Difference between revisions of "Anaplastic large cell lymphoma"
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''This regimen was used in 20 ALCL patients (CHOEP-21) and 16 ALCL patients (CHOEP-14) in the NHL-B1 trial. The authors did not report a subgroup analysis for this minority population.'' | ''This regimen was used in 20 ALCL patients (CHOEP-21) and 16 ALCL patients (CHOEP-14) in the NHL-B1 trial. The authors did not report a subgroup analysis for this minority population.'' | ||
| − | + | ====Chemotherapy==== | |
| − | *[[Cyclophosphamide (Cytoxan)]] 750 mg/ | + | *[[Cyclophosphamide (Cytoxan)]] 750 mg/m<sup>2</sup> IV once on day 1 |
| − | *[[Doxorubicin (Adriamycin)]] 50 mg/ | + | *[[Doxorubicin (Adriamycin)]] 50 mg/m<sup>2</sup> IV once on day 1 |
*[[Vincristine (Oncovin)]] 2 mg IV once on day 1 | *[[Vincristine (Oncovin)]] 2 mg IV once on day 1 | ||
*[[Prednisone (Sterapred)]] 100 mg PO once per day on days 1 to 5 | *[[Prednisone (Sterapred)]] 100 mg PO once per day on days 1 to 5 | ||
| − | *[[Etoposide (Vepesid)]] 100 mg/ | + | *[[Etoposide (Vepesid)]] 100 mg/m<sup>2</sup> IV once per day on days 1 to 3 |
*Patients with initial bulky disease (mass conglomerate at least 7.5 cm) received 36 Gy radiation therapy and to extranodal sites of disease when possible | *Patients with initial bulky disease (mass conglomerate at least 7.5 cm) received 36 Gy radiation therapy and to extranodal sites of disease when possible | ||
| − | Supportive medications | + | ====Supportive medications==== |
*For 14-day cycles: [[Filgrastim (Neupogen)]] 300 mcg (for patients <75 kg) or 480 mcg (for patients at least 75 kg) SC once per day on days 4 to 13 | *For 14-day cycles: [[Filgrastim (Neupogen)]] 300 mcg (for patients <75 kg) or 480 mcg (for patients at least 75 kg) SC once per day on days 4 to 13 | ||
*[[Filgrastim (Neupogen)]] use for 21-day cycles is by discretion of ordering physician | *[[Filgrastim (Neupogen)]] use for 21-day cycles is by discretion of ordering physician | ||
| − | '''14 or 21-day cycles | + | '''14 or 21-day cycles for 6 cycles''', next cycle to start as long as WBC is >2.5 and platelets >80 |
*CHOEP-14 uses 14-day cycles; CHOEP-21 uses 21-day cycles | *CHOEP-14 uses 14-day cycles; CHOEP-21 uses 21-day cycles | ||
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''This regimen was used in 14 ALCL patients in the NHL-B1 trial. The authors did not report a subgroup analysis for this minority population.'' | ''This regimen was used in 14 ALCL patients in the NHL-B1 trial. The authors did not report a subgroup analysis for this minority population.'' | ||
| − | + | ====Chemotherapy==== | |
| − | *[[Cyclophosphamide (Cytoxan)]] 750 mg/ | + | *[[Cyclophosphamide (Cytoxan)]] 750 mg/m<sup>2</sup> IV once on day 1 |
| − | *[[Doxorubicin (Adriamycin)]] 50 mg/ | + | *[[Doxorubicin (Adriamycin)]] 50 mg/m<sup>2</sup> IV once on day 1 |
*[[Vincristine (Oncovin)]] 2 mg IV once on day 1 | *[[Vincristine (Oncovin)]] 2 mg IV once on day 1 | ||
