Difference between revisions of "Marginal zone lymphoma"

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Line 46: Line 46:
 
====Chemotherapy====
 
====Chemotherapy====
 
''Note: the bendamustine infusion instructions are for the Treanda formulation, which was discontinued on 3/31/2016.''
 
''Note: the bendamustine infusion instructions are for the Treanda formulation, which was discontinued on 3/31/2016.''
−
*[[Bendamustine]] 90 mg/m2 IV over 30 minutes once on days 1 & 2
+
*[[Bendamustine]] 90 mg/m<sup>2</sup> IV over 30 minutes once on days 1 & 2
−
*[[Rituximab (Rituxan)]] 375 mg/m2 IV once on day 1
+
*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once on day 1
  
 
====Supportive medications====  
 
====Supportive medications====  
Line 53: Line 53:
 
*Prophylactic use of [[Filgrastim (Neupogen)|G-CSF]] allowed according [http://jop.ascopubs.org/content/2/4/196.full ASCO guidelines] (2006)
 
*Prophylactic use of [[Filgrastim (Neupogen)|G-CSF]] allowed according [http://jop.ascopubs.org/content/2/4/196.full ASCO guidelines] (2006)
  
−
'''28-day cycle x up to 8 cycles'''
+
'''28-day cycle for up to 8 cycles'''
  
 
===References===
 
===References===
Line 87: Line 87:
 
|-
 
|-
 
|}
 
|}
−
 
+
====Chemotherapy====
−
*[[Chlorambucil (Leukeran)]] 8 mg/m2 (6 mg/m2 per day if older than 75 years old) PO once per day on days 1 to 10
+
*[[Chlorambucil (Leukeran)]] 8 mg/m<sup>2</sup> (6 mg/m<sup>2</sup> per day if older than 75 years old) PO once per day on days 1 to 10
  
 
====Supportive medications====
 
====Supportive medications====
Line 95: Line 95:
 
**[[Pentamidine (Nebupent)]] 300 mg inhaled once per month
 
**[[Pentamidine (Nebupent)]] 300 mg inhaled once per month
  
−
'''28-day cycle x up to 12 cycles'''
+
'''28-day cycle for up to 12 cycles'''
  
 
===Regimen #2 {{#subobject:8fc8cb|Variant=1}}===
 
===Regimen #2 {{#subobject:8fc8cb|Variant=1}}===
Line 120: Line 120:
 
|-
 
|-
 
|}
 
|}
−
 
+
====Chemotherapy====
−
*[[Chlorambucil (Leukeran)]] 6 mg/m2 PO once per day on days 1 to 42
+
*[[Chlorambucil (Leukeran)]] 6 mg/m<sup>2</sup> PO once per day on days 1 to 42
  
 
'''One course'''
 
'''One course'''
Line 162: Line 162:
 
|-
 
|-
 
|}
 
|}
−
*[[Chlorambucil (Leukeran)]] 6 mg/m2 PO once per day on days 1 to 42
+
====Chemotherapy====
−
*[[Rituximab (Rituxan)]] 375 mg/m2 IV once per day on days 1, 8, 15, 22
+
*[[Chlorambucil (Leukeran)]] 6 mg/m<sup>2</sup> PO once per day on days 1 to 42
 +
*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once per day on days 1, 8, 15, 22
  
 
'''One course'''
 
'''One course'''
Line 201: Line 202:
 
|-
 
|-
 
|}
 
|}
−
 
+
====Chemotherapy====
−
*[[Fludarabine (Fludara)]] 40 mg/m2 (30 mg/m2 per day if older than 75 years old) PO once per day on days 1 to 5
+
*[[Fludarabine (Fludara)]] 40 mg/m<sup>2</sup> (30 mg/m<sup>2</sup> per day if older than 75 years old) PO once per day on days 1 to 5
  
 
====Supportive medications====
 
====Supportive medications====
Line 212: Line 213:
 
**[[Acyclovir (Zovirax)]] 200 to 400 mg PO BID  
 
**[[Acyclovir (Zovirax)]] 200 to 400 mg PO BID  
  
−
'''28-day cycles x up to 6 cycles'''
+
'''28-day cycle for up to 6 cycles'''
  
 
===References===
 
===References===
Line 229: Line 230:
 
Structured Concept: [http://ncit.nci.nih.gov/ncitbrowser/ConceptReport.jsp?dictionary==NCI%20Thesaurus&version==12.09d&code==C9760 C9760] (NCI-T), [http://ncim.nci.nih.gov/ncimbrowser/ConceptReport.jsp?dictionary==NCI%20MetaThesaurus&code==C0393023 C0393023] (NCI-MT/UMLS)
 
Structured Concept: [http://ncit.nci.nih.gov/ncitbrowser/ConceptReport.jsp?dictionary==NCI%20Thesaurus&version==12.09d&code==C9760 C9760] (NCI-T), [http://ncim.nci.nih.gov/ncimbrowser/ConceptReport.jsp?dictionary==NCI%20MetaThesaurus&code==C0393023 C0393023] (NCI-MT/UMLS)
  
 +
====Example orders====
 
*[[Example orders for R-CHOP in lymphoma]]
 
*[[Example orders for R-CHOP in lymphoma]]
  
Line 254: Line 256:
 
|-
 
|-
 
|}
 
|}
−
 
+
====Chemotherapy====
−
*[[Rituximab (Rituxan)]] 375 mg/m2 IV once on day 1
+
*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once on day 1
−
*[[Cyclophosphamide (Cytoxan)]] 750 mg/m2 IV once on day 1
+
*[[Cyclophosphamide (Cytoxan)]] 750 mg/m<sup>2</sup> IV once on day 1
−
*[[Doxorubicin (Adriamycin)]] 50 mg/m2 IV once on day 1
+
*[[Doxorubicin (Adriamycin)]] 50 mg/m<sup>2</sup> IV once on day 1
−
*[[Vincristine (Oncovin)]] 1.4 mg/m2 (maximum dose of 2 mg per cycle) IV once on day 1
+
*[[Vincristine (Oncovin)]] 1.4 mg/m<sup>2</sup> (maximum dose of 2 mg 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
  
Line 265: Line 267:
 
*[[Filgrastim (Neupogen)|G-CSF]] "according to the [http://jco.ascopubs.org/content/18/20/3558.full American Society of Clinical Oncology guidelines]"
 
*[[Filgrastim (Neupogen)|G-CSF]] "according to the [http://jco.ascopubs.org/content/18/20/3558.full American Society of Clinical Oncology guidelines]"
  
