B-CELL LYMPHOMA
Group A (COPAD 1,2)
Days 1 2 3 4 5 6 7Ondansetron: 5mg/m2 IV BD - Prednisone:
Ondan 60mg/m2/d in 2 divided doses, taper over 3 days.
PRD Vincristine: 2mg/m2/d (max: 2m) IV bolus on day1, 6.
Cyclophosphamide: 250mg/m2 X 100ml/m2 NS over 15
VCR
min BD. Maintain hydration at 3L/m2/d (=125ml/m2/h)
Cyclo
continue until 12h after the last dose of cyclo.
DXR
Doxorubicin 60mg/m2 X 300ml/m2 NS over 6 hours
GCSF
after the first dose of cyclo.
GCSF: 5mic/kg/day SC on day7-21. Should be discontinued when the post nadir ANC reaches
3000/mm3, even if prior to day21.
Group B (COP prephase)
Days 1 2 3 4 5 6 7 Ondansetron: 5mg/m2 IV BD -Hydration:3L/m2
Ondan D5%NS0.18% + NaHCO3 40meq/L. rate: 125ml/m2/hr.
PRD -Prednisone: 60mg/m2/d in 2 divided doses.
Vincristine: 1mg/m2/d (max: 2m) IV bolus on day1.
VCR
Cyclophosphamide: 300mg/m2 X 100ml/m2 NS over
Cyclo
15 min.
IT MTX + HDC
Evaluation
Group B Induction (COPADM 1, (2 after recovery with ANC ~ 1.0 x 109/l and platelets ~ 100 x 109/l)
Days 1 2 3 4 5 6 7 Ondansetron: 5mg/m2 IV BD -Prednisone: 60mg/m2/d
Ondan in 2 divided doses, taper over 3 days.
PRD Vincristine: 2mg/m2/d (max: 2m) IV bolus on day1.
* MTX Hydration: PRE: D5%1/5thNS + NaHCO3
VCR
40meq/L. rate: 250ml/m2/hr for 2hr. THEN MTX 1gm in
IV MTX
500ml m2 D5% over 3 hours, on other line: D5%1/5thNS
IT MTX + HDC
+ NaHCO3 40meq/L. rate: 125ml/m2/hr for 3hr. POST:
Leucovorin
D5%1/5thNS + NaHCO3 40meq/L + 10meq KCl/L, rate:
Cyclo 125ml/m2/hr for 72hr. Leucovorin: 15mg/m2 Q6hr.
DXR Cyclophosphamide: 250mg/m2 X 100ml/m2 NS over 15
GCSF min BD. Maintain hydration at 3L/m2/d (=125ml/m2/h)
Evaluation* continue until 12h after the last dose of cyclo.
2
Doxorubicin 60mg/m infusion over 1 hour after the first dose of cyclo. Evaluation* post COPADM-1.
Group B Consolidation (CYM 1, (2 after recovery with ANC ~ 1.0 x 109/l and plats ~ 100 x 109/l)
Days 1 2 3 4 5 6 7 * MTX Hydration: PRE: D5%1/5thNS + NaHCO3
IV MTX 40meq/L. rate: 250ml/m2/hr for 2hr. THEN MTX 1gm in
IT MTX + HDC 500ml m2 D5% over 3 hours, on other line: D5%1/5thNS
+ NaHCO3 40meq/L. rate: 125ml/m2/hr for 3hr. POST:
Leucovorin
D5%1/5thNS + NaHCO3 40meq/L + 10meq KCl/L, rate:
Cytarabine
125ml/m2/hr for 72hr. Leucovorin: 15mg/m2 Q6hr.
IT AraC + HDC
Cytarabine: 100mg/m2 X 1L DNS over 24hs as
GCSF
continous infusion. Evaluation* post CYM-1.
Following recovery from CYM1, a full assessment of response should be carried out, any residual
masses should be surgically excised or biopsied, unless <2cm or surgically inaccessible..
If histology -ve: CYM2, if +, even if completely excised: CYVE1.
B-CELL LYMPHOMA
Group C1 COP Prephase
Days 1 2 3 4 5 6 7 Ondansetron: 5mg/m2 IV BD -Hydration:3L/m2
Ondan D5%NS0.18% + NaHCO3 40meq/L. rate: 125ml/m2/hr.
