Canterbury DHB

Context

Modifications to R-CHOP21

In Germany, national trials found that adding etoposide (100 mg/m2 on day 1-3) to CHOP (CHEOP) improved results in young patients and in patients with T cell NHL. See Schmitz, N., et al. (2010). "Treatment and prognosis of mature T-cell and NK-cell lymphoma: and analysis of patients with T-cell lymphoma treated in studies of the German High-Grade Non-Hodgkin Lymphoma Study Group." Blood 116(18): 3418-3425.

Maxi-CHOP alternating with high dose cytarabine, as pioneered by the Nordic Group, has been used for patients with mantle cell lymphoma. Compared with CHOP, the dose of cyclophosphamide and doxyrubicin are increased to 1500 mg/m2 and 75 mg/m2 respectively. Alternate cycles are with 4 doses of cytosine arabinoside, 2 or 3 g/m2 over 2 days. Chemotherapy sheets are available.

Dose-adjusted Rituximab, Etoposide, Prednisone, Vincristine, Cyclophosphamide and Doxyrubicin (DA-REPOCH) has proved a well-tolerated and effective treatment for some of the more difficult aggressive lymphomas, particularly Double Hit DLBCL, Primary mediastinal B cell lymphoma, and even Burkitt lymphoma. Until recently it has required in-patient admission for management of drugs given by continuous IV infusion. However, at the time of writing an outpatient protocol is being prepared, now that it is known that etoposide preparation is stable for 48 hours in solution. Doses of etoposide cyclophosphamide and doxyrubicin are adjusted up or down depending on haematological toxicity.

Rituximab bendamustine and cytosine arabinoside has provided effective induction therapy for older patients with Mantle Cell Lymphoma who may not be able to tolerate the Nordic Protocol. See Visco, C., et al. (2017). "Rituximab, bendamustine, and low-dose cytarabine as induction therapy in elderly patients with mantle cell lymphoma: a multicentre, phase 2 trial from Fondazione Italiana Linfomi." Lancet Haematol 4(1): e15-e23.

About this Canterbury DHB document (6732):

Document Owner:

Peter Ganly (see Who's Who)

Issue Date:

November 2018

Next Review:

November 2021

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 6732