−
'''21-day cycle x up to 8 cycles'''
+
'''21-day cycle for up to 8 cycles'''
  
 
===References===
 
===References===
Line 301: Line 303:
 
|-
 
|-
 
|}
 
|}
−
 
+
====Chemotherapy====
−
*[[Rituximab (Rituxan)]] 375 mg/m2 IV once on day 1
+
*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once on day 1
−
*[[Cyclophosphamide (Cytoxan)]] 750 mg/m2 or 1000 mg/m2 IV once on day 1
+
*[[Cyclophosphamide (Cytoxan)]] 750 mg/m<sup>2</sup> or 1000 mg/m<sup>2</sup> IV once on day 1
−
*[[Vincristine (Oncovin)]] 1.4 mg/m2 (maximum dose of 2 mg per cycle) IV once on day 1
+
*[[Vincristine (Oncovin)]] 1.4 mg/m<sup>2</sup> (maximum dose of 2 mg 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
  
Line 311: Line 313:
 
*[[Filgrastim (Neupogen)|G-CSF]] "according to the [http://jco.ascopubs.org/content/18/20/3558.full American Society of Clinical Oncology guidelines]"
 
*[[Filgrastim (Neupogen)|G-CSF]] "according to the [http://jco.ascopubs.org/content/18/20/3558.full American Society of Clinical Oncology guidelines]"
  
−
'''21-day cycle x up to 8 cycles'''
+
'''21-day cycle for up to 8 cycles'''
  
 
===References===
 
===References===
Line 367: Line 369:
 
|}
 
|}
 
====Chemotherapy====
 
====Chemotherapy====
−
*[[Rituximab (Rituxan)]] 375 mg/m2 IV once per week; initial infusion rate of 50 mg/H, then increased as tolerated by 50 mg/H every 30 minutes, to a maximum rate of 300 mg/H
+
*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once per week; initial infusion rate of 50 mg/H, then increased as tolerated by 50 mg/H every 30 minutes, to a maximum rate of 300 mg/H
  
 
====Supportive medications====
 
====Supportive medications====
−
*[[Acetaminophen (Tylenol)]] 650 mg PO 30 minutes prior to each dose of [[Rituximab (Rituxan)]]
+
*[[Acetaminophen (Tylenol)]] 650 mg PO 30 minutes prior to each dose
−
*[[Diphenhydramine (Benadryl)]] 50 mg PO 30 minutes prior to each dose of [[Rituximab (Rituxan)]]
+
*[[Diphenhydramine (Benadryl)]] 50 mg PO 30 minutes prior to each dose
  
 
'''4-week course'''
 
'''4-week course'''
Line 408: Line 410:
 
|-
 
|-
 
|}
 
|}
−
 
+
====Chemotherapy====
−
*[[Bortezomib (Velcade)]] 1.5 mg/m2 IV bolus once per day on days 1, 4, 8, 11
+
*[[Bortezomib (Velcade)]] 1.5 mg/m<sup>2</sup> IV bolus once per day on days 1, 4, 8, 11
  
 
====Supportive medications====
 
====Supportive medications====
Line 415: Line 417:
 
*500 mL NS after [[Bortezomib (Velcade)]]
 
*500 mL NS after [[Bortezomib (Velcade)]]
  
−
'''21-day cycles x up to 8 cycles'''
+
'''21-day cycle for up to 8 cycles'''
  
 
===References===
 
===References===
Line 425: Line 427:
 
|[[#toc|back to top]]
 
|[[#toc|back to top]]
 
|}
 
|}
−
 
+
===Regimen {{#subobject:501943|Variant=1}}===
 
{| border="1" style="text-align:center;" !align="left"  
 
{| border="1" style="text-align:center;" !align="left"  
 
|'''Study'''
 
|'''Study'''
Line 439: Line 441:
 
|-
 
|-
 
|}
 
|}
−
 
+
====Chemotherapy====
−
===Regimen {{#subobject:501943|Variant=1}}===
 
 
*[[Cladribine (Leustatin)]] 0.12 mg/kg IV over 2 hours once on days 1 to 5
 
*[[Cladribine (Leustatin)]] 0.12 mg/kg IV over 2 hours once on days 1 to 5
  
Line 449: Line 450:
 
*Not described
 
*Not described
  
−
'''28-day cycles x 4 to 6 cycles'''
+
'''28-day cycle for 4 to 6 cycles'''
  
 
===References===
 
===References===
Line 460: Line 461:
 
|}
 
|}
  
 +
===Regimen {{#subobject:bd61ae|Variant=1}}===
 
{| border="1" style="text-align:center;" !align="left"  
 
{| border="1" style="text-align:center;" !align="left"  
 
|'''Study'''
 
|'''Study'''
Line 473: Line 475:
 
|-
 
|-
 
|}
 
|}
−
 
+
====Chemotherapy====
−
===Regimen {{#subobject:bd61ae|Variant=1}}===
 
 
*[[Cladribine (Leustatin)]] 0.1 mg/kg SC once per day on days 1 to 4
 
*[[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
+
*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once on day 1
  
 
====Supportive medications====
 
====Supportive medications====
Line 483: Line 484:
 
*Either [[Ondansetron (Zofran)]] or [[Tropisetron (Navoban)]] IV immediately before [[Cladribine (Leustatin)]]
 
*Either [[Ondansetron (Zofran)]] or [[Tropisetron (Navoban)]] IV immediately before [[Cladribine (Leustatin)]]
  
−
'''21-day cycles up to 6 cycles'''
+
'''21-day cycle for up to 6 cycles'''
  
 
===References===
 
===References===
Line 517: Line 518:
 
|}
 
|}
 
''This treatment was intended for patients with ocular adnexal marginal zone lymphoma (OAMZL), given the association with Chlamydia psittaci.''
 
