Mantle cell lymphoma

From HemOnc.org - A Hematology Oncology Wiki
Jump to navigation Jump to search

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.


BR

BR: Bendamustine, Rituximab

CALGB 59909

Regimen

Treatments 1-2, R-M-CHOP

Interval between treatment 1 & 2 based on count recovery. Median days between treatment 1 & 2 was 23 days, with a range of 16-41 days observed.

Supportive medications:

  • Filgrastim (Neupogen) 5 mcg/kg SC daily starting on day 4, to continue until ANC >10000 once or >5000 twice
  • Levofloxacin (Levaquin) 500 mg PO daily, starting on day 6, to continue until ANC ≥1500
  • Fluconazole (Diflucan) 200 mg PO daily, starting on day 6, to continue until ANC ≥1500

Patients with ≤15% involvement by disease in bone marrow biopsy after treatment 2 proceed to treatment 3. If bone marrow biopsy after treatment 2 has >15% involvement by disease, repeat treatment 2 (identified as "treatment 2.5"). Patients with >15% bone marrow involvement by disease after treatment 2.5 were removed from protocol.

Treatment 3, "EAR"

EAR: Etoposide, Ara-C, Rituximab
Treatment 3 begins 4 weeks after treatment 2, if ANC ≥1000, platelets ≥100,000/uL, Cr <2 mg/dL, total bilirubin <2x upper limit of normal, and AST <3x upper limit of normal.

Supportive medications:

  • Filgrastim (Neupogen) 10 mcg/kg SC daily starting on day 14, to continue until peripheral blood stem cell collection is complete
  • Levofloxacin (Levaquin) 500 mg PO daily, starting on day 7, to continue until ANC ≥500
  • Fluconazole (Diflucan) 200 mg PO daily, starting on day 6, to continue until ANC ≥500
  • Acyclovir (Zovirax) 200 mg PO TID, starting on day 6, to continue until 1 year after autologous stem cell transplant (ASCT)
  • Note: Text specified that Trimethoprim/Sulfamethoxazole (Bactrim DS) prophylaxis started during treatment 3 (see dose/schedule in treatment 4)--although table 1 did not list it--to continue until 3 months after ASCT.

Treatment 4, "CBV"

CBV: Cyclophosphamide, BiCNU, VP-16

Supportive medications:

  • Filgrastim (Neupogen) 5 mcg/kg SC daily starting on day +4, to continue until ANC >5000 once or >1500 twice
  • Levofloxacin (Levaquin) 500 mg PO daily, starting on day +2, to continue until ANC ≥500
  • Fluconazole (Diflucan) 200 mg PO daily, starting on day +1, to continue until ANC ≥500
  • Acyclovir (Zovirax) 200 mg PO TID, starting on day -2, to continue until 1 year after ASCT
  • Trimethoprim/Sulfamethoxazole (Bactrim DS) 160/800 mg PO BID on Saturday and Sunday, to continue until 3 months after ASCT

Treatment 5, Rituximab

Additional considerations

If cerebrospinal fluid (CSF) contained disease with CSF WBC ≤5 cells/uL:

  • Methotrexate (MTX) 12 mg intrathecal x 10 total doses during treatments 1-3; not given concurrently with intrathecal methotrexate or cytarabine

If CSF contained >5 cells/uL:

  • In addition to intrathecal chemotherapy above, patient also received 2 Gy x 12 fractions (total dose 24 Gy) cranial radiation

If any patient appeared to be experiencing carmustine-induced pneumonitis:

References

  1. Damon LE, Johnson JL, Niedzwiecki D, Cheson BD, Hurd DD, Bartlett NL, Lacasce AS, Blum KA, Byrd JC, Kelly M, Stock W, Linker CA, Canellos GP. Immunochemotherapy and autologous stem-cell transplantation for untreated patients with mantle-cell lymphoma: CALGB 59909. J Clin Oncol. 2009 Dec 20;27(36):6101-8. Epub 2009 Nov 16. link to original article contains protocol PubMed

R-Hyper-CVAD/R-MTX-Ara-C

CVAD: Cyclophosphamide, Vincristine, Adriamycin, Dexamethasone

Regimen

Part A (cycles 1, 3, 5, 7):

  • Cyclophosphamide (Cytoxan) 300 mg/m2 IV over 3 hours Q12H on days 2-4 (6 total doses)
  • Mesna (Mesnex) 600 mg/m2/day IV continuous infusion on days 2-4, starting 1 hour before cytoxan and completed 12 hours after the last dose of cytoxan
  • Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2 mg per cycle) IV piggyback on day 5, 12 hours after the last dose of cyclophosphamide, and on day 12
  • Doxorubicin (Adriamycin) 16.6-16.7 (note: reference had slightly different dosages in the text vs. table 1) mg/m2/day IV continuous infusion over 72 hours on days 5-7
  • Dexamethasone (Decadron) 40 mg PO/IV on days 2-5, 12-15
  • Rituximab (Rituxan) 375 mg/m2 IV on day 1
    • Patients with peripheral blood involvement could have the cycle 1 dose of rituximab delayed or omitted by clinician discretion

