CODOX-M/IVAC
(for high risk patients: do not meet low risk below)
Cycle 1 and 3 ( CODOX-M )
Cyclophosphamide (Cytoxan) 800 mg/m2 iv d1
Cyclophosphamide (Cytoxan) 200 mg/m2/d iv d2-5
Doxorubicin (Adriamycin) 40 mg/m2 iv d1
Vincristine 1.5 mg/m2 iv d1, 8 for cycle 1 and d1, 8, 15 for cycle 3
Methotrexate (MTX) 1200 mg/m2 iv over 1 h d10, then 240 mg/m2 per hour civi for the next 23 hrs
Leucovorin 50 mg iv q6h begins 36 hrs from the start of MTX till MTX level < 0.05 uM
Filgrastim (Neupogen) begins 24 hrs from the start of Leucovorin till ANC > 1000/mL
CNS prophylaxis:
Intrathecal Cytarabine (Ara-C) 70 mg d1 and 3, Methotrexate (MTX) 12 mg d15
CNS treatment:
Cycle 1: Intrathecal Cytarabine (Ara-C) 70 mg d1, 3 and 5, Methotrexate (MTX) 12 mg d15 and 17
Cycle 3: Intrathecal Cytarabine (Ara-C) 70 mg d1 and 3, Methotrexate (MTX) 12 mg d15
Cycle 2 and 4 ( IVAC )
Ifosfamide 1500 mg/m2/d iv d1-5
Etoposide (VP-16) 60 mg/m2/d iv d1-5
Cytarabine (Ara-C) 2000 mg/m2 iv q12h d1 and 2 (total 4 doses)
Filgrastim begins 24 hrs after completion of chemotherapy till ANC > 1000/mL
CNS prophylaxis:
Intrathecal Methotrexate (MTX) 12 mg d5
CNS treatment:
Cycle 2: Intrathecal Methotrexate (MTX) 12 mg d5, Cytarabine (Ara-C) 70 mg d7 and 9
Cycle 4: Intrathecal Methotrexate (MTX) 12 mg d5
Radiotherapy for CNS disease and testicular involvement
Modified CODOX-M
(for low risk patients: single extraabdominal mass or completely resected abdominal mass and normal serum LDH)
Cyclophosphamide 800 mg/m2 iv d1
Cyclophosphamide 200 mg/m2/d iv d2-5
Doxorubicin 40 mg/m2 iv d1
Vincristine 1.5 mg/m2 iv d1, 8
Methotrexate (MTX) 1200 mg/m2 iv over 1 h d10, then 240 mg/m2 per hour civi for the next 23 hrs
Leucovorin 50 mg iv q6h begins 36 hrs from the start of MTX till MTX level < 0.05 uM
Filgrastim begins 24 hrs from the start of Leucovorin till ANC > 1000/mL
CNS prophylaxis:
Intrathecal Cytarabine (Ara-C) 70 mg d1, Methotrexate (MTX) 12 mg d3
Total of 3 cycles
CALGB 9251
Cycle 1
Cyclophosphamide 200 mg/m2/d iv d1-5
Prednisone 60 mg/m2/d po d1-7
Cycle 2, 4, 6
Ifosfamide 800 mg/m2/d iv over 1 hr d1-5
Mesna 200 mg/m2 iv at 0, 4 and 8 hrs after ifosfamide d1-5
Methotrexate (MTX) 150 mg/m2 iv over 30 minutes d1, followed by 1350 mg/m2 civi over 23.5 hrs
Leucovorin 50 mg/m2 iv 36 hrs after start of MTX, followed by 15 mg/m2 iv q6h till MTX level < 0.05 uM
Vincristine 2 mg iv d1
Cytarabine (Ara-c) 150 mg/m2/d civi d 4 and 5
Etoposide (VP-16) 80 mg/m2/d iv over 1 hr d 4 and 5
Dexamethasone 10 mg/m2/d po d1-5
Cycle 3, 5, 7
Cyclophosphamide 200 mg/m2/d iv d1-5
Methotrexate (MTX) 150 mg/m2 iv over 30 minutes d1, followed by 1350 mg/m2 civi over 23.5 hrs
Leucovorin 50 mg/m2 iv 36 hrs after start of MTX, followed by 15 mg/m2 iv q6h till MTX level < 0.05 uM
Vincristine 2 mg iv d1
Doxorubicin (Adriamycin) 25 mg/m2/d iv bolus d 4 and 5
Dexamethasone (Decadron) 10 mg/m2/d po d1-5
