Difference between revisions of "Marginal zone lymphoma"
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===References=== | ===References=== | ||
# Troch M, Kiesewetter B, Willenbacher W, Willenbacher E, Zebisch A, Linkesch W, Fridrik M, Müllauer L, Greil R, Raderer M. Rituximab plus subcutaneous cladribine in patients with extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue: a phase II study by the Arbeitsgemeinschaft Medikamentose Tumortherapie. Haematologica. 2013 Feb;98(2):264-8. Epub 2012 Sep 14. [http://www.haematologica.org/content/98/2/264.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/22983582 PubMed] | # Troch M, Kiesewetter B, Willenbacher W, Willenbacher E, Zebisch A, Linkesch W, Fridrik M, Müllauer L, Greil R, Raderer M. Rituximab plus subcutaneous cladribine in patients with extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue: a phase II study by the Arbeitsgemeinschaft Medikamentose Tumortherapie. Haematologica. 2013 Feb;98(2):264-8. Epub 2012 Sep 14. [http://www.haematologica.org/content/98/2/264.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/22983582 PubMed] | ||
+ | ==Lenalidomide (Revlimid)== | ||
+ | |||
+ | ===Regimen=== | ||
+ | <span | ||
+ | style="background:#ff0000; | ||
+ | padding:3px 6px 3px 6px; | ||
+ | border-color:black; | ||
+ | border-width:2px; | ||
+ | border-style:solid;">Phase II, <20 patients reported</span> | ||
+ | |||
+ | *[[Lenalidomide (Revlimid)]] 25 mg PO once per day on days 1 to 21 | ||
+ | |||
+ | Supportive medications: | ||
+ | *[[Aspirin]] 100 mg PO once per day | ||
+ | |||
+ | '''28-day cycle x up to 6 cycles''' | ||
+ | |||
+ | ===References=== | ||
+ | # Kiesewetter B, Troch M, Dolak W, Müllauer L, Lukas J, Zielinski CC, Raderer M. A phase II study of lenalidomide in patients with extranodal marginal zone B-cell lymphoma of the mucosa associated lymphoid tissue (MALT lymphoma). Haematologica. 2013 Mar;98(3):353-6. doi: 10.3324/haematol.2012.065995. Epub 2012 Aug 16. [http://www.haematologica.org/content/98/3/353.long link to orginal article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/22899582 PubMed] | ||
+ | |||
==Rituximab (Rituxan)== | ==Rituximab (Rituxan)== | ||
<span | <span |
Revision as of 01:18, 24 December 2013
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Untreated
Note: Untreated in this context implies chemotherapy-naive. Some patients in the following studies, especially those with gastric MALT, received H. pylori eradication therapy or radiation prior to chemotherapy.
Bortezomib (Velcade)
Regimen, Troch et al. 2009
Phase II
- Bortezomib (Velcade) 1.5 mg/m2 IV bolus once daily on days 1, 4, 8, 11
Supportive medications:
- 5-HT3 antagonist IV immediately before Bortezomib (Velcade)
- 500 mL NS after bortezomib
21-day cycles x up to 8 cycles
References
- Troch M, Jonak C, Müllauer L, Püspök A, Formanek M, Hauff W, Zielinski CC, Chott A, Raderer M. A phase II study of bortezomib in patients with MALT lymphoma. Haematologica. 2009 May;94(5):738-42. Epub 2009 Mar 31. link to original article contains verified protocol PubMed
Chlorambucil (Leukeran)
Regimen #1, Leblond et al. 2013
