Difference between revisions of "T-cell lymphoma"

From HemOnc.org - A Hematology Oncology Wiki
Jump to navigation Jump to search
m
Line 11: Line 11:
  
 
===Regimen, Jaccard et al. 2011===
 
===Regimen, Jaccard et al. 2011===
−
Level of Evidence:
+
 
 
<span  
 
<span  
 
style="background:#EEEE00;
 
style="background:#EEEE00;
Line 25: Line 25:
 
*[[Dexamethasone (Decadron)]] 40 mg PO once per day on days 1 to 4
 
*[[Dexamethasone (Decadron)]] 40 mg PO once per day on days 1 to 4
 
**Patients >70 years old received [[Dexamethasone (Decadron)]] 20 mg PO once per day on days 1 to 4
 
**Patients >70 years old received [[Dexamethasone (Decadron)]] 20 mg PO once per day on days 1 to 4
−
 
−
'''21-day cycles x 3 cycles'''; see Jaccard et al. 2011 for details about further treatment
 
  
 
Supportive medications:
 
Supportive medications:
−
*[[Trimethoprim/Sulfamethoxazole (Bactrim DS)]] (dose/route/schedule not specified) prophylaxis, discontinued during methotrexate administration
+
*[[Trimethoprim/Sulfamethoxazole (Bactrim DS)]] (dose/route/schedule not specified) prophylaxis, discontinued during [[Methotrexate (MTX)]] administration
 
*[[Valacyclovir (Valtrex)]] (dose/route/schedule not specified) prophylaxis
 
*[[Valacyclovir (Valtrex)]] (dose/route/schedule not specified) prophylaxis
−
*For methotrexate: alkaline hydration and [[Folinic acid (Leucovorin)]] rescue (dose/route/schedule not specified)
+
*For [[Methotrexate (MTX)]]: alkaline hydration and [[Folinic acid (Leucovorin)]] rescue (dose/route/schedule not specified)
 +
 
 +
'''21-day cycles x 3 cycles'''; see Jaccard et al. 2011 for details about further treatment
  
 
===References===
 
===References===
Line 40: Line 40:
  
 
===Regimen, Kim et al. 2009===
 
===Regimen, Kim et al. 2009===
−
Level of Evidence:
+
 
 
<span  
 
<span  
 
style="background:#EEEE00;
 
style="background:#EEEE00;
Line 56: Line 56:
 
*[[Etoposide (Vepesid)]] 100 mg/m2 IV over 90 minutes once per day on days 1 to 3
 
*[[Etoposide (Vepesid)]] 100 mg/m2 IV over 90 minutes once per day on days 1 to 3
 
*[[Ifosfamide (Ifex)]] 1200 mg/m2 IV over 1 hour once per day on days 1 to 3
 
*[[Ifosfamide (Ifex)]] 1200 mg/m2 IV over 1 hour once per day on days 1 to 3
−
*[[Mesna (Mesnex)]] 240 mg/m2 IV over 15 minutes once per day on days 1 to 3
 
 
*[[Cisplatin (Platinol)]] 33 mg/m2 IV over 1 hour once per day on days 1 to 3
 
*[[Cisplatin (Platinol)]] 33 mg/m2 IV over 1 hour once per day on days 1 to 3
 
*[[Dexamethasone (Decadron)]] 40 mg PO/IV once per day on days 1 to 4
 
*[[Dexamethasone (Decadron)]] 40 mg PO/IV once per day on days 1 to 4
−
 
−
'''21-day cycles x up to 3 cycles'''
 
  
 
Supportive medications:
 
Supportive medications:
 +
*[[Mesna (Mesnex)]] 240 mg/m2 IV over 15 minutes once per day on days 1 to 3
 
*[[Filgrastim (Neupogen)|G-CSF]] given for grade 3 or 4 neutropenia
 
*[[Filgrastim (Neupogen)|G-CSF]] given for grade 3 or 4 neutropenia
 +
 +
'''21-day cycles x up to 3 cycles'''
  
 
===References===
 
===References===
Line 72: Line 72:
  
 
===Regimen, Yamaguchi et al. 2009 (JCOG0211)===
 
===Regimen, Yamaguchi et al. 2009 (JCOG0211)===
−
Level of Evidence:
+
 
 
<span  
 
<span  
 
style="background:#EEEE00;
 
style="background:#EEEE00;
Line 91: Line 91:
 
*[[Ifosfamide (Ifex)]] 1500 mg/m2 IV over 3 hours once per day on days 1 to 3
 
*[[Ifosfamide (Ifex)]] 1500 mg/m2 IV over 3 hours once per day on days 1 to 3
 
*[[Carboplatin (Paraplatin)]] 300 mg/m2 IV over 30 minutes once on day 1
 
*[[Carboplatin (Paraplatin)]] 300 mg/m2 IV over 30 minutes once on day 1
−
 
−
'''21-day cycles x 3 cycles'''
 
  
 
Supportive medications:
 
Supportive medications:
 
*[[Filgrastim (Neupogen)]] (dose/route/schedule not specified) started for leukocyte count <2,000/μL or ANC <1,000/μL; discontinued if leukocyte count >5,000/μL.
 
*[[Filgrastim (Neupogen)]] (dose/route/schedule not specified) started for leukocyte count <2,000/μL or ANC <1,000/μL; discontinued if leukocyte count >5,000/μL.
 +
 +
'''21-day cycles x 3 cycles'''
  
 
====Concurrent radiation therapy====
 
====Concurrent radiation therapy====
Line 110: Line 110:
  
 
===Regimen===
 
===Regimen===
−
Level of Evidence:
+
 
 
<span  
 
<span  
 
style="background:#EEEE00;
 
style="background:#EEEE00;
Line 135: Line 135:
  
 
===Regimen===
 
===Regimen===
−
Level of Evidence:
+
 
 
<span  
 
<span  
 
style="background:#ff0000;
 
style="background:#ff0000;
Line 156: Line 156:
  
 
===Regimen===
 
===Regimen===
−
Level of Evidence:
+
 
 
<span  
 
<span  
 
style="background:#EEEE00;
 
style="background:#EEEE00;
Line 181: Line 181:
  
