Hematologic Malignancies

• Acute Lymphocytic Leukemia

• Acute Myelogenous Leukemia

• Chronic Lymphocytic Leukemia

• Chronic Myelogenous Leukemia

• Hairy Cell Leukemia

• Hodgkin's Disease

• Multiple Myeloma

Waldenstrom's Macroglobulinemia

• Myelodysplastic Syndrome

• Non-Hodgkin's Lymphoma

Hematologic Malignancies

Brain Cancer

Acute Lymphocytic Leukemia

Hoelzer Regimen (BFM)

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INDUCTION—PHASE I

Vincristine 2 mg IV days 1,8,15,22 Daunorubicin 25 mg/M2 IV days 1,8,15,22 Prednisone 60 mg/M2 PO days 1-28 L-asparaginase 5,000 units/M2 IV days 1-14

INDUCTION—PHASE II

Cyclophosphamide 650 mg/M2 IV days 29,43,57 -maximum dose 1000 mg

6-Mercaptopurine 60 mg/M2 PO days 29-57

CNS PROPHYLAXIS—weeks 5 through 8

Methotrexate 10 mg/M2 IT days 31,38,45,52

-maximum dose is 15 mg Cranial 1800-2400 cGy given with phase II radiotherapy induction

CONSOLIDATION—PHASE I-begins week 20

Vincristine 2 mg IV days 1,8,15,22 Doxorubicin 25 mg/M2 IV days 1,8,15,22 Dexamethasone 10 mg/M2 PO days 1-28

CONSOLIDATION - PHASE II

Cyclophosphamide 650 mg/M2 IV day 29 - maximum dose is 1000 mg

Ara-C 75 mg/M2 IV days 31-34,38-41 6-Thioguanine 60 mg/M2 PO days 29-42

MAINTENANCE

6-Mercaptopurine 60 mg/M2 PO daily weeks 10-18,29-130

Methotrexate 20 mg/M2 PO/IV weekly weeks 10-18,29-130

REF: Hoelzer et al. Blood 1988; 71:123-131

PREMEDICATIONS

1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after: daunorubicin, doxorubicin, and cyclophosphamide

2. Compazine 10 mg PO/IV 30 minutes before: cytarabine and L-asparaginase

Brain Cancer Breast Cancer Carcinoma of Unknown Primary

Anthracyclines—monitor cumulative dose for possible cardiac toxicity; vesicant-avoid extravasation

Methotrexate—use 75% dose for CrCl < 50; 50% dose if CrCl < 25; do not give if patient has an effusion ("reservoir effect")

Vincristine—vesicant-avoid extravasation; cumulative neurotoxicity—may produce severe constipation; maximum 2 mg per administration

6-Mercaptopurine—reduce dose by 75% when used in conjunction with allopurinol

L-asparaginase—be prepared to treat anaphylaxis at each administration; giving with or immediately before Vincristine may increase Vincristine toxicity

Hyper CVAD Regimen

HYPER CVAD ALTERNATING WITH HIGH DOSE METHOTREXATE/ARA-C

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-alternate above for a total of 8 cycles

-subsequent cycles given when WBC recovers to > 3.0 and platelet count is > 60,000

HYPER CVAD—cycles 1, 3, 5, and 7

Cyclophosphamide 300 mg/M2 IV Q12H days 1-3

Mesna 600 mg/M2/d CIV days 1-3

-start at same time as cyclophosphamide and finish 6 hours after completion of cyclophosphamide Vincristine 2 mg IV days 4,11 Doxorubicin 50 mg/M2 IV day 4 Dexamethasone 40 mg PO days 1-4,

11-14

PREMEDICATIONS

1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after chemotherapy on days 1-4

OTHER MEDICATIONS

1. Levofloxacin 500 mg PO QD

2. Fluconazole 200 mg PO QD

3. Valacyclovir 500 mg PO QD

4. Neupogen 10 mcg/kg/d SQ divided BID starting day 5

HIGH DOSE METHOTREXATE AND CYTARABINE (ARA-C)-cycles 2, 4, 6, 8

Methotrexate 200 mg/M2 IV (over 2 h) day 1 -followed by

Methotrexate 800 mg/M2 CIV (over 24 h) day 1

Leucovorin 15 mg PO Q6H for 8 doses

-increase Leucovorin to 50 mg PO Q6H if methotrexate level is:

> 20 mmol/L at end of infusion

> 0.1 mmol/L 48 hr after the end of the methotrexate infusion

- continue until methotrexate level is < 0.1 mmol/L Ara-C 3 gm/M2 IV days 2-3

over 2 hr Q12H for 4 doses Methylprednisolone 50 mg IV BID days 1-3

PREMEDICATIONS

1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after chemotherapy on days 1-3

OTHER MEDICATIONS

1. Levofloxacin 500 mg PO QD

2. Fluconazole 200 mg PO QD

3. Valacyclovir 500 mg PO QD

4. Neupogen 10 mcg/kg/d SQ divided BID starting day 5

5. Dexamethasone eye drops 2 drops each eye Q3H during and for 48-72 hours after completion of cytarabine_

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