Difference between revisions of "Marginal zone lymphoma"
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border-style:solid;">Phase III, <20 in this arm</span> | border-style:solid;">Phase III, <20 in this arm</span> | ||
− | |[[Marginal_zone_lymphoma#BR|BR]] | + | |[[Marginal_zone_lymphoma#BR|BR]]<br> [[Marginal_zone_lymphoma#R-CVP|R-CVP]] |
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*[[Filgrastim (Neupogen)|G-CSF]] "according to the [http://jco.ascopubs.org/content/18/20/3558.full American Society of Clinical Oncology guidelines]" | *[[Filgrastim (Neupogen)|G-CSF]] "according to the [http://jco.ascopubs.org/content/18/20/3558.full American Society of Clinical Oncology guidelines]" | ||
− | '''21-day | + | '''21-day cycle x up to 8 cycles''' |
===References=== | ===References=== |
Revision as of 23:22, 31 December 2015
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21 regimens on this page
22 variants on this page
|
Untreated, randomized data
Note: Untreated in this context implies chemotherapy-naive. Some patients in the following studies, especially those with gastric MALT, received H. pylori eradication therapy or radiation prior to chemotherapy.
BR
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BR: Bendamustine, Rituximab
Regimen
Study | Evidence | Comparator | Efficacy |
Flinn et al. 2014 (BRIGHT) | Phase III | R-CHOP R-CVP |
Equivalent RR |
- Bendamustine (Treanda) 90 mg/m2 IV over 30 minutes once on days 1 & 2
- Rituximab (Rituxan) 375 mg/m2 IV once on day 1
Supportive medications:
- Antiemetics, antipyretics, and antibiotics according to local standard of care
- Prophylactic use of G-CSF allowed according ASCO guidelines (2006)
28-day cycle x up to 8 cycles
References
- Flinn IW, van der Jagt R, Kahl BS, Wood P, Hawkins TE, Macdonald D, Hertzberg M, Kwan YL, Simpson D, Craig M, Kolibaba K, Issa S, Clementi R, Hallman DM, Munteanu M, Chen L, Burke JM. Randomized trial of bendamustine-rituximab or R-CHOP/R-CVP in first-line treatment of indolent NHL or MCL: the BRIGHT study. Blood. 2014 May 8;123(19):2944-52. Epub 2014 Mar 3. link to original article contains verified protocol PubMed
Chlorambucil (Leukeran)
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Regimen #1
Study | Evidence | Comparator | Efficacy |
Leblond et al. 2012 (WM1) | Phase III | Fludarabine | Decreased PFS |
- Chlorambucil (Leukeran) 8 mg/m2 (6 mg/m2 per day if older than 75 years old) PO once per day on days 1 to 10
Supportive medications:
- Recommended PCP prophylaxis with one of the following:
- Trimethoprim/Sulfamethoxazole (Bactrim SS) 1 tablet PO once per day
- Pentamidine (Nebupent) 300 mg inhaled once per month
28-day cycles x up to 12 cycles
Regimen #2
Study | Evidence | Comparator | Efficacy |
Zucca et al. 2013 (IELSG-19) | Phase III | Chlorambucil & Rituximab | Decreased EFS |
Induction phase
- Chlorambucil (Leukeran) 6 mg/m2 PO once per day on days 1 to 42
42-day course of therapy
Stable disease & responders -> consolidation phase
- Chlorambucil (Leukeran) 6 mg/m2 PO once per day on days 1 to 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. 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. Epub 2013 Jan 7. link to original article contains verified protocol PubMed
Chlorambucil & Rituximab
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Regimen
Study | Evidence | Comparator | Efficacy |
Zucca et al. 2013 (IELSG-19) | Phase III | Chlorambucil | Increased EFS |
Induction phase
- Chlorambucil (Leukeran) 6 mg/m2 PO once per day on days 1 to 42
- Rituximab (Rituxan) 375 mg/m2 IV once per day on days 1, 8, 15, 22
Stable disease & responders -> consolidation phase