 
===Regimen===
 
===Regimen===
−
Level of Evidence:
+
 
 
<span  
 
<span  
 
style="background:#EEEE00;
 
style="background:#EEEE00;
Line 191: Line 191:
 
*[[Dexamethasone (Decadron)]] 40 mg PO/IV once per day on days 2 to 4
 
*[[Dexamethasone (Decadron)]] 40 mg PO/IV once per day on days 2 to 4
 
*[[Methotrexate (MTX)]] 2000 mg/m2 IV over 6 hours once on day 1
 
*[[Methotrexate (MTX)]] 2000 mg/m2 IV over 6 hours once on day 1
−
*[[Folinic acid (Leucovorin)]] 15 mg PO/IV Q6H x 4 doses per day on days 2 to 4, beginning 30 hours after completion of methotrexate
 
 
*[[Ifosfamide (Ifex)]] 1500 mg/m2 IV once per day on days 2 to 4
 
*[[Ifosfamide (Ifex)]] 1500 mg/m2 IV once per day on days 2 to 4
−
*[[Mesna (Mesnex)]] 300 mg/m2 IV three times per day on days 2 to 4; first dose given together with ifosfamide, second dose given at 4 hours after start of ifosfamide, and third dose given 8 hours after start of ifosfamide
 
 
*[[Asparaginase (Elspar)]] 6000 units/m2 IV once per day on days 8, 10, 12, 14, 16, 18, 20
 
*[[Asparaginase (Elspar)]] 6000 units/m2 IV once per day on days 8, 10, 12, 14, 16, 18, 20
 
*[[Etoposide (Vepesid)]] 100 mg/m2 IV once per day on days 2 to 4
 
*[[Etoposide (Vepesid)]] 100 mg/m2 IV once per day on days 2 to 4
−
 
−
'''28-day cycles x 2 cycles'''; after 2 cycles, patients could receive additional treatment with SMILE and/or other chemotherapy, with or without autologous/allogeneic stem cell transplant.
 
  
 
Supportive medications:
 
Supportive medications:
 +
*[[Folinic acid (Leucovorin)]] 15 mg PO/IV Q6H x 4 doses per day on days 2 to 4, beginning 30 hours after completion of [[Methotrexate (MTX)]]
 +
*[[Mesna (Mesnex)]] 300 mg/m2 IV three times per day on days 2 to 4; first dose given together with [[Ifosfamide (Ifex)]], second dose given at 4 hours after start of [[Ifosfamide (Ifex)]], and third dose given 8 hours after start of [[Ifosfamide (Ifex)]]
 
*[[Filgrastim (Neupogen)]] (dose not specified) SC/IV once per day starting on day 6, given until WBC >5 x 10<sup>9</sup>/L
 
*[[Filgrastim (Neupogen)]] (dose not specified) SC/IV once per day starting on day 6, given until WBC >5 x 10<sup>9</sup>/L
 
*[[Trimethoprim/Sulfamethoxazole (Bactrim DS)]] prophylaxis recommended
 
*[[Trimethoprim/Sulfamethoxazole (Bactrim DS)]] prophylaxis recommended
 +
 +
'''28-day cycles x 2 cycles'''; after 2 cycles, patients could receive additional treatment with SMILE and/or other chemotherapy, with or without autologous/allogeneic stem cell transplant.
  
 
===References===
 
===References===
Line 213: Line 213:
  
 
===Regimen===
 
===Regimen===
−
Level of Evidence:
+
 
 
<span  
 
<span  
 
style="background:#EEEE00;
 
style="background:#EEEE00;
Line 224: Line 224:
 
*[[Methotrexate (MTX)]] 2000 mg/m2 in 500 mL normal saline IV over 6 hours once on day 1
 
*[[Methotrexate (MTX)]] 2000 mg/m2 in 500 mL normal saline IV over 6 hours once on day 1
 
**Methotrexate levels checked at 24, 48, and 72 hours after methotrexate is given, or until methotrexate levels fall below toxic range.  Folinic acid should be continued until methotrexate levels are below toxic range.
 
**Methotrexate levels checked at 24, 48, and 72 hours after methotrexate is given, or until methotrexate levels fall below toxic range.  Folinic acid should be continued until methotrexate levels are below toxic range.
−
*[[Folinic acid (Leucovorin)]] 45 mg PO Q6H x 4 doses per day on days 2 to 4 (or until methotrexate is below the toxic range), starting 24 hours after completion of methotrexate
 
 
*[[Ifosfamide (Ifex)]] 1500 mg/m2 in 1 liter normal saline IV over 6 hours once per day on days 2 to 4, given together with mesna
 
*[[Ifosfamide (Ifex)]] 1500 mg/m2 in 1 liter normal saline IV over 6 hours once per day on days 2 to 4, given together with mesna
−
*[[Mesna (Mesnex)]] 900 mg/m2 IV over 6 hours once per day on days 2 to 4, given together with ifosfamide
 
 
*[[Asparaginase (Elspar)]] 6000 units/m2 in 250 mL normal saline IV over 2 hours once per day on days 8, 10, 12, 14, 16, 18, 20
 
*[[Asparaginase (Elspar)]] 6000 units/m2 in 250 mL normal saline IV over 2 hours once per day on days 8, 10, 12, 14, 16, 18, 20
 
**Skin test done for asparaginase before each dose; [[Asparaginase Erwinia chrysanthemi (Erwinaze)]] used for patients who developed sensitivity to L-asparaginase from E. coli
 
**Skin test done for asparaginase before each dose; [[Asparaginase Erwinia chrysanthemi (Erwinaze)]] used for patients who developed sensitivity to L-asparaginase from E. coli
 
*[[Etoposide (Vepesid)]] 100 mg/m2 in 500 mL normal saline IV over 2 hours once per day on days 2 to 4
 
*[[Etoposide (Vepesid)]] 100 mg/m2 in 500 mL normal saline IV over 2 hours once per day on days 2 to 4
−
 
−
'''up to 6 cycles given'''; paper and supplement did not specify the length of each cycle, but other SMILE regimens, e.g. Yamaguchi et al. 2011 above, describe 28-day cycles
 
