Treatment schedule summary
Drug |
Dose |
Route |
Day |
DOXOrubicin |
40 mg/m2 |
IV |
1 |
vinCRISTine |
1.5 mg/m2(Cap dose at 2 mg) |
IV infusion |
1 and 8 |
CYCLOPHOSPHamide |
800 mg/m2 |
IV infusion |
1 |
Cytarabine (Ara-C) |
70 mg |
Intrathecal |
1 and 3 |
CYCLOPHOSPHamide |
200 mg/m2 |
IV infusion |
2 to 5 |
Methotrexate |
300 mg/m2 * |
IV infusion |
10 |
Methotrexate |
2,700 mg/m2 * |
IV infusion |
10 |
Calcium folinate (Leucovorin) |
15 mg/m2 every 3 hours then see further directions below ** |
IV infusion |
11 |
Filgrastim |
5 micrograms/kg |
Subcut |
13 and continue daily until neutrophil recovery |
Methotrexate |
12 mg |
Intrathecal |
15 |
Calcium folinate (Leucovorin) *** |
15 mg ONCE |
PO |
16 |
* Patients older than 65 years are to receive reduced doses of intravenous methotrexate (100 mg/m2 and 900 mg/m2, respectively)
** Start 36 hours after commencement of methotrexate infusion and repeat every 3 hours for the next 12 hours (i.e. between hours 36 to 48). Then continue every 6 hours until methotrexate level less than 0.1 micromol/L
*** Administered 24 hours after intrathecal methotrexate
Commence next cycle when ANC is greater than 1.0 x 109/L and platelets are greater than 75 x 109/L. Number of cycles depends on risk classification (see below).
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 on Day 5 and methotrexate on day 17, with the first cycle of dmCODOX-M only. |
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:
-
- HIV positive patients were excluded from the trial. Discuss with HIV specialist for the treatment of these patients