*[[Prednisone (Sterapred)]] 100 mg PO once per day on days 1 to 5 | *[[Prednisone (Sterapred)]] 100 mg PO once per day on days 1 to 5 | ||
| − | Supportive medications | + | ====Supportive medications==== |
*At the discretion of ordering physician: [[Filgrastim (Neupogen)]] 300 mcg (for patients <75 kg) or 480 mcg (for patients at least 75 kg) SC once per day on days 4 to 13 | *At the discretion of ordering physician: [[Filgrastim (Neupogen)]] 300 mcg (for patients <75 kg) or 480 mcg (for patients at least 75 kg) SC once per day on days 4 to 13 | ||
| − | '''21-day cycle | + | '''21-day cycle for 6 cycles''' |
===References=== | ===References=== | ||
| Line 133: | Line 133: | ||
|- | |- | ||
|} | |} | ||
| − | + | ====Chemotherapy==== | |
*[[Brentuximab vedotin (Adcetris)]] 1.8 mg/kg IV over 30 minutes on day 1 | *[[Brentuximab vedotin (Adcetris)]] 1.8 mg/kg IV over 30 minutes on day 1 | ||
| − | '''3-week | + | '''3-week cycle for up to 16 infusions''' |
===References=== | ===References=== | ||
| Line 167: | Line 167: | ||
|- | |- | ||
|} | |} | ||
| + | ====Chemotherapy==== | ||
*[[Dexamethasone (Decadron)]] 40 mg PO once per day on days 1 to 4 | *[[Dexamethasone (Decadron)]] 40 mg PO once per day on days 1 to 4 | ||
| − | *[[Cytarabine (Cytosar)]] 2000 mg/ | + | *[[Cytarabine (Cytosar)]] 2000 mg/m<sup>2</sup> IV over 3 hours Q12H for 2 doses on day 2 (total of 2 doses) |
| − | *[[Cisplatin (Platinol)]] 100 mg/ | + | *[[Cisplatin (Platinol)]] 100 mg/m<sup>2</sup> IV continuous infusion over 24 hours on day 1 |
| − | '''21-day | + | '''21-day cycle for up to 3 cycles''' |
===References=== | ===References=== | ||
| Line 200: | Line 201: | ||
|- | |- | ||
|} | |} | ||
| − | + | ====Chemotherapy==== | |
| − | *[[Gemcitabine (Gemzar)]] 1000 mg/ | + | *[[Gemcitabine (Gemzar)]] 1000 mg/m<sup>2</sup> IV once per day on days 1 & 8 |
*[[Dexamethasone (Decadron)]] 40 mg PO once per day on days 1 to 4 | *[[Dexamethasone (Decadron)]] 40 mg PO once per day on days 1 to 4 | ||
| − | *[[Cisplatin (Platinol)]] 75 mg/ | + | *[[Cisplatin (Platinol)]] 75 mg/m<sup>2</sup> IV once on day 1 |
| − | '''21-day | + | '''21-day cycle for up to 3 cycles''' |
===References=== | ===References=== | ||
Revision as of 00:09, 27 June 2016
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9 regimens on this page
12 variants on this page
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Untreated
CHOEP
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CHOEP: Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Oncovin (Vincristine), Etoposide, Prednisone
Synonyms: CHOPE, VACOP
Structured Concept: C9702 (NCI-T), C0212922(NCI-MT/UMLS)
Example orders
Regimen
| Study | Evidence | Comparator | Efficacy | Toxicity |
| Pfreundschuh et al. 2004 (NHL-B1) | Phase III, >20 patients in this arm | CHOP-21 CHOP-14 |
Not reported by subgroup | Not reported by subgroup |
This regimen was used in 20 ALCL patients (CHOEP-21) and 16 ALCL patients (CHOEP-14) in the NHL-B1 trial. The authors did not report a subgroup analysis for this minority population.
