results of a phase II multicentre study. Br J Haematol. 2015 Mar;168(6):824-34. Epub 2014 Dec 28. [http://onlinelibrary.wiley.com/doi/10.1111/bjh.13234/full link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/25546611 PubMed]
 
−
# '''Abstract:''' Steven Le Gouill, MD, PhD, Catherine Thieblemont, MD, PhD, Lucie Oberic, Krimo Bouabdallah, MD, Emmanuel Gyan, MD, PhD, Gandhi Damaj, MD, Vincent Ribrag, MD, Serge Bologna, MD, Remy Gressin, MD, Olivier Casasnovas, MD, Corinne Haioun, MD, PhD, Philippe Solal-Celigny, MD, Herve Maisonneuve, MD, Eric Van Den Neste, MD, PhD, Anne Moreau, MD, Marie C Bene, Gilles Salles, MD PhD, Hervé Tilly, MD, PhD, Thierry Lamy, MD, PhD and Olivier Hermine, MD, PhD. Rituximab Maintenance Versus Wait and Watch after Four Courses of R-DHAP Followed By Autologous Stem Cell transplantation in Previously Untreated Young Patients with Mantle Cell Lymphoma: First Interim Analysis of the Phase III Prospective Lyma Trial, a Lysa Study. ASH Annual Meeting 2014, Abstract 146 [https://ash.confex.com/ash/2014/webprogram/Paper69738.html link to abstract]
 
−
 
 
−
==R-TBI/Cy {{#subobject:9a5351|Regimen=1}}==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#toc|back to top]]
 
−
|}
 
−
R-TBI/Cy: '''<u>R</u>'''ituximab, '''<u>T</u>'''otal, '''<u>B</u>'''ody, '''<u>I</u>'''rradiation, '''<u>Cy</u>'''clophosphamide
 
−
 
 
−
===Regimen {{#subobject:785614|Variant=1}}===
 
−
{| border="1" style="text-align:center;" !align="left"
 
−
|'''Study'''
 
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 
−
|-
 
−
|[http://onlinelibrary.wiley.com/doi/10.1111/bjh.13234/full Kirschey et al. 2014]
 
−
|<span
 
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
−
|-
 
−
|}
 
−
 
 
−
''A minimum number of 2 × 10^6/kg bw CD34-positive cells were required to proceed.''
 
−
 
 
−
*[[Rituximab (Rituxan)]] 375 mg/m2 IV once on days -8 & -2
 
−
*Total body irradiation (TBI) with a total dose of 12 Gy over 3 days (days -6 to -4) in fractions
 
−
*[[Cyclophosphamide (Cytoxan)]] 60 mg/kg IV once per day on days -3 & -2
 
−
 
 
−
'''Autologous blood stem cells are infused on day 0.'''
 
−
 
 
−
===References===
 
−
# Kirschey S, Flohr T, Wolf HH, Frickhofen N, Gramatzki M, Link H, Basara N, Peter N, Meyer RG, Schmitz N, Weidmann E, Banat A, Schulz A, Kolbe K, Derigs G, Theobald M, Hess G. Rituximab combined with DexaBEAM followed by high dose therapy as salvage therapy in patients with relapsed or refractory B-cell lymphoma: mature results of a phase II multicentre study. Br J Haematol. 2015 Mar;168(6):824-34. Epub 2014 Dec 28. [http://onlinelibrary.wiley.com/doi/10.1111/bjh.13234/full link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/25546611 PubMed]
 
−
 
 
−
==TAM6 {{#subobject:c810fd|Regimen=1}}==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#toc|back to top]]
 
−
|}
 
−
===Regimen {{#subobject:4aee7c|Variant=1}}===
 
−
<span
 
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
−
 
 
−
*Total body irradiation (TBI) with a total dose of 10 Gy over 3 days using twice per day fractions
 
−
*[[Cytarabine (Cytosar)]] 1500 mg/m2 IV Q12H x 2 days (total of 4 total doses)
 
−
*[[Melphalan (Alkeran)]] 140 mg/m2 IV
 
−
 
 
−
'''Peripheral stem cells are infused on day 0'''
 
−
 
 
−
Supportive medications:
 
−
"Antimicrobial prophylaxis and use of [[Filgrastim (Neupogen) | G-CSF]] or erythropoietin were permitted according to physician decision."
 
−
 
 
−
===References===
 
−
# Delarue R, Haioun C, Ribrag V, Brice P, Delmer A, Tilly H, Salles G, Van Hoof A, Casasnovas O, Brousse N, Lefrere F, Hermine O; for the Groupe d'Etude des Lymphomes de l'Adulte (GELA). CHOP and DHAP plus rituximab followed by autologous stem cell transplantation in mantle cell lymphoma: a phase 2 study from the Groupe d'Etude des Lymphomes de l'Adulte. Blood. 2013 Jan 3;121(1):48-53. Epub 2012 Jun 20. [http://bloodjournal.hematologylibrary.org/content/121/1/48.full link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/22718839 PubMed]
 
−
 
 
−
==V-BEAM {{#subobject:d6ea18|Regimen=1}}==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#toc|back to top]]
 
−
|}
 
−
V-BEAM: '''<u>V</u>'''elcade, '''<u>B</u>'''iCNU, '''<u>E</u>'''toposide, '''<u>A</u>'''ra-C, '''<u>M</u>'''elphalan
 
−
 
 
−
===Regimen, William et al. 2014 {{#subobject:7ef4f|Variant=1}}===
 
−
<span
 
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
−
 
 
−
''Full details not available in abstract; to be added later.''
 
−
 
 
−
*[[Bortezomib (Velcade)]] on days -11, -8, -5, -2
 
−
*[[Carmustine (BiCNU)]]
 
−
*[[Etoposide (Vepesid)]] 
 
−
*[[Cytarabine (Cytosar)]]
 
−
*[[Melphalan (Alkeran)]]
 
−
 
 
−
===References===
 
−
# William BM, Allen MS, Loberiza FR Jr, Bociek RG, Bierman PJ, Armitage JO, Vose JM. Phase I/II study of bortezomib-BEAM and autologous hematopoietic stem cell transplantation for relapsed indolent non-Hodgkin lymphoma, transformed, or mantle cell lymphoma. Biol Blood Marrow Transplant. 2014 Apr;20(4):536-42. Epub 2014 Jan 14. [http://www.bbmt.org/article/S1083-8791(14)00020-2/fulltext link to original article] [http://www.ncbi.nlm.nih.gov/pubmed/24434781 PubMed]
 
−
 
 
−
==VMCP & BVAP -> high-dose Melphalan (Alkeran) {{#subobject:fdb3f3|Regimen=1}}==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#toc|back to top]]
 
−
|}
 
−
VMCP: '''<u>V</u>'''incristine, '''<u>M</u>'''elphalan, '''<u>C</u>'''yclophosphamide, '''<u>P</u>'''rednisone
 
−
<br>BVAP: '''<u>B</u>'''iCNU, '''<u>V</u>'''incristine, '''<u>A</u>'''driamycin, '''<u>P</u>'''rednisone
 
−
 
 
−
===Regimen - multiple myeloma high-dose therapy {{#subobject:f90513|Variant=1}}===
 
−
<span
 
−
style="background:#00CD00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase III</span>
 
−
 
 
−
====VMCP induction therapy====
 
−
*[[Vincristine (Oncovin)]] 1 mg IV once on day 1
 
−
*[[Melphalan (Alkeran)]] 5 mg/m2 PO once per day on days 1 to 4
 
−
*[[Cyclophosphamide (Cytoxan)]] 110 mg/m2 PO once per day on days 1 to 4
 
−
*[[Prednisone (Sterapred)]] 60 mg/m2 PO once per day on days 1 to 4
 
−
 
 
−
'''21-day cycles x 2 to 3 cycles, given in an alternating fashion with BVAP'''
 
−
 
 
−
====BVAP induction therapy====
 
−
*[[Vincristine (Oncovin)]] 1 mg IV once on day 1
 
−
*[[Carmustine (BiCNU)]] 30 mg/m2 IV once on day 1
 
−
*[[Doxorubicin (Adriamycin)]] 30 mg/m2 IV once on day 1
 
−
*[[Prednisone (Sterapred)]] 60 mg/m2 PO once per day on days 1 to 4
 
−
 
 
−
'''21-day cycles x 2 to 3 cycles, given in an alternating fashion with VMCP'''
 
