Difference between revisions of "Mediastinal gray-zone lymphoma"
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'''Use of this site is subject to you reading and agreeing with the terms set forth in the [[HemOnc.org_-_A_Hematology_Oncology_Wiki:General_disclaimer|disclaimer]].''' | '''Use of this site is subject to you reading and agreeing with the terms set forth in the [[HemOnc.org_-_A_Hematology_Oncology_Wiki:General_disclaimer|disclaimer]].''' | ||
| − | Is there a regimen missing from this list? | + | 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 [[How_to_contribute|invited to contribute to the site]]. |
{| class="wikitable" style="float:right; margin-right: 5px;" | {| class="wikitable" style="float:right; margin-right: 5px;" | ||
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| − | |<div style="background-color: #66FF66; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}" align="right"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]] | + | |<div style="background-color: #66FF66; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}" align="right"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]] |?Regimen |limit=10000|format=sum}} regimens on this page</b></font></div> |
| − | <div style="background-color: #66CCFF; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]] | + | <div style="background-color: #66CCFF; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]] |?Variant |limit=10000|format=sum}} variants on this page</b></font></div> |
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{{TOC limit|limit=3}} | {{TOC limit|limit=3}} | ||
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|[[Levels_of_Evidence#Evidence|'''Evidence''']] | |[[Levels_of_Evidence#Evidence|'''Evidence''']] | ||
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| − | |[ | + | |[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155269/ Wilson et al. 2014] |
|style="background-color:#EEEE00"|Phase II | |style="background-color:#EEEE00"|Phase II | ||
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====Chemotherapy==== | ====Chemotherapy==== | ||
*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once per cycle or 1 day before the start of EPOCH (depending on reference) | *[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once per cycle or 1 day before the start of EPOCH (depending on reference) | ||
| − | *[[Etoposide (Vepesid)]] 50 mg/m<sup>2</sup>/day IV continuous infusion on days 1 to 4 (total dose | + | *[[Etoposide (Vepesid)]] 50 mg/m<sup>2</sup>/day IV continuous infusion on days 1 to 4 (total dose per cycle: 200 mg/m<sup>2</sup>) |
*[[Prednisone (Sterapred)]] 60 mg/m<sup>2</sup> PO BID on days 1 to 5 | *[[Prednisone (Sterapred)]] 60 mg/m<sup>2</sup> PO BID on days 1 to 5 | ||
| − | *[[Vincristine (Oncovin)]] 0.4 mg/m<sup>2</sup>/day IV continuous infusion on days 1 to 4 (total dose | + | *[[Vincristine (Oncovin)]] 0.4 mg/m<sup>2</sup>/day IV continuous infusion on days 1 to 4 (total dose per cycle: 1.6 mg/m<sup>2</sup>) |
*[[Cyclophosphamide (Cytoxan)]] 750 mg/m<sup>2</sup> IV over 15 minutes once on day 5 | *[[Cyclophosphamide (Cytoxan)]] 750 mg/m<sup>2</sup> IV over 15 minutes once on day 5 | ||
| − | *[[Doxorubicin (Adriamycin)]] 10 mg/m<sup>2</sup>/day IV continuous infusion on days 1 to 4 (total dose | + | *[[Doxorubicin (Adriamycin)]] 10 mg/m<sup>2</sup>/day IV continuous infusion on days 1 to 4 (total dose per cycle: 40 mg/m<sup>2</sup>) |
====Supportive medications==== | ====Supportive medications==== | ||
| − | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC once per day, starting on day 6 and continuing until ANC | + | *[[Filgrastim (Neupogen)]] 5 mcg/kg SC once per day, starting on day 6 and continuing until ANC greater than 5000/uL past nadir |