Chemotherapy
- Cyclophosphamide (Cytoxan) 750 mg/m2 IV once on day 1
- Doxorubicin (Adriamycin) 50 mg/m2 IV once on day 1
- Vincristine (Oncovin) 2 mg IV once on day 1
- Prednisone (Sterapred) 100 mg PO once per day on days 1 to 5
- Etoposide (Vepesid) 100 mg/m2 IV once per day on days 1 to 3
- Patients with initial bulky disease (mass conglomerate at least 7.5 cm) received 36 Gy radiation therapy and to extranodal sites of disease when possible
Supportive medications
- For 14-day cycles: Filgrastim (Neupogen) 300 mcg (for patients <75 kg) or 480 mcg (for patients at least 75 kg) SC once per day on days 4 to 13
- Filgrastim (Neupogen) use for 21-day cycles is by discretion of ordering physician
14 or 21-day cycles for 6 cycles, next cycle to start as long as WBC is >2.5 and platelets >80
- CHOEP-14 uses 14-day cycles; CHOEP-21 uses 21-day cycles
References
- Pfreundschuh M, Trümper L, Kloess M, Schmits R, Feller AC, Rudolph C, Reiser M, Hossfeld DK, Metzner B, Hasenclever D, Schmitz N, Glass B, Rübe C, Loeffler M; German High-Grade Non-Hodgkin's Lymphoma Study Group. Two-weekly or 3-weekly CHOP chemotherapy with or without etoposide for the treatment of young patients with good-prognosis (normal LDH) aggressive lymphomas: results of the NHL-B1 trial of the DSHNHL. Blood. 2004 Aug 1;104(3):626-33. Epub 2004 Feb 24. link to original article contains verified protocol PubMed
CHOP
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CHOP: Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Oncovin (Vincristine), Prednisone
Synonyms: CHOP-21, ACOP, CAVP, COPA, VACP, VCAP
Structured Concept: C9549 (NCI-T), C0055598 (NCI-MT/UMLS)
Regimen
| Study | Evidence | Comparator | Efficacy | Toxicity |
| Pfreundschuh et al. 2004 (NHL-B1) | Phase III, <20 patients in this arm | CHOEP CHOP-14 |
Not reported by subgroup | Not reported by subgroup |
This regimen was used in 14 ALCL patients in the NHL-B1 trial. The authors did not report a subgroup analysis for this minority population.
Chemotherapy
- Cyclophosphamide (Cytoxan) 750 mg/m2 IV once on day 1
- Doxorubicin (Adriamycin) 50 mg/m2 IV once on day 1
- Vincristine (Oncovin) 2 mg IV once on day 1
- Prednisone (Sterapred) 100 mg PO once per day on days 1 to 5
Supportive medications
- At the discretion of ordering physician: Filgrastim (Neupogen) 300 mcg (for patients <75 kg) or 480 mcg (for patients at least 75 kg) SC once per day on days 4 to 13
21-day cycle for 6 cycles
References
- Pfreundschuh M, Trümper L, Kloess M, Schmits R, Feller AC, Rudolph C, Reiser M, Hossfeld DK, Metzner B, Hasenclever D, Schmitz N, Glass B, Rübe C, Loeffler M; German High-Grade Non-Hodgkin's Lymphoma Study Group. Two-weekly or 3-weekly CHOP chemotherapy with or without etoposide for the treatment of young patients with good-prognosis (normal LDH) aggressive lymphomas: results of the NHL-B1 trial of the DSHNHL. Blood. 2004 Aug 1;104(3):626-33. Epub 2004 Feb 24. link to original article contains verified protocol PubMed
Relapsed/refractory
Brentuximab vedotin (Adcetris)
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Regimen
| Study | Evidence |
| Pro et al. 2012 (SG035-0004) | Phase II |
Chemotherapy
- Brentuximab vedotin (Adcetris) 1.8 mg/kg IV over 30 minutes on day 1
3-week cycle for up to 16 infusions
References
- Pro B, Advani R, Brice P, Bartlett NL, Rosenblatt JD, Illidge T, Matous J, Ramchandren R, Fanale M, Connors JM, Yang Y, Sievers EL, Kennedy DA, Shustov A. Brentuximab vedotin (SGN-35) in patients with relapsed or refractory systemic anaplastic large-cell lymphoma: results of a phase II study. J Clin Oncol. 2012 Jun 20;30(18):2190-6. Epub 2012 May 21. link to original article contains verified protocol PubMed