−
 
 
−
'''VMCP and BVAP are given in an alternating fashion x a total of 4 to 6 cycles'''; patients with a [[performance status|WHO performance status]] <3, creatinine <1.7 mg/dL (150 µmol/L), and bone marrow (collected after cycle 4) with greater than 200 million nucleated cells/kg would proceed to melphalan, total body irradiation (TBI), and transplant:
 
−
 
 
−
====Melphalan (Alkeran), TBI, and transplant====
 
−
*[[Melphalan (Alkeran)]] 140 mg/m2 IV (no other details given about its administration)
 
−
*Total body irradiation (TBI) with a total dose of 8 Gy given over 4 days in 4 fractions, without lung shielding
 
−
*Autologous hematopoietic stem cell transplant after melphalan and TBI
 
−
*[[Interferon alfa-2b (Intron-A)?|Interferon alfa]] treatment started after transplant when ANC >1500/mm3 and platelets >75,000/mm3
 
−
 
 
−
===References===
 
−
# Attal M, Harousseau JL, Stoppa AM, Sotto JJ, Fuzibet JG, Rossi JF, Casassus P, Maisonneuve H, Facon T, Ifrah N, Payen C, Bataille R. A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. Intergroupe Français du Myélome. N Engl J Med. 1996 Jul 11;335(2):91-7. [http://www.nejm.org/doi/full/10.1056/NEJM199607113350204 link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/8649495 PubMed]
 
−
 
 
−
==Z-BEAM {{#subobject:19f0d0|Regimen=1}}==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#toc|back to top]]
 
−
|}
 
−
Z-BEAM: '''<u>Z</u>'''evalin (Ibritumomab tiuxetan), '''<u>B</u>'''iCNU (Carmustine), '''<u>E</u>'''toposide, '''<u>A</u>'''ra-C (Cytarabine), '''<u>M</u>'''elphalan
 
−
 
 
−
===Regimen #1 {{#subobject:9aeafe|Variant=1}}===
 
−
{| border="1" style="text-align:center;" !align="left"
 
−
|'''Study'''
 
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 
−
|'''Comparator'''
 
−
|-
 
−
|[http://onlinelibrary.wiley.com/doi/10.1002/cncr.27418/full Shimoni et al. 2012]
 
−
|<span
 
−
style="background:#00CD00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Randomized Phase II, >20 per arm</span>
 
−
|[[Transplant_conditioning_regimens#BEAM|BEAM]]
 
−
|-
 
−
!colspan="4" align="center"|
 
−
|-
 
−
|[http://www.haematologica.org/content/99/3/505.full Briones et al. 2013]
 
−
|<span
 
−
style="background:#eeee00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
−
|
 
−
|-
 
−
|}
 
−
 
 
−
''Patients in Shimoni et al. 2012 had primary induction failure or were chemosensitive to salvage therapy. Patients in Briones et al. 2013 had primary induction failure or were refractory to salvage therapy.''
 
−
 
 
−
*[[Rituximab (Rituxan)]] 250 mg/m2 IV once on day -14
 
−
*[[Ibritumomab tiuxetan (Zevalin)|Ibritumomab tiuxetan & Yttrium-90 (Zevalin) ]] 0.4 mCi/kg (maximum dose of 32 mCi) IV once on day -14, given after [[Rituximab (Rituxan)]]
 
−
*[[Carmustine (BiCNU)]] 300 mg/m2 IV once on day -6
 
−
*[[Etoposide (Vepesid)]] 200 mg/m2 IV once per day on days -5 to -2
 
−
*[[Cytarabine (Cytosar)]] 200 mg/m2 IV Q12H on days -5 to -2
 
−
*[[Melphalan (Alkeran)]] 140 mg/m2 IV once on day -1
 
−
 
 
−
Supportive medications:
 
−
*[[Filgrastim (Neupogen)]] 5 mcg/kg SC once per day starting on day +4 (Shimoni et al. 2012) or day +7 (Briones et al. 2013) until engraftment
 
−
*[[Valacyclovir (Valtrex)]] (dose not specified) for one month (Shimoni et al. 2012)
 
−
*[[Acyclovir (Zovirax)]] (dose not specified) for one month (Briones et al. 2013)
 
−
*[[Trimethoprim/Sulfamethoxazole (Bactrim DS)]] (dose/frequency not specified) for six months (3 months in Briones et al. 2013)
 
−
 
 
−
'''Autologous blood stem cells are infused on day 0'''
 
−
 
 
−
===Regimen #2 {{#subobject:e7f161|Variant=1}}===
 
−
{| border="1" style="text-align:center;" !align="left"
 
−
|'''Study'''
 
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 
−
|-
 
−
|[http://www.sciencedirect.com/science/article/pii/S108387911400473X Fruchart et al. 2014]
 
−
|<span
 
−
style="background:#eeee00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
−
|-
 
−
|}
 
−
''This regimen is intended for upfront consolidation. Patients achieved at least a PR to [[Diffuse_large_B-cell_lymphoma#ACVBP-R|R-ACVBP]] or [[Diffuse_large_B-cell_lymphoma#R-CHOP|R-CHOP]].''
 
−
 
 
−
*[[Rituximab (Rituxan)]] 250 mg/m2 IV once per day on days -21 & -14
 
−
*[[Ibritumomab tiuxetan (Zevalin)|Ibritumomab tiuxetan & Yttrium-90 (Zevalin) ]] 0.4 mCi/kg (maximum dose of 32 mCi) IV once on day -14, given after [[Rituximab (Rituxan)]]
 
−
**Dose reduced to 0.3 mCi/kg if platelet count was > 100k and less than 150k.
 
−
*[[Carmustine (BiCNU)]] 300 mg/m2 IV once on day -7
 
−
*[[Etoposide (Vepesid)]] 100 mg/m2 IV once per day on days -6 to -3
 
−
*[[Cytarabine (Cytosar)]] 200 mg/m2 IV Q12H on days -6 to -3
 
−
*[[Melphalan (Alkeran)]] 140 mg/m2 IV once on day -2
 
−
 
 
−
Supportive medications: according to standard use
 
−
 
 
−
'''Autologous blood stem cells are infused on day 0'''
 
−
 
 
−
===References===
 
−
# Shimoni A, Avivi I, Rowe JM, Yeshurun M, Levi I, Or R, Patachenko P, Avigdor A, Zwas T, Nagler A. A randomized study comparing yttrium-90 ibritumomab tiuxetan (Zevalin) and high-dose BEAM chemotherapy versus BEAM alone as the conditioning regimen before autologous stem cell transplantation in patients with aggressive lymphoma. Cancer. 2012 Oct 1;118(19):4706-14. Epub 2012 Jan 17. [http://onlinelibrary.wiley.com/doi/10.1002/cncr.27418/full link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/22252613 PubMed]
 
−
# Briones J, Novelli S, García-Marco JA, Tomás JF, Bernal T, Grande C, Canales MA, Torres A, Moraleda JM, Panizo C, Jarque I, Palmero F, Hernsández M, González-Barca E, López D, Caballero D. Autologous stem cell transplantation after conditioning with Yttrium-90 ibritumomab tiuxetan plus beam in refractory non-Hodgkin diffuse large B-cell lymphoma: results of a prospective, multicenter, phase II clinical trial. Haematologica. 2014 Mar;99(3):505-10. Epub 2013 Oct 25. [http://www.haematologica.org/content/99/3/505.full link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/24162789 PubMed]
 
−
# Fruchart C, Tilly H, Morschhauser F, Ghesquières H, Bouteloup M, Fermé C, Van Den Neste E, Bordessoule D, Bouabdallah R, Delmer A, Casasnovas RO, Ysebaert L, Ciappuccini R, Briere J, Gisselbrecht C. Upfront consolidation combining yttrium-90 ibritumomab tiuxetan and high-dose therapy with stem cell transplantation in poor-risk patients with diffuse large B cell lymphoma. Biol Blood Marrow Transplant. 2014 Dec;20(12):1905-11. Epub 2014 Jul 26. [http://www.sciencedirect.com/science/article/pii/S108387911400473X link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/25072780 PubMed]
 
−
 
 
−
=Allogeneic hematopoietic cell transplant, myeloablative=
 
−
==BEAM {{#subobject:bda306|Regimen=1}}==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#toc|back to top]]
 
−
|}
 
−
BEAM: '''<u>B</u>'''iCNU, '''<u>E</u>'''toposide, '''<u>A</u>'''ra-C, '''<u>M</u>'''elphalan
 
−
 
 
−
===Regimen {{#subobject:a8d4a|Variant=1}}===
 
−
<span
 
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
−
 
 
−
''Day 0 is the day of transplantation.''
 