- Chlorambucil (Leukeran) 6 mg/m2 PO once per day on days 1 to 14
- Rituximab (Rituxan) 375 mg/m2 IV once on day 1
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. Epub 2013 Jan 7. link to original article contains verified protocol PubMed
Fludarabine (Fludara)
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Regimen
Study | Evidence | Comparator | Efficacy |
Leblond et al. 2012 (WM1) | Phase III | Chlorambucil | Increased PFS |
- Fludarabine (Fludara) 40 mg/m2 (30 mg/m2 per day if older than 75 years old) PO once per day on days 1 to 5
Supportive medications:
- Recommended PCP prophylaxis with one of the following:
- Trimethoprim/Sulfamethoxazole (Bactrim SS) 1 tablet PO once per day
- Pentamidine (Nebupent) 300 mg inhaled once per month
- Herpes zoster prophylaxis with one of the following:
- Valacyclovir (Valtrex) 500 mg PO once per day
- Acyclovir (Zovirax) 200 to 400 mg PO BID
28-day cycles x up to 6 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. Epub 2012 Dec 10. link to original article contains verified protocol PubMed
R-CHOP
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R-CHOP: Rituximab, Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Oncovin (Vincristine), Prednisone
Synonyms: R-CHOP-21, CHOP-R
Structured Concept: C9760 (NCI-T), C0393023 (NCI-MT/UMLS)
Regimen
Study | Evidence | Comparator | Efficacy |
Flinn et al. 2014 (BRIGHT) | Phase III, <20 in this arm | BR R-CVP |
Equivalent RR |
- Rituximab (Rituxan) 375 mg/m2 IV once on day 1
- 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 (maximum dose of 2 mg per cycle) IV once on day 1
- Prednisone (Sterapred) 100 mg PO once per day on days 1 to 5
Supportive medications:
- Antiemetics, antipyretics, and antibiotics per local standard of care
- G-CSF "according to the American Society of Clinical Oncology guidelines"
21-day cycle x up to 8 cycles
References
- Flinn IW, van der Jagt R, Kahl BS, Wood P, Hawkins TE, Macdonald D, Hertzberg M, Kwan YL, Simpson D, Craig M, Kolibaba K, Issa S, Clementi R, Hallman DM, Munteanu M, Chen L, Burke JM. Randomized trial of bendamustine-rituximab or R-CHOP/R-CVP in first-line treatment of indolent NHL or MCL: the BRIGHT study. Blood. 2014 May 8;123(19):2944-52. Epub 2014 Mar 3. link to original article contains verified protocol PubMed
R-CVP
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R-CVP: Rituximab, Cyclophosphamide, Vincristine, Prednisone
Regimen
Study | Evidence | Comparator | Efficacy |
Flinn et al. 2014 (BRIGHT) | Phase III, <20 in this arm | BR;R-CHOP | Equivalent RR |
- Rituximab (Rituxan) 375 mg/m2 IV once on day 1
- Cyclophosphamide (Cytoxan) 750 mg/m2 or 1000 mg/m2 IV once on day 1
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2 mg per cycle) IV once on day 1
- Prednisone (Sterapred) 100 mg PO once per day on days 1 to 5
Supportive medications:
- Antiemetics, antipyretics, and antibiotics per local standard of care
- G-CSF "according to the American Society of Clinical Oncology guidelines"
21-day cycles x up to 8 cycles
References
- Flinn IW, van der Jagt R, Kahl BS, Wood P, Hawkins TE, Macdonald D, Hertzberg M, Kwan YL, Simpson D, Craig M, Kolibaba K, Issa S, Clementi R, Hallman DM, Munteanu M, Chen L, Burke JM. Randomized trial of bendamustine-rituximab or R-CHOP/R-CVP in first-line treatment of indolent NHL or MCL: the BRIGHT study. Blood. 2014 May 8;123(19):2944-52. Epub 2014 Mar 3. link to original article contains verified protocol PubMed
Untreated, non-randomized or retrospective data
Note: Untreated in this context implies chemotherapy-naive. Some patients in the following studies, especially those with gastric MALT, received H. pylori eradication therapy or radiation prior to chemotherapy.