Phase III
- Chlorambucil (Leukeran) 8 mg/m2 (6 mg/m2 per day if older than 75 years old) PO daily on days 1 to 10
Supportive medications:
- Recommended PCP prophylaxis with one of the following:
- Trimethoprim/Sulfamethoxazole (Bactrim SS) 1 tablet PO once daily
- Pentamidine (Nebupent) 300 mg inhaled once per month
28-day cycles x up to 12 cycles
Regimen #2, Zucca et al. 2013 (IELSG-19)
Phase III
Induction phase
- Chlorambucil (Leukeran) 6 mg/m2 PO daily on days 1 to 42
42-day course of therapy
Stable disease & responders -> consolidation phase
- Chlorambucil (Leukeran) 6 mg/m2 PO daily on days 1 to 14
28-day cycles x up to 4 cycles
References
- Leblond V, Johnson S, Chevret S, Copplestone A, Rule S, Tournilhac O, Seymour JF, Patmore RD, Wright D, Morel P, Dilhuydy MS, Willoughby S, Dartigeas C, Malphettes M, Royer B, Ewings M, Pratt G, Lejeune J, Nguyen-Khac F, Choquet S, Owen RG. Results of a randomized trial of chlorambucil versus fludarabine for patients with untreated waldenstrom macroglobulinemia, marginal zone lymphoma, or lymphoplasmacytic lymphoma. J Clin Oncol. 2013 Jan 20;31(3):301-7. Epub 2012 Dec 10. link to original article contains verified protocol PubMed
- Zucca E, Conconi A, Laszlo D, López-Guillermo A, Bouabdallah R, Coiffier B, Sebban C, Jardin F, Vitolo U, Morschhauser F, Pileri SA, Copie-Bergman C, Campo E, Jack A, Floriani I, Johnson P, Martelli M, Cavalli F, Martinelli G, Thieblemont C. Addition of Rituximab to Chlorambucil Produces Superior Event-Free Survival in the Treatment of Patients With Extranodal Marginal-Zone B-Cell Lymphoma: 5-Year Analysis of the IELSG-19 Randomized Study. J Clin Oncol. 2013 Feb 10;31(5):565-72. Epub 2013 Jan 7. link to original article contains verified protocol PubMed
Chlorambucil & Rituximab
Regimen, Zucca et al. 2013 (IELSG-19)
Phase III
Induction phase
- Chlorambucil (Leukeran) 6 mg/m2 PO daily on days 1 to 42
- Rituximab (Rituxan) 375 mg/m2 IV once daily on days 1, 8, 15, 22
Stable disease & responders -> consolidation phase
- Chlorambucil (Leukeran) 6 mg/m2 PO daily on days 1 to 14
- Rituximab (Rituxan) 375 mg/m2 IV once on day 1
28-day cycles x up to 4 cycles
References
- Zucca E, Conconi A, Laszlo D, López-Guillermo A, Bouabdallah R, Coiffier B, Sebban C, Jardin F, Vitolo U, Morschhauser F, Pileri SA, Copie-Bergman C, Campo E, Jack A, Floriani I, Johnson P, Martelli M, Cavalli F, Martinelli G, Thieblemont C. Addition of Rituximab to Chlorambucil Produces Superior Event-Free Survival in the Treatment of Patients With Extranodal Marginal-Zone B-Cell Lymphoma: 5-Year Analysis of the IELSG-19 Randomized Study. J Clin Oncol. 2013 Feb 10;31(5):565-72. Epub 2013 Jan 7. link to original article contains verified protocol PubMed
Cladribine (Leustatin)
Phase II
Regimen
- Cladribine (Leustatin) 0.12 mg/kg IV over 2 hours once on days 1 to 5
Dose reductions:
- "In case of a persisting nadir of the WBCs ≤ 4.0 × 10^9/L (or neutrophils ≤ 1.5 × 10^9/L) and/or the platelets ≤ 100 × 10^9/L, the next treatment cycle was delayed by 1 week until achieving normal values and then treatment was administered at a reduced dose of 0.1 mg/kg body weight."
