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Hodgkin's Disease

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Hodgkin's Disease HODGKIN’S DISEASE ABVD (DOXORUBICIN - BLEOMYCIN - VINBLASTINE - DACARBAZINE) Doxorubicin 25 mg/m2 IV Days 1 and 15 Bleomycin 10 units/m2 IV Days 1 and 15 Vinblastine 6 mg/m2 IV Days 1 and 15 Dacarbazine 375 mg/m2 IV Days 1 and 15 Repeat cycle every 28 days if responding, for a minimum of 6 cycles and a maximum of 8 cycles. References: Santoro A, et al. Ann Intern Med 1982;96:139 – 43; Canellos GP, et al. N Engl J Med 1992;327:1478 – 84. BEACOPP (STANDARD DOSE) Bleomycin 10 units/m2 IV Day 8 Etoposide 100 mg/m2/day IV Days 1 – 3 Doxorubicin 25 mg/m2 IV Day 1 Cyclophosphamide 650 mg/m2 IV Day 1 Vincristine 1.4 mg/m2* IV Day 8 Procarbazine** 100 mg/m2/day PO Days 1 - 7 Prednisone 40 mg/m2/day PO Days 1 - 14 *Maximum dose is 2 mg; **Procarbazine is a MAOI. Counsel patient on drug-food interactions. NOTE: After the completion of chemotherapy, sites of initial bulky disease (those of at least 5 cm in diameter) received 30 Gy of irradiation and any residual tumor received 40 Gy. Repeat cycle every 21 days for 8 cycles. References: Diehl V, et al. N Engl J Med 2003;348:2386 – 95; Diehl V, et al. J Clin Oncol 2007;25(18S). Abstract LBA8015. BEACOPP (INCREASED DOSE) Bleomycin 10 units/m2 IV Day 8 Etoposide 200 mg/m2/day IV Days 1 – 3 Doxorubicin 35 mg/m2 IV Day 1 Cyclophosphamide 1250 mg/m2 IV Day 1 Vincristine 1.4 mg/m2* IV Day 8 Procarbazine** 100 mg/m2/day PO Days 1 - 7 Prednisone 40 mg/m2/day PO Days 1 - 14 Filgrastim 5 mcg/kg/day SQ Day 8 until ANC recovery *Maximum dose is 2 mg; **Procarbazine is a MAOI. Counsel patient on drug-food interactions. NOTE: After the completion of chemotherapy, sites of initial bulky disease (those of at least 5 cm in diameter) received 30 Gy of irradiation and any residual tumor received 40 Gy. Repeat cycle every 21 days for 8 cycles. References: Diehl V, et al. N Engl J Med 2003;348:2386 – 95; Erratum in N Engl J Med 2005;353:744; Diehl V, et al. J Clin Oncol 2007;25(18S). Abstract LBA8015.. Last Updated on September 24, 2007 ChlVPP (CHLORAMBUCIL - VINBLASTINE - PROCARBAZINE - PREDNISONE) Chlorambucil 6 mg/m 2/day* PO Days 1 - 14 Vinblastine 6 mg/m 2* IV Days 1 and 8 Procarbazine*** 100 mg/m2/day ** PO Days 1 - 14 Prednisone 40 mg/day PO Days 1 – 14 Radiation Therapy (if offered) Start 6 weeks after the last course of chemotherapy. *Maximum 10 mg daily; **Not to exceed 150 mg daily; ***Procarbazine is a MAOI. Counsel patient on drug-food interactions. NOTE: The Vose publication does not cap the doses of myelosuppressive agents. Repeat cycle every 28 days if responding until 2 cycles beyond complete remission. References: McElwain TJ, et al. Br J Cancer 1977;36:276 – 80; Selby P, et al. Br J Cancer 1990;62:279 – 85; Druker BJ, et al. Cancer 1989;63:1060 – 4; Vose JM, et al. J Clin Oncol 1991;9:1421 – 5. GEMCITABINE – CISPLATIN – METHYLPREDNISOLONE Gemcitabine 1000 mg/m2 IV* Days 1, 8 and 15 Followed 4 hours later by Cisplatin 100 mg/m2 IV** Day 15 Methylprednisolone 1000 mg/day IV/PO Days 1 – 5 *Administer over 30 minutes; **Administer over 4 hours with adequate pre- and post-hydration. NOTE: Prophylaxis against Pneumocystis carinii pneumonia administered to all patients. Repeat cycle every 28 days. Reference: Chau I, et al. Br J Haematol 2003;120:970 – 7. GEMCITABINE – CISPLATIN – DEXAMETHASONE Gemcitabine 1000 mg/m2 IV* Days 1 and 8 Followed by Cisplatin 75 mg/m2 IV** Day 1 Dexamethasone 40 mg/day PO Days 1 – 4 *Administer over 30 minutes; **Administer over 60 minutes with adequate pre- and post-hydration. Repeat cycle every 21 days (up to 6 cycles if not a HSCT candidate; if a HSCT candidate, 2 cycles and then to transplant). Reference: Baetz T, et al. Ann Oncol 2003;14:1762 – 7. Last Updated on September 24, 2007 LOPP-EVAP LOPP Chlorambucil 10 mg/day PO Days 1 – 10 Vincristine 1.4 mg/m2* IV Days 1 and 8 φ Procarbazine 100 mg/m2/day** PO Days 1 – 10 Prednisone 25 mg/m2/day*** PO Days 1 – 14 Alternating with EVAP Etoposide 150 mg/m2/day** PO Days 1 – 3 Vinblastine 6 mg/m2# IV Days 1 and 8 Doxorubicin 25 mg/m2 IV Days 1 and 8 Prednisone 25 mg/m2/day*** PO Days 1 – 14 *Maximum dose 2 mg; **Maximum dose 200 mg/dose; ***Maximum dose 