  
 
Supportive medications:
 
Supportive medications:
−
*Hydration with normal saline (no volume specified) Q8H x 1 day prior to methotrexate
+
*[[Folinic acid (Leucovorin)]] 45 mg PO Q6H x 4 doses per day on days 2 to 4 (or until serum methotrexate level is below the toxic range), starting 24 hours after completion of [[Methotrexate (MTX)]]
 +
*[[Mesna (Mesnex)]] 900 mg/m2 IV over 6 hours once per day on days 2 to 4, given together with [[Ifosfamide (Ifex)]]
 +
*Hydration with normal saline (no volume specified) Q8H x 1 day prior to [[Methotrexate (MTX)]]
 
*Patients told to drink at least 2 liters of fluid per day on days 1 to 4; target urine output of ≥3 liters per day on days 1 to 4
 
*Patients told to drink at least 2 liters of fluid per day on days 1 to 4; target urine output of ≥3 liters per day on days 1 to 4
 
*[[Filgrastim (Neupogen)]] 300 mcg SC once per day, starting on day 6, given until ANC >1 x 10<sup>9</sup>/L
 
*[[Filgrastim (Neupogen)]] 300 mcg SC once per day, starting on day 6, given until ANC >1 x 10<sup>9</sup>/L
 
*[[Trimethoprim/Sulfamethoxazole (Bactrim DS)|Cotrimoxazole]] or [[Pentamidine (Nebupent)]] for PJP prophylaxis
 
*[[Trimethoprim/Sulfamethoxazole (Bactrim DS)|Cotrimoxazole]] or [[Pentamidine (Nebupent)]] for PJP prophylaxis
−
*Famotidine (Pepcid) and potassium slow release tablets (no dose specified) "for dexamethasone" on days 2 to 4
+
*[[Famotidine (Pepcid)]] and potassium slow release tablets (no dose specified) "for [[Dexamethasone (Decadron)]]" on days 2 to 4
−
*Chlorpheniramine (note: was spelled in the protocol as "chlorphenarime") 10 mg PO once prior to L-asparaginase infusions on days 8, 10, 12, 14, 16, 18, 20
+
*Chlorpheniramine (note: was spelled in the protocol as "chlorphenarime") 10 mg PO once prior to [[Asparaginase (Elspar)]] infusions on days 8, 10, 12, 14, 16, 18, 20
−
*Hydrocortisone (Cortef) 100 mg IV once prior to L-asparaginase infusions on days 8, 10, 12, 14, 16, 18, 20
+
*[[Hydrocortisone (Cortef)]] 100 mg IV once prior to [[Asparaginase (Elspar)]] infusions on days 8, 10, 12, 14, 16, 18, 20
 +
 
 +
'''up to 6 cycles given'''; paper and supplement did not specify the length of each cycle, but other SMILE regimens, e.g. Yamaguchi et al. 2011 above, describe 28-day cycles
  
 
===References===
 
===References===
Line 251: Line 251:
  
 
===Regimen===
 
===Regimen===
−
Level of Evidence:
+
 
 
<span  
 
<span  
 
style="background:#EEEE00;
 
style="background:#EEEE00;
Line 262: Line 262:
 
*[[Methotrexate (MTX)]] 2000 mg/m2 in 500 mL normal saline IV over 6 hours once on day 1
 
*[[Methotrexate (MTX)]] 2000 mg/m2 in 500 mL normal saline IV over 6 hours once on day 1
 
**Methotrexate levels checked at 24, 48, and 72 hours after methotrexate is given, or until methotrexate levels fall below toxic range.  Folinic acid should be continued until methotrexate levels are below toxic range.
 
**Methotrexate levels checked at 24, 48, and 72 hours after methotrexate is given, or until methotrexate levels fall below toxic range.  Folinic acid should be continued until methotrexate levels are below toxic range.
−
*[[Folinic acid (Leucovorin)]] 45 mg PO Q6H x 4 doses per day on days 2 to 4 (or until methotrexate is below the toxic range), starting 24 hours after completion of methotrexate
 
 
*[[Ifosfamide (Ifex)]] 1500 mg/m2 in 1 liter normal saline IV over 6 hours once per day on days 2 to 4, given together with mesna
 
*[[Ifosfamide (Ifex)]] 1500 mg/m2 in 1 liter normal saline IV over 6 hours once per day on days 2 to 4, given together with mesna
−
*[[Mesna (Mesnex)]] 900 mg/m2 IV over 6 hours once per day on days 2 to 4, given together with ifosfamide
 
 
*[[Asparaginase (Elspar)]] 6000 units/m2 in 250 mL normal saline IV over 2 hours once per day on days 8, 10, 12, 14, 16, 18, 20
 
*[[Asparaginase (Elspar)]] 6000 units/m2 in 250 mL normal saline IV over 2 hours once per day on days 8, 10, 12, 14, 16, 18, 20
 
**Skin test done for asparaginase before each dose; [[Asparaginase Erwinia chrysanthemi (Erwinaze)]] used for patients who developed sensitivity to L-asparaginase from E. coli
 
**Skin test done for asparaginase before each dose; [[Asparaginase Erwinia chrysanthemi (Erwinaze)]] used for patients who developed sensitivity to L-asparaginase from E. coli
 
*[[Etoposide (Vepesid)]] 100 mg/m2 in 500 mL normal saline IV over 2 hours once per day on days 2 to 4
 
*[[Etoposide (Vepesid)]] 100 mg/m2 in 500 mL normal saline IV over 2 hours once per day on days 2 to 4
−
 
−
'''up to 6 cycles given'''; paper and supplement did not specify the length of each cycle, but other SMILE regimens, e.g. Yamaguchi et al. 2011 above, describe 28-day cycles
 
  
 
Supportive medications:
 
Supportive medications:
 +
*[[Folinic acid (Leucovorin)]] 45 mg PO Q6H x 4 doses per day on days 2 to 4 (or until serum methotrexate level is below the toxic range), starting 24 hours after completion of [[Methotrexate (MTX)]]
 +
*[[Mesna (Mesnex)]] 900 mg/m2 IV over 6 hours once per day on days 2 to 4, given together with [[Ifosfamide (Ifex)]]
 