−
*[[Carmustine (BiCNU)]] 300 mg/m2 IV once on day -6
 
−
*[[Etoposide (Vepesid)]] 200 mg/m2 IV BID on days -5 to -2
 
−
*[[Cytarabine (Cytosar)]] 200 mg/m2 IV BID on days -5 to -2
 
−
*[[Melphalan (Alkeran)]] 140 mg/m2 IV once on day -1
 
−
 
 
−
Supportive medications:
 
−
*[[Filgrastim (Neupogen)]] 5 mcg/kg SC once per day, starting on day +7 and continued until engraftment
 
−
*GVHD prophylaxis with [[Tacrolimus (Prograf)]] and [[Methotrexate (MTX)]]
 
−
*"Prophylactic antibiotics"
 
−
 
 
−
===References===
 
−
# Przepiorka D, van Besien K, Khouri I, Hagemeister F, Samuels B, Folloder J, Ueno NT, Molldrem J, Mehra R, Körbling M, Giralt S, Gajewski J, Donato M, Cleary K, Claxton D, Braunschweig I, Andersson B, Anderlini P, Champlin R. Carmustine, etoposide, cytarabine and melphalan as a preparative regimen for allogeneic transplantation for high-risk malignant lymphoma. Ann Oncol. 1999 May;10(5):527-32. [http://annonc.oxfordjournals.org/content/10/5/527.long link to original article] '''contains protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/10416001 PubMed]
 
−
# Sobol U, Rodriguez T, Smith S, Go A, Vimr R, Parthasarathy M, Guo R, Stiff P. Seven-year follow-up of allogeneic transplant using BCNU, etoposide, cytarabine and melphalan chemotherapy in patients with Hodgkin lymphoma after autograft failure: importance of minimal residual disease. Leuk Lymphoma. 2014 Jun;55(6):1281-7. Epub 2013 Oct 3. [http://informahealthcare.com/doi/full/10.3109/10428194.2013.838233 link to original article] [http://www.ncbi.nlm.nih.gov/pubmed/23987822 PubMed]
 
−
 
 
−
==BFR {{#subobject:c2659b|Regimen=1}}==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#toc|back to top]]
 
−
|}
 
−
BFR: '''<u>B</u>'''endamustine, '''<u>F</u>'''ludarabine, '''<u>R</u>'''ituximab
 
−
 
 
−
===Regimen, Khouri et al. 2014 {{#subobject:41fd04|Variant=1}}===
 
−
<span
 
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
−
 
 
−
''Day 0 is the day of transplantation.''
 
−
*[[Bendamustine (Treanda)]] 130 mg/m2 IV over 60 minutes once per day on days -5 to -3
 
−
*[[Fludarabine (Fludara)]] 30 mg/m2 IV over 30 minutes once per day on days -5 to -3
 
−
*[[Rituximab (Rituxan)]] (for "those with B-cell disease") 375 mg/m2 IV once on days -13, -6, +1, +8
 
−
*See article for GVHD prophylaxis information
 
−
 
 
−
===References===
 
−
# Khouri IF, Wei W, Korbling M, Turturro F, Ahmed S, Alousi A, Anderlini P, Ciurea S, Jabbour E, Oran B, Popat UR, Rondon G, Bassett RL Jr, Gulbis A. BFR (bendamustine, fludarabine, and rituximab) allogeneic conditioning for chronic lymphocytic leukemia/lymphoma: reduced myelosuppression and GVHD. Blood. 2014 Oct 2;124(14):2306-12. Epub 2014 Aug 21. [http://www.bloodjournal.org/content/124/14/2306.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/25145344 PubMed]
 
−
 
 
−
==Busulfan & Cyclophosphamide (BuCy) {{#subobject:83e07a|Regimen=1}}==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#toc|back to top]]
 
−
|}
 
−
===Regimen {{#subobject:eeaff3|Variant=1}}===
 
−
{| border="1" style="text-align:center;" !align="left"
 
−
|'''Study'''
 
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 
−
|'''Comparator'''
 
−
|-
 
−
|[http://jco.ascopubs.org/content/31/6/701.full Lee et al. 2013]
 
−
|<span
 
−
style="background:#00CD00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase III</span>
 
−
|[[#Busulfan_.26_Fludarabine_.28Flu.2FBu.3B_BuFlu.29|Busulfan & Fludarabine]]
 
−
|-
 
−
|[http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(15)00200-4/abstract Rambaldi et al. 2015]
 
−
|<span
 
−
style="background:#00CD00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase III</span>
 
−
|[[#Busulfan_.26_Fludarabine_.28Flu.2FBu.3B_BuFlu.29|Busulfan & Fludarabine]]
 
−
|-
 
−
|}
 
−
 
 
−
*[[Busulfan (Myleran)]] 3.2 mg/kg IV once per day on days -7 to -4
 
−
*[[Cyclophosphamide (Cytoxan)]] 60 mg/kg IV once on days -3 and -2
 
−
 
 
−
Supportive medications:
 
−
*"[[Cyclosporine non-modified (Sandimmune)|Cyclosporine]] alone or cyclosporine plus [[Methotrexate (MTX)|methotrexate]] according to the discretion of the attending physician"
 
−
*[[Filgrastim (Neupogen)]] 450 mcg SC once per day, starting on day +5 and continued until ANC >3,000
 
−
 
 
−
===References===
 
−
# Lee JH, Joo YD, Kim H, Ryoo HM, Kim MK, Lee GW, Lee JH, Lee WS, Park JH, Bae SH, Hyun MS, Kim DY, Kim SD, Min YJ, Lee KH. Randomized trial of myeloablative conditioning regimens: busulfan plus cyclophosphamide versus busulfan plus fludarabine. J Clin Oncol. 2013 Feb 20;31(6):701-9. Epub 2012 Nov 5. [http://jco.ascopubs.org/content/31/6/701.full link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/23129746 PubMed]
 
−
# '''Retrospective:''' Copelan EA, Hamilton BK, Avalos B, Ahn KW, Bolwell BJ, Zhu X, Aljurf M, van Besien K, Bredeson C, Cahn JY, Costa LJ, de Lima M, Gale RP, Hale GA, Halter J, Hamadani M, Inamoto Y, Kamble RT, Litzow MR, Loren AW, Marks DI, Olavarria E, Roy V, Sabloff M, Savani BN, Seftel M, Schouten HC, Ustun C, Waller EK, Weisdorf DJ, Wirk B, Horowitz MM, Arora M, Szer J, Cortes J, Kalaycio ME, Maziarz RT, Saber W. Better leukemia-free and overall survival in AML in first remission following cyclophosphamide in combination with busulfan compared with TBI. Blood. 2013 Dec 5;122(24):3863-70. Epub 2013 Sep 24. [http://bloodjournal.hematologylibrary.org/content/122/24/3863.long link to original article] [http://www.ncbi.nlm.nih.gov/pubmed/24065243 PubMed]
 
−
# Rambaldi A, Grassi A, Masciulli A, Boschini C, Micò MC, Busca A, Bruno B, Cavattoni I, Santarone S, Raimondi R, Montanari M, Milone G, Chiusolo P, Pastore D, Guidi S, Patriarca F, Risitano AM, Saporiti G, Pini M, Terruzzi E, Arcese W, Marotta G, Carella AM, Nagler A, Russo D, Corradini P, Alessandrino EP, Torelli GF, Scimè R, Mordini N, Oldani E, Marfisi RM, Bacigalupo A, Bosi A. Busulfan plus cyclophosphamide versus busulfan plus fludarabine as a preparative regimen for allogeneic haemopoietic stem-cell transplantation in patients with acute myeloid leukaemia: an open-label, multicentre, randomised, phase 3 trial. Lancet Oncol. 2015 Nov;16(15):1525-36. Epub 2015 Sep 28. [http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(15)00200-4/abstract link to original article] [http://www.ncbi.nlm.nih.gov/pubmed/26429297 PubMed]
 
−
 
 
−
==Busulfan & Fludarabine (Flu/Bu; BuFlu) {{#subobject:576283|Regimen=1}}==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#toc|back to top]]
 
−
|}
 
−
 
 
−
===Regimen #1 {{#subobject:d415a|Variant=1}}===
 
−
{| border="1" style="text-align:center;" !align="left"
 
−
|'''Study'''
 
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 
−
|'''Comparator'''
 
−
|-
 
−
|[http://jco.ascopubs.org/content/31/6/701.full Lee et al. 2013]
 
−
|<span
 
−
style="background:#00CD00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase III</span>
 
