Difference between revisions of "Hodgkin lymphoma, nodular lymphocyte-predominant"
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border-style:solid;">Retrospective</span> | border-style:solid;">Retrospective</span> | ||
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|[http://www.bloodjournal.org/content/123/23/3567.long Xing et al. 2014] | |[http://www.bloodjournal.org/content/123/23/3567.long Xing et al. 2014] | ||
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− | *[[Doxorubicin (Adriamycin)]] 25 mg/ | + | ====Chemotherapy==== |
− | *[[Bleomycin (Blenoxane)]] 10 units/ | + | *[[Doxorubicin (Adriamycin)]] 25 mg/m<sup>2</sup> IV once per day on days 1 & 15 |
− | *[[Vinblastine (Velban)]] 6 mg/ | + | *[[Bleomycin (Blenoxane)]] 10 units/m<sup>2</sup> IV once per day on days 1 & 15 (1 unit test dose with cycle 1 doses, 60 minutes prior to remainder of full dose) |
− | *[[Dacarbazine (DTIC)]] 375 mg/ | + | *[[Vinblastine (Velban)]] 6 mg/m<sup>2</sup> IV once per day on days 1 & 15 |
− | *+/- [[Rituximab (Rituxan)]]; schedule & number of cycles is not well-established. One potential option is 375 mg/ | + | *[[Dacarbazine (DTIC)]] 375 mg/m<sup>2</sup> IV once per day on days 1 & 15 |
+ | *+/- [[Rituximab (Rituxan)]]; schedule & number of cycles is not well-established. One potential option is 375 mg/m<sup>2</sup> IV weekly x 4 weeks on cycle 1 (see [[#Single_agent_Rituximab_.28Rituxan.29|single agent rituximab]]). Use in subsequent cycles is not well-documented. | ||
− | '''28-day cycle | + | '''28-day cycle for 2 to 6 cycles''' based on stage, response, and whether radiation therapy is used. |
===References=== | ===References=== | ||
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===Regimen {{#subobject:7bb950|Variant=1}}=== | ===Regimen {{#subobject:7bb950|Variant=1}}=== | ||
''The below regimen was intended for [[Diffuse large B-cell lymphoma|DLBCL]]; no primary reference is to our knowledge available for use of CHOP in NLP-HL.'' | ''The below regimen was intended for [[Diffuse large B-cell lymphoma|DLBCL]]; no primary reference is to our knowledge available for use of CHOP in NLP-HL.'' | ||
− | + | ====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)]] 1.4 mg/ | + | *[[Vincristine (Oncovin)]] 1.4 mg/m<sup>2</sup> (maximum dose of 2mg per cycle) 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 | ||
− | '''21-day cycle | + | '''21-day cycle for 6 to 8 cycles''' (number of cycles for CHOP in NLPHL is not well-established) |
===References=== | ===References=== | ||
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===Regimen {{#subobject:8938af|Variant=1}}=== | ===Regimen {{#subobject:8938af|Variant=1}}=== | ||
''The below regimen was intended for [[Follicular lymphoma|follicular lymphoma]]; no primary reference is to our knowledge available for use of CVP in NLP-HL.'' | ''The below regimen was intended for [[Follicular lymphoma|follicular lymphoma]]; no primary reference is to our knowledge available for use of CVP in NLP-HL.'' | ||
+ | ====Chemotherapy==== | ||
+ | *[[Cyclophosphamide (Cytoxan)]] 750 mg/m<sup>2</sup> IV once on day 1 | ||
+ | *[[Vincristine (Oncovin)]] 1.4 mg/m<sup>2</sup> (maximum dose of 2mg per cycle) IV once on day 1 | ||
+ | *[[Prednisone (Sterapred)]] 40 mg/m<sup>2</sup> PO once per day on days 1 to 5 | ||
− | + | '''21-day cycle for up to 8 cycles''' (number of cycles for CVP in NLPHL is not well-established) | |
− | |||
− | |||
− | |||
− | '''21-day | ||
===References=== | ===References=== | ||
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===Regimen #1, Wilson et al. 1993 - original EPOCH protocol {{#subobject:1eb77a|Variant=1}}=== | ===Regimen #1, Wilson et al. 1993 - original EPOCH protocol {{#subobject:1eb77a|Variant=1}}=== | ||
− | *[[Etoposide (Vepesid)]] 50 mg/m2/day (200 mg/ | + | ====Chemotherapy==== |
+ | *[[Etoposide (Vepesid)]] 50 mg/m2/day (200 mg/m<sup>2</sup> total) IV continuous infusion on days 1 to 4 | ||
*[[Prednisone (Sterapred)]] 60 mg/m2/day PO on days 1 to 5 (regimen originally was days 1 to 6, but now is just days 1 to 5) | *[[Prednisone (Sterapred)]] 60 mg/m2/day PO on days 1 to 5 (regimen originally was days 1 to 6, but now is just days 1 to 5) | ||