*Hydration with normal saline (no volume specified) Q8H x 1 day prior to methotrexate
 
*Hydration with normal saline (no volume specified) Q8H x 1 day prior to methotrexate
 
*Patients told to drink at least 2 liters of fluid per day on days 1 to 4; target urine output of ≥3 liters per day on days 1 to 4
 
*Patients told to drink at least 2 liters of fluid per day on days 1 to 4; target urine output of ≥3 liters per day on days 1 to 4
 
*[[Filgrastim (Neupogen)]] 300 mcg SC once per day, starting on day 6, given until ANC >1 x 10<sup>9</sup>/L
 
*[[Filgrastim (Neupogen)]] 300 mcg SC once per day, starting on day 6, given until ANC >1 x 10<sup>9</sup>/L
 
*[[Trimethoprim/Sulfamethoxazole (Bactrim DS)|Cotrimoxazole]] or [[Pentamidine (Nebupent)]] for PJP prophylaxis
 
*[[Trimethoprim/Sulfamethoxazole (Bactrim DS)|Cotrimoxazole]] or [[Pentamidine (Nebupent)]] for PJP prophylaxis
−
*Famotidine (Pepcid) and potassium slow release tablets (no dose specified) "for dexamethasone" on days 2 to 4
+
*[[Famotidine (Pepcid)]] and potassium slow release tablets (no dose specified) "for [[Dexamethasone (Decadron)]]" on days 2 to 4
−
*Chlorpheniramine (note: was spelled in the protocol as "chlorphenarime") 10 mg PO once prior to L-asparaginase infusions on days 8, 10, 12, 14, 16, 18, 20
+
*Chlorpheniramine (note: was spelled in the protocol as "chlorphenarime") 10 mg PO once prior to [[Asparaginase (Elspar)]] infusions on days 8, 10, 12, 14, 16, 18, 20
−
*Hydrocortisone (Cortef) 100 mg IV once prior to L-asparaginase infusions on days 8, 10, 12, 14, 16, 18, 20
+
*[[Hydrocortisone (Cortef)]] 100 mg IV once prior to [[Asparaginase (Elspar)]] infusions on days 8, 10, 12, 14, 16, 18, 20
 +
 
 +
'''up to 6 cycles given'''; paper and supplement did not specify the length of each cycle, but other SMILE regimens, e.g. Yamaguchi et al. 2011 above, describe 28-day cycles
  
 
===References===
 
===References===
Line 288: Line 288:
  
 
===Regimen, Demaj et al. 2013 (BENTLY)===
 
===Regimen, Demaj et al. 2013 (BENTLY)===
−
Level of Evidence:
+
 
 
<span  
 
<span  
 
style="background:#EEEE00;
 
style="background:#EEEE00;
Line 306: Line 306:
  
 
===Regimen, Morschhauser et al. 2013 (EXPECT)===
 
===Regimen, Morschhauser et al. 2013 (EXPECT)===
−
Level of Evidence:
+
 
 
<span  
 
<span  
 
style="background:#EEEE00;
 
style="background:#EEEE00;
Line 327: Line 327:
  
 
===Regimen, O'Connor et al. 2011 (PROPEL)===
 
===Regimen, O'Connor et al. 2011 (PROPEL)===
−
Level of Evidence:
+
 
 
<span  
 
<span  
 
style="background:#EEEE00;
 
style="background:#EEEE00;
Line 336: Line 336:
  
 
*[[Pralatrexate (Folotyn)]] 30 mg/m2 IV push over 3 to 5 minutes once per day on days 1, 8, 15, 22, 29, 36
 
*[[Pralatrexate (Folotyn)]] 30 mg/m2 IV push over 3 to 5 minutes once per day on days 1, 8, 15, 22, 29, 36
−
 
−
'''7-week cycles,  given until progression of disease, unacceptable toxicity, or patient/physician preference'''
 
  
 
Supportive medications:
 
Supportive medications:
 
*[[Cyanocobalamin (Vitamin B12)]] 1 mg IM once every 8 to 10 weeks
 
*[[Cyanocobalamin (Vitamin B12)]] 1 mg IM once every 8 to 10 weeks
−
*Folic acid 1 to 1.25 mg PO once per day
+
*[[Folic acid (Folate)]] 1 to 1.25 mg PO once per day
−
*"Elevated methylmalonic acid (>200 nmol/L) and/or homocysteine (>10 μmol/L) at screening required initiation of vitamins ≥ 10 days before the first dose of pralatrexate."
+
**"Elevated methylmalonic acid (>200 nmol/L) and/or homocysteine (>10 μmol/L) at screening required initiation of [[Folic acid (Folate)]] and [[Cyanocobalamin (Vitamin B12)]] ≥ 10 days before the first dose of [[Pralatrexate (Folotyn)]]."
 +
 
 +
'''7-week cycles,  given until progression of disease, unacceptable toxicity, or patient/physician preference'''
  
 
===References===
 
===References===
Line 350: Line 350:
  
 
===Regimen, Coiffier et al. 2012===
 
===Regimen, Coiffier et al. 2012===
−
Level of Evidence:
+
 
 
<span  
 
<span  
 
style="background:#EEEE00;
 
style="background:#EEEE00;
Line 370: Line 370:
  
 
===Regimen, Demaj et al. 2013 (BENTLY)===
 
===Regimen, Demaj et al. 2013 (BENTLY)===
−
Level of Evidence:
+
 
 
<span  
 
<span  
 
style="background:#EEEE00;
 
style="background:#EEEE00;
Line 388: Line 388:
  
 
===Regimen, Olsen et al. 2001 & Prince et al. 2010===
 
===Regimen, Olsen et al. 2001 & Prince et al. 2010===
−
Level of Evidence:
+
 
 
<span  
 
<span  
 
style="background:#00CD00;
 
style="background:#00CD00;
Line 400: Line 400:
 
*[[Denileukin diftitox (Ontak)]] 18 mcg/kg IV over 30 to 60 minutes once per day on days 1 to 5
 
*[[Denileukin diftitox (Ontak)]] 18 mcg/kg IV over 30 to 60 minutes once per day on days 1 to 5
 
**Olsen et al. 2001 & Prince et al. 2010 also investigated [[Denileukin diftitox (Ontak)]] 9 mcg/kg IV once per day on days 1 to 5.  Olsen et al. 2001's [[Denileukin diftitox (Ontak)]] was given over 15 to 60 minutes.
 