−
|[[#Busulfan_.26_Cyclophosphamide_.28BuCy.29|Busulfan & Cyclophosphamide]]
 
−
|-
 
−
|}
 
−
 
 
−
*[[Busulfan (Myleran)]] 3.2 mg/kg IV once per day on days -7 to -4
 
−
*[[Fludarabine (Fludara)]] 30 mg/m2 IV once per day on days -6 to -2
 
−
 
 
−
Supportive medications:
 
−
*"[[Cyclosporine non-modified (Sandimmune)|Cyclosporine]] alone or with [[Methotrexate (MTX)|methotrexate]] according to the discretion of the attending physician"
 
−
*[[Filgrastim (Neupogen)]] 450 mcg SC once per day, starting on day +5 and continued until ANC >3,000
 
−
 
 
−
===Regimen #2 {{#subobject:6eb66d|Variant=1}}===
 
−
{| border="1" style="text-align:center;" !align="left"
 
−
|'''Study'''
 
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 
−
|-
 
−
|[http://www.bbmt.org/article/S1083-8791%2802%2950007-0/abstract Russell et al. 2002]
 
−
|<span
 
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
−
|-
 
−
|}
 
−
 
 
−
*[[Fludarabine (Fludara)]] 50 mg/m2 IV once per day on days -6 to -2
 
−
*[[Busulfan (Myleran)]] 3.2 mg/kg (ideal body weight) IV once per day over 3 hours on days -5 to -2
 
−
 
 
−
Supportive medications:
 
−
*[[Phenytoin (Dilantin)]] "loading" PO/IV, dosed to maintain therapeutic levels of 40 to 80 umol/L on days -5 to -2
 
−
*[[Ciprofloxacin (Cipro)]] 500 mg PO BID as prophylaxis
 
−
*[[Trimethoprim/Sulfamethoxazole (Bactrim DS)]] (dose not specified in reference, but assume 160/800 mg dose) PO 2 times a week as PCP prophylaxis
 
−
*No routine fungal prophylaxis
 
−
*No routine use of growth factors
 
−
*CMV negative blood
 
−
 
 
−
Acute GVHD prophylaxis:
 
−
*[[Antithymocyte globulin (ATG)|Antithymocyte globulin (Thymoglobulin, rabbit ATG)]] 0.5 mg/kg IV once on day -2; 2 mg/kg/day IV once on days -1 and 0 (total dose of 4.5 mg/kg)
 
−
*[[Cyclosporine modified (Neoral)]] or [[Cyclosporine non-modified (Sandimmune)]] PO/IV BID, with doses adjusted to maintain cyclosporine levels of 150 to 400 umol/L
 
−
*[[Methotrexate (MTX)]] 15 mg/m2 once on day 1; 10 mg/m2 once per day on days 3, 6, 11
 
−
*[[Folinic acid (Leucovorin)]] 5 mg started 24 hours after each dose of [[Methotrexate (MTX)]] and continued Q6H until 12 hours before the next dose of [[Methotrexate (MTX)]]
 
−
 
 
−
===References===
 
−
# Russell JA, Tran HT, Quinlan D, Chaudhry A, Duggan P, Brown C, Stewart D, Ruether JD, Morris D, Glick S, Gyonyor E, Andersson BS. Once-daily intravenous busulfan given with fludarabine as conditioning for allogeneic stem cell transplantation: study of pharmacokinetics and early clinical outcomes. Biol Blood Marrow Transplant. 2002;8(9):468-76. [http://www.bbmt.org/article/S1083-8791%2802%2950007-0/abstract link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/12374451 PubMed]
 
−
# Lee JH, Joo YD, Kim H, Ryoo HM, Kim MK, Lee GW, Lee JH, Lee WS, Park JH, Bae SH, Hyun MS, Kim DY, Kim SD, Min YJ, Lee KH. Randomized trial of myeloablative conditioning regimens: busulfan plus cyclophosphamide versus busulfan plus fludarabine. J Clin Oncol. 2013 Feb 20;31(6):701-9. Epub 2012 Nov 5. [http://jco.ascopubs.org/content/31/6/701.full link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/23129746 PubMed]
 
−
 
 
−
==Cyclophosphamide & TBI {{#subobject:a9f7e8|Regimen=1}}==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#toc|back to top]]
 
−
|}
 
−
 
 
−
===Regimen, Copelan et al. 2013 {{#subobject:6ca28d|Variant=1}}===
 
−
<span
 
−
style="background:#ff0000;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Retrospective</span>
 
−
 
 
−
''This was a retrospective study from CIBMTR data; regimen and supportive medication details vary.''
 
−
*[[Cyclophosphamide (Cytoxan)]]
 
−
*Total body irradiation (TBI)
 
−
 
 
−
===References===
 
−
# Copelan EA, Hamilton BK, Avalos B, Ahn KW, Bolwell BJ, Zhu X, Aljurf M, van Besien K, Bredeson C, Cahn JY, Costa LJ, de Lima M, Gale RP, Hale GA, Halter J, Hamadani M, Inamoto Y, Kamble RT, Litzow MR, Loren AW, Marks DI, Olavarria E, Roy V, Sabloff M, Savani BN, Seftel M, Schouten HC, Ustun C, Waller EK, Weisdorf DJ, Wirk B, Horowitz MM, Arora M, Szer J, Cortes J, Kalaycio ME, Maziarz RT, Saber W. Better leukemia-free and overall survival in AML in first remission following cyclophosphamide in combination with busulfan compared with TBI. Blood. 2013 Dec 5;122(24):3863-70. Epub 2013 Sep 24. [http://bloodjournal.hematologylibrary.org/content/122/24/3863.long link to original article] [http://www.ncbi.nlm.nih.gov/pubmed/24065243 PubMed]
 
−
 
 
−
==Fludarabine, Busulfan, Cyclophosphamide {{#subobject:84acb0|Regimen=1}}==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#toc|back to top]]
 
−
|}
 
−
 
 
−
===Regimen {{#subobject:bfe434|Variant=1}}===
 
−
{| border="1" style="text-align:center;" !align="left"
 
−
|'''Study'''
 
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 
−
|-
 
−
|[http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)70161-5/fulltext Glass et al. 2014 (DSHNHL R3)]
 
−
|<span
 
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Non-randomized</span>
 
−
|-
 
−
|}
 
−
 
 
−
''This is described by the authors as a lymphoma-directed myeloablative conditioning regimen''
 
−
 
 
−
====Conditioning====
 
−
*[[Fludarabine (Fludara)]] 25 mg/m2/day IV on days -8 to -4
 
−
*[[Busulfan (Myleran)]] 4 mg/kg/day PO or 3.2 mg/kg/day IV on days -6 to -4
 
−
*[[Cyclophosphamide (Cytoxan)]] 60 mg/kg/day IV on days -3 and -2
 
−
 
 
−
'''Day 0 is the day of transplantation'''
 
−
 
 
−
====GVHD prophylaxis====
 
−
*[[Tacrolimus (Prograf)]] 8 to 12 µg/L (route/frequency not specified) starting on day -1, tapered from day +100 in absence of GVHD
 
−
*[[Mycophenolate mofetil (CellCept)]] 1000 mg (route not specified) BID from day +1 to +28
 
−
*[[Antithymocyte globulin (ATG)|Antithymocyte globulin (Thymoglobulin, rabbit ATG)]] 2 mg/kg IV from day -3 to -1 (''unclear if this is a total dose or a daily dose; option also to use ATG-Fresenius S at a higher dose of 10 mg/kg)
 
−
 
 
−
===References===
 
−
<!-- # Glass B, rabbits Kamp J, Wulf G, Dreger P, Pfreundschuh M, Gramatzki M Silling G, Wilhelm C, Zeis M, Görlitz A, Pfeiffer S, Hilgers R, Truemper L, Schmitz N. High-dose chemotherapy Followed by allogeneic stem cell transplantation in relapsed and refractory high-risk aggressive non-Hodgkin's lymphoma: Results of a prospective study of the German high-grade non-Hodgkin's lymphoma study group. J Clin Oncol 30, 2012 (suppl; abstr 8004) -->
 
−
# Glass B, Hasenkamp J, Wulf G, Dreger P, Pfreundschuh M, Gramatzki M, Silling G, Wilhelm C, Zeis M, Görlitz A, Pfeiffer S, Hilgers R, Truemper L, Schmitz N; on behalf of the German High-Grade Lymphoma Study Group. Rituximab after lymphoma-directed conditioning and allogeneic stem-cell transplantation for relapsed and refractory aggressive non-Hodgkin lymphoma (DSHNHL R3): an open-label, randomised, phase 2 trial. Lancet Oncol. 2014 Jun;15(7):757-66. Epub 2014 May 11. [http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)70161-5/fulltext link to original article] [http://www.dshnhl.org/app/download/9495510598/Studienprotokoll+DSHNHL+alloFBC+final+vollst.pdf link to original protocol (in German)] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/24827808 PubMed]
 
−
 
 
−
=Allogeneic hematopoietic cell transplant, reduced-intensity conditioning (RIC)=
 
−
 
 
−
==Busulfan & Fludarabine {{#subobject:3fe0f0|Regimen=1}}==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#toc|back to top]]
 
−
|}
 
−
===Regimen {{#subobject:a7e574|Variant=1}}===
 
−
{| border="1" style="text-align:center;" !align="left"
 
−
|'''Study'''
 
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 
−
|-
 
−
|[http://jco.ascopubs.org/content/33/35/4167.full Devine et al. 2015 (CALGB 100103)]
 
−
|<span
 
−
style="background:#ff0000;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II, <20 patients in this subgroup</span>
 
−
|-
 
−
|}
 
−
 
 
−
''This regimen is meant for related donors; only 8 patients received this regimen before the addition of ATG (rabbit) after 2006.''
 