− | *[[Vincristine (Oncovin)]] 0.4 mg/m2/day (1.6 mg/ | + | *[[Vincristine (Oncovin)]] 0.4 mg/m2/day (1.6 mg/m<sup>2</sup> total) (sometimes capped at maximum total dose of 2mg per cycle) IV continuous infusion on days 1 to 4 |
− | *[[Doxorubicin (Adriamycin)]] 10 mg/m2/day (40 mg/ | + | *[[Doxorubicin (Adriamycin)]] 10 mg/m2/day (40 mg/m<sup>2</sup> total) IV continuous infusion on days 1 to 4 |
− | *[[Cyclophosphamide (Cytoxan)]] 750 mg/ | + | *[[Cyclophosphamide (Cytoxan)]] 750 mg/m<sup>2</sup> IV over 15 minutes on day 5 (regimen originally was day 6, but now is day 5) |
− | Supportive medications | + | ====Supportive medications==== |
*PCP prophylaxis (choose one) | *PCP prophylaxis (choose one) | ||
**[[Trimethoprim/Sulfamethoxazole (Bactrim DS)]] (160/800 mg) PO BID 3 days per week | **[[Trimethoprim/Sulfamethoxazole (Bactrim DS)]] (160/800 mg) PO BID 3 days per week | ||
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*[[Filgrastim (Neupogen)]] 5 mcg/kg SQ daily start day 6 and continue until ANC >5,000/uL past nadir | *[[Filgrastim (Neupogen)]] 5 mcg/kg SQ daily start day 6 and continue until ANC >5,000/uL past nadir | ||
− | '''21-day | + | '''21-day cycle for 6 to 8 cycles''' |
===Regimen #2, Wilson et al. 2002 - dose-adjusted EPOCH {{#subobject:77d453|Variant=1}}=== | ===Regimen #2, Wilson et al. 2002 - dose-adjusted EPOCH {{#subobject:77d453|Variant=1}}=== | ||
− | *[[Etoposide (Vepesid)]] 50 mg/m2/day (200 mg/ | + | ====Chemotherapy==== |
− | *[[Prednisone (Sterapred)]] 60 mg/ | + | *[[Etoposide (Vepesid)]] 50 mg/m2/day (200 mg/m<sup>2</sup> total) IV continuous infusion on days 1 to 4 |
− | *[[Vincristine (Oncovin)]] 0.4 mg/m2/day (1.6 mg/ | + | *[[Prednisone (Sterapred)]] 60 mg/m<sup>2</sup> PO BID on days 1 to 5 |
− | *[[Doxorubicin (Adriamycin)]] 10 mg/m2/day (40 mg/ | + | *[[Vincristine (Oncovin)]] 0.4 mg/m2/day (1.6 mg/m<sup>2</sup> total) (not capped in the paper, but sometimes capped at a maximum total dose of 2mg per cycle) IV continuous infusion on days 1 to 4 |
− | *[[Cyclophosphamide (Cytoxan)]] 750 mg/ | + | *[[Doxorubicin (Adriamycin)]] 10 mg/m2/day (40 mg/m<sup>2</sup> total) IV continuous infusion on days 1 to 4 |
+ | *[[Cyclophosphamide (Cytoxan)]] 750 mg/m<sup>2</sup> IV over 15 minutes on day 5 | ||
− | Supportive medications | + | ====Supportive medications==== |
*PCP prophylaxis (choose one) | *PCP prophylaxis (choose one) | ||
**[[Trimethoprim/Sulfamethoxazole (Bactrim DS)]] (160/800 mg) PO BID 3 days per week | **[[Trimethoprim/Sulfamethoxazole (Bactrim DS)]] (160/800 mg) PO BID 3 days per week | ||
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*[[Filgrastim (Neupogen)]] 5 mcg/kg SQ daily start day 6 and continue until ANC >5,000/uL past nadir | *[[Filgrastim (Neupogen)]] 5 mcg/kg SQ daily start day 6 and continue until ANC >5,000/uL past nadir | ||
− | '''21-day | + | '''21-day cycle for 6 to 8 cycles''' |
Dose-adjustments for EPOCH protocol: | Dose-adjustments for EPOCH protocol: | ||
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<br>If ANC on day 1 is: | <br>If ANC on day 1 is: | ||
* >1,500, full dose cyclophosphamide | * >1,500, full dose cyclophosphamide | ||
− | * 1,000-1,500, reduce cyclophosphamide by 187 mg/ | + | * 1,000-1,500, reduce cyclophosphamide by 187 mg/m<sup>2</sup> (equal to 25% dose reduction) |
* <1,000, hold EPOCH | * <1,000, hold EPOCH | ||
*If ANC nadir is <500, reduce cyclophosphamide an additional 187 mg/m2 | *If ANC nadir is <500, reduce cyclophosphamide an additional 187 mg/m2 | ||
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|} | |} | ||
''The below regimen was intended for [[Diffuse large B-cell lymphoma|DLBCL]]; no prospective reference is to our knowledge available for use of R-CHOP in NLP-HL.'' | ''The below regimen was intended for [[Diffuse large B-cell lymphoma|DLBCL]]; no prospective reference is to our knowledge available for use of R-CHOP in NLP-HL.'' | ||
− | + | ====Chemotherapy==== | |
− | *[[Rituximab (Rituxan)]] 375 mg/ | + | *[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once on day 1 |
− | *[[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)]] 1.4 mg/ | + | *[[Vincristine (Oncovin)]] 1.4 mg/m<sup>2</sup> (maximum dose of 2mg per cycle) 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 | ||