Bortezomib (Velcade)
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Regimen
Study | Evidence |
Troch et al. 2009 | Phase II |
- Bortezomib (Velcade) 1.5 mg/m2 IV bolus once per day on days 1, 4, 8, 11
Supportive medications:
- 5-HT3 antagonist IV immediately before Bortezomib (Velcade)
- 500 mL NS after Bortezomib (Velcade)
21-day cycles x up to 8 cycles
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. Epub 2009 Mar 31. link to original article contains verified protocol PubMed
Cladribine (Leustatin)
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Study | Evidence |
Jäger et al. 2002 | Phase II |
Regimen
- Cladribine (Leustatin) 0.12 mg/kg IV over 2 hours once on days 1 to 5
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
28-day cycles x 4 to 6 cycles
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
Cladribine & Rituximab
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Study | Evidence |
Troch et al. 2012 | Phase II |
Regimen
- Cladribine (Leustatin) 0.1 mg/kg SC once per day on days 1 to 4
- Rituximab (Rituxan) 375 mg/m2 IV once on day 1
Supportive medications:
- Acetaminophen (Tylenol) 1000 mg PO prior to Rituximab (Rituxan)
- Antihistamine IV prior to Rituximab (Rituxan)
- Either Ondansetron (Zofran) or Tropisetron (Navoban) IV immediately before Cladribine (Leustatin)
21-day cycles up to 6 cycles
References
- Troch M, Kiesewetter B, Willenbacher W, Willenbacher E, Zebisch A, Linkesch W, Fridrik M, Müllauer L, Greil R, Raderer M. Rituximab plus subcutaneous cladribine in patients with extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue: a phase II study by the Arbeitsgemeinschaft Medikamentose Tumortherapie. Haematologica. 2013 Feb;98(2):264-8. Epub 2012 Sep 14. link to original article contains verified protocol PubMed
Fludarabine & Rituximab
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Regimen
Study | Evidence |
Salar et al. 2009 | Phase II |
- Fludarabine (Fludara) 25 mg/m2 IV (or 40 mg/m2 PO) once per day on days 1 to 5
- Patients with gastric lymphoma received the cycle 1 dose intravenously to guarantee drug absorption
- Rituximab (Rituxan) 375 mg/m2 IV once on day 1
Dose reductions:
- Patients >70 years old could receive Fludarabine (Fludara) at the above dose, but only once per day on days 1 to 3
Supportive medications:
- Trimethoprim/Sulfamethoxazole prophylaxis (dose/schedule not listed) per physician preference
- No routine antiviral prophylaxis or G-CSF use
28-day cycles for 4-6 cycles
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. link to orginal article contains verified protocol PubMed
Ibritumomab tiuxetan (Zevalin)
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Regimen
Study | Evidence |
Samaniego et al. 2014 | Phase II, <20 patients reported |
- Rituximab (Rituxan) 250 mg/m2 IV once on day 1, then another single dose on day 8
- Ibritumomab tiuxetan & Yttrium-90 (Zevalin) 14.8 MBq/kg (maximum dose of 1184 MBq) IV once on day 8, given after Rituximab (Rituxan)
Dose reductions:
- Ibritumomab tiuxetan & Yttrium-90 (Zevalin) 11.1 MBq/kg (maximum dose of 1184 MBq) for platelet count between 100 and 149.