''This treatment was intended for patients with ocular adnexal marginal zone lymphoma (OAMZL), given the association with Chlamydia psittaci.''
 +
====Antibiotic therapy====
 
*[[Doxycycline]] 100 mg PO BID
 
*[[Doxycycline]] 100 mg PO BID
  
Line 532: Line 534:
  
 
===Regimen {{#subobject:8551bb|Variant=1}}===
 
===Regimen {{#subobject:8551bb|Variant=1}}===
−
 
 
{| border="1" style="text-align:center;" !align="left"  
 
{| border="1" style="text-align:center;" !align="left"  
 
|'''Study'''
 
|'''Study'''
Line 546: Line 547:
 
|-
 
|-
 
|}
 
|}
−
 
+
====Chemotherapy====
−
*[[Fludarabine (Fludara)]] 25 mg/m2 IV (or 40 mg/m2 PO) once per day on days 1 to 5
+
*[[Fludarabine (Fludara)]] 25 mg/m<sup>2</sup> IV (or 40 mg/m<sup>2</sup> PO) once per day on days 1 to 5
 
**Patients with gastric lymphoma received the cycle 1 dose intravenously to guarantee drug absorption
 
**Patients with gastric lymphoma received the cycle 1 dose intravenously to guarantee drug absorption
−
*[[Rituximab (Rituxan)]] 375 mg/m2 IV once on day 1
+
*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once on day 1
  
 
Dose reductions:
 
Dose reductions:
Line 570: Line 571:
  
 
===Regimen {{#subobject:619265|Variant=1}}===
 
===Regimen {{#subobject:619265|Variant=1}}===
−
 
 
{| border="1" style="text-align:center;" !align="left"  
 
{| border="1" style="text-align:center;" !align="left"  
 
|'''Study'''
 
|'''Study'''
Line 592: Line 592:
 
|-
 
|-
 
|}
 
|}
−
 
+
====Chemotherapy====
−
*[[Rituximab (Rituxan)]] 250 mg/m2 IV once on day 1, then another single dose on day 8
+
*[[Rituximab (Rituxan)]] 250 mg/m<sup>2</sup> IV once on day 1, then another single dose on day 8
 
*[[Ibritumomab tiuxetan (Zevalin)|Ibritumomab tiuxetan & Yttrium-90 (Zevalin) ]] 14.8 MBq/kg (maximum dose of 1184 MBq) IV once on day 8, given after [[Rituximab (Rituxan)]]
 
*[[Ibritumomab tiuxetan (Zevalin)|Ibritumomab tiuxetan & Yttrium-90 (Zevalin) ]] 14.8 MBq/kg (maximum dose of 1184 MBq) IV once on day 8, given after [[Rituximab (Rituxan)]]
  
Line 626: Line 626:
 
|-
 
|-
 
|}
 
|}
−
 
+
====Chemotherapy====
 
*[[Lenalidomide (Revlimid)]] 25 mg PO once per day on days 1 to 21
 
*[[Lenalidomide (Revlimid)]] 25 mg PO once per day on days 1 to 21
  
Line 632: Line 632:
 
*[[Aspirin]] 100 mg PO once per day
 
*[[Aspirin]] 100 mg PO once per day
  
−
'''28-day cycle x up to 6 cycles'''
+
'''28-day cycle for up to 6 cycles'''
  
 
===References===
 
===References===
Line 658: Line 658:
 
|-
 
|-
 
|}
 
|}
−
 
+
====Chemotherapy====
 
*[[Lenalidomide (Revlimid)]] 20 mg PO once per day on days 1 to 21
 
*[[Lenalidomide (Revlimid)]] 20 mg PO once per day on days 1 to 21
−
*[[Rituximab (Rituxan)]] 375 mg/m2 IV once on day 1
+
*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once on day 1
  
 
'''28-day cycles up to 12 cycles'''
 
'''28-day cycles up to 12 cycles'''
Line 678: Line 678:
  
 
===Regimen {{#subobject:2421bc|Variant=1}}===
 
===Regimen {{#subobject:2421bc|Variant=1}}===
−
 
 
{| border="1" style="text-align:center;" !align="left"  
 
{| border="1" style="text-align:center;" !align="left"  
 
|'''Study'''
 
|'''Study'''
Line 692: Line 691:
 
|-
 
|-
 
|}
 
|}
 +
====Chemotherapy====
 +
*[[Mitoxantrone (Novantrone)]] 8 mg/m<sup>2</sup> IV once per day on days 1 & 2
 +
*[[Chlorambucil (Leukeran)]] 3 mg/m<sup>2</sup> 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/m<sup>2</sup> PO/IV once per day on days 1 to 5
  
−
*[[Mitoxantrone (Novantrone)]] 8 mg/m2 IV once per day on days 1 & 2
+
'''28-day cycle for up to 8 cycles'''
−
*[[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 per day on days 1 to 5
 
−
 
 
−
'''28-day cycles x up to 8 cycles'''
 
  
 
===References===
 
===References===
Line 723: Line 722:
 
|-
 
|-
 
|}
 
|}
−
 
+
====Chemotherapy====
−
*[[Pentostatin (Nipent)]] 4 mg/m2 IV once on day 1
+
*[[Pentostatin (Nipent)]] 4 mg/m<sup>2</sup> IV once on day 1
−
*[[Cyclophosphamide (Cytoxan)]] 600 mg/m2 IV once on day 1
+
*[[Cyclophosphamide (Cytoxan)]] 600 mg/m<sup>2</sup> IV once on day 1
−
*[[Rituximab (Rituxan)]] 375 mg/m2 IV once on day 1
+
*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once on day 1
  
 
====Supportive medications====
 
====Supportive medications====
Line 737: Line 736:
 
*[[Acyclovir (Zovirax)]] 400 mg PO BID during and for 1 month following therapy
 
*[[Acyclovir (Zovirax)]] 400 mg PO BID during and for 1 month following therapy
  
−
'''21-day cycle x 6 cycles'''
+
'''21-day cycle for 6 cycles'''
  
 
===References===
 
===References===
Line 765: Line 764:
 
|}
 
|}
 
''Treatment preceded by [[#Chlorambucil_.28Leukeran.29|chlorambucil induction]].''
 
''Treatment preceded by [[#Chlorambucil_.28Leukeran.29|chlorambucil induction]].''
 +
====Chemotherapy====
 +
*[[Chlorambucil (Leukeran)]] 6 mg/m<sup>2</sup> PO once per day on days 1 to 14
  
−
*[[Chlorambucil (Leukeran)]] 6 mg/m2 PO once per day on days 1 to 14
+
'''28-day cycle for up to 4 cycles'''
−
 
 
−
'''28-day cycle x up to 4 cycles'''
 
  
 
===References===
 
===References===
Line 794: Line 793:
 
|}
 
|}
 
''Treatment preceded by [[#Chlorambucil_.26_Rituximab|chlorambucil & rituximab induction]].''
 