− | '''21-day cycle | + | '''21-day cycle for 6 to 8 cycles''' |
===References=== | ===References=== | ||
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R-CVP: '''<u>R</u>'''ituximab, '''<u>C</u>'''yclophosphamide, '''<u>V</u>'''incristine, '''<u>P</u>'''rednisone | R-CVP: '''<u>R</u>'''ituximab, '''<u>C</u>'''yclophosphamide, '''<u>V</u>'''incristine, '''<u>P</u>'''rednisone | ||
===Regimen {{#subobject:c15033|Variant=1}}=== | ===Regimen {{#subobject:c15033|Variant=1}}=== | ||
− | *[[Rituximab (Rituxan)]] 375 mg/ | + | ====Chemotherapy==== |
− | *[[Cyclophosphamide (Cytoxan)]] 750 mg/ | + | *[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once on day 1 |
− | *[[Vincristine (Oncovin)]] 1.4 mg/ | + | *[[Cyclophosphamide (Cytoxan)]] 750 mg/m<sup>2</sup> IV once on day 1 |
− | *[[Prednisone (Sterapred)]] 40 mg/ | + | *[[Vincristine (Oncovin)]] 1.4 mg/m<sup>2</sup> (maximum dose of 2mg per cycle) IV once on day 1 |
+ | *[[Prednisone (Sterapred)]] 40 mg/m<sup>2</sup> PO once daily on days 1 to 5 | ||
− | '''21-day | + | '''21-day cycle for up to 8 cycles''' (number of cycles for R-CVP in NLPHL is not well-established) |
===References=== | ===References=== | ||
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R-EPOCH: '''<u>R</u>'''ituximab, '''<u>E</u>'''toposide, '''<u>P</u>'''rednisone, '''<u>O</u>'''ncovin (Vincristine), '''<u>C</u>'''yclophosphamide, '''<u>H</u>'''ydroxydaunorubicin (Doxorubicin) | R-EPOCH: '''<u>R</u>'''ituximab, '''<u>E</u>'''toposide, '''<u>P</u>'''rednisone, '''<u>O</u>'''ncovin (Vincristine), '''<u>C</u>'''yclophosphamide, '''<u>H</u>'''ydroxydaunorubicin (Doxorubicin) | ||
===Regimen #1, Wilson et al. 1993 - original EPOCH protocol (which did not include rituximab) {{#subobject:1f818a|Variant=1}}=== | ===Regimen #1, Wilson et al. 1993 - original EPOCH protocol (which did not include rituximab) {{#subobject:1f818a|Variant=1}}=== | ||
− | *[[Rituximab (Rituxan)]] 375 mg/ | + | ====Chemotherapy==== |
− | *[[Etoposide (Vepesid)]] 50 mg/m2/day (200 mg/ | + | *[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once per cycle (usually given as outpatient due to reimbursement issues) |
+ | *[[Etoposide (Vepesid)]] 50 mg/m2/day (200 mg/m<sup>2</sup> total) IV continuous infusion on days 1 to 4 | ||
*[[Prednisone (Sterapred)]] 60 mg/m2/day PO on days 1 to 5 (regimen originally was days 1 to 6, but now is just days 1 to 5) | *[[Prednisone (Sterapred)]] 60 mg/m2/day PO on days 1 to 5 (regimen originally was days 1 to 6, but now is just days 1 to 5) | ||
− | *[[Vincristine (Oncovin)]] 0.4 mg/m2/day (1.6 mg/ | + | *[[Vincristine (Oncovin)]] 0.4 mg/m2/day (1.6 mg/m<sup>2</sup> total) (sometimes capped at maximum total dose of 2mg per cycle) IV continuous infusion on days 1 to 4 |
− | *[[Doxorubicin (Adriamycin)]] 10 mg/m2/day (40 mg/ | + | *[[Doxorubicin (Adriamycin)]] 10 mg/m2/day (40 mg/m<sup>2</sup> total) IV continuous infusion on days 1 to 4 |
− | *[[Cyclophosphamide (Cytoxan)]] 750 mg/ | + | *[[Cyclophosphamide (Cytoxan)]] 750 mg/m<sup>2</sup> IV over 15 minutes on day 5 (regimen originally was day 6, but now is day 5) |
− | Supportive medications | + | ====Supportive medications==== |
*PCP prophylaxis (choose one) | *PCP prophylaxis (choose one) | ||
**[[Trimethoprim/Sulfamethoxazole (Bactrim DS)]] (160/800 mg) PO BID 3 days per week | **[[Trimethoprim/Sulfamethoxazole (Bactrim DS)]] (160/800 mg) PO BID 3 days per week | ||
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*[[Filgrastim (Neupogen)]] 5 mcg/kg SQ daily start day 6 and continue until ANC >5,000/uL past nadir | *[[Filgrastim (Neupogen)]] 5 mcg/kg SQ daily start day 6 and continue until ANC >5,000/uL past nadir | ||
− | '''21-day | + | '''21-day cycle for 6 to 8 cycles''' |
===Regimen #2, Wilson et al. 2002 - dose-adjusted EPOCH {{#subobject:f46430|Variant=1}}=== | ===Regimen #2, Wilson et al. 2002 - dose-adjusted EPOCH {{#subobject:f46430|Variant=1}}=== | ||
− | *[[Rituximab (Rituxan)]] 375 mg/ | + | ====Chemotherapy==== |
− | *[[Etoposide (Vepesid)]] 50 mg/m2/day (200 mg/ | + | *[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once per cycle (usually given as outpatient due to reimbursement issues) |
