Difference between revisions of "Marginal zone lymphoma"
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{{TOC limit|limit=2}} | {{TOC limit|limit=2}} | ||
| − | =Bortezomib | + | ==Bortezomib (Velcade)== |
Level of Evidence: | Level of Evidence: | ||
| Line 15: | Line 15: | ||
border-style:solid;">Phase II</span> | border-style:solid;">Phase II</span> | ||
| − | ==Regimen #1, Troch, et al. 2009== | + | ===Regimen #1, Troch, et al. 2009=== |
| − | *[[Bortezomib (Velcade)]] 1.5 mg/m2 IV bolus on days 1, 4, 8, 11 | + | *[[Bortezomib (Velcade)]] 1.5 mg/m2 IV bolus once daily on days 1, 4, 8, 11 |
'''21-day cycles x up to 8 cycles''' | '''21-day cycles x up to 8 cycles''' | ||
| Line 24: | Line 24: | ||
*500 mL NS after bortezomib | *500 mL NS after bortezomib | ||
| − | ==Regimen #2, Conconi, et al. 2011== | + | ===Regimen #2, Conconi, et al. 2011=== |
| − | *[[Bortezomib (Velcade)]] 1.3 mg/m2 IV on days 1, 4, 8, 11 | + | *[[Bortezomib (Velcade)]] 1.3 mg/m2 IV once daily on days 1, 4, 8, 11 |
'''21-day cycles x up to 6 cycles''' | '''21-day cycles x up to 6 cycles''' | ||
| Line 32: | Line 32: | ||
*No routine growth factors, antibiotic, or antiviral prophylaxis was given | *No routine growth factors, antibiotic, or antiviral prophylaxis was given | ||
| − | ==References== | + | ===References=== |
# 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. doi:10.3324/haematol.2008.001537. Epub 2009 Mar 31. [http://www.haematologica.org/content/94/5/738.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/19336742 PubMed] | # 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. doi:10.3324/haematol.2008.001537. Epub 2009 Mar 31. [http://www.haematologica.org/content/94/5/738.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/19336742 PubMed] | ||
# 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. [http://annonc.oxfordjournals.org/content/22/3/689.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/20810546 PubMed] | # 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. [http://annonc.oxfordjournals.org/content/22/3/689.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/20810546 PubMed] | ||
| − | =Chlorambucil | + | ==Chlorambucil (Leukeran)== |
===Regimen #1, Leblond, et al. 2013=== | ===Regimen #1, Leblond, et al. 2013=== | ||
*[[Chlorambucil (Leukeran)]] 8 mg/m2 (6 mg/m2 per day if older than 75 years old) PO daily on days 1-10 | *[[Chlorambucil (Leukeran)]] 8 mg/m2 (6 mg/m2 per day if older than 75 years old) PO daily on days 1-10 | ||
| Line 44: | Line 44: | ||
Supportive medications: | Supportive medications: | ||
*Recommended PCP prophylaxis with one of the following: | *Recommended PCP prophylaxis with one of the following: | ||
| − | **[[Trimethoprim/Sulfamethoxazole (Bactrim DS)|Trimethoprim/Sulfamethoxazole (Bactrim SS)]] 1 tablet PO daily | + | **[[Trimethoprim/Sulfamethoxazole (Bactrim DS)|Trimethoprim/Sulfamethoxazole (Bactrim SS)]] 1 tablet PO once daily |
| − | **[[Pentamidine (Nebupent)]] 300 mg inhaled | + | **[[Pentamidine (Nebupent)]] 300 mg inhaled once per month |
| − | |||
| − | |||
| − | |||
| + | ===Regimen #2, Zucca, et al. 2013 - IELSG-19=== | ||
| + | ====Induction phase==== | ||
*[[Chlorambucil (Leukeran)]] 6 mg/m2 PO daily on days 1-42 | *[[Chlorambucil (Leukeran)]] 6 mg/m2 PO daily on days 1-42 | ||
| − | ''' | + | '''42-day course of therapy''' |
| + | ====Stable disease & responders -> consolidation phase==== | ||
*[[Chlorambucil (Leukeran)]] 6 mg/m2 PO daily on days 1-14 | *[[Chlorambucil (Leukeran)]] 6 mg/m2 PO daily on days 1-14 | ||
| Line 62: | Line 62: | ||
# 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. doi: 10.1200/JCO.2011.40.6272. Epub 2013 Jan 7. [http://jco.ascopubs.org/content/31/5/565.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/23295789 PubMed] | # 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. doi: 10.1200/JCO.2011.40.6272. Epub 2013 Jan 7. [http://jco.ascopubs.org/content/31/5/565.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/23295789 PubMed] | ||
| − | =Cladribine | + | ==Cladribine (Leustatin)== |
Level of Evidence: | Level of Evidence: | ||
| Line 72: | Line 72: | ||
