Difference between revisions of "Adult T-cell leukemia-lymphoma"
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===Regimen {{#subobject:b1307e|Variant=1}}=== | ===Regimen {{#subobject:b1307e|Variant=1}}=== | ||
{| class="wikitable" style="width: 100%; text-align:center;" | {| class="wikitable" style="width: 100%; text-align:center;" | ||
− | !Study | + | !style="width: 50%"|Study |
− | ![[Levels_of_Evidence#Evidence|Evidence]] | + | !style="width: 50%"|[[Levels_of_Evidence#Evidence|Evidence]] |
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|[https://www.nejm.org/doi/10.1056/NEJM199506293322603 Gill et al. 1995] | |[https://www.nejm.org/doi/10.1056/NEJM199506293322603 Gill et al. 1995] | ||
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===Regimen {{#subobject:2fae5f|Variant=1}}=== | ===Regimen {{#subobject:2fae5f|Variant=1}}=== | ||
{| class="wikitable" style="width: 100%; text-align:center;" | {| class="wikitable" style="width: 100%; text-align:center;" | ||
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− | ![[Levels_of_Evidence#Evidence|Evidence]] | + | !style="width: 50%"|[[Levels_of_Evidence#Evidence|Evidence]] |
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|[https://onlinelibrary.wiley.com/doi/10.1046/j.1365-2141.2001.02737.x/full Yamada et al. 2001 (JCOG 9303)] | |[https://onlinelibrary.wiley.com/doi/10.1046/j.1365-2141.2001.02737.x/full Yamada et al. 2001 (JCOG 9303)] | ||
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===Regimen {{#subobject:32e392|Variant=1}}=== | ===Regimen {{#subobject:32e392|Variant=1}}=== | ||
{| class="wikitable" style="width: 100%; text-align:center;" | {| class="wikitable" style="width: 100%; text-align:center;" | ||
− | !Study | + | !style="width: 50%"|Study |
− | ![[Levels_of_Evidence#Evidence|Evidence]] | + | !style="width: 50%"|[[Levels_of_Evidence#Evidence|Evidence]] |
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|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5215752/ Sharma et al. 2016] | |[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5215752/ Sharma et al. 2016] |
Revision as of 01:51, 19 August 2018
5 regimens on this page
5 variants on this page
|
Guidelines
NCCN
Untreated
CHOP-14
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CHOP-14: Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Oncovin (Vincristine), Prednisone every 14 days
CHOP-DI: Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Oncovin (Vincristine), Prednisone, Dose-Intense
I-CHOP: Intensive Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Oncovin (Vincristine), Prednisone
Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Tsukasaki et al. 2007 (JCOG 9801) | Phase III (C) | mLSG15 | Seems to have inferior CR rate |
Chemotherapy
- Cyclophosphamide (Cytoxan) 750 mg/m2 IV once on day 1
- Doxorubicin (Adriamycin) 50 mg/m2 IV once on day 1
- Vincristine (Oncovin) 1.4 mg/m2 (max dose 2 mg) IV once on day 1
- Prednisone (Sterapred) 100 mg PO once per day on days 1 to 5
Supportive medications
- Filgrastim (Neupogen) given once ANC decreased to less than 1000/uL and continued once per day until count increased to greater than 5000/uL
14-day cycle for 8 cycles
Intrathecal component
Intrathecal triple-therapy was given during recovery phase of cycles 1, 3, and 5 after platelet count was greater than 70 × 109/L.
- Cytarabine (Cytosar) 40 mg IT
- Methotrexate (MTX) 15 mg IT
- Prednisone (Sterapred) 10 mg IT
3 doses, total
References
- Tsukasaki K, Utsunomiya A, Fukuda H, Shibata T, Fukushima T, Takatsuka Y, Ikeda S, Masuda M, Nagoshi H, Ueda R, Tamura K, Sano M, Momita S, Yamaguchi K, Kawano F, Hanada S, Tobinai K, Shimoyama M, Hotta T, Tomonaga M; Japan Clinical Oncology Group Study JCOG9801. VCAP-AMP-VECP compared with biweekly CHOP for adult T-cell leukemia-lymphoma: Japan Clinical Oncology Group Study JCOG9801. J Clin Oncol. 2007 Dec 1;25(34):5458-64. Epub 2007 Oct 29. link to original article contains verified protocol PubMed
Interferon alfa-2b & Zidovudine
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Regimen
Study | Evidence |
---|---|
Gill et al. 1995 | Non-randomized, <20 pts |
Of historic interest.
Immunotherapy
References
- Gill PS, Harrington W Jr, Kaplan MH, Ribeiro RC, Bennett JM, Liebman HA, Bernstein-Singer M, Espina BM, Cabral L, Allen S, Kornblau S, Pike MC, Levine AM. Treatment of adult T-cell leukemia-lymphoma with a combination of interferon alfa and zidovudine. N Engl J Med. 1995 Jun 29;332(26):1744-8. link to original article PubMed
LSG15
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Regimen
Study | Evidence |
---|---|
Yamada et al. 2001 (JCOG 9303) | Phase II |
Ranimustine is not available in the United States and is approved only in Japan. This regimen was notable for excess CNS relapses and was subsequently replaced by mLSG15.