− | *[[Prednisone (Sterapred)]] 60 mg/ | + | *[[Etoposide (Vepesid)]] 50 mg/m2/day (200 mg/m<sup>2</sup> total) IV continuous infusion on days 1 to 4 |
− | *[[Vincristine (Oncovin)]] 0.4 mg/m2/day (1.6 mg/ | + | *[[Prednisone (Sterapred)]] 60 mg/m<sup>2</sup> PO BID on days 1 to 5 |
− | *[[Doxorubicin (Adriamycin)]] 10 mg/m2/day (40 mg/ | + | *[[Vincristine (Oncovin)]] 0.4 mg/m2/day (1.6 mg/m<sup>2</sup> total) (not capped in the paper, but sometimes capped at a maximum total dose of 2mg per cycle) IV continuous infusion on days 1 to 4 |
− | *[[Cyclophosphamide (Cytoxan)]] 750 mg/ | + | *[[Doxorubicin (Adriamycin)]] 10 mg/m2/day (40 mg/m<sup>2</sup> total) IV continuous infusion on days 1 to 4 |
+ | *[[Cyclophosphamide (Cytoxan)]] 750 mg/m<sup>2</sup> IV over 15 minutes on day 5 | ||
− | Supportive medications | + | ====Supportive medications==== |
*PCP prophylaxis (choose one) | *PCP prophylaxis (choose one) | ||
**[[Trimethoprim/Sulfamethoxazole (Bactrim DS)]] (160/800 mg) PO BID 3 days per week | **[[Trimethoprim/Sulfamethoxazole (Bactrim DS)]] (160/800 mg) PO BID 3 days per week | ||
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*[[Filgrastim (Neupogen)]] 5 mcg/kg SQ daily start day 6 and continue until ANC >5,000/uL past nadir | *[[Filgrastim (Neupogen)]] 5 mcg/kg SQ daily start day 6 and continue until ANC >5,000/uL past nadir | ||
− | '''21-day | + | '''21-day cycle for 6 to 8 cycles''' |
===Dose-adjusted R-EPOCH protocol=== | ===Dose-adjusted R-EPOCH protocol=== | ||
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<br>If ANC on day 1 is: | <br>If ANC on day 1 is: | ||
* >1,500, full dose cyclophosphamide | * >1,500, full dose cyclophosphamide | ||
− | * 1,000-1,500, reduce cyclophosphamide by 187 mg/ | + | * 1,000-1,500, reduce cyclophosphamide by 187 mg/m<sup>2</sup> (equal to 25% dose reduction) |
* <1,000, hold EPOCH | * <1,000, hold EPOCH | ||
*If ANC nadir is <500, reduce cyclophosphamide an additional 187 mg/m2 | *If ANC nadir is <500, reduce cyclophosphamide an additional 187 mg/m2 | ||
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border-width:2px; | border-width:2px; | ||
border-style:solid;">Phase II</span> | border-style:solid;">Phase II</span> | ||
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− | |||
|- | |- | ||
|[http://bloodjournal.hematologylibrary.org/content/101/11/4285.long Ekstrand et al. 2003] | |[http://bloodjournal.hematologylibrary.org/content/101/11/4285.long Ekstrand et al. 2003] | ||
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border-width:2px; | border-width:2px; | ||
border-style:solid;">Phase II</span> | border-style:solid;">Phase II</span> | ||
− | |||
− | |||
|- | |- | ||
|[http://jco.ascopubs.org/content/32/9/912.full Advani et al. 2014] | |[http://jco.ascopubs.org/content/32/9/912.full Advani et al. 2014] | ||
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|- | |- | ||
|} | |} | ||
+ | ====Chemotherapy==== | ||
+ | *[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once per week x 4 weeks | ||
− | + | ====Supportive medications==== | |
− | + | *[[Acetaminophen (Tylenol)]] 650 mg PO 30 minutes prior to each dose | |
− | Supportive medications | + | *[[Diphenhydramine (Benadryl)]] 25 mg PO 30 minutes prior to each dose |
− | *[[Acetaminophen (Tylenol)]] 650 mg PO 30 minutes prior to each dose | ||
− | *[[Diphenhydramine (Benadryl)]] 25 mg PO 30 minutes prior to each dose | ||
'''One course of 4 week therapy''' | '''One course of 4 week therapy''' | ||
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|- | |- | ||
|} | |} | ||
− | + | ====Chemotherapy==== | |
− | *[[Rituximab (Rituxan)]] 375 mg/ | + | *[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once per week x 4 weeks |
'''One course, followed by maintenance:''' | '''One course, followed by maintenance:''' | ||
− | *[[Rituximab (Rituxan)]] 375 mg/ | + | *[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once per week x 4 weeks |
− | '''One course every 6 | + | '''One course every 6 month for 2 years''' |
===References=== | ===References=== |
Revision as of 00:49, 28 June 2016
Use of this site is subject to you reading and agreeing with the terms set forth in the disclaimer.
