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تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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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
  • 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; leucovorin rescue begins 36 hours from the start of the methotrexate infusion
  • 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; leucovorin rescue begins 36 hours from the start of the methotrexate infusion
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.
IV: intravenous; CNS: central nervous system.
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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