ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
نسخه الکترونیک
medimedia.ir

Chemotherapy regimens for Hodgkin lymphoma: ABVD[1]

Chemotherapy regimens for Hodgkin lymphoma: ABVD[1]
Cycle length: 28 days.
Drug Dose and route Administration Given on days
Doxorubicin 25 mg/m2 IV Dilute in 50 mL normal saline (NS) and administer over three to five minutes through a central line or IV push through a peripheral line. Days 1 and 15
Bleomycin* 10 units/m2 IV

Dilute in 50 mL NS and administer over 10 minutes or IV push through a peripheral line.

Test dose of 2 units given one hour before full dose can be considered for the first cycle.		 Days 1 and 15
Vinblastine 6 mg/m2 IV Administer over one minute. Days 1 and 15
Dacarbazine 375 mg/m2 IV

Central line: Dilute in 250 mL of 5% dextrose (D5W) and administer over 30 minutes.

Peripheral line: Dilute in 500 mL of D5W and administer over 60 minutes.

Dacarbazine should be protected from light.		 Days 1 and 15
Pretreatment considerations:
Emesis risk
  • HIGH (>90% frequency of emesis).
  • Refer to UpToDate topics on prevention of chemotherapy-induced nausea and vomiting in adults.
Prophylaxis for infusion reactions
  • Premedicate with acetaminophen prior to administration of the full bleomycin dose. Some clinicians administer a bleomycin test dose before the first cycle.
  • Refer to UpToDate topics on infusion reactions to systemic chemotherapy.
Vesicant/irritant properties
  • Doxorubicin and vinblastine are vesicants.
  • Refer to UpToDate topics on extravasation injury from chemotherapy and other non-antineoplastic vesicants.
Infection prophylaxis
  • Primary prophylaxis with G-CSF is generally not indicated, and G-CSF is avoided in some centers because of concerns that concurrent use may increase bleomycin lung toxicity.
  • Refer to UpToDate topics on bleomycin-induced lung injury.
Dose adjustment for baseline liver or kidney dysfunction
  • A dose reduction in bleomycin of at least 25% is recommended for patients with creatinine clearance 10 to 50 mL/min, and at least 50% reduction for clearance <10 mL/min. Chemotherapy dose adjustments for doxorubicin and vinblastine are needed in patients with cholestasis.
  • Refer to UpToDate topics on chemotherapy hepatotoxicity and dose modification in patients with liver disease, conventional cytotoxic agents; chemotherapy hepatotoxicity and dose modification in patients with liver disease, molecularly targeted agents; and chemotherapy nephrotoxicity and dose modification in patients with kidney impairment, conventional cytotoxic agents.
Monitoring parameters:
  • Assess CBC with differential, electrolytes, kidney function, and liver function prior to each treatment cycle.
  • Cumulative doxorubicin dose should be monitored. Measure left ventricular ejection fraction prior to first cycle, then as clinically indicated.
  • Monitor for respiratory complaints or unexplained findings on lung exam (eg, rales). Maximum bleomycin lifetime dose not to exceed 400 mg. Measure pulmonary diffusion capacity before first cycle and then per institutional policy.
  • Refer to UpToDate topics on bleomycin-induced lung injury.
Suggested dose modifications for toxicity:
Myelotoxicity
  • No routine dose modifications; G-CSF is not routinely administered unless previous cycles were complicated by infection or fever in setting of neutropenia.
  • Refer to the UpToDate topics on use of granulocyte colony stimulating factors in adult patients with chemotherapy-induced neutropenia and conditions other than acute leukemia, myelodysplastic syndrome, and hematopoietic cell transplantation.
Pulmonary toxicity
  • Bleomycin should be discontinued in patients with documented or strongly suspected bleomycin-induced lung injury.
  • Refer to UpToDate topics on bleomycin-induced lung injury.
Neuropathy
  • For severe paresthesias and/or constipation, the dose of vinblastine may be reduced by 50%; vinblastine should be discontinued permanently if an adynamic ileus occurs.
If there is a change in body weight of at least 10%, doses should be recalculated.
This table is provided as an example of how to administer this regimen; there may be other acceptable methods. This regimen must be administered by a clinician trained in the use of chemotherapy, who should use independent medical judgment in the context of individual circumstances to make adjustments, as necessary.

ALT: alanine aminotransferase; AST: aspartate aminotransferase; CBC: complete blood count; G-CSF: granulocyte colony stimulating factors; IV: intravenous; WBC: white blood cell.


* 1 mg bleomycin = 1 unit bleomycin.

¶ A test dose of bleomycin before the first dose is recommended by the manufacturer;[2] however, many institutions no longer perform this test dose. Refer to UpToDate topics on infusion reactions to systemic chemotherapy.

References:
  1. Canellos GP, Anderson JR, Propert KJ, et al. Chemotherapy of advanced Hodgkin's disease with MOPP, ABVD, or MOPP alternating with ABVD. N Engl J Med 1992; 327:1478.
  2. Bleomycin sulfate injection. United States Prescribing Information. US National Library of Medicine. (Available online at dailymed.nlm.nih.gov, accessed on January 3, 2012).
Graphic 68131 Version 43.0

آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