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 invited to contribute to the site.
9 regimens on this page
11 variants on this page
|
Untreated
ABVD
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ABVD: Adriamycin (Doxorubicin), Bleomycin, Vinblastine, Dacarbazine
Regimen
Study | Evidence |
Savage et al. 2011 | Retrospective |
Xing et al. 2014 | Retrospective |
Chemotherapy
- Doxorubicin (Adriamycin) 25 mg/m2 IV once per day on days 1 & 15
- Bleomycin (Blenoxane) 10 units/m2 IV once per day on days 1 & 15 (1 unit test dose with cycle 1 doses, 60 minutes prior to remainder of full dose)
- Vinblastine (Velban) 6 mg/m2 IV once per day on days 1 & 15
- Dacarbazine (DTIC) 375 mg/m2 IV once per day on days 1 & 15
- +/- Rituximab (Rituxan); schedule & number of cycles is not well-established. One potential option is 375 mg/m2 IV weekly x 4 weeks on cycle 1 (see single agent rituximab). Use in subsequent cycles is not well-documented.
28-day cycle for 2 to 6 cycles based on stage, response, and whether radiation therapy is used.
References
- Retrospective: Savage KJ, Skinnider B, Al-Mansour M, Sehn LH, Gascoyne RD, Connors JM. Treating limited-stage nodular lymphocyte predominant Hodgkin lymphoma similarly to classical Hodgkin lymphoma with ABVD may improve outcome. Blood. 2011 Oct 27;118(17):4585-90. link to original article PubMed
- Retrospective: Xing KH, Connors JM, Lai A, Al-Mansour M, Sehn LH, Villa D, Klasa R, Shenkier T, Gascoyne RD, Skinnider B, Savage KJ. Advanced-stage nodular lymphocyte predominant Hodgkin lymphoma compared with classical Hodgkin lymphoma: a matched pair outcome analysis. Blood. 2014 Jun 5;123(23):3567-73. Epub 2014 Apr 8. link to original article PubMed
CHOP
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CHOP: Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Oncovin (Vincristine), Prednisone
Regimen
The below regimen was intended for DLBCL; no primary reference is to our knowledge available for use of CHOP in NLP-HL.
Chemotherapy
- Cyclophosphamide (Cytoxan) 750 mg/m2 IV once on day 1
- Doxorubicin (Adriamycin) 50 mg/m2 IV once on day 1
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2mg per cycle) IV once on day 1
- Prednisone (Sterapred) 100 mg PO once per day on days 1 to 5
21-day cycle for 6 to 8 cycles (number of cycles for CHOP in NLPHL is not well-established)
References
- Feugier P, Van Hoof A, Sebban C, Solal-Celigny P, Bouabdallah R, Fermé C, Christian B, Lepage E, Tilly H, Morschhauser F, Gaulard P, Salles G, Bosly A, Gisselbrecht C, Reyes F, Coiffier B. Long-term results of the R-CHOP study in the treatment of elderly patients with diffuse large B-cell lymphoma: a study by the Groupe d'Etude des Lymphomes de l'Adulte. J Clin Oncol. 2005 Jun 20;23(18):4117-26. link to original article contains protocol PubMed
CVP
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CVP: Cyclophosphamide, Vincristine, Prednisone
Regimen
The below regimen was intended for follicular lymphoma; no primary reference is to our knowledge available for use of CVP in NLP-HL.
