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Diffuse large B-cell lymphoma | HemOnc.org – A Hematology …

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76 regimens on this page

106 variants on this page

Recommended in NHL-B1 and NHL-B2 "to improve the performance status of patients and to ameliorate side-effects of the first chemotherapy cycle." Mandated in RICOVER-60 and SMARTE-R-CHOP-14. Note: NHL-B1 gave the option of a 5 to 7 day course of prednisone.

7-day course

Treatment in NHL-B1 and NHL-B2 followed by randomization to CHOP versus CHOP-14 versus CHOEP versus CHOEP-14. Treatment in RICOVER-60 followed by randomization to CHOP-14 versus R-CHOP-14. Treatment in SMARTE-R-CHOP-14 followed by R-CHOP-14.

ACVBP-R: Adriamycin (Doxorubicin), Cyclophosphamide, Vindesine, Bleomycin, Prednisone, Rituximab

Synonyms: R-ACVBP

Structured Concept: none

14-day cycle for 4 cycles

Treatment followed in 4 weeks by methotrexate consolidation.

CHOP: Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Oncovin (Vincristine), Prednisone

Synonyms: CHOP-21, ACOP, CAVP, COPA, VACP, VCAP

Structured Concept: C9549 (NCI-T), C0055598 (NCI-MT/UMLS)

21-day cycle for 8 cycles

Treatment in NHL-B1 and NHL-B2 preceded by pre-phase vincristine & prednisone.

21-day cycle for 6 cycles

"Initial bulky disease": patients with "lymphoma masses or conglomerates with a diameter 7.5 cm) or extranodal involvement"

21-day cycle for 3 cycles, followed in 3 weeks by:

21-day cycle for 8 cycles

21-day cycle for 6 to 8 cycles

Patients with CR/PR proceeded to receive maintenance rituximab versus observation.

CHOP-DI: Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Oncovin (Vincristine), Prednisone, Dose Intense I-CHOP: Intensified Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Oncovin (Vincristine), Prednisone

Synonyms: CHOP-14, CHOP-DI, I-CHOP

Structured Concept: none

14-day cycle for up to 6 cycles

14-day cycle for 6 cycles

Treatment preceded by pre-phase vincristine & prednisone (recommended in NHL-B1 and mandatory in RICOVER-60).

Supportive medications (per Pfreundschuh et al. 2004):

14-day cycle for 6 cycles; some patients in Pfreundschuh et al. 2008 received 14-day cycle for 8 cycles

"Initial bulky disease": patients with "lymphoma masses or conglomerates with a diameter =7.5 cm) or extranodal involvement"

CHOP: Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Oncovin (Vincristine), Prednisone

This regimen is designed for elderly patients and is of lower intensity than standard CHOP.

21-day cycle for 6 cycles

CNOP: Cyclophosphamide, Novantrone (Mitoxantrone), Oncovin (Vincristine), Prednisone MCOP: Mitoxantrone, Cyclophosphamide, Oncovin (Vincristine), Prednisone

21-day cycle for 6 cycles

R-CHOEP-14: Rituximab, Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Oncovin (Vincristine), Etoposide, Prednisone, 14-day cycles

14-day cycle for 8 cycles

14-day cycle for 8 cycles, followed by:

Note that IT treatment was not part of prophylaxis, except that Methotrexate (MTX) 15 mg IT was allowed at time of diagnostic LP.

Followed 3 weeks later by:

One course

R-CHOP: Rituximab, Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Oncovin (Vincristine), Prednisone

Synonyms: R-CHOP-21, CHOP-R

Structured Concept: C9760 (NCI-T), C0393023 (NCI-MT/UMLS)

Note: most of the variation between these regimen variants is in the dose or type of steroid.

Note: Cunningham et al. 2013 states that the regimen is based on Coiffier et al. 2002, but notably it uses prednisolone instead of prednisone. AGMT NHL-14 states that R-CHOP was "given in standard doses" per LNH-98.5, but this regimen uses prednisone, whereas the title and text of Fridrik et al. 2016 implies that prednisolone was used. The authors have confirmed that prednisolone was used, due to prednisone not being available in Austria.

Per investigator discretion, but Cunningham et al. 2013 recommended that patients who had involvement of the "bone marrow, peripheral blood, nasal or paranasal sinuses, orbit, and testis" (they probably intended to say "or testis") receive:

21-day cycle for 8 cycles

This regimen was used for non-germinal center B-cell (non-GCB) DLBCL.