−
 
 
−
*[[Fludarabine (Fludara)]] 30 mg/m2 IV over 30 minutes once per day on days -7 to -3
 
−
*[[Busulfan (Myleran)]] 0.8 mg/kg IV over 2 hours q6h on days -4 & -3 (8 total doses)
 
−
 
 
−
GVHD prophylaxis:
 
−
*[[Tacrolimus (Prograf)]] with doses adjusted to maintain levels of 5 to 10 ng/mL, tapered on day +90 to off by day +180 (if no GVHD)
 
−
*[[Methotrexate (MTX)]] 5 mg/m2 IV once per day on days +1, +3, +6, +11
 
−
 
 
−
===References===
 
−
<!-- Presented in part as an oral presentation at the 54th American Society of Hematology Annual Meeting and Exposition, Atlanta, GA, December 8-11, 2012. -->
 
−
# Devine SM, Owzar K, Blum W, Mulkey F, Stone RM, Hsu JW, Champlin RE, Chen YB, Vij R, Slack J, Soiffer RJ, Larson RA, Shea TC, Hars V, Sibley AB, Giralt S, Carter S, Horowitz MM, Linker C, Alyea EP. Phase II Study of Allogeneic Transplantation for Older Patients With Acute Myeloid Leukemia in First Complete Remission Using a Reduced-Intensity Conditioning Regimen: Results From Cancer and Leukemia Group B 100103 (Alliance for Clinical Trials in Oncology)/Blood and Marrow Transplant Clinical Trial Network 0502. J Clin Oncol. 2015 Nov 2. [Epub ahead of print] [http://jco.ascopubs.org/content/33/35/4167.full link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/26527780 PubMed]
 
−
 
 
−
==Cyclophosphamide, Fludarabine, Thiotepa {{#subobject:ee93e3|Regimen=1}}==
 
−
 
 
−
===Regimen {{#subobject:81245f|Variant=1}}===
 
−
 
 
−
Details to be completed.
 
−
*[[Cyclophosphamide (Cytoxan)]]
 
−
*[[Fludarabine (Fludara)]]
 
−
*[[Thiotepa (Thioplex)]]
 
−
 
 
−
===References===
 
−
# Corradini P, Tarella C, Olivieri A, Gianni AM, Voena C, Zallio F, Ladetto M, Falda M, Lucesole M, Dodero A, Ciceri F, Benedetti F, Rambaldi A, Sajeva MR, Tresoldi M, Pileri A, Bordignon C, Bregni M. Reduced-intensity conditioning followed by allografting of hematopoietic cells can produce clinical and molecular remissions in patients with poor-risk hematologic malignancies. Blood. 2002 Jan 1;99(1):75-82. [http://www.bloodjournal.org/content/99/1/75.long link to original article] [http://www.ncbi.nlm.nih.gov/pubmed/11756155 PubMed]
 
−
 
 
−
==Fludarabine and Low-dose TBI {{#subobject:53c6af|Regimen=1}}==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#toc|back to top]]
 
−
|}
 
−
===Regimen {{#subobject:7fa6ce|Variant=1}}===
 
−
{| border="1" style="text-align:center;" !align="left"
 
−
|'''Study'''
 
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 
−
|'''Comparator'''
 
−
|-
 
−
|[http://www.bloodjournal.org/content/102/6/2021.full Maris et al. 2003]
 
−
|<span
 
−
style="background:#eeee00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
−
|
 
−
|-
 
−
!colspan="4" align="center"|
 
−
|-
 
−
|[http://jco.ascopubs.org/content/23/16/3819.long Sorror et al. 2005]
 
−
|<span
 
−
style="background:#eeee00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
−
|
 
−
|-
 
−
!colspan="4" align="center"|
 
−
|-
 
−
|[http://jco.ascopubs.org/content/28/17/2859.long Gyukocza et al. 2010]
 
−
|<span
 
−
style="background:#00CD00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase III</span>
 
−
|[[Transplant_conditioning_regimens#Low-dose_TBI|Low-dose TBI]]
 
−
|-
 
−
|}
 
−
 
 
−
''Details are best described in Maris et al. 2003.''
 
−
 
 
−
*[[Fludarabine (Fludara)]] 30 mg/m2 IV once per day on days -4 to -2
 
−
*Total body irradiation (TBI) 2 Gy at a rate of 0.07 Gy/min on day 0
 
−
 
 
−
Supportive medications for GVHD prophylaxis:
 
−
*Cyclosporine (type not specified) 6.25 mg/kg PO BID starting 4 to 6 hours after transplant, tapered at day 100 over 80 days (if no GVHD)
 
−
*[[Mycophenolate mofetil (CellCept)]] 15 mg/kg PO BID starting 4 to 6 hours after transplant, tapered at day 40 over 56 days (if no GVHD)
 
−
 
 
−
===References===
 
−
# Maris MB, Niederwieser D, Sandmaier BM, Storer B, Stuart M, Maloney D, Petersdorf E, McSweeney P, Pulsipher M, Woolfrey A, Chauncey T, Agura E, Heimfeld S, Slattery J, Hegenbart U, Anasetti C, Blume K, Storb R. HLA-matched unrelated donor hematopoietic cell transplantation after nonmyeloablative conditioning for patients with hematologic malignancies. Blood. 2003 Sep 15;102(6):2021-30. Epub 2003 Jun 5. [http://www.bloodjournal.org/content/102/6/2021.full link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/12791654 PubMed]
 
−
<!-- Presented in part at the Tandem Bone Marrow Transplantation meeting, February 13-17, 2004, Orlando, FL (for part of the patient population). -->
 
−
# Sorror ML, Maris MB, Sandmaier BM, Storer BE, Stuart MJ, Hegenbart U, Agura E, Chauncey TR, Leis J, Pulsipher M, McSweeney P, Radich JP, Bredeson C, Bruno B, Langston A, Loken MR, Al-Ali H, Blume KG, Storb R, Maloney DG. Hematopoietic cell transplantation after nonmyeloablative conditioning for advanced chronic lymphocytic leukemia. J Clin Oncol. 2005 Jun 1;23(16):3819-29. Epub 2005 Apr 4. [http://jco.ascopubs.org/content/23/16/3819.long link to original article] [http://www.ncbi.nlm.nih.gov/pubmed/15809448 PubMed]
 
−
## '''Update:''' Sorror ML, Storer BE, Sandmaier BM, Maris M, Shizuru J, Maziarz R, Agura E, Chauncey TR, Pulsipher MA, McSweeney PA, Wade JC, Bruno B, Langston A, Radich J, Niederwieser D, Blume KG, Storb R, Maloney DG. Five-year follow-up of patients with advanced chronic lymphocytic leukemia treated with allogeneic hematopoietic cell transplantation after nonmyeloablative conditioning. J Clin Oncol. 2008 Oct 20;26(30):4912-20. Epub 2008 Sep 15. [http://jco.ascopubs.org/content/26/30/4912.long link to original article] [http://www.ncbi.nlm.nih.gov/pubmed/18794548 PubMed]
 
−
<!-- no pre-pub disclosed -->
 
−
# Gyurkocza B, Storb R, Storer BE, Chauncey TR, Lange T, Shizuru JA, Langston AA, Pulsipher MA, Bredeson CN, Maziarz RT, Bruno B, Petersen FB, Maris MB, Agura E, Yeager A, Bethge W, Sahebi F, Appelbaum FR, Maloney DG, Sandmaier BM. Nonmyeloablative allogeneic hematopoietic cell transplantation in patients with acute myeloid leukemia. J Clin Oncol. 2010 Jun 10;28(17):2859-67. Epub 2010 May 3. [http://jco.ascopubs.org/content/28/17/2859.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/20439626 PubMed]
 
−
 
 
−
==Fludarabine, Busulfan, ATG {{#subobject:ed545b|Regimen=1}}==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#toc|back to top]]
 
−
|}
 
−
 
 
−
===Regimen #1 {{#subobject:dd1486|Variant=1}}===
 
−
{| border="1" style="text-align:center;" !align="left"
 
−
|'''Study'''
 
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 
−
|-
 
−
|[http://jco.ascopubs.org/content/33/35/4167.full Devine et al. 2015 (CALGB 100103)]
 
−
|<span
 
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
−
|-
 
−
|}
 
−
 
 
−
''This regimen is meant for all types of donors.''
 