Chemotherapy
- Cyclophosphamide (Cytoxan) 750 mg/m2 IV once on day 1
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2mg per cycle) IV once on day 1
- Prednisone (Sterapred) 40 mg/m2 PO once per day on days 1 to 5
21-day cycle for up to 8 cycles (number of cycles for CVP in NLPHL is not well-established)
References
- Marcus R, Imrie K, Belch A, Cunningham D, Flores E, Catalano J, Solal-Celigny P, Offner F, Walewski J, Raposo J, Jack A, Smith P. CVP chemotherapy plus rituximab compared with CVP as first-line treatment for advanced follicular lymphoma. Blood. 2005 Feb 15;105(4):1417-23. link to original article contains protocol PubMed
EPOCH
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EPOCH: Etoposide, Prednisone, Oncovin (Vincristine), Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin)
Regimen #1, Wilson et al. 1993 - original EPOCH protocol
Chemotherapy
- Etoposide (Vepesid) 50 mg/m2/day (200 mg/m2 total) IV continuous infusion on days 1 to 4
- Prednisone (Sterapred) 60 mg/m2/day PO on days 1 to 5 (regimen originally was days 1 to 6, but now is just days 1 to 5)
- Vincristine (Oncovin) 0.4 mg/m2/day (1.6 mg/m2 total) (sometimes capped at maximum total dose of 2mg per cycle) IV continuous infusion on days 1 to 4
- Doxorubicin (Adriamycin) 10 mg/m2/day (40 mg/m2 total) IV continuous infusion on days 1 to 4
- Cyclophosphamide (Cytoxan) 750 mg/m2 IV over 15 minutes on day 5 (regimen originally was day 6, but now is day 5)
Supportive medications
- PCP prophylaxis (choose one)
- Trimethoprim/Sulfamethoxazole (Bactrim DS) (160/800 mg) PO BID 3 days per week
- Atovaquone (Mepron) 1500 mg PO daily
- Pentamidine (Nebupent) 300 mg nebulized Q28days
- Filgrastim (Neupogen) 5 mcg/kg SQ daily start day 6 and continue until ANC >5,000/uL past nadir
21-day cycle for 6 to 8 cycles
Regimen #2, Wilson et al. 2002 - dose-adjusted EPOCH
Chemotherapy
- Etoposide (Vepesid) 50 mg/m2/day (200 mg/m2 total) IV continuous infusion on days 1 to 4
- Prednisone (Sterapred) 60 mg/m2 PO BID on days 1 to 5
- Vincristine (Oncovin) 0.4 mg/m2/day (1.6 mg/m2 total) (not capped in the paper, but sometimes capped at a maximum total dose of 2mg per cycle) IV continuous infusion on days 1 to 4
- Doxorubicin (Adriamycin) 10 mg/m2/day (40 mg/m2 total) IV continuous infusion on days 1 to 4
- Cyclophosphamide (Cytoxan) 750 mg/m2 IV over 15 minutes on day 5
Supportive medications
- PCP prophylaxis (choose one)
- Trimethoprim/Sulfamethoxazole (Bactrim DS) (160/800 mg) PO BID 3 days per week
- Atovaquone (Mepron) 1500 mg PO daily
- Pentamidine (Nebupent) 300 mg nebulized Q28days
- Filgrastim (Neupogen) 5 mcg/kg SQ daily start day 6 and continue until ANC >5,000/uL past nadir
21-day cycle for 6 to 8 cycles
Dose-adjustments for EPOCH protocol:
- Start cycle 1 as described above
- Obtain twice per week CBCs for nadir measurements
- If nadir ANC >500, increase Etoposide (Vepesid), Doxorubicin (Adriamycin), and Cyclophosphamide (Cytoxan) by 20% compared to previous cycle.
- If nadir ANC <500 on 1 or 2 measurements, use same doses as last cycle
- If nadir ANC <500 on at least 3 measurements, decrease Etoposide (Vepesid), Doxorubicin (Adriamycin), and Cyclophosphamide (Cytoxan) by 20% compared to previous cycle.
- And/or if nadir platelet count <25 on at least 1 measurement, decrease Etoposide (Vepesid), Doxorubicin (Adriamycin), and Cyclophosphamide (Cytoxan) 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 Q21days if ANC >1,000 and platelets >100. If counts are below those levels, check daily CBC and continue growth factor support until counts are adequate and next cycle can start.
Historic dose adjustments for hematologic toxicity:
These adjustments were in the original paper for standard EPOCH, which are much less relevant due to growth factor support.