**Olsen et al. 2001 & Prince et al. 2010 also investigated [[Denileukin diftitox (Ontak)]] 9 mcg/kg IV once per day on days 1 to 5.  Olsen et al. 2001's [[Denileukin diftitox (Ontak)]] was given over 15 to 60 minutes.
−
 
−
'''21-day cycles x up to 8 cycles; up to 3 additional cycles allowed in the Olsen et al. 2001 trial for patients who had ongoing response'''
 
  
 
Supportive medications:
 
Supportive medications:
−
*"Premedication with acetaminophen [≤ 650 mg in Olsen et al. 2001] and an antihistamine was required 30 to 60 minutes before each infusion" and could be used after infusions as needed.
+
*"Premedication with [[Acetaminophen (Tylenol)]] [≤ 650 mg in Olsen et al. 2001] and an antihistamine was required 30 to 60 minutes before each infusion" and could be used after infusions as needed.
−
*Olsen et al. 2001 used Promethazine (Phenergan) 25 mg or Prochlorperazine (Compazine) 10 mg (route/schedule not specified) as needed for nausea.
+
*Olsen et al. 2001 used [[Promethazine (Phenergan)]] 25 mg or [[Prochlorperazine (Compazine)]] 10 mg (route/schedule not specified) as needed for nausea.
 
*Corticosteroid use was not allowed.
 
*Corticosteroid use was not allowed.
 +
 +
'''21-day cycles x up to 8 cycles; up to 3 additional cycles allowed in the Olsen et al. 2001 trial for patients who had ongoing response'''
  
 
===References===
 
===References===
Line 416: Line 416:
  
 
===Regimen===
 
===Regimen===
−
Level of Evidence:
+
 
 
<span  
 
<span  
 
style="background:#EEEE00;
 
style="background:#EEEE00;
Line 427: Line 427:
  
 
*[[Pralatrexate (Folotyn)]] 15 mg/m2 IV push once per day on days 1, 8, 15
 
*[[Pralatrexate (Folotyn)]] 15 mg/m2 IV push once per day on days 1, 8, 15
−
 
−
'''4-week cycles,  given until progression of disease, unacceptable toxicity, or patient/physician preference'''
 
  
 
Supportive medications:
 
Supportive medications:
 
*[[Cyanocobalamin (Vitamin B12)]] 1 mg IM once every 8 to 10 weeks, within 10 weeks of treatment initiation
 
*[[Cyanocobalamin (Vitamin B12)]] 1 mg IM once every 8 to 10 weeks, within 10 weeks of treatment initiation
−
*Folic acid 1 mg PO once per day, starting at least 10 days prior to treatment initiation
+
*[[Folic acid (Folate)]] 1 mg PO once per day, starting at least 10 days prior to treatment initiation
 +
 
 +
'''4-week cycles,  given until progression of disease, unacceptable toxicity, or patient/physician preference'''
  
 
===References===
 
===References===
Line 438: Line 438:
  
 
==Romidepsin (Istodax)==
 
==Romidepsin (Istodax)==
−
Level of Evidence:
+
 
 
<span  
 
<span  
 
style="background:#EEEE00;
 
style="background:#EEEE00;
Line 458: Line 458:
  
 
===Regimen, Olsen et al. 2007===
 
===Regimen, Olsen et al. 2007===
−
Level of Evidence:
+
 
 
<span  
 
<span  
 
style="background:#EEEE00;
 
style="background:#EEEE00;

Revision as of 23:04, 14 November 2013

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.


Extranodal NK/T-cell lymphoma, nasal type

AspaMetDex

AspaMetDex: Asparaginase, Methotrexate, Dexamethasone

Regimen, Jaccard et al. 2011

Phase II

Supportive medications:

21-day cycles x 3 cycles; see Jaccard et al. 2011 for details about further treatment

References

  1. Jaccard A, Gachard N, Marin B, Rogez S, Audrain M, Suarez F, Tilly H, Morschhauser F, Thieblemont C, Ysebaert L, Devidas A, Petit B, de Leval L, Gaulard P, Feuillard J, Bordessoule D, Hermine O; GELA and GOELAMS Intergroup. Efficacy of L-asparaginase with methotrexate and dexamethasone (AspaMetDex regimen) in patients with refractory or relapsing extranodal NK/T-cell lymphoma, a phase 2 study. Blood. 2011 Feb 10;117(6):1834-9. link to original article contains verified protocol PubMed

Cisplatin & Concurrent RT -> VIPD

VIPD: VP-16, Ifosfamide, Platinol, Dexamethasone

Regimen, Kim et al. 2009

Phase II

Chemoradiation

  • Cisplatin (Platinol) 30 mg/m2 IV once per week
  • Concurrent radiation therapy to the primary tumor, 1.8 to 2 Gy fractions (median total dose: 40 Gy), given 5 times per week.

Chemotherapy

Chemotherapy starts 3 to 5 weeks after the last dose of cisplatin

Supportive medications:

  • Mesna (Mesnex) 240 mg/m2 IV over 15 minutes once per day on days 1 to 3
  • G-CSF given for grade 3 or 4 neutropenia

21-day cycles x up to 3 cycles

References

  1. Kim SJ, Kim K, Kim BS, Kim CY, Suh C, Huh J, Lee SW, Kim JS, Cho J, Lee GW, Kang KM, Eom HS, Pyo HR, Ahn YC, Ko YH, Kim WS. Phase II trial of concurrent radiation and weekly cisplatin followed by VIPD chemotherapy in newly diagnosed, stage IE to IIE, nasal, extranodal NK/T-Cell Lymphoma: Consortium for Improving Survival of Lymphoma study. J Clin Oncol. 2009 Dec 10;27(35):6027-32. link to original article contains verified protocol PubMed

DeVIC & Concurrent RT

DeVIC: Dexamethasone, VP-16, Ifosfamide, Carboplatin

Regimen, Yamaguchi et al. 2009 (JCOG0211)

Phase II

Dose Level I

Dose Level II

Supportive medications:

  • Filgrastim (Neupogen) (dose/route/schedule not specified) started for leukocyte count <2,000/μL or ANC <1,000/μL; discontinued if leukocyte count >5,000/μL.