−
 
 
−
*[[Fludarabine (Fludara)]] 30 mg/m2 IV over 30 minutes once per day on days -7 to -3
 
−
*[[Busulfan (Myleran)]] 0.8 mg/kg IV over 2 hours q6h on days -4 & -3 (8 total doses)
 
−
*[[Antithymocyte globulin, rabbit ATG (Thymoglobulin)|ATG (Rabbit)]] 2.5 mg/kg IV over 6 hours once per day on days -4 to -2
 
−
 
 
−
GVHD prophylaxis:
 
−
*[[Tacrolimus (Prograf)]] with doses adjusted to maintain levels of 5 to 10 ng/mL, tapered on day +90 to off by day +180 (if no GVHD)
 
−
*[[Methotrexate (MTX)]] 5 mg/m2 IV once per day on days +1, +3, +6, +11
 
−
 
 
−
===Regimen #2 {{#subobject:e2c4bf|Variant=1}}===
 
−
{| border="1" style="text-align:center;" !align="left"
 
−
|'''Study'''
 
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 
−
|-
 
−
|[http://www.bloodjournal.org/content/91/3/756.full Slavin et al. 1998]
 
−
|<span
 
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
−
|-
 
−
|}
 
−
 
 
−
*[[Fludarabine (Fludara)]] 30 mg/m2 IV once per day on days -10 to -5 (6 consecutive days)
 
−
*[[Busulfan (Myleran)]] 4 mg/kg/day PO on days -6 to -5 (2 consecutive days)
 
−
*[[Antithymocyte globulin (ATG)]] (ATG-Fresenius) 10 mg/kg/day on days -4 to -1 (4 consecutive days)
 
−
 
 
−
===Regimen #3 {{#subobject:335733|Variant=1}}===
 
−
{| border="1" style="text-align:center;" !align="left"
 
−
|'''Study'''
 
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 
−
|-
 
−
|[http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)70161-5/fulltext Mohti et al. 2014]
 
−
|<span
 
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
−
|-
 
−
|}
 
−
 
 
−
*[[Fludarabine (Fludara)]] 30 mg/m2/day (route not specified) on days -6 to -2 (5 consecutive days)
 
−
*[[Busulfan (Myleran)]] 130 mg/m2 IV over 3 hours once per day on days -5 to -3 (3 consecutive days)
 
−
*[[Antithymocyte globulin (ATG)]] (subtype not specified) 2.5 mg/kg/day IV on days -2 & -1
 
−
 
 
−
''Supportive care as per [http://www.ncbi.nlm.nih.gov/pubmed/12931226 Mohty et al. 2003].''
 
−
 
 
−
===References===
 
−
# Slavin S, Nagler A, Naparstek E, Kapelushnik Y, Aker M, Cividalli G, Varadi G, Kirschbaum M, Ackerstein A, Samuel S, Amar A, Brautbar C, Ben-Tal O, Eldor A, Or R. Nonmyeloablative stem cell transplantation and cell therapy as an alternative to conventional bone marrow transplantation with lethal cytoreduction for the treatment of malignant and nonmalignant hematologic diseases. Blood. 1998 Feb 1;91(3):756-63. [http://www.bloodjournal.org/content/91/3/756.full link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/9446633 PubMed]
 
−
# Mohty M, Malard F, Blaise D, Milpied N, Furst S, Tabrizi R, Guillaume T, Vigouroux S, El-Cheikh J, Delaunay J, Le Gouill S, Moreau P, Labopin M, Chevallier P. Reduced-toxicity conditioning with fludarabine, once-daily intravenous busulfan, and antithymocyte globulins prior to allogeneic stem cell transplantation: results of a multicenter prospective phase 2 trial. Cancer. 2015 Feb 15;121(4):562-9. Epub 2014 Oct 3. Erratum in: Cancer. 2015 Mar 1;121(5):800. [http://onlinelibrary.wiley.com/doi/10.1002/cncr.29087/full link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/25283774 PubMed]
 
−
<!-- Presented in part as an oral presentation at the 54th American Society of Hematology Annual Meeting and Exposition, Atlanta, GA, December 8-11, 2012. -->
 
−
# Devine SM, Owzar K, Blum W, Mulkey F, Stone RM, Hsu JW, Champlin RE, Chen YB, Vij R, Slack J, Soiffer RJ, Larson RA, Shea TC, Hars V, Sibley AB, Giralt S, Carter S, Horowitz MM, Linker C, Alyea EP. Phase II Study of Allogeneic Transplantation for Older Patients With Acute Myeloid Leukemia in First Complete Remission Using a Reduced-Intensity Conditioning Regimen: Results From Cancer and Leukemia Group B 100103 (Alliance for Clinical Trials in Oncology)/Blood and Marrow Transplant Clinical Trial Network 0502. J Clin Oncol. 2015 Nov 2. [Epub ahead of print] [http://jco.ascopubs.org/content/33/35/4167.full link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/26527780 PubMed]
 
−
 
 
−
==Fludarabine, Busulfan, ATG, Ibritumomab tiuxetan {{#subobject:68bee2|Regimen=1}}==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#toc|back to top]]
 
−
|}
 
−
 
 
−
===Regimen {{#subobject:822e5a|Variant=1}}===
 
−
{| border="1" style="text-align:center;" !align="left"
 
−
|'''Study'''
 
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 
−
|-
 
−
|[http://annonc.oxfordjournals.org/content/26/1/193.full Bouabdallah et al. 2015]
 
−
|<span
 
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
−
|-
 
−
|}
 
−
 
 
−
''Day 0 is the day of transplantation.''
 
−
 
 
−
*[[Fludarabine (Fludara)]] 30 mg/m2 IV once per day on days -6 to -2
 
−
*[[Busulfan (Myleran)]] 3.2 mg/kg/day (route not specified) on days -5 & -4
 
−
*[[Antithymocyte globulin, rabbit ATG (Thymoglobulin)]] 2.5 mg/kg IV once on day -1
 
−
*[[Rituximab (Rituxan)]] 250 mg/m2 IV once per day on days -21 & -14
 
−
*[[Ibritumomab tiuxetan (Zevalin)]] 0.4 mCi/kg (maximum dose of 32 mCi) IV once on day -14
 
−
 
 
−
GVHD prophylaxis:
 
−
*Cyclosporine (type and dose not specified) until day +90 and tapered off by day +180 based on chimerism and GVHD
 
−
*[[Methotrexate (MTX)]] as follows (for unrelated donors with HLA mismatch):
 
−
**15 mg/m2 (route not specified) once on day +1
 
−
**10 mg/m2 (route not specified) once per day on days +3 & +6
 
−
 
 
−
===References===
 
−
# Bouabdallah K, Furst S, Asselineau J, Chevalier P, Tournilhac O, Ceballos P, Vigouroux S, Tabrizi R, Doussau A, Bouabdallah R, Mohty M, Le Gouill S, Blaise D, Milpied N. 90Y-ibritumomab tiuxetan, fludarabine, busulfan and antithymocyte globulin reduced-intensity allogeneic transplant conditioning for patients with advanced and high-risk B-cell lymphomas. Ann Oncol. 2015 Jan;26(1):193-8. Epub 2014 Oct 30. [http://annonc.oxfordjournals.org/content/26/1/193.full link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/25361987 PubMed]
 
−
 
 
−
==Fludarabine & Cyclophosphamide {{#subobject:1a1ed9|Regimen=1}}==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#toc|back to top]]
 
−
|}
 
−
 
 
−
===Regimen {{#subobject:886e40|Variant=1}}===
 
−
{| border="1" style="text-align:center;" !align="left"
 
−
|'''Study'''
 
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 
−
|-
 
−
|[http://www.bloodjournal.org/content/116/14/2438 Dreger et al. 2010 (CLL3X)]
 
−
|<span
 
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
−
|-
 
−
|}
 
−
 
 
−
''This regimen is intended for related donors.''
 