''Treatment preceded by [[#Chlorambucil_.26_Rituximab|chlorambucil & rituximab induction]].''
 +
====Chemotherapy====
 +
*[[Chlorambucil (Leukeran)]] 6 mg/m<sup>2</sup> PO once per day on days 1 to 14
 +
*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once on day 1
  
−
*[[Chlorambucil (Leukeran)]] 6 mg/m2 PO once per day on days 1 to 14
+
'''28-day cycle for up to 4 cycles'''
−
*[[Rituximab (Rituxan)]] 375 mg/m2 IV once on day 1
 
−
 
 
−
'''28-day cycle x up to 4 cycles'''
 
  
 
===References===
 
===References===
Line 834: Line 833:
  
 
''Treatment preceded by [[#Rituximab_.28Rituxan.29|rituximab]].''
 
''Treatment preceded by [[#Rituximab_.28Rituxan.29|rituximab]].''
−
 
+
====Chemotherapy====
−
*[[Rituximab (Rituxan)]] 375 mg/m2 IV once every 13 weeks
+
*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once every 13 weeks
  
 
'''Continued until treatment failure'''
 
'''Continued until treatment failure'''
Line 867: Line 866:
 
====Chemotherapy====
 
====Chemotherapy====
 
''Note: these infusion instructions are for the Treanda formulation, which was discontinued on 3/31/2016.''
 
''Note: these infusion instructions are for the Treanda formulation, which was discontinued on 3/31/2016.''
−
*[[Bendamustine]] 120 mg/m2 IV over 60 to 120 minutes once on days 1 & 2
+
*[[Bendamustine]] 120 mg/m<sup>2</sup> IV over 60 to 120 minutes once on days 1 & 2
  
−
'''21-day cycle x 6 to 8 cycles'''
+
'''21-day cycle for 6 to 8 cycles'''
  
 
===References===
 
===References===
Line 895: Line 894:
 
|-
 
|-
 
|}
 
|}
−
 
+
====Chemotherapy====
−
*[[Bortezomib (Velcade)]] 1.3 mg/m2 IV once per day on days 1, 4, 8, 11
+
*[[Bortezomib (Velcade)]] 1.3 mg/m<sup>2</sup> IV once per day on days 1, 4, 8, 11
  
 
====Supportive medications====
 
====Supportive medications====
 
*No routine growth factors, antibiotic, or antiviral prophylaxis was given
 
*No routine growth factors, antibiotic, or antiviral prophylaxis was given
  
−
'''21-day cycles x up to 6 cycles'''
+
'''21-day cycle for up to 6 cycles'''
  
 
===Regimen #2 {{#subobject:fd9bf5|Variant=1}}===
 
===Regimen #2 {{#subobject:fd9bf5|Variant=1}}===
Line 918: Line 917:
 
|}
 
|}
  
−
*[[Bortezomib (Velcade)]] 1.5 mg/m2 IV bolus once per day on days 1, 4, 8, 11
+
*[[Bortezomib (Velcade)]] 1.5 mg/m<sup>2</sup> IV bolus once per day on days 1, 4, 8, 11
  
 
====Supportive medications====
 
====Supportive medications====
Line 924: Line 923:
 
*500 mL NS after [[Bortezomib (Velcade)]]
 
*500 mL NS after [[Bortezomib (Velcade)]]
  
−
'''21-day cycles x up to 8 cycles'''
+
'''21-day cycle for up to 8 cycles'''
  
 
===References===
 
===References===
Line 954: Line 953:
 
''Note: the bendamustine infusion instructions are for the Treanda formulation, which was discontinued on 3/31/2016.''
 
''Note: the bendamustine infusion instructions are for the Treanda formulation, which was discontinued on 3/31/2016.''
 
*[[Rituximab (Rituxan)]] as follows:
 
*[[Rituximab (Rituxan)]] as follows:
−
**One week prior to start of cycle 1: 375 mg/m2 IV once
+
**One week prior to start of cycle 1: 375 mg/m<sup>2</sup> IV once
−
**Cycles 1 to 4: 375 mg/m2 IV once on day 1
+
**Cycles 1 to 4: 375 mg/m<sup>2</sup> IV once on day 1
−
**4 weeks after cycle 4: 375 mg/m2 IV once
+
**4 weeks after cycle 4: 375 mg/m<sup>2</sup> IV once
−
*[[Bendamustine]] 90 mg/m2 IV over 30 minutes once per day on days 2 & 3
+
*[[Bendamustine]] 90 mg/m<sup>2</sup> IV over 30 minutes once per day on days 2 & 3
  
−
'''28-day cycle x 4 cycles'''
+
'''28-day cycle for 4 cycles'''
  
 
===References===
 
===References===
Line 984: Line 983:
 
|-
 
|-
 
|}
 
|}
−
 
+
====Chemotherapy====
 
*[[Cladribine (Leustatin)]] 0.1 mg/kg SC once per day on days 1 to 4
 
*[[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
+
*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once on day 1
  
 
====Supportive medications====
 
====Supportive medications====
Line 993: Line 992:
 
*Either [[Ondansetron (Zofran)]] or [[Tropisetron (Navoban)]] IV immediately before [[Cladribine (Leustatin)]]
 
*Either [[Ondansetron (Zofran)]] or [[Tropisetron (Navoban)]] IV immediately before [[Cladribine (Leustatin)]]
  
−
'''21-day cycles up to 6 cycles'''
+
'''21-day cycle for up to 6 cycles'''
  
 
===References===
 
===References===
Line 1,018: Line 1,017:
 
|-
 
|-
 
|}
 
|}
−
 
+
====Antibiotic therapy====
 
*[[Clarithromycin (Biaxin)]] 2 g PO once per day on days 1 to 14
 
*[[Clarithromycin (Biaxin)]] 2 g PO once per day on days 1 to 14
  
−
'''21-day cycle x 4 cycles'''
+
'''21-day cycle for 4 cycles'''
  
 
===References===
 
===References===
Line 1,047: Line 1,046:
 
|}
 
|}
 
''This treatment was intended for patients with ocular adnexal marginal zone lymphoma (OAMZL), given the association with Chlamydia psittaci.''
 