border-style:solid;">Phase II</span> | border-style:solid;">Phase II</span> | ||
| − | ==Regimen== | + | ===Regimen=== |
| − | *[[Cladribine (Leustatin)]] 0.12 mg/kg IV over 2 hours on days 1 | + | *[[Cladribine (Leustatin)]] 0.12 mg/kg IV over 2 hours once on days 1-5 |
'''28-day cycles x 4 to 6 cycles''' | '''28-day cycles x 4 to 6 cycles''' | ||
| Line 83: | Line 83: | ||
*Not described | *Not described | ||
| − | ==References== | + | ===References=== |
# 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. [http://jco.ascopubs.org/content/20/18/3872.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/12228207 PubMed] | # 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. [http://jco.ascopubs.org/content/20/18/3872.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/12228207 PubMed] | ||
| − | =Fludarabine | + | ==Fludarabine (Fludara)== |
| − | |||
===Regimen=== | ===Regimen=== | ||
| − | *[[Fludarabine (Fludara)]] 40 mg/m2 (30 mg/m2 per day if older than 75 years old) PO daily on days 1-5 | + | *[[Fludarabine (Fludara)]] 40 mg/m2 (30 mg/m2 per day if older than 75 years old) PO once daily on days 1-5 |
'''28-day cycles x up to 6 cycles''' | '''28-day cycles x up to 6 cycles''' | ||
| Line 95: | Line 94: | ||
Supportive medications: | Supportive medications: | ||
*Recommended PCP prophylaxis with one of the following: | *Recommended PCP prophylaxis with one of the following: | ||
| − | **[[Trimethoprim/Sulfamethoxazole (Bactrim DS)|Trimethoprim/Sulfamethoxazole (Bactrim SS)]] 1 tablet PO daily | + | **[[Trimethoprim/Sulfamethoxazole (Bactrim DS)|Trimethoprim/Sulfamethoxazole (Bactrim SS)]] 1 tablet PO once daily |
| − | **[[Pentamidine (Nebupent)]] 300 mg inhaled | + | **[[Pentamidine (Nebupent)]] 300 mg inhaled once per month |
*Herpes zoster prophylaxis with one of the following: | *Herpes zoster prophylaxis with one of the following: | ||
| − | **[[Valacyclovir (Valtrex)]] 500 mg PO daily | + | **[[Valacyclovir (Valtrex)]] 500 mg PO once daily |
**[[Acyclovir (Zovirax)]] 200-400 mg PO BID | **[[Acyclovir (Zovirax)]] 200-400 mg PO BID | ||
| Line 104: | Line 103: | ||
# 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. doi:10.1200/JCO.2012.44.7920. Epub 2012 Dec 10. [http://jco.ascopubs.org/content/31/3/301.full link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/23233721 PubMed] | # 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. doi:10.1200/JCO.2012.44.7920. Epub 2012 Dec 10. [http://jco.ascopubs.org/content/31/3/301.full link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/23233721 PubMed] | ||
| − | =MCP= | + | ==MCP== |
MCP: '''<u>M</u>'''itoxantrone, '''<u>C</u>'''hlorambucil, '''<u>P</u>'''rednisolone | MCP: '''<u>M</u>'''itoxantrone, '''<u>C</u>'''hlorambucil, '''<u>P</u>'''rednisolone | ||
| − | ==Regimen== | + | ===Regimen=== |
| − | *[[Mitoxantrone (Novantrone)]] 8 mg/m2 IV on days 1 & 2 | + | *[[Mitoxantrone (Novantrone)]] 8 mg/m2 IV once daily on days 1 & 2 |
*[[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 1-5 | *[[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 1-5 | ||
| − | *[[Prednisolone (Millipred)]] 25 mg/m2 PO/IV on days 1-5 | + | *[[Prednisolone (Millipred)]] 25 mg/m2 PO/IV once daily on days 1-5 |
'''28-day cycles x up to 8 cycles''' | '''28-day cycles x up to 8 cycles''' | ||
| − | ==References== | + | ===References=== |
# 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. [http://annonc.oxfordjournals.org/content/14/12/1758.long link to orginal article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/14630681 PubMed] | # 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. [http://annonc.oxfordjournals.org/content/14/12/1758.long link to orginal article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/14630681 PubMed] | ||
| − | =Rituximab= | + | ==Rituximab (Rituxan)== |
Level of Evidence: | Level of Evidence: | ||
| Line 127: | Line 126: | ||
border-style:solid;">Phase II</span> | border-style:solid;">Phase II</span> | ||
| − | ==Regimen== | + | ===Regimen=== |
| − | *[[Rituximab (Rituxan)]] 375 mg/m2 IV on days 1, 8, 15, 21 | + | *[[Rituximab (Rituxan)]] 375 mg/m2 IV once daily on days 1, 8, 15, 21 |