| − | *PCP prophylaxis with | + | *PCP prophylaxis with ONE of the following: |
**[[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 | ||
***Alternative used only in García-Suárez et al. 2007: cotrimoxazole 480 mg PO BID 3 days per week | ***Alternative used only in García-Suárez et al. 2007: cotrimoxazole 480 mg PO BID 3 days per week | ||
**[[Atovaquone (Mepron)]] 1500 mg PO once per day | **[[Atovaquone (Mepron)]] 1500 mg PO once per day | ||
**[[Pentamidine (Nebupent)]] 300 mg nebulized every 28 days | **[[Pentamidine (Nebupent)]] 300 mg nebulized every 28 days | ||
| − | *Only in García-Suárez et al. 2007: [[Darbepoetin alfa (Aranesp)]] 2.25 | + | *Only in García-Suárez et al. 2007: [[Darbepoetin alfa (Aranesp)]] 2.25 mcg/kg SC when hemoglobin concentration was less than or equal to 10 g/dL. |
'''21-day cycle for 6 to 8 cycles''' | '''21-day cycle for 6 to 8 cycles''' | ||
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*Start cycle 1 as described above. | *Start cycle 1 as described above. | ||
*Obtain CBCs twice per week for nadir measurements. | *Obtain CBCs twice per week for nadir measurements. | ||
| − | *If nadir ANC | + | *If nadir ANC greater than 500/uL, increase etoposide, doxorubicin, and cyclophosphamide by 20% compared to previous cycle. |
| − | *If nadir ANC | + | *If nadir ANC less than 500/uL on 1 or 2 measurements, use same doses as last cycle. |
| − | *If nadir ANC | + | *If nadir ANC less than 500/uL on at least 3 measurements, decrease etoposide, doxorubicin, and cyclophosphamide by 20% compared to previous cycle. |
| − | *And/or if nadir platelet count < | + | *And/or if nadir platelet count less than 25 x 10<sup>9</sup>/L on at least 1 measurement, decrease etoposide, doxorubicin, and cyclophosphamide by 20% compared to previous cycle. |
| − | *'''Dose adjustments below the cycle 1 starting dose only applies to cyclophosphamide.''' | + | *'''Dose adjustments below the cycle 1 starting dose only applies to cyclophosphamide.''' The lowest etoposide and doxorubicin would be dosed at is the original cycle 1 dose. |
| − | *Can start new cycle every 21 days if ANC | + | *Can start new cycle every 21 days if ANC greater than 1000/uL and platelets greater than 100 x 10<sup>9</sup>/L. If counts are below those levels, check daily CBC and continue growth factor support until counts are adequate and next cycle can start. |
===References=== | ===References=== | ||
| − | # Wilson WH, Pittaluga S, Nicolae A, Camphausen K, Shovlin M, Steinberg SM, Roschewski M, Staudt LM, Jaffe ES, Dunleavy K. A prospective study of mediastinal gray-zone lymphoma. Blood. 2014 Sep 4;124(10):1563-9. Epub 2014 Jul 14. [http://www.bloodjournal.org/content/124/10/1563.long link to original article] '''contains protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/25024303 PubMed] | + | # Wilson WH, Pittaluga S, Nicolae A, Camphausen K, Shovlin M, Steinberg SM, Roschewski M, Staudt LM, Jaffe ES, Dunleavy K. A prospective study of mediastinal gray-zone lymphoma. Blood. 2014 Sep 4;124(10):1563-9. Epub 2014 Jul 14. [http://www.bloodjournal.org/content/124/10/1563.long link to original article] '''contains protocol''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155269/ link to PMC article] [https://www.ncbi.nlm.nih.gov/pubmed/25024303 PubMed] |
=Relapsed/Refractory= | =Relapsed/Refractory= | ||
Revision as of 01:39, 29 July 2017
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.
2 regimens on this page
2 variants on this page
|
Note: Mediastinal gray-zone lymphome (MGZL) is considered intermediate between primary mediastinal B-cell lymphoma (PMBL) and nodular sclerosis Hodgkin lymphoma (NSHL). Given that it is treated more similarly to the non-Hodgkin lymphoma, it is included here.