''This treatment was intended for patients with ocular adnexal marginal zone lymphoma (OAMZL), given the association with Chlamydia psittaci.''
 +
====Antibiotic therapy====
 
*[[Doxycycline]] 100 mg PO BID
 
*[[Doxycycline]] 100 mg PO BID
  
Line 1,075: Line 1,075:
 
|-
 
|-
 
|}
 
|}
−
 
+
====Chemotherapy====
 
*[[Idelalisib (Zydelig)]] 150 mg PO BID
 
*[[Idelalisib (Zydelig)]] 150 mg PO BID
  
Line 1,104: Line 1,104:
 
|-
 
|-
 
|}
 
|}
−
 
+
====Chemotherapy====
 
*[[Lenalidomide (Revlimid)]] 25 mg PO once per day on days 1 to 21
 
*[[Lenalidomide (Revlimid)]] 25 mg PO once per day on days 1 to 21
  
Line 1,110: Line 1,110:
 
*[[Aspirin]] 100 mg PO once per day
 
*[[Aspirin]] 100 mg PO once per day
  
−
'''28-day cycle x up to 6 cycles'''
+
'''28-day cycle for up to 6 cycles'''
  
 
===References===
 
===References===
Line 1,166: Line 1,166:
  
 
''Treatment in '''RESORT''' was preceded by [[#Rituximab_.28Rituxan.29|rituximab]] and is given at time of progression.''
 
''Treatment in '''RESORT''' was preceded by [[#Rituximab_.28Rituxan.29|rituximab]] and is given at time of progression.''
−
 
+
====Chemotherapy====
−
*[[Rituximab (Rituxan)]] 375 mg/m2 IV once per day on days 1, 8, 15, 22
+
*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once per day on days 1, 8, 15, 22
  
 
'''One course'''
 
'''One course'''
Line 1,197: Line 1,197:
 
|-
 
|-
 
|}
 
|}
−
 
+
====Chemotherapy====
 
*[[Vorinostat (Zolinza)]] 200 mg PO BID on days 1 to 14
 
*[[Vorinostat (Zolinza)]] 200 mg PO BID on days 1 to 14
  

Revision as of 00:57, 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.

21 regimens on this page
22 variants on this page


Untreated, randomized data

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.

BR

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BR: Bendamustine, Rituximab

Regimen

Study Evidence Comparator Efficacy
Flinn et al. 2014 (BRIGHT) Phase III R-CHOP
R-CVP 		Equivalent RR

Chemotherapy

Note: the bendamustine infusion instructions are for the Treanda formulation, which was discontinued on 3/31/2016.

Supportive medications

  • Antiemetics, antipyretics, and antibiotics according to local standard of care
  • Prophylactic use of G-CSF allowed according ASCO guidelines (2006)

28-day cycle for up to 8 cycles

References

  1. Flinn IW, van der Jagt R, Kahl BS, Wood P, Hawkins TE, Macdonald D, Hertzberg M, Kwan YL, Simpson D, Craig M, Kolibaba K, Issa S, Clementi R, Hallman DM, Munteanu M, Chen L, Burke JM. Randomized trial of bendamustine-rituximab or R-CHOP/R-CVP in first-line treatment of indolent NHL or MCL: the BRIGHT study. Blood. 2014 May 8;123(19):2944-52. Epub 2014 Mar 3. link to original article contains verified protocol PubMed

Chlorambucil (Leukeran)

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Regimen #1

Study Evidence Comparator Efficacy
Leblond et al. 2012 (WM1) Phase III Fludarabine Decreased PFS

Chemotherapy

Supportive medications

28-day cycle for up to 12 cycles

Regimen #2

Study Evidence Comparator Efficacy
Zucca et al. 2013 (IELSG-19) Phase III Chlorambucil & Rituximab
Rituximab 		Inferior EFS

Chemotherapy

One course

Patients with stable disease or better proceeded to chlorambucil consolidation.

References

  1. 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
  2. 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
    1. Abstract: Update: E. Zucca, A. Conconi, G. Martinelli, A. Tucci, U. Vitolo, E. Russo, B. Coiffier, H. Ghesquieres, F. Morschhauser, R. Pettengell, G. Pinotti, L. Devizzi, R. Bouabdallah, C. Copie-Bergman, S. Pileri, A. Jack, E. Campo, A. Lopez-Guillermo, P. W. Johnson, C. Thieblemont. CHLORAMBUCIL PLUS RITUXIMAB PRODUCES BETTER EVENTFREE AND PROGRESSION-FREE SURVIVAL IN COMPARISON WITH CHLORAMBUCIL OR RITUXIMAB ALONE IN EXTRANODAL MARGINAL ZONE B-CELL LYMPHOMA (MALT LYMPHOMA): FINAL RESULTS OF THE IELSG-19 STUDY. XII INTERNATIONAL CONFERENCE ON MALIGNANT LYMPHOMA Abstract 007 (2013). link to abstract

Chlorambucil & Rituximab

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Regimen

Study Evidence Comparator Efficacy
Zucca et al. 2013 (IELSG-19) Phase III Chlorambucil
Rituximab 		Superior EFS

Chemotherapy

One course

Patients with stable disease or better proceeded to chlorambucil & rituximab consolidation.

References

  1. 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
  2. Abstract: E. Zucca, A. Conconi, G. Martinelli, A. Tucci, U. Vitolo, E. Russo, B. Coiffier, H. Ghesquieres, F. Morschhauser, R. Pettengell, G. Pinotti, L. Devizzi, R. Bouabdallah, C. Copie-Bergman, S. Pileri, A. Jack, E. Campo, A. Lopez-Guillermo, P. W. Johnson, C. Thieblemont. CHLORAMBUCIL PLUS RITUXIMAB PRODUCES BETTER EVENTFREE AND PROGRESSION-FREE SURVIVAL IN COMPARISON WITH CHLORAMBUCIL OR RITUXIMAB ALONE IN EXTRANODAL MARGINAL ZONE B-CELL LYMPHOMA (MALT LYMPHOMA): FINAL RESULTS OF THE IELSG-19 STUDY. XII INTERNATIONAL CONFERENCE ON MALIGNANT LYMPHOMA Abstract 007 (2013). link to abstract

Fludarabine (Fludara)

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Regimen

Study Evidence Comparator Efficacy
Leblond et al. 2012 (WM1) Phase III Chlorambucil Increased PFS

Chemotherapy

  • Fludarabine (Fludara) 40 mg/m2 (30 mg/m2 per day if older than 75 years old) PO once per day on days 1 to 5

Supportive medications

28-day cycle for up to 6 cycles

References

  1. 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

R-CHOP

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R-CHOP: Rituximab, Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Oncovin (Vincristine), Prednisone

Synonyms: R-CHOP-21, CHOP-R

Structured Concept: C9760 (NCI-T), C0393023 (NCI-MT/UMLS)

Example orders

Regimen

Study Evidence Comparator Efficacy
Flinn et al. 2014 (BRIGHT) Phase III, <20 in this arm BR
R-CVP 		Equivalent RR