21-day cycles, alternating every 21 days with Part B, for a total of 4 cycles of Part A and 4 cycles of Part B

Part B (cycles 2, 4, 6, 8):

  • Methotrexate (MTX) 200 mg/m2 IV over 2 hours, then 800 mg/m2 IV over 22 hours on day 2
    • Patients with a Cr >1.5 mg/dL received a 50% reduced dose of methotrexate
  • Cytarabine (Cytosar) 3000 mg/m2 (1000 mg/m2 for patients >60 years old or with Cr >1.5) IV over 2 hours Q12H on days 3 & 4 (4 total doses)
  • Folinic acid (Leucovorin) 50 mg PO x1 12 hours after methotrexate is complete, then 15 mg PO Q6H x 8 doses. If serum methotrexate level at 24 hours is >1 umol/L or at 48 hours is >0.1 umol/L, dose of folinic acid is increased to 100 mg IV Q3H.
  • Rituximab (Rituxan) 375 mg/m2 IV on day 1
  • Urine alkalinized to pH of 6.8 or more prior to the start of methotrexate and kept within that range until methotrexate is cleared
  • Prednisolone 1% ophthalmic solution 2 drops in each eye 4 times per day on days 3-9was started on the day of the start of cytarabine infusion and was continued for 7 days to prevent chemical conjunctivitis.

21-day cycles, alternating every 21 days with Part A, for a total of 4 cycles of Part A and 4 cycles of Part B

Supportive medications (for both Part A and Part B):
All medications given for 10 days, starting 24-36 hours after doxorubicin infusion is complete

  • Filgrastim (Neupogen) 5 mcg/kg SC daily
  • Valacyclovir (Valtrex) 500 mg PO daily
  • Fluconazole (Diflucan) 100 mg PO daily
  • Levofloxacin (Levaquin) 500 mg PO daily or Ciprofloxacin (Cipro) (reference did not specify dose/frequency)
  • "Erythropoietin was permitted throughout therapy"

References

  1. Romaguera JE, Fayad L, Rodriguez MA, Broglio KR, Hagemeister FB, Pro B, McLaughlin P, Younes A, Samaniego F, Goy A, Sarris AH, Dang NH, Wang M, Beasley V, Medeiros LJ, Katz RL, Gagneja H, Samuels BI, Smith TL, Cabanillas FF. High rate of durable remissions after treatment of newly diagnosed aggressive mantle-cell lymphoma with rituximab plus hyper-CVAD alternating with rituximab plus high-dose methotrexate and cytarabine. J Clin Oncol. 2005 Oct 1;23(28):7013-23. Epub 2005 Sep 6. link to original article contains protocol PubMed

Nordic regimen, maxi-CHOP, HiDAC, Rituximab (Rituxan)

CHOP: Cyclophosphamide, Hydroxydaunorubicin, Oncovin, Prednisone
HiDAC: High Dose Ara-C

Regimen

Protocol originally started rituximab during cycle 4, but the protocol was amended to start it on cycle 2.
Cycle 1 uses maxi-CHOP, cycle 2 uses HiDAC, cycle 3 uses maxi-CHOP, etc.

  • Rituximab (Rituxan) 375 mg/m2 IV on day 1 of cycles 2-5, and 375 mg/m2 IV on days 1 & 9 of cycle 6

maxi-CHOP

21-day cycles, alternating with high-dose cytarabine, for a total of 3 cycles of maxi-CHOP and 3 cycles of high-dose cytarabine

HiDAC/HDAC, high-dose Cytarabine (Cytosar)

21-day cycles, alternating with maxi-CHOP, for a total of 3 cycles of maxi-CHOP and 3 cycles of high-dose cytarabine

Supportive medications:

  • Filgrastim (Neupogen) given during cycle 6 as part of stem cell mobilization, with at least 2 million CD34+ cells/kg harvested

High-dose chemotherapy with BEAM or BEAC started 1-2 weeks after completion of cycle 6, followed by stem cell transplant. If transplant was delayed, an additional 1-2 cycles of chemotherapy with maxi-CHOP or HiDAC could be given.

References

  1. Geisler CH, Kolstad A, Laurell A, Andersen NS, Pedersen LB, Jerkeman M, Eriksson M, Nordström M, Kimby E, Boesen AM, Kuittinen O, Lauritzsen GF, Nilsson-Ehle H, Ralfkiaer E, Akerman M, Ehinger M, Sundström C, Langholm R, Delabie J, Karjalainen-Lindsberg ML, Brown P, Elonen E; Nordic Lymphoma Group. Long-term progression-free survival of mantle cell lymphoma after intensive front-line immunochemotherapy with in vivo-purged stem cell rescue: a nonrandomized phase 2 multicenter study by the Nordic Lymphoma Group. Blood. 2008 Oct 1;112(7):2687-93. Epub 2008 Jul 14. link to original article PubMed
Retrieved from "https://hemonc.org/w/index.php?title=Mantle_cell_lymphoma&oldid=2350"