Supportive medications:
- Not described
28-day cycles x 4 to 6 cycles
References
- Jäger G, Neumeister P, Brezinschek R, Hinterleitner T, Fiebiger W, Penz M, Neumann HJ, Mlineritsch B, DeSantis M, Quehenberger F, Chott A, Beham-Schmid C, Höfler G, Linkesch W, Raderer M. Treatment of extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue type with cladribine: a phase II study. J Clin Oncol. 2002 Sep 15;20(18):3872-7. link to original article contains verified protocol PubMed
Cladribine & Rituximab
Phase II
Regimen
- Cladribine (Leustatin) 0.1 mg/kg SC once per day on days 1 to 4
- Rituximab (Rituxan) 375 mg/m2 IV once on day 1
Supportive medications:
- Acetominophen (Tylenol) 1000 mg PO prior to Rituximab (Rituxan)
- Antihistamine IV prior to Rituximab (Rituxan)
- Either Ondansetron (Zofran) or Tropisetron (Navoban) IV immediately before Cladribine (Leustatin)
21-day cycles up to 6 cycles
References
- Troch M, Kiesewetter B, Willenbacher W, Willenbacher E, Zebisch A, Linkesch W, Fridrik M, Müllauer L, Greil R, Raderer M. Rituximab plus subcutaneous cladribine in patients with extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue: a phase II study by the Arbeitsgemeinschaft Medikamentose Tumortherapie. Haematologica. 2013 Feb;98(2):264-8. Epub 2012 Sep 14. link to original article contains verified protocol PubMed
Fludarabine (Fludara)
Regimen
Phase III
- Fludarabine (Fludara) 40 mg/m2 (30 mg/m2 per day if older than 75 years old) PO once daily on days 1 to 5
Supportive medications:
- Recommended PCP prophylaxis with one of the following:
- Trimethoprim/Sulfamethoxazole (Bactrim SS) 1 tablet PO once daily
- Pentamidine (Nebupent) 300 mg inhaled once per month
- Herpes zoster prophylaxis with one of the following:
- Valacyclovir (Valtrex) 500 mg PO once daily
- Acyclovir (Zovirax) 200 to 400 mg PO BID
28-day cycles x up to 6 cycles
References
- Leblond V, Johnson S, Chevret S, Copplestone A, Rule S, Tournilhac O, Seymour JF, Patmore RD, Wright D, Morel P, Dilhuydy MS, Willoughby S, Dartigeas C, Malphettes M, Royer B, Ewings M, Pratt G, Lejeune J, Nguyen-Khac F, Choquet S, Owen RG. Results of a randomized trial of chlorambucil versus fludarabine for patients with untreated waldenstrom macroglobulinemia, marginal zone lymphoma, or lymphoplasmacytic lymphoma. J Clin Oncol. 2013 Jan 20;31(3):301-7. Epub 2012 Dec 10. link to original article contains verified protocol PubMed
Fludarabine & Rituximab
Regimen
Phase II
- Fludarabine (Fludara) 25 mg/m2 IV (or 40 mg/m2 PO) once daily on days 1 to 5
- Patients with gastric lymphoma received the cycle 1 dose intravenously to guarantee drug absorption
- Rituximab (Rituxan) 375 mg/m2 IV once on day 1
Dose reductions:
- Patients >70 years old could receive Fludarabine (Fludara) at the above dose, but only once daily on days 1 to 3
Supportive medications:
- Trimethoprim/Sulfamethoxazole prophylaxis (dose/schedule not listed) per physician preference
- No routine antiviral prophylaxis or G-CSF use
28-day cycles for 4-6 cycles
References
- Salar A, Domingo-Domenech E, Estany C, Canales MA, Gallardo F, Servitje O, Fraile G, Montalbán C. Combination therapy with rituximab and intravenous or oral fludarabine in the first-line, systemic treatment of patients with extranodal marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue type. Cancer. 2009 Nov 15;115(22):5210-7. link to orginal article contains verified protocol PubMed