One course of therapy
References
- Samaniego F, Berkova Z, Romaguera JE, Fowler N, Fanale MA, Pro B, Shah JJ, McLaughlin P, Sehgal L, Selvaraj V, Braun FK, Mathur R, Feng L, Neelapu SS, Kwak LW. 90Y-ibritumomab tiuxetan radiotherapy as first-line therapy for early stage low-grade B-cell lymphomas, including bulky disease. Br J Haematol. 2014 Oct;167(2):207-13. Epub 2014 Jul 8. link to original article contains verified protocol PubMed
Lenalidomide (Revlimid)
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Regimen
Study | Evidence |
Kiesewetter et al. 2012 | Phase II, <20 patients reported |
- Lenalidomide (Revlimid) 25 mg PO once per day on days 1 to 21
Supportive medications:
- Aspirin 100 mg PO once per day
28-day cycle x up to 6 cycles
References
- Kiesewetter B, Troch M, Dolak W, Müllauer L, Lukas J, Zielinski CC, Raderer M. A phase II study of lenalidomide in patients with extranodal marginal zone B-cell lymphoma of the mucosa associated lymphoid tissue (MALT lymphoma). Haematologica. 2013 Mar;98(3):353-6. doi: 10.3324/haematol.2012.065995. Epub 2012 Aug 16. link to orginal article contains verified protocol PubMed
Lenalidomide & Rituximab
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Regimen
Study | Evidence |
Fowler et al. 2014 | Phase II |
- Lenalidomide (Revlimid) 20 mg PO once per day on days 1 to 21
- Rituximab (Rituxan) 375 mg/m2 IV once on day 1
28-day cycles up to 12 cycles
References
- Fowler NH, Davis RE, Rawal S, Nastoupil L, Hagemeister FB, McLaughlin P, Kwak LW, Romaguera JE, Fanale MA, Fayad LE, Westin JR, Shah J, Orlowski RZ, Wang M, Turturro F, Oki Y, Claret LC, Feng L, Baladandayuthapani V, Muzzafar T, Tsai KY, Samaniego F, Neelapu SS. Safety and activity of lenalidomide and rituximab in untreated indolent lymphoma: an open-label, phase 2 trial. Lancet Oncol. 2014 Nov;15(12):1311-8. Epub 2014 Oct 15. link to original article contains protocol PubMed
MCP
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MCP: Mitoxantrone, Chlorambucil, Prednisolone
Regimen
Study | Evidence |
Wöhrer et al. 2003 | Retrospective |
- Mitoxantrone (Novantrone) 8 mg/m2 IV once per day 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 to 5
- Prednisolone (Millipred) 25 mg/m2 PO/IV once per day on days 1 to 5
28-day cycles x up to 8 cycles
References
- Retrospective: 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
PCR
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PCR: Pentostatin, Cyclophosphamide, Rituximab
Regimen
Study | Evidence |
Samaniego et al. 2015 | Phase II, <20 patients in this subgroup |
- Pentostatin (Nipent) 4 mg/m2 IV once on day 1
- Cyclophosphamide (Cytoxan) 600 mg/m2 IV once on day 1
- Rituximab (Rituxan) 375 mg/m2 IV once on day 1
Supportive medications:
- Ondansetron (Zofran) 8 mg (route not specified) prior to chemo
- Diphenhydramine (Benadryl) 25 mg (route not specified) prior to chemo
- 500 ml of 5% dextrose/one-half normal saline before and after each pentostatin dose
- Filgrastim (Neupogen) at the discretion of the treating physician
- Allopurinol (Zyloprim) 300 mg PO once per day on days 1 to 15 of cycle 1
- Trimethoprim/Sulfamethoxazole (Bactrim DS) once per day three days per week during and for 1 month following therapy
- Acyclovir (Zovirax) 400 mg PO BID during and for 1 month following therapy
21-day cycle x 6 cycles
References