| − | ==References== | + | ===References=== |
| − | #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. [http://bloodjournal.hematologylibrary.org/content/102/8/2741.long link to orginal article] '''contains protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/12842999 PubMed] | + | # 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. [http://bloodjournal.hematologylibrary.org/content/102/8/2741.long link to orginal article] '''contains protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/12842999 PubMed] |
# 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. [http://jco.ascopubs.org/content/23/9/1979.long link to original article] '''contains protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/15668468 PubMed] | # 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. [http://jco.ascopubs.org/content/23/9/1979.long link to original article] '''contains protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/15668468 PubMed] | ||
| − | =Rituximab & Chlorambucil= | + | ==Rituximab (Rituxan) & Chlorambucil (Leukeran)== |
| − | + | ===Regimen, Zucca, et al. 2013 - IELSG-19=== | |
| − | ===Regimen, Zucca, et al. 2013 | + | ====Induction phase==== |
| − | + | *[[Rituximab (Rituxan)]] 375 mg/m2 IV once daily on days 1, 8, 15, 22 | |
| − | |||
| − | *[[Rituximab (Rituxan)]] 375 mg/m2 IV once on days 1, 8, 15, 22 | ||
*[[Chlorambucil (Leukeran)]] 6 mg/m2 PO daily on days 1-42 | *[[Chlorambucil (Leukeran)]] 6 mg/m2 PO daily on days 1-42 | ||
| − | + | ====Stable disease & responders -> consolidation phase==== | |
| − | |||
*[[Rituximab (Rituxan)]] 375 mg/m2 IV once on day 1 | *[[Rituximab (Rituxan)]] 375 mg/m2 IV once on day 1 | ||
*[[Chlorambucil (Leukeran)]] 6 mg/m2 PO daily on days 1-14 | *[[Chlorambucil (Leukeran)]] 6 mg/m2 PO daily on days 1-14 | ||
| Line 152: | Line 148: | ||
# 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. doi: 10.1200/JCO.2011.40.6272. Epub 2013 Jan 7. [http://jco.ascopubs.org/content/31/5/565.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/23295789 PubMed] | # 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. doi: 10.1200/JCO.2011.40.6272. Epub 2013 Jan 7. [http://jco.ascopubs.org/content/31/5/565.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/23295789 PubMed] | ||
| − | =Rituximab & Fludarabine (R-Flu)= | + | ==Rituximab (Rituxan) & Fludarabine (Fludara) (R-Flu)== |
R-Flu: '''<u>R</u>'''ituximab, '''<u>Flu</u>'''darabine | R-Flu: '''<u>R</u>'''ituximab, '''<u>Flu</u>'''darabine | ||
| − | ==Regimen== | + | ===Regimen=== |
| − | *[[Rituximab (Rituxan)]] 375 mg/m2 IV on day 1 | + | *[[Rituximab (Rituxan)]] 375 mg/m2 IV once on day 1 |
| − | *[[Fludarabine (Fludara)]] 25 mg/m2 IV (or 40 mg/m2 PO) on days 1-5 | + | *[[Fludarabine (Fludara)]] 25 mg/m2 IV (or 40 mg/m2 PO) once daily on days 1-5 |
**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 | ||
| − | **Patients >70 years old could receive fludarabine at the above dose, but only on days 1-3 | + | **Patients >70 years old could receive fludarabine at the above dose, but only once daily on days 1-3 |
'''28-day cycles for 4-6 cycles''' | '''28-day cycles for 4-6 cycles''' | ||
| − | ==References== | + | Supportive medications: |
| + | *[[Trimethoprim/Sulfamethoxazole (Bactrim DS)|Trimethoprim/Sulfamethoxazole]] prophylaxis (dose/schedule not listed) per physician preference | ||
| + | *No routine antiviral prophylaxis or G-CSF use | ||
| + | |||
| + | ===References=== | ||
# 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. doi: 10.1002/cncr.24605. [http://onlinelibrary.wiley.com/doi/10.1002/cncr.24605/full link to orginal article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/19672998 PubMed] | # 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. doi: 10.1002/cncr.24605. [http://onlinelibrary.wiley.com/doi/10.1002/cncr.24605/full link to orginal article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/19672998 PubMed] | ||
Revision as of 19:12, 26 March 2013
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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.