21-day cycles x 3 cycles

Concurrent radiation therapy

Started simultaneously with the beginning of cycle 1 of chemotherapy

  • Stage IE disease: Concurrent radiation therapy, 2 Gy fractions x 25 fractions (total dose: 50 Gy) over 5 weeks
  • Stage IIE disease: Concurrent radiation therapy, 1.8 Gy fractions x 28 fractions (total dose: 50.4 Gy) over 6 weeks

References

  1. Yamaguchi M, Tobinai K, Oguchi M, Ishizuka N, Kobayashi Y, Isobe Y, Ishizawa K, Maseki N, Itoh K, Usui N, Wasada I, Kinoshita T, Ohshima K, Matsuno Y, Terauchi T, Nawano S, Ishikura S, Kagami Y, Hotta T, Oshimi K. Phase I/II study of concurrent chemoradiotherapy for localized nasal natural killer/T-cell lymphoma: Japan Clinical Oncology Group Study JCOG0211. J Clin Oncol. 2009 Nov 20;27(33):5594-600. link to original article contains verified protocol PubMed
  2. Update: Yamaguchi M, Tobinai K, Oguchi M, Ishizuka N, Kobayashi Y, Isobe Y, Ishizawa K, Maseki N, Itoh K, Usui N, Wasada I, Kinoshita T, Hotta T, Tsukasaki K, Oshimi K. Concurrent chemoradiotherapy for localized nasal natural killer/T-cell lymphoma: an updated analysis of the Japan clinical oncology group study JCOG0211. J Clin Oncol. 2012 Nov 10;30(32):4044-6. doi: 10.1200/JCO.2012.45.6541. Epub 2012 Oct 8. link to original article PubMed

GELOX

GELOX: Gemcitabine, L-asparaginase, Oxaliplatin

Regimen

Phase II

3-weeks cycles for at least 2 cycles, then:

  • Involved field radiation to 56 grays (Gy) in 28 fractions, 5 fractions per week

Followed by more chemotherapy within one week of radiation completion, up to 6 total cycles

References

  1. Wang L, Wang ZH, Chen XQ, Li YJ, Wang KF, Xia YF, Xia ZJ. First-line combination of gemcitabine, oxaliplatin, and L-asparaginase (GELOX) followed by involved-field radiation therapy for patients with stage IE/IIE extranodal natural killer/T-cell lymphoma. Cancer. 2013 Jan 15;119(2):348-55. doi:10.1002/cncr.27752. Epub 2012 Jul 18. link to original article contains verified protocol PubMed

LVP

LVP: L-asparaginase, Vincristine, Prednisolone

Regimen

Phase II, <20 patients reported

Regimen details are from a review article; original article is not available through PubMed

References

  1. Yong W, Zheng W, Zhang Y, Zhu J, Wei Y, Zhu D, Li J. L-asparaginase-based regimen in the treatment of refractory midline nasal/nasal-type T/NK-cell lymphoma. Int J Hematol. 2003 Aug;78(2):163-7. PubMed

LVP "Sandwich"

LVP: L-asparaginase, Vincristine, Prednisolone

Regimen

Phase II

3-week cycles x 2 cycles, then

  • Radiation to the nasal cavity and surrounding sinuses, 56 Gy in 28 fractions, once per day, five days per week

Resume chemotherapy one week after completion of radiation, up to 6 total cycles

References

  1. Jiang M, Zhang H, Jiang Y, Yang Q, Xie L, Liu W, Zhang W, Ji X, Li P, Chen N, Zhao S, Wang F, Zou L. Phase 2 trial of "sandwich" L-asparaginase, vincristine, and prednisone chemotherapy with radiotherapy in newly diagnosed, stage IE to IIE, nasal type, extranodal natural killer/T-cell lymphoma. Cancer. 2012 Jul 1;118(13):3294-301. doi: 10.1002/cncr.26629. Epub 2011 Dec 2. link to original article contains verified protocol PubMed

SMILE

SMILE: Steroid (dexamethasone), Methotrexate, Ifosfamide, L-asparaginase, Etoposide

Regimen

Phase II

Supportive medications:

28-day cycles x 2 cycles; after 2 cycles, patients could receive additional treatment with SMILE and/or other chemotherapy, with or without autologous/allogeneic stem cell transplant.

References

  1. Yamaguchi M, Suzuki R, Kwong YL, Kim WS, Hasegawa Y, Izutsu K, Suzumiya J, Okamura T, Nakamura S, Kawa K, Oshimi K. Phase I study of dexamethasone, methotrexate, ifosfamide, L-asparaginase, and etoposide (SMILE) chemotherapy for advanced-stage, relapsed or refractory extranodal natural killer (NK)/T-cell lymphoma and leukemia. Cancer Sci. 2008 May;99(5):1016-20. doi:10.1111/j.1349-7006.2008.00768.x. Epub 2008 Feb 19. link to original article contains verified protocol PubMed content property of HemOnc.org
  2. Yamaguchi M, Kwong YL, Kim WS, Maeda Y, Hashimoto C, Suh C, Izutsu K, Ishida F, Isobe Y, Sueoka E, Suzumiya J, Kodama T, Kimura H, Hyo R, Nakamura S, Oshimi K, Suzuki R. Phase II study of SMILE chemotherapy for newly diagnosed stage IV, relapsed, or refractory extranodal natural killer (NK)/T-cell lymphoma, nasal type: the NK-Cell Tumor Study Group study. J Clin Oncol. 2011 Nov 20;29(33):4410-6. doi: 10.1200/JCO.2011.35.6287. Epub 2011 Oct 11. link to original article contains verified protocol PubMed