PRD -Prednisone: 60mg/m2/d in 2 divided doses.
Vincristine: 1mg/m2/d (max: 2m) IV bolus on day1.
VCR
Cyclophosphamide: 300mg/m2 X 100ml/m2 NS over
Cyclo
15 min.
TIT
TIT: MTX+ Hydrocortisone+ AraC
Evaluation
Group C1 - Induction (COPADM 1, (2 after recovery with ANC ~ 1.0 x 109/l and plats ~ 100 x 109/l)
Days 1 2 3 4 5 6 7 Ondansetron: 5mg/m2 IV BD -Prednisone: 60mg/m2/d
Ondan in 2 divided doses, taper over 3 days.
PRD Vincristine: 2mg/m2/d (max: 2m) IV bolus on day1.
* MTX Hydration: PRE: D5%1/5thNS + NaHCO3
VCR
IV MTX
40meq/L. rate: 250ml/m2/hr for 2hr. THEN MTX 1gm in
500ml m2 D5% over 3 hours, on other line: D5%1/5thNS
TIT
+ NaHCO3 40meq/L. rate: 125ml/m2/hr for 3hr. POST:
Leucovorin
D5%1/5thNS + NaHCO3 40meq/L + 10meq KCl/L, rate:
Cyclo 125ml/m2/hr for 72hr. Leucovorin: 15mg/m2 Q6hr.
DXR Cyclophosphamide: 250mg/m2 (500 mg/m2 in
GCSF COPADM2) X 100ml/m2 NS over 15 min BD. Maintain
hydration at 3L/m2/d (=125ml/m2/h) continue until 12h after the last dose of cyclo.
Doxorubicin 60mg/m2 infusion over 1 hour after the first dose of cyclo.
Group C1 CONSOLIDATION (CYVE 1, (2 after recovery with ANC ~ 1.0 x 109/l and plats ~ 100 x 109/l)
Days 1 2 3 4 5 6 * Arac 50mg/m2 X 100ml D5% over 12 hr (8pm – 8am).
AraC HD AraC: 1gm/m2 X 375ml DNS over 3hr (8am-11am).
HD AraC Etoposide: 200 mg/m2 X 500 ml/m2 D5% or NS. IV infusion
Etoposide
over 2 hours (2pm-4pm). # Steroid eye drops.
Following recovery from CYVE2, a full assessment of response should be carried out, The patient
should be in CR to continue on protocol. Only progressive disease or incomplete remission with
histological confirmation of presence of viable cells in the residue will be considered as treatment
failure. A decision should not be taken on the basis of a positive PET/CT alone.
Group C1 – Maintenance1 (starts when ANC: 1.0 and plts 100 (usually by day 25 to 28).
Days 1 2 3 4 5 6 7 Ondansetron: 5mg/m2 IV BD -Prednisone: 60mg/m2/d
Ondan in 2 divided doses, taper over 3 days.
PRD Vincristine: 2mg/m2/d (max: 2m) IV bolus on day1.
* MTX Hydration: PRE: D5%1/5thNS + NaHCO3
VCR
IV MTX
40meq/L. rate: 250ml/m2/hr for 2hr. THEN MTX 1gm in
500ml m2 D5% over 3 hours, on other line: D5%1/5thNS
TIT
+ NaHCO3 40meq/L. rate: 125ml/m2/hr for 3hr. POST:
Leucovorin
D5%1/5thNS + NaHCO3 40meq/L + 10meq KCl/L, rate:
Cyclo 125ml/m2/hr for 72hr. Leucovorin: 15mg/m2 Q6hr.
DXR Cyclophosphamide: 500 mg/m2 X 100ml/m2 NS over 30
min. Maintain hydration at 3L/m2/d (=125ml/m2/h) continue until 12h after the last dose of cyclo.
Doxorubicin 60mg/m2 infusion over 1 hour after the first dose of cyclo.
Group C – Maintenance 2 (starts when ANC: 1.0 and plts 100 (usually by day 25 to 28).
Days 1 2 3 4 5 * Arac 50mg/m2 SC every 12 hr.
AraC Etoposide: 150mg/m2 X 500 ml/m2 D5% or NS. IV infusion over
Etoposide 90min.
