Classical Hodgkin lymphoma

ABVD (Doxorubicin (Adriamycin), Bleomycin (Blenoxane), Vinblastine (Velban), Dacarbazine (DTIC)) (stage I-IV Hodgkin lymphoma)

Regimen

• Doxorubicin (Adriamycin) 25 mg/m2 IV days 1 & 15
• Bleomycin (Blenoxane) 10 units/m2 IV 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 days 1 & 15
• Dacarbazine (DTIC) 375 mg/m2 IV days 1 & 15

Q28days x 4-6 cycles based on stage, response, and whether radiation therapy is used.

Supportive medications

Antiemesis alternatives

• Acetaminophen 650 mg PO, 30 minutes prior to chemotherapy.
• Aprepitant (Emend) 125 mg PO on days 1 & 15 prior to chemotherapy, 80mg PO on days 2-3, 16-17
• Ondansetron (Zofran) 8 mg PO, 30 minutes prior to chemotherapy on days 1 & 15, daily on days 2-3, 16-17
• Dexamethasone 4 mg PO BID on days 1-3, days 15-17
• Diphendyramine (Benadryl) 25 mg PO on day 1 & 15 prior to chemotherapy

Supportive Hydration

• 500 ml NS at KVO rate. Use as running IV for chemotherapy infusion.

Pretreatment monitoring parameters

• CBC with diff, liver function tests, pulmonary function tests with DLCO

References

1. Bonadonna G, Santoro A. ABVD chemotherapy in the treatment of Hodgkin's disease. Cancer Treat Rev. 1982 Mar;9(1):21-35. (no link to original article available) PubMed
2. Bonadonna G. Chemotherapy strategies to improve the control of Hodgkin's disease: the Richard and Hinda Rosenthal Foundation Award Lecture. Cancer Res. 1982 Nov;42(11):4309-20. link to original article (contains protocol) PubMed
3. Santoro A, Bonadonna G, Valagussa P, Zucali R, Viviani S, Villani F, Pagnoni AM, Bonfante V, Musumeci R, Crippa F, et al. Long-term results of combined chemotherapy-radiotherapy approach in Hodgkin's disease: superiority of ABVD plus radiotherapy versus MOPP plus radiotherapy. J Clin Oncol. 1987 Jan;5(1):27-37. link to original article PubMed
4. Canellos GP, et al. Chemotherapy of advanced Hodgkin's disease with MOPP, ABVD, or MOPP alternating with ABVD. N Engl J Med. 1992 Nov 19;327(21):1478-84.PubMed
5. Gianni AM et al. Comparable 3-year outcome following ABVD or BEACOPP first-line chemotherapy, plus pre-planned high-dose salvage, in advanced Hodgkin's lymphoma (HL): a randomized trial of the Michelangelo, GITIL and IIL cooperative groups. 2008 ASCO annual meeting. Abstract 8506
6. Bonadonna G et al. ABVD plus subtotal nodal versus involved-field radiotherapy in early-stage Hodgkin's disease: long-term results. J Clin Oncol 2004; 22:2835
7. Carde, P et al. Clinical staging versus laparotomy and combined modality with MOPP versus ABVD in early-stage Hodgkin's disease: The H6 twin randomized trials from the European Organization for Research and Treatment of Cancer Lymphoma Cooperative Group. J Clin Oncol 1993; 11:2258
8. Engert A et al. Two cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine plus extended-field radiotherapy is superior to radiotherapy alone in early favorable Hodgkin's lymphoma: Final results of the GHSG HD7 trial. J Clin Oncol 2007; 25:3495

Escalated Dose BEACOPP (Bleomycin (Blenoxane), Etoposide (Vepesid), Doxorubicin (Adriamycin), Cyclophosphamide (Cytoxan), Vincristine (Oncovin), Procarbazine (Matulane), Prednisone (Sterapred)) (stage III-IV Hodgkin lymphoma, IPS>=4)

BEACOPP: Bleomycin, Etoposide, Adriamycin, Cyclophosphamide, Oncovin, Procarbazine, Prednisone

Regimen

• Bleomycin (Blenoxane) 10 units/m2 IV day 8
• Etoposide (Vepesid) 200 mg/m2 IV days 1-3
• Doxorubicin (Adriamycin) 35 mg/m2 IV day 1
• Cyclophosphamide (Cytoxan) 1200 mg/m2 IV day 1
• Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2mg per cycle) IV day 8
• Procarbazine (Matulane) 100 mg/m2 PO days 1-7
• Prednisone (Sterapred) 40 mg/m2 PO days 1-14