−
 
 
−
*[[Fludarabine (Fludara)]] 30 mg/m2 IV once per day on days -6 to -2
 
−
*[[Cyclophosphamide (Cytoxan)]] 500 mg/m2 IV once per day on days -6 to -2
 
−
 
 
−
===References===
 
−
<!-- Presented in part in abstract form at the 50th annual meeting of the American Society of Hematology, San Francisco, CA, December 6-9, 2008. -->
 
−
# Dreger P, Döhner H, Ritgen M, Böttcher S, Busch R, Dietrich S, Bunjes D, Cohen S, Schubert J, Hegenbart U, Beelen D, Zeis M, Stadler M, Hasenkamp J, Uharek L, Scheid C, Humpe A, Zenz T, Winkler D, Hallek M, Kneba M, Schmitz N, Stilgenbauer S; German CLL Study Group. Allogeneic stem cell transplantation provides durable disease control in poor-risk chronic lymphocytic leukemia: long-term clinical and MRD results of the German CLL Study Group CLL3X trial. Blood. 2010 Oct 7;116(14):2438-47. Epub 2010 Jul 1. [http://www.bloodjournal.org/content/116/14/2438 link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/20595516 PubMed]
 
−
## '''Update:''' Dreger P, Schnaiter A, Zenz T, Böttcher S, Rossi M, Paschka P, Bühler A, Dietrich S, Busch R, Ritgen M, Bunjes D, Zeis M, Stadler M, Uharek L, Scheid C, Hegenbart U, Hallek M, Kneba M, Schmitz N, Döhner H, Stilgenbauer S. TP53, SF3B1, and NOTCH1 mutations and outcome of allotransplantation for chronic lymphocytic leukemia: six-year follow-up of the GCLLSG CLL3X trial. Blood. 2013 Apr 18;121(16):3284-8. Epub 2013 Feb 22. [http://www.bloodjournal.org/content/121/16/3284.long link to original article] [http://www.ncbi.nlm.nih.gov/pubmed/23435461 PubMed]
 
−
 
 
−
==Fludarabine, Cyclophosphamide, ATG {{#subobject:f2ce14|Regimen=1}}==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#toc|back to top]]
 
−
|}
 
−
 
 
−
===Regimen {{#subobject:3e71d0|Variant=1}}===
 
−
{| border="1" style="text-align:center;" !align="left"
 
−
|'''Study'''
 
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 
−
|-
 
−
|[http://www.bloodjournal.org/content/116/14/2438 Dreger et al. 2010 (CLL3X)]
 
−
|<span
 
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
−
|-
 
−
|}
 
−
 
 
−
''This regimen is intended for unrelated donors.''
 
−
 
 
−
*[[Fludarabine (Fludara)]] 30 mg/m2 IV once per day on days -6 to -2 (5 consecutive days)
 
−
*[[Cyclophosphamide (Cytoxan)]] 500 mg/m2 IV once per day on days -6 to -2 (5 consecutive days)
 
−
*[[Antithymocyte globulin (ATG)]] (ATG-Fresenius) 10 mg/kg/day on days -4 to -1 (4 consecutive days)
 
−
 
 
−
===References===
 
−
<!-- Presented in part in abstract form at the 50th annual meeting of the American Society of Hematology, San Francisco, CA, December 6-9, 2008. -->
 
−
# Dreger P, Döhner H, Ritgen M, Böttcher S, Busch R, Dietrich S, Bunjes D, Cohen S, Schubert J, Hegenbart U, Beelen D, Zeis M, Stadler M, Hasenkamp J, Uharek L, Scheid C, Humpe A, Zenz T, Winkler D, Hallek M, Kneba M, Schmitz N, Stilgenbauer S; German CLL Study Group. Allogeneic stem cell transplantation provides durable disease control in poor-risk chronic lymphocytic leukemia: long-term clinical and MRD results of the German CLL Study Group CLL3X trial. Blood. 2010 Oct 7;116(14):2438-47. Epub 2010 Jul 1. [http://www.bloodjournal.org/content/116/14/2438 link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/20595516 PubMed]
 
−
## '''Update:''' Dreger P, Schnaiter A, Zenz T, Böttcher S, Rossi M, Paschka P, Bühler A, Dietrich S, Busch R, Ritgen M, Bunjes D, Zeis M, Stadler M, Uharek L, Scheid C, Hegenbart U, Hallek M, Kneba M, Schmitz N, Döhner H, Stilgenbauer S. TP53, SF3B1, and NOTCH1 mutations and outcome of allotransplantation for chronic lymphocytic leukemia: six-year follow-up of the GCLLSG CLL3X trial. Blood. 2013 Apr 18;121(16):3284-8. Epub 2013 Feb 22. [http://www.bloodjournal.org/content/121/16/3284.long link to original article] [http://www.ncbi.nlm.nih.gov/pubmed/23435461 PubMed]
 
−
 
 
−
==Fludarabine, Cyclophosphamide, TBI for dUCB or haploidentical transplant {{#subobject:3a1faf|Regimen=1}}==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#toc|back to top]]
 
−
|}
 
−
dUCB: '''<u>d</u>'''ouble '''<u>U</u>'''mbilical '''<u>C</u>'''ord '''<u>B</u>'''lood
 
−
 
 
−
===Regimen #1, dUCB transplantation {{#subobject:f5d1b1|Variant=1}}===
 
−
{| border="1" style="text-align:center;" !align="left"
 
−
|'''Study'''
 
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 
−
|-
 
−
|[http://bloodjournal.hematologylibrary.org/content/118/2/282.long Brunstein et al. 2011]
 
−
|<span
 
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
−
|-
 
−
|}
 
−
 
 
−
*[[Fludarabine (Fludara)]] 40 mg/m2 IV once per day on days -6 to -2 (5 consecutive days)
 
−
*[[Cyclophosphamide (Cytoxan)]] 50 mg/kg IV once on day -6
 
−
*Total body irradiation (TBI) 2 Gy once on day -1
 
−
 
 
−
Supportive medications:
 
−
*[[Mesna (Mesnex)]] (dose/route/schedule not specified) and "vigorous IV hydration for uroprotection."
 
−
*[[Filgrastim (Neupogen)]] 5 µg/kg SC once per day, starting on day +1, continued until ANC =2000/µL for 3 consecutive days
 
−
 
 
−
====GVHD Prophylaxis====
 
−
*[[Mycophenolate mofetil (CellCept)]] 1000 mg (route not specified) Q8H for patients >50 kg, starting on day -3 "and continuing until day +30 or 7 days after engraftment, whichever was later"
 
−
**Patients <50 kg received [[Mycophenolate mofetil (CellCept)]] 15 mg/kg (route not specified) Q8H, starting on day -3 "and continuing until day +30 or 7 days after engraftment, whichever was later"
 
−
*[[Cyclosporine modified (Neoral)|Cyclosporine A]] ([[Cyclosporine modified (Neoral)|Neoral]] vs. [[Cyclosporine non-modified (Sandimmune)|Sandimmune]] not specified, route not specified) with a goal trough of 200 to 400 ng/mL (starting date not specified) until day +100.  Patients without GVHD had their dose tapered by 10% each week starting on day +101, with discontinuation of cyclosporine A around day +180 to +200.
 
−
*[[Tacrolimus (Prograf)]] (route not specified) with a goal trough level of 5 to 10 ng/mL could be substituted for cyclosporine.
 
−
 
 
−
===Regimen #2, Haploidentical {{#subobject:61264d|Variant=1}}===
 
−
{| border="1" style="text-align:center;" !align="left"
 
−
|'''Study'''
 
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 
−
|-
 
−
|[http://bloodjournal.hematologylibrary.org/content/118/2/282.long Brunstein et al. 2011]
 
−
|<span
 
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
−
|-
 
−
|}
 
−
 
 
−
*[[Fludarabine (Fludara)]] 30 mg/m2 IV once per day on days -6 to -2 (5 consecutive days)
 
−
*[[Cyclophosphamide (Cytoxan)]] 14.5 mg/kg IV once on days -6 and -5 (2 consecutive days)
 
−
*Total body irradiation (TBI) 2 Gy once on day -1
 
−
 
 
−
Supportive medications:
 
−
*[[Mesna (Mesnex)]] (dose/route/schedule not specified) and "vigorous IV hydration for uroprotection."
 