60 mg/dose; #Maximum φ dose 10 mg/dose; Procarbazine is a MAOI. Counsel patient on drug-food interactions. Repeat every 28 day [Courses of LOPP alternated with courses of EVAP every 4 weeks]. Patients were completely assessed after 4 cycles of therapy. If the patient was in CR at this time, 4 additional cycles were scheduled (total 8 cycles). If patient was in PR after 4 cycles, chemotherapy was continued until a clinical CR was obtained, after which a further 4 cycles of therapy were scheduled. Reference: Hancock BW, et al. J Clin Oncol 1992;10:1252 – 8. MOPP (MECHLORETHAMINE – VINCRISTINE – PROCARBAZINE – PREDNISONE) Mechlorethamine (Mustine) 6 mg/m2 IVP Days 1 and 8 Vincristine 1.4 mg/m2* IVP Days 1 and 8 Procarbazine* 100 mg/m2/day PO Days 1 - 14 Prednisone 40 mg/m2/day PO Days 1 - 14 *Maximum dose 2 mg; *Procarbazine is a MAOI. Counsel patient on drug-food interactions. Repeat cycle every 28 days (total of 6 cycles). References: DeVita VT, et al. Ann Intern Med 1970;73:881 – 95; Canellos GP, et al. N Engl J Med 1992;327:1478 – 84. Last Updated on September 24, 2007 MOPP/ABV HYBRID Mechlorethamine (Mustine)* 6 mg/m2 IV Day 1 Vincristine 1.4 mg/m2** IV Day 1 φ Procarbazine 100 mg/m2/day PO Days 1 - 7 Prednisone 40 mg/m2/day PO Days 1 - 14 Doxorubicin 35 mg/m2 IV Day 8 Bleomycin 10 units/m2*** IV Day 8 Vinblastine 6 mg/m2 IV Day 8 *Cyclophosphamide is substituted for mechlorethamine at a dose of 650 mg/m2 IV Day 1 if severe chemical phlebitis develops; **Maximum dose 2 mg; ***Premedicate with hydrocortisone 100 mg; φ Procarbazine is a MAOI. Counsel patient on drug-food interactions. Repeat cycle every 28 days. Responding patients receive 6 cycles of MOPP/ABV and then are completed reassessed. Patients achieving a CR receive a further 2 cycles of chemotherapy and then treatment is stopped. Patients with a PR (because of persistent extranodal or multifocal lymph node residual disease) receive a further 2 cycles of chemotherapy. Patients with a PR due to persistent disease in a single LN receive a course of involved field radiation (35 Gy in 20 fractions). PR patients who achieve a CR with radiation receive no further therapy, and those with persistent disease receive another 2 cycles of chemotherapy. Maximum treatment is 8 cycles of chemotherapy and a course of involved field radiation therapy between cycles 6 and 7. Reference: Klimo P, et al. J Clin Oncol 1985;3:1174 – 82. STANFORD V Mechlorethamine (Mustine) 6 mg/m2 IV Day 1 Doxorubicin 25 mg/m2 IV Days 1 and 15 Vinblastine 6 mg/m2 * IV Days 1 and 15 Vincristine 1.4 mg/m2 *# IV Days 8 and 22 Bleomycin 5 units/m2 IV Day 8 and 22 Etoposide 60 mg/m2 IV Days 15 and 16 Prednisone 40 mg/ m2 QOD PO Dose tapered by 10mg every other day starting at the end of week 10. Radiation 36 Gy radiation was administered to patients with initial disease 5 cm or greater in transverse diameter and macroscopic splenic disease (discrete tumor masses visible on CT scan, usually as low attenuation lesions). Most patients with bulky mediastinal disease received a modified mantle field that included mediastinal, bilateral hilar and bilateral low neck irradiation, but excluded axillary, occipital and cervical irradiation. Start 2 – 4 weeks after chemotherapy complete *Vinblastine dose decreased to 4 mg/m2 and vincristine dose to 1 mg/m2 during cycle 3 for patients 50 years of age and older; #Maximum dose 2mg. NOTE: Prophylactic ancillary medications prescribed included: trimethoprim-sulfamethoxazole, ranitidine, acyclovir (if HSV positive only) throughout the entire treatment period. Repeat cycle every 28 days for 3 cycles (12 week course of chemotherapy). References: Horning SJ, et al. J Clin Oncol 2002;20:630 – 7; Bartlett NL, et al. J Clin Oncol 1995;13:1080 – 8. Last Updated on September 24, 2007 VBM (VINBLASTINE, BLEOMYCIN, METHOTREXATE) Vinblastine 6 mg/m2 IV Days 1 and 8 Bleomycin 10 units/m2 IV Days 1 and 8 Methotrexate 25 mg/m2 IV Days 1 and 8 Repeat cycle every 28 days for 6 cycles. NOTE: Radiation therapy if applicable to areas of initial bulky disease. 30 – 36 Gy over 4 – 5 weeks (1.8 Gy/day Monday to Friday). Reference: Zinzani PL, et al. Haematologica 2000;85:729 – 32. Last Updated on September 24, 2007 .
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