Lenalidomide (Revlimid)
Regimen
Phase II, <20 patients reported
- Lenalidomide (Revlimid) 25 mg PO once per day on days 1 to 21
Supportive medications:
- Aspirin 100 mg PO once per day
28-day cycle x up to 6 cycles
References
- Kiesewetter B, Troch M, Dolak W, Müllauer L, Lukas J, Zielinski CC, Raderer M. A phase II study of lenalidomide in patients with extranodal marginal zone B-cell lymphoma of the mucosa associated lymphoid tissue (MALT lymphoma). Haematologica. 2013 Mar;98(3):353-6. doi: 10.3324/haematol.2012.065995. Epub 2012 Aug 16. link to orginal article contains verified protocol PubMed
MCP
MCP: Mitoxantrone, Chlorambucil, Prednisolone
Regimen
Retrospective
- Mitoxantrone (Novantrone) 8 mg/m2 IV once daily on days 1 & 2
- Chlorambucil (Leukeran) 3 mg/m2 PO TID (written in the reference as "3 x 3 mg/m2"; total dose per day is 9 mg/m2) on days 1 to 5
- Prednisolone (Millipred) 25 mg/m2 PO/IV once daily on days 1 to 5
28-day cycles x up to 8 cycles
References
- Wöhrer S, Drach J, Hejna M, Scheithauer W, Dirisamer A, Püspök A, Chott A, Raderer M. Treatment of extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) with mitoxantrone, chlorambucil and prednisone (MCP). Ann Oncol. 2003 Dec;14(12):1758-61. link to orginal article contains verified protocol PubMed
Rituximab (Rituxan)
Phase II
Regimen
- Rituximab (Rituxan) 375 mg/m2 IV once daily on days 1, 8, 15, 21
References
- Conconi A, Martinelli G, Thiéblemont C, Ferreri AJ, Devizzi L, Peccatori F, Ponzoni M, Pedrinis E, Dell'Oro S, Pruneri G, Filipazzi V, Dietrich PY, Gianni AM, Coiffier B, Cavalli F, Zucca E. Clinical activity of rituximab in extranodal marginal zone B-cell lymphoma of MALT type. Blood. 2003 Oct 15;102(8):2741-5. link to orginal article contains protocol PubMed
- Martinelli G, Laszlo D, Ferreri AJ, Pruneri G, Ponzoni M, Conconi A, Crosta C, Pedrinis E, Bertoni F, Calabrese L, Zucca E. Clinical activity of rituximab in gastric marginal zone non-Hodgkin's lymphoma resistant to or not eligible for anti-Helicobacter pylori therapy. J Clin Oncol. 2005 Mar 20;23(9):1979-83. link to original article contains protocol PubMed
Relapsed/refractory
Bortezomib (Velcade)
Regimen #1, Troch et al. 2009
Phase II
- Bortezomib (Velcade) 1.5 mg/m2 IV bolus once daily on days 1, 4, 8, 11
Supportive medications:
- 5-HT3 antagonist IV immediately before Bortezomib (Velcade)
- 500 mL NS after Bortezomib (Velcade)
21-day cycles x up to 8 cycles
Regimen #2, Conconi et al. 2011
Phase II
- Bortezomib (Velcade) 1.3 mg/m2 IV once daily on days 1, 4, 8, 11
Supportive medications:
- No routine growth factors, antibiotic, or antiviral prophylaxis was given
21-day cycles x up to 6 cycles
References
- Troch M, Jonak C, Müllauer L, Püspök A, Formanek M, Hauff W, Zielinski CC, Chott A, Raderer M. A phase II study of bortezomib in patients with MALT lymphoma. Haematologica. 2009 May;94(5):738-42. Epub 2009 Mar 31. link to original article contains verified protocol PubMed
- Conconi A, Martinelli G, Lopez-Guillermo A, Zinzani PL, Ferreri AJ, Rigacci L, Devizzi L, Vitolo U, Luminari S, Cavalli F, Zucca E; International Extranodal Lymphoma Study Group (IELSG). Clinical activity of bortezomib in relapsed/refractory MALT lymphomas: results of a phase II study of the International Extranodal Lymphoma Study Group (IELSG). Ann Oncol. 2011 Mar;22(3):689-95. link to original article contains verified protocol PubMed