Chemotherapy

Supportive medications

21-day cycle for up to 8 cycles

References

  1. Flinn IW, van der Jagt R, Kahl BS, Wood P, Hawkins TE, Macdonald D, Hertzberg M, Kwan YL, Simpson D, Craig M, Kolibaba K, Issa S, Clementi R, Hallman DM, Munteanu M, Chen L, Burke JM. Randomized trial of bendamustine-rituximab or R-CHOP/R-CVP in first-line treatment of indolent NHL or MCL: the BRIGHT study. Blood. 2014 May 8;123(19):2944-52. Epub 2014 Mar 3. link to original article contains verified protocol PubMed

R-CVP

back to top

R-CVP: Rituximab, Cyclophosphamide, Vincristine, Prednisone

Regimen

Study Evidence Comparator Efficacy
Flinn et al. 2014 (BRIGHT) Phase III, <20 in this arm BR
R-CHOP 		Equivalent RR

Chemotherapy

Supportive medications

21-day cycle for up to 8 cycles

References

  1. Flinn IW, van der Jagt R, Kahl BS, Wood P, Hawkins TE, Macdonald D, Hertzberg M, Kwan YL, Simpson D, Craig M, Kolibaba K, Issa S, Clementi R, Hallman DM, Munteanu M, Chen L, Burke JM. Randomized trial of bendamustine-rituximab or R-CHOP/R-CVP in first-line treatment of indolent NHL or MCL: the BRIGHT study. Blood. 2014 May 8;123(19):2944-52. Epub 2014 Mar 3. link to original article contains verified protocol PubMed

Rituximab (Rituxan)

back to top

Regimen

Study Evidence Comparator
Conconi et al. 2003 (IELSG 6) Phase II
Martinelli et al. 2005 Phase II
Zucca et al. 2013 (IELSG-19) Phase III Chlorambucil
Chlorambucil & Rituximab
Williams et al. 2016 (RESORT) Non-randomized

Chemotherapy

  • Rituximab (Rituxan) 375 mg/m2 IV once per week; initial infusion rate of 50 mg/H, then increased as tolerated by 50 mg/H every 30 minutes, to a maximum rate of 300 mg/H

Supportive medications

4-week course

Patients with PR/CR in RESORT were randomized to indefinite rituximab versus salvage rituximab at time of progression.

References

  1. 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 verified protocol PubMed content property of HemOnc.org
  2. 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 verified protocol PubMed
  3. Abstract: E. Zucca, A. Conconi, G. Martinelli, A. Tucci, U. Vitolo, E. Russo, B. Coiffier, H. Ghesquieres, F. Morschhauser, R. Pettengell, G. Pinotti, L. Devizzi, R. Bouabdallah, C. Copie-Bergman, S. Pileri, A. Jack, E. Campo, A. Lopez-Guillermo, P. W. Johnson, C. Thieblemont. CHLORAMBUCIL PLUS RITUXIMAB PRODUCES BETTER EVENTFREE AND PROGRESSION-FREE SURVIVAL IN COMPARISON WITH CHLORAMBUCIL OR RITUXIMAB ALONE IN EXTRANODAL MARGINAL ZONE B-CELL LYMPHOMA (MALT LYMPHOMA): FINAL RESULTS OF THE IELSG-19 STUDY. XII INTERNATIONAL CONFERENCE ON MALIGNANT LYMPHOMA Abstract 007 (2013). link to abstract
  4. Williams ME, Hong F, Gascoyne RD, Wagner LI, Krauss JC, Habermann TM, Swinnen LJ, Schuster SJ, Peterson CG, Sborov MD, Martin SE, Weiss M, Ehmann WC, Horning SJ, Kahl BS. Rituximab extended schedule or retreatment trial for low tumour burden non-follicular indolent B-cell non-Hodgkin lymphomas: Eastern Cooperative Oncology Group Protocol E4402. Br J Haematol. 2016 Jun;173(6):867-75. Epub 2016 Mar 11. link to original article contains protocol PubMed

Untreated, non-randomized or retrospective data

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)

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Regimen

Study Evidence
Troch et al. 2009 Phase II

Chemotherapy

Supportive medications

21-day cycle for up to 8 cycles

References

  1. 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

Cladribine (Leustatin)

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Regimen

Study Evidence
Jäger et al. 2002 Phase II

Chemotherapy

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 cycle for 4 to 6 cycles

References

  1. 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

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Regimen

Study Evidence
Troch et al. 2012 Phase II

Chemotherapy

Supportive medications

21-day cycle for up to 6 cycles

References

  1. 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

Doxycycline

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Regimen

Study Evidence
Ferreri et al. 2006 Phase II, <20 patients in this subgroup
Ferreri et al. 2012 Phase II

This treatment was intended for patients with ocular adnexal marginal zone lymphoma (OAMZL), given the association with Chlamydia psittaci.

Antibiotic therapy

3-week course

References

  1. Ferreri AJ, Ponzoni M, Guidoboni M, Resti AG, Politi LS, Cortelazzo S, Demeter J, Zallio F, Palmas A, Muti G, Dognini GP, Pasini E, Lettini AA, Sacchetti F, De Conciliis C, Doglioni C, Dolcetti R. Bacteria-eradicating therapy with doxycycline in ocular adnexal MALT lymphoma: a multicenter prospective trial. J Natl Cancer Inst. 2006 Oct 4;98(19):1375-82. link to original article contains verified protocol PubMed
  2. Ferreri AJ, Govi S, Pasini E, Mappa S, Bertoni F, Zaja F, Montalbán C, Stelitano C, Cabrera ME, Giordano Resti A, Politi LS, Doglioni C, Cavalli F, Zucca E, Ponzoni M, Dolcetti R. Chlamydophila psittaci eradication with doxycycline as first-line targeted therapy for ocular adnexae lymphoma: final results of an international phase II trial. J Clin Oncol. 2012 Aug 20;30(24):2988-94. Epub 2012 Jul 16. Erratum in: J Clin Oncol. 2012 Nov 1;30(31):3903. link to original article contains verified protocol PubMed

Fludarabine & Rituximab

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Regimen

Study Evidence
Salar et al. 2009 Phase II

Chemotherapy

  • Fludarabine (Fludara) 25 mg/m2 IV (or 40 mg/m2 PO) once per day 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 per day on days 1 to 3

Supportive medications

28-day cycles for 4-6 cycles

References

  1. 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

Ibritumomab tiuxetan (Zevalin)

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Regimen

Study Evidence
Samaniego et al. 2014 Phase II, <20 patients reported
Lossos et al. 2014 Phase II, <20 patients reported