NK/T-cell lymphoma, untreated

SMILE

SMILE: Steroid (dexamethasone), Methotrexate, Ifosfamide, L-asparaginase, Etoposide

Regimen

Phase II

  • Dexamethasone (Decadron) 40 mg PO once per day on days 2 to 4
  • Methotrexate (MTX) 2000 mg/m2 in 500 mL normal saline IV over 6 hours once on day 1
    • Methotrexate levels checked at 24, 48, and 72 hours after methotrexate is given, or until methotrexate levels fall below toxic range. Folinic acid should be continued until methotrexate levels are below toxic range.
  • Ifosfamide (Ifex) 1500 mg/m2 in 1 liter normal saline IV over 6 hours once per day on days 2 to 4, given together with mesna
  • Asparaginase (Elspar) 6000 units/m2 in 250 mL normal saline IV over 2 hours once per day on days 8, 10, 12, 14, 16, 18, 20
  • Etoposide (Vepesid) 100 mg/m2 in 500 mL normal saline IV over 2 hours once per day on days 2 to 4

Supportive medications:

up to 6 cycles given; paper and supplement did not specify the length of each cycle, but other SMILE regimens, e.g. Yamaguchi et al. 2011 above, describe 28-day cycles

References

  1. Kwong YL, Kim WS, Lim ST, Kim SJ, Tang T, Tse E, Leung AY, Chim CS. SMILE for natural killer/T-cell lymphoma: analysis of safety and efficacy from the Asia Lymphoma Study Group. Blood. 2012 Oct 11;120(15):2973-80. doi:10.1182/blood-2012-05-431460. Epub 2012 Aug 23. link to original article supplemental materials supplemental materials contain verified protocol PubMed

NK/T-cell lymphoma, relapsed/refractory

SMILE

SMILE: Steroid (dexamethasone), Methotrexate, Ifosfamide, L-asparaginase, Etoposide

Regimen

Phase II

  • Dexamethasone (Decadron) 40 mg PO once per day on days 2 to 4
  • Methotrexate (MTX) 2000 mg/m2 in 500 mL normal saline IV over 6 hours once on day 1
    • Methotrexate levels checked at 24, 48, and 72 hours after methotrexate is given, or until methotrexate levels fall below toxic range. Folinic acid should be continued until methotrexate levels are below toxic range.
  • Ifosfamide (Ifex) 1500 mg/m2 in 1 liter normal saline IV over 6 hours once per day on days 2 to 4, given together with mesna
  • Asparaginase (Elspar) 6000 units/m2 in 250 mL normal saline IV over 2 hours once per day on days 8, 10, 12, 14, 16, 18, 20
  • Etoposide (Vepesid) 100 mg/m2 in 500 mL normal saline IV over 2 hours once per day on days 2 to 4

Supportive medications:

up to 6 cycles given; paper and supplement did not specify the length of each cycle, but other SMILE regimens, e.g. Yamaguchi et al. 2011 above, describe 28-day cycles

References

  1. Kwong YL, Kim WS, Lim ST, Kim SJ, Tang T, Tse E, Leung AY, Chim CS. SMILE for natural killer/T-cell lymphoma: analysis of safety and efficacy from the Asia Lymphoma Study Group. Blood. 2012 Oct 11;120(15):2973-80. doi:10.1182/blood-2012-05-431460. Epub 2012 Aug 23. link to original article supplemental materials supplemental materials contain verified protocol PubMed

Peripheral T-cell Lymphoma (PTCL)

Bendamustine (Treanda)

Regimen, Demaj et al. 2013 (BENTLY)

Phase II

3-week cycles x 6 cycles

References

  1. Damaj G, Gressin R, Bouabdallah K, Cartron G, Choufi B, Gyan E, Banos A, Jaccard A, Park S, Tournilhac O, Schiano-de Collela JM, Voillat L, Joly B, Le Gouill S, Saad A, Cony-Makhoul P, Vilque JP, Sanhes L, Schmidt-Tanguy A, Bubenheim M, Houot R, Diouf M, Marolleau JP, Béné MC, Martin A, Lamy T. Results from a prospective, open-label, phase II trial of bendamustine in refractory or relapsed T-cell lymphomas: the BENTLY trial. J Clin Oncol. 2013 Jan 1;31(1):104-10. doi: 10.1200/JCO.2012.43.7285. Epub 2012 Oct 29. link to original article contains verified protocol PubMed

Lenalidomide (Revlimid)

Regimen, Morschhauser et al. 2013 (EXPECT)

Phase II

28-day cycles, up to 2 years

References

  1. Morschhauser F, Fitoussi O, Haioun C, Thieblemont C, Quach H, Delarue R, Glaisner S, Gabarre J, Bosly A, Lister J, Li J, Coiffier B. A phase 2, multicentre, single-arm, open-label study to evaluate the safety and efficacy of single-agent lenalidomide (Revlimid®) in subjects with relapsed or refractory peripheral T-cell non-Hodgkin lymphoma: The EXPECT trial. Eur J Cancer. 2013 Sep;49(13):2869-76. Epub 2013 May 31. link to original article contains protocol PubMed

Pralatrexate (Folotyn)

Example orders

Regimen, O'Connor et al. 2011 (PROPEL)

Phase II

Supportive medications:

7-week cycles, given until progression of disease, unacceptable toxicity, or patient/physician preference

References

  1. O'Connor OA, Pro B, Pinter-Brown L, Bartlett N, Popplewell L, Coiffier B, Lechowicz MJ, Savage KJ, Shustov AR, Gisselbrecht C, Jacobsen E, Zinzani PL, Furman R, Goy A, Haioun C, Crump M, Zain JM, Hsi E, Boyd A, Horwitz S. Pralatrexate in patients with relapsed or refractory peripheral T-cell lymphoma: results from the pivotal PROPEL study. J Clin Oncol. 2011 Mar 20;29(9):1182-9. link to original article contains verified protocol PubMed

Romidepsin (Istodax)

Regimen, Coiffier et al. 2012

Phase II

28-day cycles, up to 6 cycles, with optional extension of treatment for patients with stable disease or response