- Samaniego F, Hagemeister F, Romaguera JE, Fanale MA, Pro B, McLaughlin P, Rodriguez MA, Neelapu SS, Fayad L, Younes A, Feng L, Berkova Z, Khashab T, Sehgal L, Vega-Vasquez F, Kwak LW. Pentostatin, cyclophosphamide and rituximab for previously untreated advanced stage, low-grade B-cell lymphomas. Br J Haematol. 2015 Jun;169(6):814-23. Epub 2015 Mar 31. link to original article contains verified protocol PubMed
Rituximab (Rituxan)
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Regimen
Study | Evidence | ||
Conconi et al. 2003 | Phase II | ||
Martinelli et al. 2005 | Phase II |
- Rituximab (Rituxan) 375 mg/m2 IV once per day on days 1, 8, 15, 22
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 content property of HemOnc.org
- 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
Relapsed/refractory, non-randomized or retrospective data
Bendamustine (Treanda)
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Regimen
Study | Evidence |
Kahl et al. 2010 | Phase II, <20 patients reported |
- Bendamustine (Treanda) 120 mg/m2 IV over 60 to 120 minutes once on days 1 & 2
21-day cycle x 6 to 8 cycles
References
- Kahl BS, Bartlett NL, Leonard JP, Chen L, Ganjoo K, Williams ME, Czuczman MS, Robinson KS, Joyce R, van der Jagt RH, Cheson BD. Bendamustine is effective therapy in patients with rituximab-refractory, indolent B-cell non-Hodgkin lymphoma: results from a Multicenter Study. Cancer. 2010 Jan 1;116(1):106-14. link to original article contains verified protocol PubMed
Bortezomib (Velcade)
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Regimen #1
Study | Evidence |
Conconi et al. 2011 | Phase II |
- Bortezomib (Velcade) 1.3 mg/m2 IV once per day on days 1, 4, 8, 11
Supportive medications:
- No routine growth factors, antibiotic, or antiviral prophylaxis was given
21-day cycles x up to 6 cycles
Regimen #2
Study | Evidence |
Troch et al. 2009 | Phase II |
- Bortezomib (Velcade) 1.5 mg/m2 IV bolus once per day on days 1, 4, 8, 11
Supportive medications:
- 5-HT3 antagonist IV immediately before Bortezomib (Velcade)
- 500 mL NS after Bortezomib (Velcade)
21-day cycles x up to 8 cycles
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. 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
BR
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BR: Bendamustine, Rituximab
Regimen
Study | Evidence |
Rummel et al. 2005 | Phase II, <20 patients reported |
Pre-treatment phase
- Rituximab (Rituxan) 375 mg/m2 IV once on day 1
Cycle 1 is started 7 days after the first dose of rituximab
Main regimen=
- Bendamustine (Treanda) 90 mg/m2 IV over 30 minutes once on days 1 & 2 of cycles 1 to 4
- Rituximab (Rituxan) 375 mg/m2 IV once on day 1 of cycles 1 to 5
28-day cycles x 5 cycles
References
- Rummel MJ, Al-Batran SE, Kim SZ, Welslau M, Hecker R, Kofahl-Krause D, Josten KM, Dürk H, Rost A, Neise M, von Grünhagen U, Chow KU, Hansmann ML, Hoelzer D, Mitrou PS. Bendamustine plus rituximab is effective and has a favorable toxicity profile in the treatment of mantle cell and low-grade non-Hodgkin's lymphoma. J Clin Oncol. 2005 May 20;23(15):3383-9. link to original article contains protocol PubMed
Cladribine & Rituximab
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Regimen
Study | Evidence |
Troch et al. 2012 | Phase II, <20 patients reported |
- Cladribine (Leustatin) 0.1 mg/kg SC once per day on days 1 to 4
- Rituximab (Rituxan) 375 mg/m2 IV once on day 1
Supportive medications:
- Acetaminophen (Tylenol) 1000 mg PO prior to Rituximab (Rituxan)
- Antihistamine IV prior to Rituximab (Rituxan)
- Either Ondansetron (Zofran) or Tropisetron (Navoban) IV immediately before Cladribine (Leustatin)