−
*[[Filgrastim (Neupogen)]] 5 µg/kg SC once per day, starting on day +5, continued until ANC =1000/µL for 3 consecutive days
 
−
 
 
−
====GVHD Prophylaxis====
 
−
*[[Cyclophosphamide (Cytoxan)]] 50 mg/kg IBW IV over 1 to 2 hours once per day on days +3 (60 to 72 hours after marrow infusion) and +4
 
−
*[[Mycophenolate mofetil (CellCept)]] 15 mg/kg (maximum daily dose of 3000 mg; route not specified) Q8H, starting on day +5, continued until day +35 or longer at physician discretion if active GVHD was present
 
−
*[[Tacrolimus (Prograf)]] (route not specified) with a goal trough level of 5 to 10 ng/mL, starting on day +5, continued until day +180
 
−
 
 
−
===References===
 
−
# Brunstein CG, Fuchs EJ, Carter SL, Karanes C, Costa LJ, Wu J, Devine SM, Wingard JR, Aljitawi OS, Cutler CS, Jagasia MH, Ballen KK, Eapen M, O'Donnell PV;Blood and Marrow Transplant Clinical Trials Network. Alternative donor transplantation after reduced intensity conditioning: results of parallel phase 2 trials using partially HLA-mismatched related bone marrow or unrelated double umbilical cord blood grafts. Blood. 2011 Jul 14;118(2):282-8. [http://bloodjournal.hematologylibrary.org/content/118/2/282.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/21527516 PubMed]
 
−
 
 
−
==Fludarabine & Melphalan==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#toc|back to top]]
 
−
|}
 
−
===Regimen #1===
 
−
{| border="1" style="text-align:center;" !align="left"
 
−
|'''Study'''
 
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 
−
|-
 
−
|[http://www.haematologica.org/content/97/2/310.long Sureda et al. 2011]
 
−
|<span
 
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
−
|-
 
−
|}
 
−
 
 
−
*[[Fludarabine (Fludara)]] 150 mg/m2 IV once per day on days -8 to -4
 
−
*[[Melphalan (Alkeran)]] 140 mg/m2 IV once per day on days -3 & -2
 
−
 
 
−
Recipients of stem cells from matched unrelated donors also received:
 
−
*[[Antithymocyte globulin (ATG)]] 45 mg/kg IV once per day on days -4 to -2
 
−
 
 
−
====Graft-versus-host disease prophylaxis====
 
−
*Cyclosporine A (not specified whether modified or non-modified) starting at 1.5 mg/kg BID IV on day -2
 
−
*[[Methotrexate (MTX)]] 10 mg/m2 IV once per day on days +1, +3, +6 and +11
 
−
 
 
−
''If no acute GVHD of grade 2 or more, cyclosporine A is tapered down by 10% per week starting on day +90 with planned discontinuation by day +180.''
 
−
 
 
−
===Regimen #2===
 
−
{| border="1" style="text-align:center;" !align="left"
 
−
|'''Study'''
 
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 
−
|-
 
−
|[http://www.haematologica.org/content/93/2/257.long Anderlini et al. 2008]
 
−
|<span
 
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
−
|-
 
−
|}
 
−
 
 
−
*[[Fludarabine (Fludara)]] 33 mg/m2 IV once per day on days -5 to -2
 
−
*[[Melphalan (Alkeran)]] 70 mg/m2 IV once per day on days -3 & -2
 
−
 
 
−
Recipients of stem cells from matched unrelated donors also received:
 
−
*[[Antithymocyte globulin (ATG)]] 2 mg/kg IV once per day on days -4 to -2
 
−
 
 
−
====Graft-versus-host disease prophylaxis====
 
−
*[[Tacrolimus (Prograf)]] IV starting on day -2, dosed to achieve serum levels 4–12 ng/mL and switched to PO as soon as possible. Continued for at least 6 months and then "tapered off" (instructions not given).
 
−
*[[Methotrexate (MTX)]] 5 mg/m2 IV once per day on days +1, +3, +6 (extra dose on day +11 for MUD recipients)
 
−
 
 
−
===References===
 
−
# Alvarez I, Sureda A, Caballero MD, Urbano-Ispizua A, Ribera JM, Canales M, García-Conde J, Sanz G, Arranz R, Bernal MT, de la Serna J, Díez JL, Moraleda JM, Rubió-Félix D, Xicoy B, Martínez C, Mateos MV, Sierra J. Nonmyeloablative stem cell transplantation is an effective therapy for refractory or relapsed hodgkin lymphoma: results of a spanish prospective cooperative protocol. Biol Blood Marrow Transplant. 2006 Feb;12(2):172-83. [http://www.bbmt.org/article/S1083-8791(05)00673-7/fulltext link to original article] '''contains protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/16443515 PubMed]
 
−
# Anderlini P, Saliba R, Acholonu S, Giralt SA, Andersson B, Ueno NT, Hosing C, Khouri IF, Couriel D, de Lima M, Qazilbash MH, Pro B, Romaguera J, Fayad L, Hagemeister F, Younes A, Munsell MF, Champlin RE. Fludarabine-melphalan as a preparative regimen for reduced-intensity conditioning allogeneic stem cell transplantation in relapsed and refractory Hodgkin's lymphoma: the updated M.D. Anderson Cancer Center experience. Haematologica. 2008 Feb;93(2):257-64. Epub 2008 Jan 26. [http://www.haematologica.org/content/93/2/257.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/18223284 PubMed]
 
−
# Sureda A, Canals C, Arranz R, Caballero D, Ribera JM, Brune M, Passweg J, Martino R, Valcárcel D, Besalduch J, Duarte R, León A, Pascual MJ, García-Noblejas A, López Corral L, Xicoy B, Sierra J, Schmitz N. Allogeneic stem cell transplantation after reduced intensity conditioning in patients with relapsed or refractory Hodgkin's lymphoma. Results of the HDR-ALLO study - a prospective clinical trial by the Grupo Español de Linfomas/Trasplante de Médula Osea (GEL/TAMO) and the Lymphoma Working Party of the European Group for Blood and Marrow Transplantation. Haematologica. 2012 Feb;97(2):310-7. Epub 2011 Oct 11. [http://www.haematologica.org/content/97/2/310.long link to original article] '''contains protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/21993674 PubMed]
 
−
 
 
−
==Low-dose TBI {{#subobject:529ee7|Regimen=1}}==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#toc|back to top]]
 
−
|}
 
−
===Regimen {{#subobject:174a8e|Variant=1}}===
 
−
{| border="1" style="text-align:center;" !align="left"
 
−
|'''Study'''
 
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 
−
|'''Comparator'''
 
−
|-
 
−
|[http://jco.ascopubs.org/content/28/17/2859.long Gyukocza et al. 2010]
 
−
|<span
 
−
style="background:#00CD00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase III</span>
 
−
|[[Transplant_conditioning_regimens#Fludarabine_and_Low-dose_TBI|Fludarabine and Low-dose TBI]]
 
−
|-
 
−
|}
 
−
 
 
−
''Day 0 is the day of transplantation.''
 
−
*Total body irradiation (TBI) 2 Gy at a rate of 0.07 to 0.20 Gy/min on day 0
 
−
 
 
−
Supportive medications for GVHD prophylaxis:
 
−
*"Postgrafting immunosuppression consisted of [[Cyclosporine non-modified (Sandimmune) | cyclosporine]] or [[Tacrolimus (Prograf) | tacrolimus]] combined with [[Mycophenolate mofetil (CellCept) | mycophenolate mofetil]]," further details not specified
 
−
 
 
−
===References===
 
−
<!-- no pre-pub disclosed -->
 
−
# Gyurkocza B, Storb R, Storer BE, Chauncey TR, Lange T, Shizuru JA, Langston AA, Pulsipher MA, Bredeson CN, Maziarz RT, Bruno B, Petersen FB, Maris MB, Agura E, Yeager A, Bethge W, Sahebi F, Appelbaum FR, Maloney DG, Sandmaier BM. Nonmyeloablative allogeneic hematopoietic cell transplantation in patients with acute myeloid leukemia. J Clin Oncol. 2010 Jun 10;28(17):2859-67. Epub 2010 May 3. [http://jco.ascopubs.org/content/28/17/2859.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/20439626 PubMed]
 

Latest revision as of 00:29, 4 July 2024


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Stem cell mobilization

Autologous stem cell transplant

Allogeneic hematopoietic cell transplant, myeloablative

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