Example orders for CHOEP in lymphoma

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Remember that example order sets that may contain additional information about supportive medications, suggestions for monitoring, hydration, and pre-treatment screening information for chemotherapy regimens are purely anecdotal, provided only as examples of what some other providers may be using, and are typically not based on references in the primary literature.

CHOEP, CHOPE

CHOEP: Cyclophosphamide, Hydroxydaunorubicin, Oncovin, Etoposide, Prednisone

Published regimens and references may be found on the Aggressive Non-Hodgkin lymphoma page.

Example regimen #1

• Cyclophosphamide (Cytoxan) 750 mg/m² IV on day 1
• Doxorubicin (Adriamycin) 50 mg/m² IV on day 1
• Vincristine (Oncovin) 2 mg IV on day 1
• Etoposide (Vepesid) 100 mg/m² IV on days days 1-3
• Prednisone (Sterapred) 100 mg PO on days 1 to 5
• Patients with initial bulky disease (mass conglomerate at least 7.5 cm) received 36 Gy radiation therapy and to extranodal sites of disease when possible

21-day cycles x 6 cycles

Supportive medications

• Fosaprepitant (Emend injection) 150 mg IV x1 on day 1 prior to chemotherapy
• Ondansetron (Zofran) 8 mg IV 30 minutes prior to chemotherapy
• Allopurinol (Aloprim) as described below

Hydration:

• 500 ml NS and/or D5W KVO rate to be used as running IV for chemotherapy infusion. Give up to 500 ml NS and/or D5W.

Monitoring:

• On days 1, 3, 8, and 17 of cycle 1: CBC with differential, absolute neutrophil count (ANC), comprehensive metabolic panel (chem 10 and LFTs), LDH, uric acid; future labs to be determined based on patient's cycle 1 counts
• Prior to start of therapy, check beta-2 microglobulin, SPEP, IgG, IgA, IgM
• Initial staging with CT torso & bone marrow biopsy
• In anticipation of rituxan use starting cycle 2, check hepatitis B surface antibody (HbsAb), hepatitis B surface antigen (HbsAg), hepatitis B core antibody (HbcAb), hepatitis C antibody (HCV Ab)

Outpatient medications:

• Acyclovir (Zovirax) 400 mg PO TID
• Allopurinol (Aloprim) 300 mg PO daily
• Filgrastim (Neupogen) 300 mcg (patient is 63 kg) SC daily on days 4-13
• Ondansetron (Zofran) 8 mg PO TID
• Pantoprazole (Protonix) 40 mg PO daily
• Prednisone (Sterapred) as described above
• Docusate (Colace) 100 mg PO BID prn constipation
• Sennosides (Senna) 8.6 mg PO Q8H prn constipation

Clinical scenario & comments:

• 44 year-old lady with primary mediastinal lymphoma; 7 cm anterior mediastinal mass, ECOG performance status 0.