References

  1. Coiffier B, Pro B, Prince HM, Foss F, Sokol L, Greenwood M, Caballero D, Borchmann P, Morschhauser F, Wilhelm M, Pinter-Brown L, Padmanabhan S, Shustov A, Nichols J, Carroll S, Balser J, Balser B, Horwitz S. Results from a pivotal, open-label, phase II study of romidepsin in relapsed or refractory peripheral T-cell lymphoma after prior systemic therapy. J Clin Oncol. 2012 Feb 20;30(6):631-6. doi: 10.1200/JCO.2011.37.4223. Epub 2012 Jan 23. link to original article contains verified protocol PubMed

Cutaneous T-cell Lymphoma (CTCL), relapsed/refractory

Bendamustine (Treanda)

Regimen, Demaj et al. 2013 (BENTLY)

Phase II

3-week cycles x 6 cycles

References

  1. Damaj G, Gressin R, Bouabdallah K, Cartron G, Choufi B, Gyan E, Banos A, Jaccard A, Park S, Tournilhac O, Schiano-de Collela JM, Voillat L, Joly B, Le Gouill S, Saad A, Cony-Makhoul P, Vilque JP, Sanhes L, Schmidt-Tanguy A, Bubenheim M, Houot R, Diouf M, Marolleau JP, Béné MC, Martin A, Lamy T. Results from a prospective, open-label, phase II trial of bendamustine in refractory or relapsed T-cell lymphomas: the BENTLY trial. J Clin Oncol. 2013 Jan 1;31(1):104-10. doi: 10.1200/JCO.2012.43.7285. Epub 2012 Oct 29. link to original article contains verified protocol PubMed

Denileukin Diftitox (Ontak)

Regimen, Olsen et al. 2001 & Prince et al. 2010

Phase III

Dose is that which was recommended by Prince et al. 2010 based on superior response.

Supportive medications:

  • "Premedication with Acetaminophen (Tylenol) [≤ 650 mg in Olsen et al. 2001] and an antihistamine was required 30 to 60 minutes before each infusion" and could be used after infusions as needed.
  • Olsen et al. 2001 used Promethazine (Phenergan) 25 mg or Prochlorperazine (Compazine) 10 mg (route/schedule not specified) as needed for nausea.
  • Corticosteroid use was not allowed.

21-day cycles x up to 8 cycles; up to 3 additional cycles allowed in the Olsen et al. 2001 trial for patients who had ongoing response

References

  1. Olsen E, Duvic M, Frankel A, Kim Y, Martin A, Vonderheid E, Jegasothy B, Wood G, Gordon M, Heald P, Oseroff A, Pinter-Brown L, Bowen G, Kuzel T, Fivenson D, Foss F, Glode M, Molina A, Knobler E, Stewart S, Cooper K, Stevens S, Craig F, Reuben J, Bacha P, Nichols J. Pivotal phase III trial of two dose levels of denileukin diftitox for the treatment of cutaneous T-cell lymphoma. J Clin Oncol. 2001 Jan 15;19(2):376-88. link to original article contains verified protocol PubMed
  2. Prince HM, Duvic M, Martin A, Sterry W, Assaf C, Sun Y, Straus D, Acosta M, Negro-Vilar A. Phase III placebo-controlled trial of denileukin diftitox for patients with cutaneous T-cell lymphoma. J Clin Oncol. 2010 Apr 10;28(11):1870-7. doi: 10.1200/JCO.2009.26.2386. Epub 2010 Mar 8. link to original article contains verified protocol PubMed
  3. Duvic M, Martin AG, Olsen EA, Fivenson DP, Prince HM. Efficacy and safety of denileukin diftitox retreatment in patients with relapsed cutaneous T-cell lymphoma. Leuk Lymphoma. 2013 Mar;54(3):514-9. doi: 10.3109/10428194.2012.720372. Epub 2012 Sep 3. link to original article PubMed

Pralatrexate (Folotyn)

Regimen

Phase II

Dose is that identified as recommended based on de-escalation strategy.

Supportive medications:

4-week cycles, given until progression of disease, unacceptable toxicity, or patient/physician preference

References

  1. Horwitz SM, Kim YH, Foss F, Zain JM, Myskowski PL, Lechowicz MJ, Fisher DC, Shustov AR, Bartlett NL, Delioukina ML, Koutsoukos T, Saunders ME, O'Connor OA, Duvic M. Identification of an active, well-tolerated dose of pralatrexate in patients with relapsed or refractory cutaneous T-cell lymphoma. Blood. 2012 May 3;119(18):4115-22. doi: 10.1182/blood-2011-11-390211. Epub 2012 Mar 6. link to original article contains verified protocol PubMed

Romidepsin (Istodax)

Phase II

Regimen, Whittaker et al. 2010

28-day cycles, up to 6 cycles, with optional extension of treatment for patients with stable disease or response

References

  1. Whittaker SJ, Demierre MF, Kim EJ, Rook AH, Lerner A, Duvic M, Scarisbrick J, Reddy S, Robak T, Becker JC, Samtsov A, McCulloch W, Kim YH. Final results from a multicenter, international, pivotal study of romidepsin in refractory cutaneous T-cell lymphoma. J Clin Oncol. 2010 Oct 10;28(29):4485-91. doi: 10.1200/JCO.2010.28.9066. Epub 2010 Aug 9. link to original article contains verified protocol PubMed

Vorinostat (Zolinza)

Regimen, Olsen et al. 2007

Phase II

Continued on drug until disease progression or intolerable toxicity

References

  1. Olsen EA, Kim YH, Kuzel TM, Pacheco TR, Foss FM, Parker S, Frankel SR, Chen C, Ricker JL, Arduino JM, Duvic M. Phase IIb multicenter trial of vorinostat in patients with persistent, progressive, or treatment refractory cutaneous T-cell lymphoma. J Clin Oncol. 2007 Jul 20;25(21):3109-15. link to original article contains verified protocol PubMed
Retrieved from "https://hemonc.org/w/index.php?title=T-cell_lymphoma&oldid=4027"