BR
BR: Bendamustine, Rituximab
Regimen, Rummel et al. 2005
Phase II, <20 patients reported
Pre-treatment phase
- Rituximab (Rituxan) 375 mg/m2 IV once on day 1
Cycle 1 is started 7 days after the first dose of rituximab
Main regimen=
- Bendamustine (Treanda) 90 mg/m2 IV over 30 minutes once on days 1 & 2 of cycles 1 to 4
- Rituximab (Rituxan) 375 mg/m2 IV once on day 1 of cycles 1 to 5
28-day cycles x 5 cycles
References
- Rummel MJ, Al-Batran SE, Kim SZ, Welslau M, Hecker R, Kofahl-Krause D, Josten KM, Dürk H, Rost A, Neise M, von Grünhagen U, Chow KU, Hansmann ML, Hoelzer D, Mitrou PS. Bendamustine plus rituximab is effective and has a favorable toxicity profile in the treatment of mantle cell and low-grade non-Hodgkin's lymphoma. J Clin Oncol. 2005 May 20;23(15):3383-9. link to original article contains protocol PubMed
Cladribine & Rituximab
Phase II, <20 patients reported
Regimen
- Cladribine (Leustatin) 0.1 mg/kg SC once per day on days 1 to 4
- Rituximab (Rituxan) 375 mg/m2 IV once on day 1
Supportive medications:
- Acetaminophen (Tylenol) 1000 mg PO prior to Rituximab (Rituxan)
- Antihistamine IV prior to Rituximab (Rituxan)
- Either Ondansetron (Zofran) or Tropisetron (Navoban) IV immediately before Cladribine (Leustatin)
21-day cycles up to 6 cycles
References
- Troch M, Kiesewetter B, Willenbacher W, Willenbacher E, Zebisch A, Linkesch W, Fridrik M, Müllauer L, Greil R, Raderer M. Rituximab plus subcutaneous cladribine in patients with extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue: a phase II study by the Arbeitsgemeinschaft Medikamentose Tumortherapie. Haematologica. 2013 Feb;98(2):264-8. Epub 2012 Sep 14. link to original article contains verified protocol PubMed
Lenalidomide (Revlimid)
Regimen
Phase II, <20 patients reported
- Lenalidomide (Revlimid) 25 mg PO once per day on days 1 to 21
Supportive medications:
- Aspirin 100 mg PO once per day
28-day cycle x up to 6 cycles
References
- Kiesewetter B, Troch M, Dolak W, Müllauer L, Lukas J, Zielinski CC, Raderer M. A phase II study of lenalidomide in patients with extranodal marginal zone B-cell lymphoma of the mucosa associated lymphoid tissue (MALT lymphoma). Haematologica. 2013 Mar;98(3):353-6. doi: 10.3324/haematol.2012.065995. Epub 2012 Aug 16. link to orginal article contains verified protocol PubMed
Rituximab (Rituxan)
Phase II
Regimen
- Rituximab (Rituxan) 375 mg/m2 IV once daily on days 1, 8, 15, 21
References
- Conconi A, Martinelli G, Thiéblemont C, Ferreri AJ, Devizzi L, Peccatori F, Ponzoni M, Pedrinis E, Dell'Oro S, Pruneri G, Filipazzi V, Dietrich PY, Gianni AM, Coiffier B, Cavalli F, Zucca E. Clinical activity of rituximab in extranodal marginal zone B-cell lymphoma of MALT type. Blood. 2003 Oct 15;102(8):2741-5. link to orginal article contains protocol PubMed
- Martinelli G, Laszlo D, Ferreri AJ, Pruneri G, Ponzoni M, Conconi A, Crosta C, Pedrinis E, Bertoni F, Calabrese L, Zucca E. Clinical activity of rituximab in gastric marginal zone non-Hodgkin's lymphoma resistant to or not eligible for anti-Helicobacter pylori therapy. J Clin Oncol. 2005 Mar 20;23(9):1979-83. link to original article contains protocol PubMed