Chemotherapy

Dose reductions:

One course of therapy

References

  1. Samaniego F, Berkova Z, Romaguera JE, Fowler N, Fanale MA, Pro B, Shah JJ, McLaughlin P, Sehgal L, Selvaraj V, Braun FK, Mathur R, Feng L, Neelapu SS, Kwak LW. 90Y-ibritumomab tiuxetan radiotherapy as first-line therapy for early stage low-grade B-cell lymphomas, including bulky disease. Br J Haematol. 2014 Oct;167(2):207-13. Epub 2014 Jul 8. link to original article contains verified protocol PubMed
  2. Lossos IS, Fabregas JC, Koru-Sengul T, Miao F, Goodman D, Serafini AN, Hosein PJ, Stefanovic A, Rosenblatt JD, Hoffman JE. Phase II study of (90)Y Ibritumomab tiuxetan (Zevalin) in patients with previously untreated marginal zone lymphoma. Leuk Lymphoma. 2015 Jun;56(6):1750-5. Epub 2014 Nov 20. link to original article PubMed

Lenalidomide (Revlimid)

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Regimen

Study Evidence
Kiesewetter et al. 2012 Phase II, <20 patients reported

Chemotherapy

Supportive medications

28-day cycle for up to 6 cycles

References

  1. 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. Epub 2012 Aug 16. link to orginal article contains verified protocol PubMed

Lenalidomide & Rituximab

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Regimen

Study Evidence
Fowler et al. 2014 Phase II

Chemotherapy

28-day cycles up to 12 cycles

References

  1. Fowler NH, Davis RE, Rawal S, Nastoupil L, Hagemeister FB, McLaughlin P, Kwak LW, Romaguera JE, Fanale MA, Fayad LE, Westin JR, Shah J, Orlowski RZ, Wang M, Turturro F, Oki Y, Claret LC, Feng L, Baladandayuthapani V, Muzzafar T, Tsai KY, Samaniego F, Neelapu SS. Safety and activity of lenalidomide and rituximab in untreated indolent lymphoma: an open-label, phase 2 trial. Lancet Oncol. 2014 Nov;15(12):1311-8. Epub 2014 Oct 15. link to original article contains protocol PubMed

MCP

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MCP: Mitoxantrone, Chlorambucil, Prednisolone

Regimen

Study Evidence
Wöhrer et al. 2003 Retrospective

Chemotherapy

28-day cycle for up to 8 cycles

References

  1. Retrospective: 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

PCR

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PCR: Pentostatin, Cyclophosphamide, Rituximab

Regimen

Study Evidence
Samaniego et al. 2015 Phase II, <20 patients in this subgroup

Chemotherapy

Supportive medications

21-day cycle for 6 cycles

References

  1. Samaniego F, Hagemeister F, Romaguera JE, Fanale MA, Pro B, McLaughlin P, Rodriguez MA, Neelapu SS, Fayad L, Younes A, Feng L, Berkova Z, Khashab T, Sehgal L, Vega-Vasquez F, Kwak LW. Pentostatin, cyclophosphamide and rituximab for previously untreated advanced stage, low-grade B-cell lymphomas. Br J Haematol. 2015 Jun;169(6):814-23. Epub 2015 Mar 31. link to original article contains verified protocol PubMed

Consolidation after upfront therapy

Chlorambucil (Leukeran)

back to top

Regimen

Study Evidence
Zucca et al. 2013 (IELSG-19) Non-randomized

Treatment preceded by chlorambucil induction.

Chemotherapy

28-day cycle for up to 4 cycles

References

  1. 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

back to top

Regimen

Study Evidence
Zucca et al. 2013 (IELSG-19) Non-randomized

Treatment preceded by chlorambucil & rituximab induction.

Chemotherapy

28-day cycle for up to 4 cycles

References

  1. 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

Rituximab (Rituxan)

back to top

Regimen

Study Evidence Comparator Efficacy
Williams et al. 2016 (RESORT) Phase III Salvage rituximab Seems to have superior TTTF

Treatment preceded by rituximab.

Chemotherapy

Continued until treatment failure

References

  1. Williams ME, Hong F, Gascoyne RD, Wagner LI, Krauss JC, Habermann TM, Swinnen LJ, Schuster SJ, Peterson CG, Sborov MD, Martin SE, Weiss M, Ehmann WC, Horning SJ, Kahl BS. Rituximab extended schedule or retreatment trial for low tumour burden non-follicular indolent B-cell non-Hodgkin lymphomas: Eastern Cooperative Oncology Group Protocol E4402. Br J Haematol. 2016 Jun;173(6):867-75. Epub 2016 Mar 11. link to original article contains protocol PubMed

Relapsed/refractory, non-randomized or retrospective data

Bendamustine

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Regimen

Study Evidence
Kahl et al. 2010 Phase II, <20 patients reported

Chemotherapy

Note: these infusion instructions are for the Treanda formulation, which was discontinued on 3/31/2016.

  • Bendamustine 120 mg/m2 IV over 60 to 120 minutes once on days 1 & 2

21-day cycle for 6 to 8 cycles

References

  1. Kahl BS, Bartlett NL, Leonard JP, Chen L, Ganjoo K, Williams ME, Czuczman MS, Robinson KS, Joyce R, van der Jagt RH, Cheson BD. Bendamustine is effective therapy in patients with rituximab-refractory, indolent B-cell non-Hodgkin lymphoma: results from a Multicenter Study. Cancer. 2010 Jan 1;116(1):106-14. link to original article contains verified protocol PubMed

Bortezomib (Velcade)

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Regimen #1

Study Evidence
Conconi et al. 2011 Phase II

Chemotherapy

Supportive medications

  • No routine growth factors, antibiotic, or antiviral prophylaxis was given

21-day cycle for up to 6 cycles

Regimen #2

Study Evidence
Troch et al. 2009 Phase II

Supportive medications

21-day cycle for up to 8 cycles

References

  1. 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
  2. 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

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BR: Bendamustine, Rituximab

Regimen

Study Evidence
Rummel et al. 2005 Phase II, <20 patients in this subgroup

Chemotherapy

Note: the bendamustine infusion instructions are for the Treanda formulation, which was discontinued on 3/31/2016.

