Typical Leukemia/Lymphoma/Multiple Myeloma Treatment Protocols

 

 

1/25/2012

 

AML

Newly Diagnosed AML

-Inversion 16 and t(8;21) [CBFB-MYH11]

               Fludarabine + Ara-C + G-CSF + Idarubicin

                 (G-CSF to induce synchronization of tumor  cells into S phase for chemosensitivity)

-APL [PML-RARA]

ATRA and arsenic +/- Idarubicin (for highWBC)

-Not APL, not CBFB-MYH11

        Age < 60

Idarubicin (day 3) + High-dose Ara-C (day7)   [3-7 regimen]

       Age ≥ 60

DAC  (doxifluridine, adriamycin, cyclophosphamide)

Azacitidine (Vidaza)  + Revlimid

Azacitidine (Vidaza)

            Vorinostat +/- Aza

-FLT3 Mutated only

Idarubicin + Ara-C +/- Sorafenib

 

ALL/AML RELAPSE

Consider allogenic transplant, particularly if 1st CR< 12 months

 

ALL/Lymphoblastic Lymphoma

-B-lymphoblastic leukemia/lymphoma:

 Age < 40:

Augmented Berlin-Frankfurt-Munster. 

              Age > 40:

Hyper-CVAD +/- Rituximab [CD20 > 10%]

              Age > 60

                   Low-dose Hyper-CVAD (1/2 regular dose)

                        (hyperCVAD: 4 cycles of R-CHOP, alternated with 4 cycles of
                          Cytarabine (Ara C) and Methotrexate)

 

-T-lymphoblastic leukemia/lymphoma:

 Age < 40

                   Augmented Berlin-Frankfurt-Munster

                   Hyper-CVAD [preferred for lymphoblastic lymphoma]

              Age > 40

Hyper-CVAD

 

-Philadelphia-positive:

Age < 50

Hyper-CVAD + Dasatinib

              Age > 50

                    Hyper-CVAD + Dasatinib +/- Rituximab

 

AML/ALL: Minimal Residual Disease, as measured by flow cytometry.

     Consider transplant.

 

MDS (IncludingCMML)

       Chemo based on specific Situations

Lenalidomide

Vorinostat + Azacytidine

             Oral Clofarabine

 

CLL

           Treanda (Bendamustine)-Rituximab

 

CML

CML Chronic phase

Early (Diagnosis < 12 months); include Ph-negative /Bcr-abl1  positive CML

   Gleevec

   Dasatinib       

   Nilotinib

 

CML Accelerated Phase

   Dasatinib

 

CML Blast Phase

   Imatinib failures with T315l mutations (any stage)

 

 

Hodgkin Lymphoma

   <25 y/o ABVD

   >25 y/o AVD (Bleomycin taken off to avoid pulmonary complications)

  

   Salvage:

     Gemzar (Gemcitabine), vinorelbine, doxil

     Brentuximab vedotin [anti CD-30, SGN-35]

 

 

DLBCL

   GC subtype: R-CHOP

     (rituximab, cyclophosphomide, hydroxydaunomycin, oncovin, and prednisone)

   ABC sub-type: Ki: 30-40% R-CHOP+ bortezomib

                              Ki: >60%    R-hyperCVAD+ bortezomib

 

Follicular lymphoma

   R-Treanda

   R-CHOP

 

Burkitt Lymphoma

    R-hyperCVAD+ Rituximab

 

Mantle cell lymphoma

   R-Treanda

   HyperCVAD

 

MALT lymphoma

  R-CHOP

 

T-cell lymphoma

  HyperCVAD

  ICE [ifosfamide, carboplatin and etoposide]

  ESHAP [etoposide, methylprednisolone, high-dose cytarabine, and cisplatin]

 

  Salvage regimens:

    ICE

    ESHAP

 

Primary CNS Lymphoma

 HIGH-DOSE Methotrexate

   +HIV: Up to 3 Gm/m2 B.S.A.

   Non-HIV: 6-8 Gm/m2 B.S.A.

      plus

Rituximab: 500mg/m2 B.S.A.

Vincristine:2mg total dose.

•      Monitor: CSF EBV DNA.

 

ANTIDOTE: GlucarpIdarubicinse

 

Multiple myeloma

  Transplant Candidate (TC):

  Bortezomib + dexamethasone

  Lenolidomide + Dexamethasone

  Thalidomide + Dexamethasone

  VAD (Vincristine, doxorubicin , dexamethasone) 

  Non-Transplant Candidate:

  Melphalan + Prednisone (MP)

  Melphalan + Prednisone + Thalidomide (MPT)

  Dexamethasone (Dex) + TC regimens.