Bortezomib (Velcade)
Level of Evidence: Phase II
Regimen #1, Troch, et al. 2009
- Bortezomib (Velcade) 1.5 mg/m2 IV bolus once daily on days 1, 4, 8, 11
21-day cycles x up to 8 cycles
Supportive medications:
- 5-HT3 antagonist IV immediately before bortezomib
- 500 mL NS after bortezomib
Regimen #2, Conconi, et al. 2011
- Bortezomib (Velcade) 1.3 mg/m2 IV once daily on days 1, 4, 8, 11
21-day cycles x up to 6 cycles
Supportive medications:
- No routine growth factors, antibiotic, or antiviral prophylaxis was given
References
- 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. doi:10.3324/haematol.2008.001537. Epub 2009 Mar 31. link to original article contains verified protocol PubMed
- 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
Chlorambucil (Leukeran)
Regimen #1, Leblond, et al. 2013
- Chlorambucil (Leukeran) 8 mg/m2 (6 mg/m2 per day if older than 75 years old) PO daily on days 1-10
28-day cycles x up to 12 cycles
Supportive medications:
- Recommended PCP prophylaxis with one of the following:
- Trimethoprim/Sulfamethoxazole (Bactrim SS) 1 tablet PO once daily
- Pentamidine (Nebupent) 300 mg inhaled once per month
Regimen #2, Zucca, et al. 2013 - IELSG-19
Induction phase
- Chlorambucil (Leukeran) 6 mg/m2 PO daily on days 1-42
42-day course of therapy
Stable disease & responders -> consolidation phase
- Chlorambucil (Leukeran) 6 mg/m2 PO daily on days 1-14
28-day cycles x up to 4 cycles
References
- 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. doi:10.1200/JCO.2012.44.7920. Epub 2012 Dec 10. link to original article contains verified protocol PubMed
- 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. doi: 10.1200/JCO.2011.40.6272. Epub 2013 Jan 7. link to original article contains verified protocol PubMed
Cladribine (Leustatin)
Level of Evidence: Phase II
Regimen
- Cladribine (Leustatin) 0.12 mg/kg IV over 2 hours once on days 1-5
28-day cycles x 4 to 6 cycles
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
References
- 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
Fludarabine (Fludara)
Regimen
- Fludarabine (Fludara) 40 mg/m2 (30 mg/m2 per day if older than 75 years old) PO once daily on days 1-5
28-day cycles x up to 6 cycles
Supportive medications:
- Recommended PCP prophylaxis with one of the following:
- Trimethoprim/Sulfamethoxazole (Bactrim SS) 1 tablet PO once daily
- Pentamidine (Nebupent) 300 mg inhaled once per month
- Herpes zoster prophylaxis with one of the following:
- Valacyclovir (Valtrex) 500 mg PO once daily
- Acyclovir (Zovirax) 200-400 mg PO BID
References
- 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. doi:10.1200/JCO.2012.44.7920. Epub 2012 Dec 10. link to original article contains verified protocol PubMed
MCP
MCP: Mitoxantrone, Chlorambucil, Prednisolone
Regimen
- Mitoxantrone (Novantrone) 8 mg/m2 IV once daily on days 1 & 2
- 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 1-5
- Prednisolone (Millipred) 25 mg/m2 PO/IV once daily on days 1-5
28-day cycles x up to 8 cycles
References
- 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
Rituximab (Rituxan)
Level of Evidence: Phase II
Regimen
- Rituximab (Rituxan) 375 mg/m2 IV once daily on days 1, 8, 15, 21
References
- 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
- 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
Rituximab (Rituxan) & Chlorambucil (Leukeran)
Regimen, Zucca, et al. 2013 - IELSG-19
Induction phase
- Rituximab (Rituxan) 375 mg/m2 IV once daily on days 1, 8, 15, 22
- Chlorambucil (Leukeran) 6 mg/m2 PO daily on days 1-42
Stable disease & responders -> consolidation phase
- Rituximab (Rituxan) 375 mg/m2 IV once on day 1
- Chlorambucil (Leukeran) 6 mg/m2 PO daily on days 1-14
28-day cycles x up to 4 cycles
References
- 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. doi: 10.1200/JCO.2011.40.6272. Epub 2013 Jan 7. link to original article contains verified protocol PubMed
Rituximab (Rituxan) & Fludarabine (Fludara) (R-Flu)
R-Flu: Rituximab, Fludarabine
Regimen
- Rituximab (Rituxan) 375 mg/m2 IV once on day 1
- Fludarabine (Fludara) 25 mg/m2 IV (or 40 mg/m2 PO) once daily on days 1-5
- Patients with gastric lymphoma received the cycle 1 dose intravenously to guarantee drug absorption
- Patients >70 years old could receive fludarabine at the above dose, but only once daily on days 1-3
28-day cycles for 4-6 cycles
Supportive medications:
- Trimethoprim/Sulfamethoxazole prophylaxis (dose/schedule not listed) per physician preference
- No routine antiviral prophylaxis or G-CSF use
References
- 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. doi: 10.1002/cncr.24605. link to orginal article contains verified protocol PubMed