Q21days x 8 cycles

References

1. Engert A, Diehl V, Franklin J, Lohri A, Dörken B, Ludwig WD, Koch P, Hänel M, Pfreundschuh M, Wilhelm M, Trümper L, Aulitzky WE, Bentz M, Rummel M, Sezer O, Müller-Hermelink HK, Hasenclever D, Löffler M. Escalated-dose BEACOPP in the treatment of patients with advanced-stage Hodgkin's lymphoma: 10 years of follow-up of the GHSG HD9 study. J Clin Oncol. 2009 Sep 20;27(27):4548-54. link to original article PubMed
2. Diehl V, Franklin J, Pfreundschuh M, Lathan B, Paulus U, Hasenclever D, Tesch H, Herrmann R, Dörken B, Müller-Hermelink HK, Dühmke E, Loeffler M; German Hodgkin's Lymphoma Study Group. Standard and increased-dose BEACOPP chemotherapy compared with COPP-ABVD for advanced Hodgkin's disease. N Engl J Med. 2003 Jun 12;348(24):2386-95. link to original article(contains protocol) PubMed

Lymphocyte predominant Hodgkin Lymphoma

ABVD (Doxorubicin (Adriamycin), Bleomycin (Blenoxane), Vinblastine (Velban), Dacarbazine (DTIC), +/- Rituximab (Rituxan)) (lymphocyte predominant Hodgkin lymphoma)

Regimen

• Doxorubicin (Adriamycin) 25 mg/m2 IV days 1 & 15
• Bleomycin (Blenoxane) 10 units/m2 IV 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 days 1 & 15
• Dacarbazine (DTIC) 375 mg/m2 IV 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 Ibom 2003). Use in subsequent cycles is not well-documented.

Q28days x 2-6 cycles based on stage, response, and whether radiation therapy is used.

References

1. See additional references above
2. 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 articlePubMed
3. Ibom VK, Prosnitz RG, Gong JZ, Moore JO, DeCastro CM, Prosnitz LR, Rizzieri DA, Gockerman JP. Rituximab in lymphocyte predominance Hodgkin's disease: a case series. Blood. 2003 Jun 1;101(11):4285-9. link to original article (contains protocol) PubMed

CHOP (Cyclophosphamide (Cytoxan), Doxorubicin (Adriamycin), Vincristine (Oncovin), Prednisone (Sterapred)) (lymphocyte predominant Hodgkin lymphoma)

Regimen

• Cyclophosphamide (Cytoxan) 750 mg/m2 IV day 1
• Doxorubicin (Adriamycin) 50 mg/m2 IV day 1
• Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2mg per cycle) IV day 1
• Prednisone (Sterapred) 100 mg PO days 1-5
• Rituximab (Rituxan) 375mg/m2 IV day 1

Q21days x 6-8 cycles (number of cycles for CHOP in LPHL is not well-established)

References

1. 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--this was for diffuse large B-cell lymphomas; no primary reference available for use of CHOP in LPHL) PubMed

R-CHOP (Rituximab (Rituxan), Cyclophosphamide (Cytoxan), Doxorubicin (Adriamycin), Vincristine (Oncovin), Prednisone (Sterapred)) (lymphocyte predominant Hodgkin lymphoma)

Regimen

• Cyclophosphamide (Cytoxan) 750 mg/m2 IV day 1
• Doxorubicin (Adriamycin) 50 mg/m2 IV day 1
• Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2mg per cycle) IV day 1
• Prednisone (Sterapred) 100 mg PO days 1-5
• Rituximab (Rituxan) 375mg/m2 IV day 1

Q21days x 6-8 cycles (number of cycles for R-CHOP in LPHL is not well-established)

References

See references for CHOP

CVP (Cyclophosphamide (Cytoxan), Vincristine (Oncovin), Prednisone (Sterapred)) (lymphocyte predominant Hodgkin lymphoma)

Regimen

• Cyclophosphamide (Cytoxan) 750 mg/m2 IV day 1
• Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2mg per cycle) IV day 1
• Prednisone (Sterapred) 40 mg/m2 PO days 1-5

Q21days x up to 8 cycles (number of cycles for CVP in LPHL is not well-established)

References

1. 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--this was for follicular lymphoma; no primary reference available for use of CVP in LPHL)) PubMed

R-CVP (Rituximab (Rituxan), Cyclophosphamide (Cytoxan), Vincristine (Oncovin), Prednisone (Sterapred)) (lymphocyte predominant Hodgkin lymphoma)

Regimen

• Cyclophosphamide (Cytoxan) 750 mg/m2 IV day 1
• Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2mg per cycle) IV day 1
• Prednisone (Sterapred) 40 mg/m2 PO days 1-5
• Rituximab (Rituxan) 375mg/m2 IV day 1

Q21days x up to 8 cycles (number of cycles for R-CVP in LPHL is not well-established)

References

See references for CVP