Adult T-cell leukemia-lymphoma
Section editor | |
---|---|
Bhagirathbhai Dholaria, MBBS Vanderbilt University Nashville, TN, USA |
Are you looking for a regimen, but can't find it here? It is possible that we've moved it to the historical regimens page.
4 regimens on this page
4 variants on this page
|
- We have moved How I Treat articles to a dedicated page.
Guidelines
Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any article published 5+ years ago to be for historical purposes, only.
NCCN
- NCCN does not currently have guidelines at this granular level; please see NCCN Guidelines - T-cell Lymphomas.
Untreated
CHOP-14
CHOP-14: Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Oncovin (Vincristine), Predniso(lo)ne every 14 days
CHOP-DI: Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Oncovin (Vincristine), Predniso(lo)ne, Dose-Intense
I-CHOP: Intensive Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Oncovin (Vincristine), Predniso(lo)ne
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy | Comparative Toxicity |
---|---|---|---|---|---|
Itoh et al. 2002 (JCOG 9505) | 1995-1998 | Randomized Phase 2 (E-de-esc) | dose-escalated CHOP | Did not meet primary endpoint of CR rate | Less toxic |
Tsukasaki et al. 2007 (JCOG 9801) | 1998-2003 | Phase 3 (C) | mLSG15 | Did not meet primary endpoint of OS | Less toxic |
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 (maximum dose of 2 mg) IV once on day 1
Glucocorticoid therapy
- Prednisone (Sterapred) 100 mg PO once per day on days 1 to 5
Supportive therapy
- Filgrastim (Neupogen) given once ANC decreased to less than 1000/μL and continued once per day until count increased to greater than 5000/μL
14-day cycle for 8 cycles
CNS therapy
Intrathecal triple-therapy was given during recovery phase of cycles 1, 3, and 5 after platelet count was greater than 70 × 109/L.
- Cytarabine (Ara-C) 40 mg IT
- Methotrexate (MTX) 15 mg IT
- Prednisone (Sterapred) 10 mg IT
3 doses, total
References
- JCOG 9505: Itoh K, Ohtsu T, Fukuda H, Sasaki Y, Ogura M, Morishima Y, Chou T, Aikawa K, Uike N, Mizorogi F, Ohno T, Ikeda S, Sai T, Taniwaki M, Kawano F, Niimi M, Hotta T, Shimoyama M, Tobinai K; JCOG. Randomized phase II study of biweekly CHOP and dose-escalated CHOP with prophylactic use of lenograstim (glycosylated G-CSF) in aggressive non-Hodgkin's lymphoma: Japan Clinical Oncology Group Study 9505. Ann Oncol. 2002 Sep;13(9):1347-55. link to original article PubMed
- JCOG 9801: 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; JCOG. 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 dosing details in manuscript PubMed NCT00145002
mLSG15
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Tsukasaki et al. 2007 (JCOG 9801) | 1998-2003 | Phase 3 (E-esc) | CHOP-14 | Did not meet primary endpoint of OS |
Ishida et al. 2015 (Kyowa 0761-003) | 2010-2011 | Randomized Phase 2 (C) | mLSG15 & Mogamulizumab | Did not meet primary endpoint of CR rate |
Note: Ranimustine is not available in the United States and is approved only in Japan.
Chemotherapy
- Vincristine (Oncovin) 1 mg/m2 (maximum dose of 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
- 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
Glucocorticoid therapy
- Prednisone (Sterapred) 40 mg/m2 PO once per day on days 1, 8, 15 to 17
28-day cycle for 6 cycles
CNS therapy, prophylaxis
- Cytarabine (Ara-C) 40 mg IT, admixed with MTX & prednisone
- Methotrexate (MTX) 15 mg IT, admixed with Ara-C & prednisone
- Prednisone (Sterapred) 10 mg IT, admixed with Ara-C & MTX
Given after cycles 1, 3, and 5 after platelets greater than 70 × 109/L and within 2 days before the next cycle
References
- JCOG 9801: 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; JCOG. 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 dosing details in manuscript PubMed NCT00145002
- Kyowa 0761-003: 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 NCT01173887
Relapsed or refractory
Alemtuzumab monotherapy
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Sharma et al. 2016 | 2004-2009 | Phase 2 |
Targeted therapy
- Alemtuzumab (Campath) 30 mg IV once per day on days 1, 3, 5 (three times per week)
7-day cycle for up to 7 cycles
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
Regimen
Study | Dates of enrollment | Evidence | Efficacy |
---|---|---|---|
Ishida et al. 2016 (ATLL-002) | 2012-2014 | Phase 2 | ORR: 42% (95% CI 23-63) |
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. Epub 2016 Sep 30. link to original article PubMed NCT01724177