If ANC on day 1 is:
- >1,500, full dose cyclophosphamide
- 1,000-1,500, reduce cyclophosphamide by 187 mg/m2 (equal to 25% dose reduction)
- <1,000, hold EPOCH
- If ANC nadir is <500, reduce cyclophosphamide an additional 187 mg/m2
- If ANC nadir is >500 and patient had previously been dose-reduced, increase cyclophosphamide dose by 187 mg/m2
References
- Wilson WH, Bryant G, Bates S, Fojo A, Wittes RE, Steinberg SM, Kohler DR, Jaffe ES, Herdt J, Cheson BD et al. EPOCH chemotherapy: toxicity and efficacy in relapsed and refractory non-Hodgkin's lymphoma. J Clin Oncol. 1993 Aug;11(8):1573-82 link to original article contains protocol PubMed
- Wilson WH, Grossbard ML, Pittaluga S, Cole D, Pearson D, Drbohlav N, Steinberg SM, Little RF, Janik J, Gutierrez M, Raffeld M, Staudt L, Cheson BD, Longo DL, Harris N, Jaffe ES, Chabner BA, Wittes R, Balis F. Dose-adjusted EPOCH chemotherapy for untreated large B-cell lymphomas: a pharmacodynamic approach with high efficacy. Blood. 2002 Apr 15;99(8):2685-93. link to original article contains protocol PubMed content property of HemOnc.org
- Wilson WH, Dunleavy K, Pittaluga S, Hegde U, Grant N, Steinberg SM, Raffeld M, Gutierrez M, Chabner BA, Staudt L, Jaffe ES, Janik JE. Phase II study of dose-adjusted EPOCH and rituximab in untreated diffuse large B-cell lymphoma with analysis of germinal center and post-germinal center biomarkers. J Clin Oncol. 2008 Jun 1;26(16):2717-24. link to original article PubMed
R-CHOP
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R-CHOP: Rituximab, Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Oncovin (Vincristine), Prednisone
Regimen
Study | Evidence |
Fanale et al. 2010 | Retrospective |
The below regimen was intended for DLBCL; no prospective reference is to our knowledge available for use of R-CHOP in NLP-HL.
Chemotherapy
- Rituximab (Rituxan) 375 mg/m2 IV once on day 1
- Cyclophosphamide (Cytoxan) 750 mg/m2 IV once on day 1
- Doxorubicin (Adriamycin) 50 mg/m2 IV once on day 1
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2mg per cycle) IV once on day 1
- Prednisone (Sterapred) 100 mg PO once per day on days 1 to 5
21-day cycle for 6 to 8 cycles
References
- Retrospective Abstract: Fanale, Michelle A., Lai, Chao-Ming, McLaughlin, Peter, Romaguera, Jorge, Fayad, Luis, Hagemeister, Fredrick, Samaniego, Felipe, Rodriguez, Maria Alma, Neelapu, Sattva S., Shah, Jatin J, Kwak, Larry, Dong, Wenli, Reed, Valerie, Dabaja, Bouthaina S., Popat, Uday, Younes, Anas. Outcomes of Nodular Lymphocyte Predominant Hodgkin's Lymphoma (NLPHL) Patients Treated with R-CHOP. ASH Annual Meeting Abstracts 2010 116: 2812 link to abstract
R-CVP
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R-CVP: Rituximab, Cyclophosphamide, Vincristine, Prednisone
Regimen
Chemotherapy
- Rituximab (Rituxan) 375 mg/m2 IV once on day 1
- Cyclophosphamide (Cytoxan) 750 mg/m2 IV once on day 1
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2mg per cycle) IV once on day 1
- Prednisone (Sterapred) 40 mg/m2 PO once daily on days 1 to 5
21-day cycle for up to 8 cycles (number of cycles for R-CVP in NLPHL is not well-established)
References
R-EPOCH
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R-EPOCH: Rituximab, Etoposide, Prednisone, Oncovin (Vincristine), Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin)
Regimen #1, Wilson et al. 1993 - original EPOCH protocol (which did not include rituximab)
Chemotherapy
- Rituximab (Rituxan) 375 mg/m2 IV once per cycle (usually given as outpatient due to reimbursement issues)
- Etoposide (Vepesid) 50 mg/m2/day (200 mg/m2 total) IV continuous infusion on days 1 to 4
- Prednisone (Sterapred) 60 mg/m2/day PO on days 1 to 5 (regimen originally was days 1 to 6, but now is just days 1 to 5)
- Vincristine (Oncovin) 0.4 mg/m2/day (1.6 mg/m2 total) (sometimes capped at maximum total dose of 2mg per cycle) IV continuous infusion on days 1 to 4
- Doxorubicin (Adriamycin) 10 mg/m2/day (40 mg/m2 total) IV continuous infusion on days 1 to 4
- Cyclophosphamide (Cytoxan) 750 mg/m2 IV over 15 minutes on day 5 (regimen originally was day 6, but now is day 5)
Supportive medications
- PCP prophylaxis (choose one)
- Trimethoprim/Sulfamethoxazole (Bactrim DS) (160/800 mg) PO BID 3 days per week
- Atovaquone (Mepron) 1500 mg PO daily
- Pentamidine (Nebupent) 300 mg nebulized Q28days
- Filgrastim (Neupogen) 5 mcg/kg SQ daily start day 6 and continue until ANC >5,000/uL past nadir
21-day cycle for 6 to 8 cycles
Regimen #2, Wilson et al. 2002 - dose-adjusted EPOCH
Chemotherapy
- Rituximab (Rituxan) 375 mg/m2 IV once per cycle (usually given as outpatient due to reimbursement issues)
- Etoposide (Vepesid) 50 mg/m2/day (200 mg/m2 total) IV continuous infusion on days 1 to 4
- Prednisone (Sterapred) 60 mg/m2 PO BID on days 1 to 5
- Vincristine (Oncovin) 0.4 mg/m2/day (1.6 mg/m2 total) (not capped in the paper, but sometimes capped at a maximum total dose of 2mg per cycle) IV continuous infusion on days 1 to 4
- Doxorubicin (Adriamycin) 10 mg/m2/day (40 mg/m2 total) IV continuous infusion on days 1 to 4
- Cyclophosphamide (Cytoxan) 750 mg/m2 IV over 15 minutes on day 5
Supportive medications
- PCP prophylaxis (choose one)
- Trimethoprim/Sulfamethoxazole (Bactrim DS) (160/800 mg) PO BID 3 days per week
- Atovaquone (Mepron) 1500 mg PO daily
- Pentamidine (Nebupent) 300 mg nebulized Q28days
- Filgrastim (Neupogen) 5 mcg/kg SQ daily start day 6 and continue until ANC >5,000/uL past nadir
21-day cycle for 6 to 8 cycles
Dose-adjusted R-EPOCH protocol
- Start cycle 1 as described above
- Obtain twice per week CBCs for nadir measurements
- If nadir ANC >500, increase etoposide, doxorubicin, and cyclophosphamide by 20% compared to previous cycle.