- Update: Abstract: Barbara Pro, MD, Ranjana Advani, MD, Pauline Brice, MD, Nancy L. Bartlett, MD, Joseph D. Rosenblatt, MD, Tim Illidge, Jeffrey Matous, MD, Radhakrishnan Ramchandern, MD, Michelle A. Fanale, MD, Joseph M. Connors, MD, Yinghui Wang, MS, Dirk Huebner, MD, Dana A. Kennedy, PharmD, BCOP and Andrei R. Shustov, MD. Four-Year Survival Data from an Ongoing Pivotal Phase 2 Study of Brentuximab Vedotin in Patients with Relapsed or Refractory Systemic Anaplastic Large Cell Lymphoma. ASH Annual Meeting 2014, Abstract 3095 link to abstract
- Gibb A, Jones C, Bloor A, Kulkarni S, Illidge T, Linton K, Radford J. Brentuximab vedotin in refractory CD30+ lymphomas: a bridge to allogeneic transplantation in approximately one quarter of patients treated on a Named Patient Programme at a single UK center. Haematologica. 2013 Apr;98(4):611-4. Epub 2012 Oct 12. link to original article contains verified protocol PubMed
- Retrospective: Gopal AK, Bartlett NL, Forero-Torres A, Younes A, Chen R, Friedberg JW, Matous JV, Shustov AR, Smith SE, Zain J, O'Meara MM, Fanale MA. Brentuximab vedotin in patients aged 60 years or older with relapsed or refractory CD30-positive lymphomas: a retrospective evaluation of safety and efficacy. Leuk Lymphoma. 2014 Oct;55(10):2328-34. Epub 2014 Feb 24. link to original article PubMed
DHAP
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DHAP: Dexamethasone, High-dose Ara-C (cytarabine), Platinol (cisplatin)
Regimen
| Study | Evidence | Comparator |
| Crump et al. 2014 (NCIC-CTG LY.12) | Phase III, <20 in this arm | GDP |
Chemotherapy
- Dexamethasone (Decadron) 40 mg PO once per day on days 1 to 4
- Cytarabine (Cytosar) 2000 mg/m2 IV over 3 hours Q12H for 2 doses on day 2 (total of 2 doses)
- Cisplatin (Platinol) 100 mg/m2 IV continuous infusion over 24 hours on day 1
21-day cycle for up to 3 cycles
References
- Crump M, Kuruvilla J, Couban S, MacDonald DA, Kukreti V, Kouroukis CT, Rubinger M, Buckstein R, Imrie KR, Federico M, Di Renzo N, Howson-Jan K, Baetz T, Kaizer L, Voralia M, Olney HJ, Turner AR, Sussman J, Hay AE, Djurfeldt MS, Meyer RM, Chen BE, Shepherd LE. Randomized Comparison of Gemcitabine, Dexamethasone, and Cisplatin Versus Dexamethasone, Cytarabine, and Cisplatin Chemotherapy Before Autologous Stem-Cell Transplantation for Relapsed and Refractory Aggressive Lymphomas: NCIC-CTG LY.12. J Clin Oncol. 2014 Nov 1;32(31):3490-6. Epub 2014 Sep 29. link to original article contains verified protocol PubMed
GDP
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GDP: Gemcitabine, Dexamethasone, Platinol
Regimen
| Study | Evidence | Comparator |
| Crump et al. 2014 (NCIC-CTG LY.12) | Phase III, <20 in this arm | DHAP |
Chemotherapy
- Gemcitabine (Gemzar) 1000 mg/m2 IV once per day on days 1 & 8
- Dexamethasone (Decadron) 40 mg PO once per day on days 1 to 4
- Cisplatin (Platinol) 75 mg/m2 IV once on day 1
21-day cycle for up to 3 cycles
References
- Crump M, Kuruvilla J, Couban S, MacDonald DA, Kukreti V, Kouroukis CT, Rubinger M, Buckstein R, Imrie KR, Federico M, Di Renzo N, Howson-Jan K, Baetz T, Kaizer L, Voralia M, Olney HJ, Turner AR, Sussman J, Hay AE, Djurfeldt MS, Meyer RM, Chen BE, Shepherd LE. Randomized Comparison of Gemcitabine, Dexamethasone, and Cisplatin Versus Dexamethasone, Cytarabine, and Cisplatin Chemotherapy Before Autologous Stem-Cell Transplantation for Relapsed and Refractory Aggressive Lymphomas: NCIC-CTG LY.12. J Clin Oncol. 2014 Nov 1;32(31):3490-6. Epub 2014 Sep 29. link to original article contains verified protocol PubMed