Treatment schedule summary
Drug |
Dose |
Route |
Day |
Cytarabine (Ara-C) |
2,000 mg/m2 TWICE a day (12 hours apart) * |
IV infusion |
1 and 2 |
Etoposide ** |
60 mg/m2 |
IV infusion |
1 to 5 |
Mesna |
360 mg/m2 |
IV infusion |
1 |
iFOSFamide |
1,500 mg/m2 * |
IV infusion |
1 to 5 |
Mesna |
1,500 mg/m2 * |
IV infusion |
1 to 5 |
Methotrexate |
12 mg |
Intrathecal |
5 |
Calcium folinate (Leucovorin) *** |
15 mg |
PO |
6 |
Filgrastim |
5 micrograms/kg |
Subcut |
7 and continue daily until neutrophil recovery |
* Patients older than 65 years should receive reduced doses of cytarabine (1000 mg/m2), ifosfamide (1000 mg/m2) and mesna (1000 mg/m2).
** Etopophos (etoposide phosphate) 113.6 mg is equivalent to etoposide 100 mg. Doses in this protocol are expressed as etoposide.
*** Administered 24 hours after intrathecal methotrexate
IVAC to commence on the first day after CODOX-M that ANC is greater than 1.0 x109/L and platelets are greater than 75 x109/L
Link to the International Non-Hodgkin Lymphoma International Prognostic Index (IPI)
Low risk disease |
THREE cycles of dmCODOX-M |
High risk disease |
Alternating dmCODOX-M / IVAC TWICE
(i.e. dmCODOX-M / IVAC / dmCODOX-M / IVAC) |
Proven CNS disease |
Additional intrathecal cytarabine 70 mg administered on Day 7 and 9 with FIRST cycle of IVAC only.
Note: This is in addition to intrathecal methotrexate given in Day 5 as part of the IVAC protocol |
Patients are considered Low Risk if they have at least 3 of the following international prognostic index (IPI) factors:
- normal LDH
- Ann Arbor stage I to II
- WHO performance status 0 to 1
- number of extra nodal sites less than or equal to 1
All other patients are considered High Risk
- Notes:
-
- Patients presenting with CNS disease are to receive additional intrathecal therapy with cytarabine on Days 7 and 9 with the first cycle of IVAC only.
- The dosing schedule of mesna in this protocol differs from the regimen reported in the LY10 trial, and was selected by the Haematology reference committee to reflect clinical practice.