- If nadir ANC <500 on 1 or 2 measurements, use same doses as last cycle
- If nadir ANC <500 on at least 3 measurements, decrease etoposide, doxorubicin, and cyclophosphamide by 20% compared to previous cycle.
- And/or if nadir platelet count <25 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 Q21days if ANC >1,000 and platelets >100. If counts are below those levels, check daily CBC and continue growth factor support until counts are adequate and next cycle can start.
Historic dose adjustments for hematologic toxicity
These adjustments were in the original paper for standard EPOCH, which are much less relevant due to growth factor support.
If ANC on day 1 is:
- >1,500, full dose cyclophosphamide
- 1,000-1,500, reduce cyclophosphamide by 187 mg/m2 (equal to 25% dose reduction)
- <1,000, hold EPOCH
- If ANC nadir is <500, reduce cyclophosphamide an additional 187 mg/m2
- If ANC nadir is >500 and patient had previously been dose-reduced, increase cyclophosphamide dose by 187 mg/m2
References
Rituximab (Rituxan)
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Regimen #1 (4-week course)
Study | Evidence |
Rehwald et al. 2003 | Phase II |
Ekstrand et al. 2003 | Phase II |
Advani et al. 2014 | Phase II |
Chemotherapy
- Rituximab (Rituxan) 375 mg/m2 IV once per week x 4 weeks
Supportive medications
- Acetaminophen (Tylenol) 650 mg PO 30 minutes prior to each dose
- Diphenhydramine (Benadryl) 25 mg PO 30 minutes prior to each dose
One course of 4 week therapy
Regimen #2, with maintenance
Study | Evidence |
Advani et al. 2014 | Phase II, <20 patients in this arm |
Chemotherapy
- Rituximab (Rituxan) 375 mg/m2 IV once per week x 4 weeks
One course, followed by maintenance:
- Rituximab (Rituxan) 375 mg/m2 IV once per week x 4 weeks
One course every 6 month for 2 years
References
- Rehwald U, Schulz H, Reiser M, Sieber M, Staak JO, Morschhauser F, Driessen C, Rudiger T, Muller-Hermelink K, Diehl V, Engert A; German Hodgkin Lymphoma Study Group (GHSG). Treatment of relapsed CD20+ Hodgkin lymphoma with the monoclonal antibody rituximab is effective and well tolerated: results of a phase 2 trial of the German Hodgkin Lymphoma Study Group. Blood. 2003 Jan 15;101(2):420-4. link to original article contains verified protocol PubMed
- Update: Schulz H, Rehwald U, Morschhauser F, Elter T, Driessen C, Rüdiger T, Borchmann P, Schnell R, Diehl V, Engert A, Reiser M. Rituximab in relapsed lymphocyte-predominant Hodgkin lymphoma: long-term results of a phase 2 trial by the German Hodgkin Lymphoma Study Group (GHSG). Blood. 2008 Jan 1;111(1):109-11. link to original article contains protocol PubMed
- Ekstrand BC, Lucas JB, Horwitz SM, Fan Z, Breslin S, Hoppe RT, Natkunam Y, Bartlett NL, Horning SJ. Rituximab in lymphocyte-predominant Hodgkin disease: results of a phase 2 trial. Blood. 2003 Jun 1;101(11):4285-9. link to original article contains protocol PubMed
- Advani RH, Horning SJ, Hoppe RT, Daadi S, Allen J, Natkunam Y, Bartlett NL. Mature Results of a Phase II Study of Rituximab Therapy for Nodular Lymphocyte-Predominant Hodgkin Lymphoma. J Clin Oncol. 2014 Mar 20;32(9):912-8. Epub 2014 Feb 10. link to original article contains verified protocol PubMed