Difference between revisions of "Mediastinal gray-zone lymphoma"
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*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once per cycle or 1 day before the start of EPOCH (depending on reference) | *[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once per cycle or 1 day before the start of EPOCH (depending on reference) | ||
*[[Etoposide (Vepesid)]] 50 mg/m<sup>2</sup>/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 200 mg/m<sup>2</sup>) | *[[Etoposide (Vepesid)]] 50 mg/m<sup>2</sup>/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 200 mg/m<sup>2</sup>) | ||
| − | *[[Prednisone (Sterapred)]] 60 mg/m<sup>2</sup> PO | + | *[[Prednisone (Sterapred)]] 60 mg/m<sup>2</sup> PO twice per day on days 1 to 5 |
*[[Vincristine (Oncovin)]] 0.4 mg/m<sup>2</sup>/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 1.6 mg/m<sup>2</sup>) | *[[Vincristine (Oncovin)]] 0.4 mg/m<sup>2</sup>/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 1.6 mg/m<sup>2</sup>) | ||
*[[Cyclophosphamide (Cytoxan)]] 750 mg/m<sup>2</sup> IV over 15 minutes once on day 5 | *[[Cyclophosphamide (Cytoxan)]] 750 mg/m<sup>2</sup> IV over 15 minutes once on day 5 | ||
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*[[Filgrastim (Neupogen)]] 5 mcg/kg SC once per day, starting on day 6 and continuing until ANC greater than 5000/uL past nadir | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC once per day, starting on day 6 and continuing until ANC greater than 5000/uL past nadir | ||
*PCP prophylaxis with ONE of the following: | *PCP prophylaxis with ONE of the following: | ||
| − | **[[Trimethoprim/Sulfamethoxazole (Bactrim DS)]] 160/800 mg PO | + | **[[Trimethoprim/Sulfamethoxazole (Bactrim DS)]] 160/800 mg PO twice per day 3 days per week |
| − | ***Alternative used only in García-Suárez et al. 2007: cotrimoxazole 480 mg PO | + | ***Alternative used only in García-Suárez et al. 2007: cotrimoxazole 480 mg PO twice per day 3 days per week |
**[[Atovaquone (Mepron)]] 1500 mg PO once per day | **[[Atovaquone (Mepron)]] 1500 mg PO once per day | ||
**[[Pentamidine (Nebupent)]] 300 mg nebulized every 28 days | **[[Pentamidine (Nebupent)]] 300 mg nebulized every 28 days | ||
Revision as of 21:25, 24 January 2019
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J.C. Villasboas Bisneto, MD Rochester, MN |
2 regimens on this page
2 variants on this page
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Note: Mediastinal gray-zone lymphome (MGZL) is considered intermediate between primary mediastinal B-cell lymphoma (PMBL) and nodular sclerosis Hodgkin lymphoma (NSHL). Given that it is treated more similarly to the non-Hodgkin lymphoma, it is included here.
Untreated
DA-R-EPOCH
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DA-R-EPOCH: Dose Adjusted Rituximab, Etoposide, Prednisone, Oncovin (Vincristine), Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin)
DA-EPOCH-R
Regimen
| Study | Evidence |
|---|---|
| Wilson et al. 2014 (NCI 93-C-0133) | Phase II |
Chemotherapy
- Rituximab (Rituxan) 375 mg/m2 IV once per cycle or 1 day before the start of EPOCH (depending on reference)
- Etoposide (Vepesid) 50 mg/m2/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 200 mg/m2)
- Prednisone (Sterapred) 60 mg/m2 PO twice per day on days 1 to 5
- Vincristine (Oncovin) 0.4 mg/m2/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 1.6 mg/m2)
- Cyclophosphamide (Cytoxan) 750 mg/m2 IV over 15 minutes once on day 5
- Doxorubicin (Adriamycin) 10 mg/m2/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 40 mg/m2)
Supportive medications
- Filgrastim (Neupogen) 5 mcg/kg SC once per day, starting on day 6 and continuing until ANC greater than 5000/uL past nadir
- PCP prophylaxis with ONE of the following:
- Trimethoprim/Sulfamethoxazole (Bactrim DS) 160/800 mg PO twice per day 3 days per week
- Alternative used only in García-Suárez et al. 2007: cotrimoxazole 480 mg PO twice per day 3 days per week
- Atovaquone (Mepron) 1500 mg PO once per day
- Pentamidine (Nebupent) 300 mg nebulized every 28 days
- Trimethoprim/Sulfamethoxazole (Bactrim DS) 160/800 mg PO twice per day 3 days per week
- Only in García-Suárez et al. 2007: Darbepoetin alfa (Aranesp) 2.25 mcg/kg SC when hemoglobin concentration was less than or equal to 10 g/dL.
21-day cycle for 6 to 8 cycles
Dose-adjustments
- Start cycle 1 as described above.
- Obtain CBCs twice per week for nadir measurements.
- If nadir ANC greater than 500/uL, increase etoposide, doxorubicin, and cyclophosphamide by 20% compared to previous cycle.
- If nadir ANC less than 500/uL on 1 or 2 measurements, use same doses as last cycle.
- If nadir ANC less than 500/uL on at least 3 measurements, decrease etoposide, doxorubicin, and cyclophosphamide by 20% compared to previous cycle.
- And/or if nadir platelet count less than 25 x 109/L on at least 1 measurement, decrease etoposide, doxorubicin, and cyclophosphamide by 20% compared to previous cycle.
- Dose adjustments below the cycle 1 starting dose only applies to cyclophosphamide. The lowest etoposide and doxorubicin would be dosed at is the original cycle 1 dose.
- Can start new cycle every 21 days if ANC greater than 1000/uL and platelets greater than 100 x 109/L. If counts are below those levels, check daily CBC and continue growth factor support until counts are adequate and next cycle can start.
References
- NCI 93-C-0133: Wilson WH, Pittaluga S, Nicolae A, Camphausen K, Shovlin M, Steinberg SM, Roschewski M, Staudt LM, Jaffe ES, Dunleavy K. A prospective study of mediastinal gray-zone lymphoma. Blood. 2014 Sep 4;124(10):1563-9. Epub 2014 Jul 14. link to original article contains protocol link to PMC article PubMed
Relapsed or refractory
Brentuximab vedotin monotherapy
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Regimen
| Study | Evidence |
|---|---|
| Jacobsen et al. 2015 | Phase II, <20 pts in this subgroup |
This regimen was evaluated in patients with CD30+ non-Hodgkin lymphoma, as determined by immunohistochemistry.
Chemotherapy
- Brentuximab vedotin (Adcetris) 1.8 mg/kg IV over 30 minutes once on day 1
21-day cycles, given until progression or unacceptable toxicity
References
- Jacobsen ED, Sharman JP, Oki Y, Advani RH, Winter JN, Bello CM, Spitzer G, Palanca-Wessels MC, Kennedy DA, Levine P, Yang J, Bartlett NL. Brentuximab vedotin demonstrates objective responses in a phase 2 study of relapsed/refractory DLBCL with variable CD30 expression. Blood. 2015 Feb 26;125(9):1394-402. Epub 2015 Jan 8. link to original article contains verified protocol PubMed