Protocols - Hemorio

SECOND-LINE TREATMENT:
• late relapse (more than 6 months after the conclusion of the first-line treatment): repeat the initial
treatment protocol.
• early relapse or progression in the course of the treatment:
WITHOUT A PREVIOUS USAGE OF
FLUDARABINE
fludarabine 25 mg/m 2 IV D1-D3
cyclophosphamide 250 mg/m 2 IV D1-D3
or
fludarabine 25 mg/m 2 IV D1-D5
or
fludarabine 24 mg/m 2 VO D1-D5
cyclophosphamide 150 mg/m 2 VO D1-D5
PREVIOUS USAGE OF FLUDARABINE
(repeat every 28 days for 6 cycles)
CYCLE 1:
Rituximab 375mg/m2 IV D1
fludarabine 25 mg/m2 IV D2-D4
cyclophosphamide 250 mg/m2 IV D2-D4
CYCLES 2-6:
Rituximab 500mg/m 2 IV D1
fludarabine 25 mg/m 2 IV D1-D3
cyclophosphamide 250 mg/m 2 IV D1-D3
ALLOGENIC TRANSPLANT
Take into account subjects below 60 years old, refractory to the treatment based on analogous of purine
or with 17p-. The optimal transplant is the non-myeloablative related type. Try to reduce the tumoral
charge of the subject before the transplant.
SPECIAL SITUATIONS
Richter Transformation. Usually associated to the fast increase of lymph nodes, fever and weight loss.
Make a biopsy in the lymph node for the diagnostic confirmation. It must be treated as an aggressive
lymphoma (R-CHOP). Evaluate the autologous transplant for consolidation.
Pro-lymphocytic B transformation. Occurs in 10% of the subjects and presents reserved prognosis.
Consider the usage of purine analogous and/or monoclonal antibodies.
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