Difference between revisions of "HIV-associated lymphoma"

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Revision as of 16:46, 26 December 2012

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CODOX-M/IVAC

CODOX-M: Cyclophosphamide, Oncovin, DOXorubicin, M ethotrexate

IVAC: Ifosfamide, Vepesid (etoposide), AC Ara-C (cytarabine)

Part 1: CODOX-M

Age 65 years or younger:

Age more than 65 years:

  • Folinic acid (Leucovorin) 15 mg/m2 IV Q3H, starting 36 hours after start of IV methotrexate until 48 hours, then Q6H until methotrexate level undetectable

Supportive medications:

Part 2: IVAC

Age 65 years or younger:

Age more than 65 years:

Supportive medications:

References

  1. Magrath I, Adde M, Shad A, Venzon D, Seibel N, Gootenberg J, Neely J, Arndt C, Nieder M, Jaffe E, Wittes RA, Horak ID. Adults and children with small non-cleaved-cell lymphoma have a similar excellent outcome when treated with the same chemotherapy regimen. J Clin Oncol. 1996 Mar;14(3):925-34. link to original article contains verified protocol PubMed
  2. Wang ES, Straus DJ, Teruya-Feldstein J, Qin J, Portlock C, Moskowitz C, Goy A, Hedrick E, Zelenetz AD, Noy A. Intensive chemotherapy with cyclophosphamide, doxorubicin, high-dose methotrexate/ifosfamide, etoposide, and high-dose cytarabine (CODOX-M/IVAC) for human immunodeficiency virus-associated Burkitt lymphoma. Cancer. 2003 Sep 15;98(6):1196-205. link to original article PubMed

R-CODOX-M/IVAC

Regimen

To be completed

References

  1. Kassam S, Bower M, Lee SM, de Vos J, Fields P, Gandhi S, Nelson M, Montoto S, Tenant-Flowers M, Burns F, Marcus R, Edwards SG, Cwynarski K. A retrospective, multi-center analysis of treatment intensification for HIV-positive patients with high-risk diffuse large B-cell lymphoma. Leuk Lymphoma. 2012 Dec 3. [Epub ahead of print] link to original article PubMed

R-EPOCH, dose-escalated (EPOCH-R)

Regimen

21-day cycles x 6-8 cycles

Supportive medications:

  • EITHER Filgrastim (Neupogen) 5 mcg/kg SC daily, starting 24 hours after EPOCH is completed and continuing until "neutrophil recovery"—no absolute count specified
  • OR Pegfilgrastim (Neulasta) 6 mg SC x1 24 hours after EPOCH is completed
  • Trimethoprim/Sulfamethoxazole (Bactrim DS) 160/800 mg PO 3x per week (e.g. Monday, Wednesday, Friday)
  • Fluconazole (Diflucan) 100 mg PO daily
  • Ciprofloxacin (Cipro) 500 mg PO BID, starting on day 8 and to continue to at least day 15 or postnadir ANC of at least 1000
    • Other fluoroquinolone can be used at discretion of physician

References

  1. Sparano JA, Lee JY, Kaplan LD, Levine AM, Ramos JC, Ambinder RF, Wachsman W, Aboulafia D, Noy A, Henry DH, Von Roenn J, Dezube BJ, Remick SC, Shah MH, Leichman L, Ratner L, Cesarman E, Chadburn A, Mitsuyasu R; AIDS Malignancy Consortium. Rituximab plus concurrent infusional EPOCH chemotherapy is highly effective in HIV-associated B-cell non-Hodgkin lymphoma. Blood. 2010 Apr 15;115(15):3008-16. Epub 2009 Dec 18. link to original article contains verified protocol PubMed