21-day cycle for 6 cycles

As described in Delarue et al. 2013 (LNH03-6B):

21-day cycle for 8 cycles

21-day cycle for 6 cycles

21-day cycle for 6 to 8 cycles

This trial also included a randomization to maintenance rituximab versus observation for responders; however an advantage was only seen in the group receiving CHOP upfront, which is no longer standard of care.

21-day cycle for 6 cycles

"At the end of chemotherapy, radiotherapy (RT) was scheduled for sites of previous bulky disease or partially responding sites."

21-day cycle for 3 cycles, followed by:

Involved-field radiation therapy to begin 3 weeks after last cycle of R-CHOP, see paper for details.

This regimen is for primary testicular lymphoma. All patients had a diagnostic orchiectomy prior to starting chemotherapy.

21-day cycle for 6 cycles (up to 8 cycles for stage II patients), followed by:

25 to 30 Gy to the contralateral testis. For patients with stage II disease, involved-field radiation therapy was added, see paper for details.

R-CHOP: Rituximab, Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Oncovin (Vincristine), Prednisone

Synonyms: R-CHOP-14, Dose-dense rituximab-CHOP

Structured Concept: none

Two arms were assessed; results are pending from this comparison. These higher doses were for males, only.

OR

14-day cycle for 6 cycles (8 doses of rituximab regardless of total number of CHOP-14 cycles)

14-day cycle for 8 cycles

Per investigator discretion, but Cunningham et al. 2013 recommended that patients who had involvement of the "bone marrow, peripheral blood, nasal or paranasal sinuses, orbit, and testis" (they probably intended to say "or testis") receive:

14-day cycle for 6 cycles; then give additional doses of rituximab as described below

14-day cycle for 2 cycles

Treatment preceded by pre-phase vincristine & prednisone.

14-day cycle for 6 to 8 cycles (8 doses of rituximab regardless of total number of cycles)

Patients with initial bulky disease received:

"Initial bulky disease": patients with "lymphoma masses or conglomerates with a diameter >=7.5 cm) or extranodal involvement"

Treatment preceded by pre-phase vincristine & prednisone.

14-day cycle for 6 cycles

Patients with initial bulky disease received:

"Initial bulky disease": patients with "lymphoma masses or conglomerates with a diameter =7.5 cm) or extranodal involvement"

R-CVP: Rituximab, Cyclophosphamide, Vincristine, Prednisone

Structured Concept: C63473 (NCI-T), C1882520 (NCI-MT/UMLS)

21-day cycle for up to 8 cycles

See references for CVP

R-HCVAD: Rituximab, Hyperfractionated Cyclophosphamide, Vincristine, Adriamycin (Doxorubicin), Dexamethasone R-MA: Rituximab, Methotrexate, Ara-C (Cytarabine)

Intended for high-risk DLBCL (IPI 3). The authors report "excellent outcome" in patients 45 years old, however patients >45 years old had "unacceptable mortality."

Next cycle to start once ANC count is 1 x 10^9/L and platelet count is 100 x 10^9/L.

Although the protocol does not specify, it is assumed that if these thresholds are not met by day 21, the next cycle will start with the dose reductions as specified.

21-day cycles

"Recommended in patients with paraspinal disease, paranasal sinus disease, testicular disease, bone marrow disease, diffuse osseous disease or 2 sites of extranodal disease. Actual administration of prophylactic intrathecal chemotherapy was at the treating physician's discretion."

R-miniCEOP: Rituximab, mini, Cyclophosphamide, Epirubicin, O?? (vinblastine), Prednisone

21-day cycle for 6 cycles

Patients with initial bulky disease and/or partially responding sites received:

"At the end of chemotherapy, radiotherapy (RT) was scheduled for sites of previous bulky disease or partially responding sites."

CHOP: Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Oncovin (Vincristine), Prednisone

This regimen is intended for limited-stage aggressive B-cell NHL; the majority of patients studied had DLBCL.

21-day cycle for 3 cycles, followed 3 weeks later by:

Involved-field radiation therapy, see paper for details.

Continued here:
Diffuse large B-cell lymphoma | HemOnc.org - A Hematology ...

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