Untreated
DA-EPOCH-R
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DA-R-EPOCH: Dose Adjusted Etoposide, Prednisone, Oncovin (Vincristine), Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Rituximab
Synonyms: DA-R-EPOCH-R
Structured Concept: C63461 (NCI-T), C1882521 (NCI-MT/UMLS)
Regimen
| Study | Evidence |
| Wilson et al. 2014 | Phase II |
Chemotherapy
- Rituximab (Rituxan) 375 mg/m2 IV once per cycle or 1 day before the start of EPOCH (depending on reference)
- Etoposide (Vepesid) 50 mg/m2/day IV continuous infusion on days 1 to 4 (total dose per cycle: 200 mg/m2)
- Prednisone (Sterapred) 60 mg/m2 PO BID on days 1 to 5
- Vincristine (Oncovin) 0.4 mg/m2/day IV continuous infusion on days 1 to 4 (total dose per cycle: 1.6 mg/m2)
- Cyclophosphamide (Cytoxan) 750 mg/m2 IV over 15 minutes once on day 5
- Doxorubicin (Adriamycin) 10 mg/m2/day IV continuous infusion on days 1 to 4 (total dose per cycle: 40 mg/m2)
Supportive medications
- Filgrastim (Neupogen) 5 mcg/kg SC once per day, starting on day 6 and continuing until ANC greater than 5000/uL past nadir
- PCP prophylaxis with ONE of the following:
- Trimethoprim/Sulfamethoxazole (Bactrim DS) 160/800 mg PO BID 3 days per week
- Alternative used only in García-Suárez et al. 2007: cotrimoxazole 480 mg PO BID 3 days per week
- Atovaquone (Mepron) 1500 mg PO once per day
- Pentamidine (Nebupent) 300 mg nebulized every 28 days
- Trimethoprim/Sulfamethoxazole (Bactrim DS) 160/800 mg PO BID 3 days per week
- Only in García-Suárez et al. 2007: Darbepoetin alfa (Aranesp) 2.25 mcg/kg SC when hemoglobin concentration was less than or equal to 10 g/dL.
21-day cycle for 6 to 8 cycles
Dose-adjustments
- Start cycle 1 as described above.
- Obtain CBCs twice per week for nadir measurements.
- If nadir ANC greater than 500/uL, increase etoposide, doxorubicin, and cyclophosphamide by 20% compared to previous cycle.
- If nadir ANC less than 500/uL on 1 or 2 measurements, use same doses as last cycle.
- If nadir ANC less than 500/uL on at least 3 measurements, decrease etoposide, doxorubicin, and cyclophosphamide by 20% compared to previous cycle.
- And/or if nadir platelet count less than 25 x 109/L on at least 1 measurement, decrease etoposide, doxorubicin, and cyclophosphamide by 20% compared to previous cycle.
- Dose adjustments below the cycle 1 starting dose only applies to cyclophosphamide. The lowest etoposide and doxorubicin would be dosed at is the original cycle 1 dose.
- Can start new cycle every 21 days if ANC greater than 1000/uL and platelets greater than 100 x 109/L. If counts are below those levels, check daily CBC and continue growth factor support until counts are adequate and next cycle can start.
References
- Wilson WH, Pittaluga S, Nicolae A, Camphausen K, Shovlin M, Steinberg SM, Roschewski M, Staudt LM, Jaffe ES, Dunleavy K. A prospective study of mediastinal gray-zone lymphoma. Blood. 2014 Sep 4;124(10):1563-9. Epub 2014 Jul 14. link to original article contains protocol link to PMC article PubMed
Relapsed/Refractory
Brentuximab vedotin (Adcetris)
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Regimen
| Study | Evidence |
| Bartlett et al. 2013 | Phase II, <20 pts |
This regimen was evaluated in patients with CD30+ non-Hodgkin lymphoma, as determined by immunohistochemistry.
Chemotherapy
- Brentuximab vedotin (Adcetris) 1.8 mg/kg IV over 30 minutes once on day 1
21-day cycles, given until progression or unacceptable toxicity
References
- Abstract: Nancy L. Bartlett, MD, Jeff P. Sharman, MD, Yasuhiro Oki, MD, Ranjana H. Advani, MD, Celeste M. Bello, MD, Jane N. Winter, MD, Yin Yang, MS, Dana A. Kennedy, PharmD and Eric D. Jacobsen, MD. A Phase 2 Study Of Brentuximab Vedotin In Patients With Relapsed Or Refractory CD30-Positive Non-Hodgkin Lymphomas: Interim Results In Patients With DLBCL and Other B-Cell Lymphomas. ASH Abstract 848. link to abstract