  • Rituximab (Rituxan) as follows:
    • One week prior to start of cycle 1: 375 mg/m2 IV once
    • Cycles 1 to 4: 375 mg/m2 IV once on day 1
    • 4 weeks after cycle 4: 375 mg/m2 IV once
  • Bendamustine 90 mg/m2 IV over 30 minutes once per day on days 2 & 3

28-day cycle for 4 cycles

References

  1. 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 verified protocol PubMed

Cladribine & Rituximab

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Regimen

Study Evidence
Troch et al. 2012 Phase II, <20 patients reported

Chemotherapy

Supportive medications

21-day cycle for up to 6 cycles

References

  1. 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

Clarithromycin (Biaxin)

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Regimen

Study Evidence
Ferreri et al. 2015 (HD-K) Phase II

Antibiotic therapy

21-day cycle for 4 cycles

References

  1. Ferreri AJ, Sassone M, Kiesewetter B, Govi S, Scarfò L, Donadoni G, Raderer M. High-dose clarithromycin is an active monotherapy for patients with relapsed/refractory extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT): the HD-K phase II trial. Ann Oncol. 2015 Aug;26(8):1760-5. Epub 2015 May 1. link to original article contains verified protocol PubMed

Doxycycline

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Regimen

Study Evidence
Ferreri et al. 2006 Phase II, <20 patients in this subgroup

This treatment was intended for patients with ocular adnexal marginal zone lymphoma (OAMZL), given the association with Chlamydia psittaci.

Antibiotic therapy

3-week course

References

  1. Ferreri AJ, Ponzoni M, Guidoboni M, Resti AG, Politi LS, Cortelazzo S, Demeter J, Zallio F, Palmas A, Muti G, Dognini GP, Pasini E, Lettini AA, Sacchetti F, De Conciliis C, Doglioni C, Dolcetti R. Bacteria-eradicating therapy with doxycycline in ocular adnexal MALT lymphoma: a multicenter prospective trial. J Natl Cancer Inst. 2006 Oct 4;98(19):1375-82. link to original article contains verified protocol PubMed

Idelalisib (Zydelig)

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On 3/21/2016 Gilead announced that they were stopping seven clinical trials of idelalisib in patients with CLL, SLL, and iNHL due to excess deaths and increased rates of SAEs. A REMS program has also been announced.

Regimen,

Study Evidence
Gopal et al. 2014 (DELTA) Phase II, <20 patients in this subgroup

Chemotherapy

Continued until progression, death, or unacceptable toxicity

References

  1. Gopal AK, Kahl BS, de Vos S, Wagner-Johnston ND, Schuster SJ, Jurczak WJ, Flinn IW, Flowers CR, Martin P, Viardot A, Blum KA, Goy AH, Davies AJ, Zinzani PL, Dreyling M, Johnson D, Miller LL, Holes L, Li D, Dansey RD, Godfrey WR, Salles GA. PI3Kd Inhibition by Idelalisib in Patients with Relapsed Indolent Lymphoma. N Engl J Med. 2014 Jan 22. link to original article contains verified protocol PubMed
    1. Update: Abstract: Ajay K. Gopal, MD, Brad S. Kahl, MD, Sven de Vos, MD, PhD, Nina D. Wagner-Johnston, MD, Stephen J. Schuster, MD, Wojciech Jurczak, MD, PhD, Ian W. Flinn, MD, PhD, Christopher R. Flowers, MD, Peter Martin, MD, Andreas Viardot, MD, Kristie A. Blum, MD, Andre Goy, MD, Andrew Davies, BM PhD, Pier Luigi Zinzani, MD, Martin H. Dreyling, MD, PhD, Leanne M. Holes, Bess Sorensen, PhD, Wayne R. Godfrey, MD and Gilles Andre Salles, MD, PhD. Mature Follow up from a Phase 2 Study of PI3K-Delta Inhibitor Idelalisib in Patients with Double (Rituximab and Alkylating agent)-Refractory Indolent B-Cell Non-Hodgkin Lymphoma (iNHL). ASH Annual Meeting 2014, Abstract 1708 link to abstract

Lenalidomide (Revlimid)

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Regimen

Study Evidence
Kiesewetter et al. 2012 Phase II, <20 patients reported

Chemotherapy

Supportive medications

28-day cycle for up to 6 cycles

References

  1. 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. Epub 2012 Aug 16. link to orginal article contains verified protocol PubMed

Rituximab (Rituxan)

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Regimen

Study Evidence Comparator Efficacy
Conconi et al. 2003 Phase II
Martinelli et al. 2005 Phase II
Williams et al. 2016 (RESORT) Phase III Maintenance rituximab Seems to have inferior TTTF

Treatment in RESORT was preceded by rituximab and is given at time of progression.

Chemotherapy

One course

References

  1. 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
  2. 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
  3. Williams ME, Hong F, Gascoyne RD, Wagner LI, Krauss JC, Habermann TM, Swinnen LJ, Schuster SJ, Peterson CG, Sborov MD, Martin SE, Weiss M, Ehmann WC, Horning SJ, Kahl BS. Rituximab extended schedule or retreatment trial for low tumour burden non-follicular indolent B-cell non-Hodgkin lymphomas: Eastern Cooperative Oncology Group Protocol E4402. Br J Haematol. 2016 Jun;173(6):867-75. Epub 2016 Mar 11. link to original article contains protocol PubMed

Vorinostat (Zolinza)

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Regimen

Study Evidence
Kirschbaum et al. 2011 Phase II, <20 pts in subgroup

Chemotherapy

21-day cycles until progression or unacceptable toxicity

References

  1. Kirschbaum M, Frankel P, Popplewell L, Zain J, Delioukina M, Pullarkat V, Matsuoka D, Pulone B, Rotter AJ, Espinoza-Delgado I, Nademanee A, Forman SJ, Gandara D, Newman E. Phase II study of vorinostat for treatment of relapsed or refractory indolent non-Hodgkin's lymphoma and mantle cell lymphoma. J Clin Oncol. 2011 Mar 20;29(9):1198-203. Epub 2011 Feb 7. link to original article contains verified protocol PubMed

Response criteria

NCI Sponsored International Working Group Criteria (1999)

  1. Cheson BD, Horning SJ, Coiffier B, Shipp MA, Fisher RI, Connors JM, Lister TA, Vose J, Grillo-López A, Hagenbeek A, Cabanillas F, Klippensten D, Hiddemann W, Castellino R, Harris NL, Armitage JO, Carter W, Hoppe R, Canellos GP. Report of an international workshop to standardize response criteria for non-Hodgkin's lymphomas. NCI Sponsored International Working Group. J Clin Oncol. 1999 Apr;17(4):1244. Review. Erratum in: J Clin Oncol 2000 Jun;18(11):2351. link to original article PubMed
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