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تعداد آیتم قابل مشاهده باقیمانده : -11 مورد

R-CODOX-M/IVAC (Magrath) regimen for Burkitt lymphoma

R-CODOX-M/IVAC (Magrath) regimen for Burkitt lymphoma
The R-CODOX-M/IVAC regimen is composed of four cycles, each cycle lasting until the absolute neutrophil count returns to >1000/microL and the platelet count >100,000/microL. Cycles 1 and 3 are R-CODOX-M and cycles 2 and 4 are R-IVAC. Three cycles of R-CODOX-M are sufficient for patients with low-risk disease (ie, a single focus of disease <10 cm in diameter and a normal serum lactate dehydrogenase level).
R-CODOX-M (cycles 1 and 3):[1-4]
Rituximab 375 mg/m2 IV on day 1
Cyclophosphamide 800 mg/m2 IV on day 1
Cyclophosphamide 200 mg/m2 IV on days 2 through 5
Doxorubicin 40 mg/m2 slow IV push on day 1
Vincristine 1.5 mg/m2 (maximum 2 mg) IV on days 1 and 8 (cycle 1) and days 1 and 8 (cycle 3)
Methotrexate – Leucovorin rescue is required. Follow institutional guidelines, as the preferred protocol for dose and schedule of leucovorin administration varies.
  • Age 65 years or younger: 300 mg/m2 IV loading dose over one hour on day 10, followed by 2700 mg/m2 IV infusion administered over the next 23 hours
  • Age >65 years: 100 mg/m2 IV loading dose over one hour on day 10, followed by 900 mg/m2 IV infusion administered over the next 23 hours
Granulocyte colony stimulating factor begins 24 hours after leucovorin rescue is started and continues until the absolute neutrophil count is >1000/microL
Intrathecal medications
  • Intrathecal cytarabine 70 mg (if >3 years of age) on days 1 and 3
  • Intrathecal methotrexate 12 mg (if >3 years of age) on day 15
  • Oral leucovorin 15 mg/dose on day 16, 24 hours after intrathecal methotrexate
  • Enhanced CNS-directed therapy for patients with CNS disease at presentation: cytarabine 70 mg/dose (if >3 years of age) intrathecal (or 15 mg if via Ommaya reservoir) on day 5 and methotrexate 12 mg (if >3 years of age) intrathecal (or 2 mg if via Ommaya reservoir) on day 17 in cycle 1[2]
R-IVAC (cycles 2 and 4):[1-4]
Rituximab 375 mg/m2 IV on day 1
Ifosfamide
  • Age 65 years or younger: 1500 mg/m2 IV on days 1 through 5 with mesna uroprotection
  • Age >65 years: 1000 mg/m2 IV on days 1 through 5 with mesna uroprotection
Etoposide 60 mg/m2 IV on days 1 through 5
Cytarabine
  • Age 65 years or younger: 2 g/m2 IV every 12 hours on days 1 and 2 (four doses)
  • Age >65 years: 1 g/m2 IV every 12 hours on days 1 and 2 (four doses)
Granulocyte colony stimulating factor begins 24 hours after the completion of IV chemotherapy and continues until the absolute neutrophil count is >1000/microL
Intrathecal medications
  • Intrathecal methotrexate 12 mg (if >3 years of age) on day 5
  • Oral leucovorin 15 mg on day 6, 24 hours after intrathecal methotrexate
  • Enhanced CNS-directed therapy for patients with CNS disease at presentation: cytarabine 70 mg (if >3 years of age) intrathecal (or 15 mg if via Ommaya reservoir) on days 7 and 9 in cycle 2[2]
This table illustrates the R-CODOX-M/IVAC (Magrath) regimen used for aggressive lymphomas. The version used in the earliest clinical trial included a cycle 3, day 15 dose of vincristine, which has been eliminated from most subsequent trials investigating this regimen.
CNS: central nervous system; IV: intravenous.
References:
  1. Magrath I, Adde M, Shad A, et al. Adults and children with small non-cleaved-cell lymphoma have a similar excellent outcome when treated with the same chemotherapy regimen. J Clin Oncol 1996; 14:925.
  2. Mead GM, Sydes MR, Walewski J, et al. An international evaluation of CODOX-M and CODOX-M alternating with IVAC in adult Burkitt's lymphoma: results of United Kingdom Lymphoma Group LY06 Study. Ann Oncol 2002; 13:1264.
  3. Mead GM, Barrans SL, Qian W, et al. A prospective clinicopathologic study of dose-modified CODOX-M/IVAC in patients with sporadic Burkitt lymphoma defined using cytogenetic and immunophenotypic criteria (MRC/NCRI LY10 Trial). Blood 2008; 112:2248.
  4. Lacasce A, Howard O, Lib S, et al. Modified magrath regimens for adults with Burkitt and Burkitt-like lymphomas: preserved efficacy with decreased toxicity. Leuk Lymphoma 2004; 45:761.
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