Chemotherapy
- Vincristine (Oncovin) 1 mg/m2 (maximum dose = 2 mg) IV once on day 1
- Cyclophosphamide (Cytoxan) 350 mg/m2 IV once on day 1
- Doxorubicin (Adriamycin) 40 mg/m2 IV once on day 1, then 30 mg/m2 IV once on day 8
- Prednisone (Sterapred) 40 mg/m2 PO once per day on days 1, 8, 15 to 17
- Ranimustine (Cymerin) 60 mg/m2 IV once on day 8
- Vindesine (Eldisine) 2.4 mg/m2 IV once on day 15
- Etoposide (Vepesid) 100 mg/m2 IV once per day on days 15 to 17
- Carboplatin (Paraplatin) 250 mg/m2 IV once on day 15
28-day cycle for 7 cycles
References
- Yamada Y, Tomonaga M, Fukuda H, Hanada S, Utsunomiya A, Tara M, Sano M, Ikeda S, Takatsuki K, Kozuru M, Araki K, Kawano F, Niimi M, Tobinai K, Hotta T, Shimoyama M. A new G-CSF-supported combination chemotherapy, LSG15, for adult T-cell leukaemia-lymphoma: Japan Clinical Oncology Group Study 9303. Br J Haematol. 2001 May;113(2):375-82. link to original article PubMed
mLSG15
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Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Tsukasaki et al. 2007 (JCOG 9801) | Phase III (E) | CHOP-14 | Seems to have superior CR rate |
Ishida et al. 2015 | Randomized Phase II (C) | mLSG15 & Mogamulizumab | Seems not superior |
Ranimustine is not available in the United States and is approved only in Japan.
Chemotherapy
- Vincristine (Oncovin) 1 mg/m2 (maximum dose = 2 mg) IV once on day 1
- Cyclophosphamide (Cytoxan) 350 mg/m2 IV once on day 1
- Doxorubicin (Adriamycin) 40 mg/m2 IV once on day 1, then 30 mg/m2 IV once on day 8
- Prednisone (Sterapred) 40 mg/m2 PO once per day on days 1, 8, 15 to 17
- Ranimustine (Cymerin) 60 mg/m2 IV once on day 8
- Vindesine (Eldisine) 2.4 mg/m2 IV once on day 15
- Etoposide (Vepesid) 100 mg/m2 IV once per day on days 15 to 17
- Carboplatin (Paraplatin) 250 mg/m2 IV once on day 15
28-day cycle for 6 cycles
CNS prophylaxis
- Cytarabine (Cytosar) 40 mg mixed with Methotrexate (MTX) 15 mg and Prednisone (Sterapred) 10 mg IT
Given after cycles 1, 3, and 5 after platelets greater than 70 × 109/L and within 2 days before the next cycle
References
- Tsukasaki K, Utsunomiya A, Fukuda H, Shibata T, Fukushima T, Takatsuka Y, Ikeda S, Masuda M, Nagoshi H, Ueda R, Tamura K, Sano M, Momita S, Yamaguchi K, Kawano F, Hanada S, Tobinai K, Shimoyama M, Hotta T, Tomonaga M; Japan Clinical Oncology Group Study JCOG9801. VCAP-AMP-VECP compared with biweekly CHOP for adult T-cell leukemia-lymphoma: Japan Clinical Oncology Group Study JCOG9801. J Clin Oncol. 2007 Dec 1;25(34):5458-64. Epub 2007 Oct 29. link to original article contains verified protocol PubMed
- Ishida T, Jo T, Takemoto S, Suzushima H, Uozumi K, Yamamoto K, Uike N, Saburi Y, Nosaka K, Utsunomiya A, Tobinai K, Fujiwara H, Ishitsuka K, Yoshida S, Taira N, Moriuchi Y, Imada K, Miyamoto T, Akinaga S, Tomonaga M, Ueda R. Dose-intensified chemotherapy alone or in combination with mogamulizumab in newly diagnosed aggressive adult T-cell leukaemia-lymphoma: a randomized phase II study. Br J Haematol. 2015 Jun;169(5):672-82. Epub 2015 Mar 2. link to original article link to PMC article PubMed
Relapsed or refractory
Alemtuzumab monotherapy
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Regimen
Study | Evidence |
---|---|
Sharma et al. 2016 | Phase II |
Chemotherapy
- Alemtuzumab (Campath) 30 mg IV TIW (three times per week)
Up to 12-week course
References
- Sharma K, Janik JE, O'Mahony D, Stewart D, Pittaluga S, Stetler-Stevenson M, Jaffe ES, Raffeld M, Fleisher TA, Lee CC, Steinberg SM, Waldmann TA, Morris JC. Phase II Study of Alemtuzumab (CAMPATH-1) in Patients with HTLV-1-Associated Adult T-cell Leukemia/lymphoma. Clin Cancer Res. 2017 Jan 1;23(1):35-42. Epub 2016 Aug 2. link to original article contain protocol link to PMC article PubMed
Lenalidomide monotherapy
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Regimen
Study | Evidence | ORR |
---|---|---|
Ishida et al. 2016 (ATLL-002) | Phase II | 42% (95% CI 23-63) |
Chemotherapy
- Lenalidomide (Revlimid) 25 mg PO once per day
Continued until progression
References
- ATLL-002: Ishida T, Fujiwara H, Nosaka K, Taira N, Abe Y, Imaizumi Y, Moriuchi Y, Jo T, Ishizawa K, Tobinai K, Tsukasaki K, Ito S, Yoshimitsu M, Otsuka M, Ogura M, Midorikawa S, Ruiz W, Ohtsu T. Multicenter Phase II Study of Lenalidomide in Relapsed or Recurrent Adult T-Cell Leukemia/Lymphoma: ATLL-002. J Clin Oncol. 2016 Dec;34(34):4086-4093. link to original article PubMed