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.