21-day cycles up to 6 cycles
References
- Troch M, Kiesewetter B, Willenbacher W, Willenbacher E, Zebisch A, Linkesch W, Fridrik M, Müllauer L, Greil R, Raderer M. Rituximab plus subcutaneous cladribine in patients with extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue: a phase II study by the Arbeitsgemeinschaft Medikamentose Tumortherapie. Haematologica. 2013 Feb;98(2):264-8. Epub 2012 Sep 14. link to original article contains verified protocol PubMed
Clarithromycin (Biaxin)
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Regimen
Study | Evidence |
Ferreri et al. 2015 (HD-K) | Phase II |
- Clarithromycin (Biaxin) 2 g PO once per day on days 1 to 14
21-day cycle x 4 cycles
References
- Ferreri AJ, Sassone M, Kiesewetter B, Govi S, Scarfò L, Donadoni G, Raderer M. High-dose clarithromycin is an active monotherapy for patients with relapsed/refractory extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT): the HD-K phase II trial. Ann Oncol. 2015 Aug;26(8):1760-5. Epub 2015 May 1. link to original article contains verified protocol PubMed
Idelalisib (Zydelig)
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Regimen,
Study | Evidence |
Gopal et al. 2014 (DELTA) | Phase II, <20 patients in this subgroup |
- Idelalisib (Zydelig) 150 mg PO BID
Continued until progression, death, or unacceptable toxicity
References
- Gopal AK, Kahl BS, de Vos S, Wagner-Johnston ND, Schuster SJ, Jurczak WJ, Flinn IW, Flowers CR, Martin P, Viardot A, Blum KA, Goy AH, Davies AJ, Zinzani PL, Dreyling M, Johnson D, Miller LL, Holes L, Li D, Dansey RD, Godfrey WR, Salles GA. PI3Kd Inhibition by Idelalisib in Patients with Relapsed Indolent Lymphoma. N Engl J Med. 2014 Jan 22. link to original article contains verified protocol PubMed
- Update: Abstract: Ajay K. Gopal, MD, Brad S. Kahl, MD, Sven de Vos, MD, PhD, Nina D. Wagner-Johnston, MD, Stephen J. Schuster, MD, Wojciech Jurczak, MD, PhD, Ian W. Flinn, MD, PhD, Christopher R. Flowers, MD, Peter Martin, MD, Andreas Viardot, MD, Kristie A. Blum, MD, Andre Goy, MD, Andrew Davies, BM PhD, Pier Luigi Zinzani, MD, Martin H. Dreyling, MD, PhD, Leanne M. Holes, Bess Sorensen, PhD, Wayne R. Godfrey, MD and Gilles Andre Salles, MD, PhD. Mature Follow up from a Phase 2 Study of PI3K-Delta Inhibitor Idelalisib in Patients with Double (Rituximab and Alkylating agent)-Refractory Indolent B-Cell Non-Hodgkin Lymphoma (iNHL). ASH Annual Meeting 2014, Abstract 1708 link to abstract
Lenalidomide (Revlimid)
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Regimen
Study | Evidence |
Kiesewetter et al. 2012 | Phase II, <20 patients reported |
- Lenalidomide (Revlimid) 25 mg PO once per day on days 1 to 21
Supportive medications:
- Aspirin 100 mg PO once per day
28-day cycle x up to 6 cycles
References
- Kiesewetter B, Troch M, Dolak W, Müllauer L, Lukas J, Zielinski CC, Raderer M. A phase II study of lenalidomide in patients with extranodal marginal zone B-cell lymphoma of the mucosa associated lymphoid tissue (MALT lymphoma). Haematologica. 2013 Mar;98(3):353-6. doi: 10.3324/haematol.2012.065995. Epub 2012 Aug 16. link to orginal article contains verified protocol PubMed
Rituximab (Rituxan)
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Regimen
Study | Evidence | ||
Conconi et al. 2003 | Phase II | ||
Martinelli et al. 2005 | Phase II |
- Rituximab (Rituxan) 375 mg/m2 IV once per day on days 1, 8, 15, 22
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