Intrathecal (cycle 2-7)
Methotrexate (MTX) 15 mg d1
Cytarabine (Ara-c) 40 mg d1
Hydrocortisone 50 mg d1
Brain radiation 24 Gy post chemotherapy if bone marrow involvement
Start cycle 2 right after cycle 1, cycle 2-7 are given q3w
Pre-B or T lymphoblastic lymphoma
Hyper-CVAD/MTX-Ara-C
Cycle 1,3,5,7 (3-4 wks/cycle)
Cyclophosphamide (Cytoxan) 300 mg/m2 iv over 2 hrs q12 hrs x 6 doses d1-3
Mesna 600 mg/m2/d civi d1-3 to start 1 h before cyclophosphamide till 12 hrs after completion of cyclophosphamide
Vincristine 2 mg iv d4, 11
Doxorubicin 50 mg/m2 iv over 24 hrs (over 48 hrs if LVEF < 50%) d4
Dexamethasone 40 mg po or iv qd d1-4 and d11-14
Cycle 2,4,6,8 (3-4 wks/cycle)
Methotrexate (MTX) 200 mg/m2 iv over 2 hrs followed by 800 mg/m2 civi over 22 hrs d1
Cytarabine (Ara-C) 3 g/m2 (1 g/m2 for patients over 60 years old) iv over 2 hrs q12 hrs x 4 doses d2-3
Leucovorin 50 mg iv q6 hrs starting 12 hrs after completion of MTX till MTX level < 0.05 uM
Intrathecal chemotherapy
Prophylaxis
Methotrexate (MTX) 12 mg d2 of each cycle for a total of 3-4 treatments
Cytarabine (Ara-C) 100 mg d8 of each cycle for a total of 3-4 treatments
Therapeutic
Intrathecal chemotherapy twice a week (Methotrexate (MTX) 12 mg and Cytarabine (Ara-C) 100 mg respectively) till no more cancer cells in CSF, then decrease intrathecal chemotherapy to once a week x 4, followed by Methotrexate (MTX) 12 mg d2, Cytarabine (Ara-C) 100 mg d8 for the remaining chemotherapy cycles
Cranial radiotherapy 24-30 Gy if cranial nerve palsies
CALGB 9111
Cycle 1 (4 wks)
Cyclophosphamide 1200 mg/m2 iv d1
Doxorubicin 45 mg/m2/d iv d1, 2, 3
Vincristine 2 mg iv d1, 8, 15, 22
Prednisone 60 mg/m2 po or iv qd d1-21
L-Asparaginase 6000 IU/m2 sc or im d5, 8, 11, 15, 18, 22
Reduce doses if patients older than 60:
Cyclophosphamide 800 mg/m2 iv d1
Doxorubicin 30 mg/m2/d iv d1, 2, 3
Prednisone 60 mg/m2 po qd d1-7
Filgrastim 5 mcg/kg sc qd d4 till ANC > 1000/uL
Cycle 2 (4 wks,repeat once)
Cyclophosphamide 1000 mg/m2 iv d1
6-Mercaptopurine (6-MP) 60 mg/m2/d po d1-14
Cytarabine (Ara-C) 75 mg/m2/d sc d1-4 and 8-11
Vincristine 2 mg iv d15, 22
L-Asparaginase 6000 IU/m2 sc or im d15, 18, 22, 25
Intrathecal Methotrexate (MTX) 15 mg d1
Filgrastim 5 mcg/kg sc qd d2 till ANC > 5000/uL
Cycle 3 (12 wks)
6-Mercaptopurine (6-MP) 60 mg/m2/d po d1-70
Methotrexate (MTX) 20 mg/m2 po d36, 43, 50, 57, 64
Intrathecal Methotrexate (MTX) 15 mg d1, 8, 15, 22, 29
Brain radiation 24 Gy d1-12
Cycel 4 (8 wks)
Doxorubicin 30 mg/m2/d iv d1, 8, 15
Vincristine 2 mg iv d1, 8, 15
Dexamethasone 10 mg/m2/d po d1-14
Cyclophosphamide 1000 mg/m2 iv d29
6-Thioguanine 60 mg/m2/d po d29-42
Cytarabine (Ara-C) 75 mg/m2/d sc d29-32 and 36-39
Cycle 5 (16 months)
Vincristine 2 mg iv d1 qm
Prednisone 60 mg/m2/d d1-5 qm
Methotrexate (MTX) 20 mg/m2/d po d1, 8, 15, 22
6-Mercaptopurine (6-MP) 60 mg/m2/d po d1-28