Protocols - Hemorio

INDICATIONS FOR THE TREATMENT:
Symptoms, dysfunction of target organ, cytopenia secondary to LNH, Bulky, progression and preference
of the subject
- Stage I and II – Radiotherapy of the field involved
- Stages II Bulky, III, IV – Chemotherapy evaluate if it is CD 20+
The treatment may be palliative with monotherapy, or more aggressive according to the age, PS and FLIP.
Younger subjects and with an intermediate or high risk must be treated aggressively.
Rituximab, in case of CD20+, at 1 st line according to subject’s PS.
Chlorambucil - Chlorambucil – 0.1 mg/kg/day
- Chlorambucil - 40mg/m 2 at D1 (low dose) or
- Chlorambucil - 10 mg/m 2 /day from D1 to D7 (high dose)
Fludarabine (28 days) - Fludarabine 25 mg/m 2 D1-D5
FC (28 days) - Fludarabine 25 mg/m 2 D1-D3
- Cyclophosphamide 250 mg/m 2 D1-D3
COP (21 days) - Cyclophosphamide 600mg/m 2 D1
- Oncovin 1.4mg/m 2 (max 2 mg) D1
- Prednisone 100mg VO D1 to D5
Rituximab - 375mg/m 2 at D1 of R-COP or R-Fludarabine
Perform a pre-medication with Polaramine and Decadron 10mg. Dilute 1mg/1ml. Infuse 50 ml/h at the 2
initial hours, then increase the infusion to 50ml/h every 30 min up to 200ml/h. If there is any reaction,
discontinue the infusion, perform Hydrocortisone 100mg EV and return the infusion slowly after the
reaction recovery. Fludarabine presents a better response, but with a higher toxicity. It must be avoided in
candidates to TCTH. It must also be avoided in subjects with AHAI associated to activity. Perform a
prophylaxis with SMZ+TMP.
- 2 nd Line Treatment (Self-TMO – evaluate age and PS) - Protocols not used yet. Evaluate Big Cells
Diffuse Lymphoma protocol.
- Maintenance – Rituximab 375mg/m 2 one application every 4 months for 2 years.
2 - BIG CELLS DIFFUSE LYMPHOMA
Lumbar puncture in case of testicular, paranasal, parameningeal, MO infiltration, paraorbital, or HIV attack
Immunophenotype – CD 20+, CD45+, CD3- .
PROGNOSIS
IPI Criterion
AGE > 60 YEARS OLD RISK GROUP FACTORS NUMBER
Stage Ann Arbor III - IV Low 0 - 1
Performance status 2 - 4 Intermediate Low 2
LDH > upper limit Intermediate High 3
Number of nodal sites > 1 High 4 or 5
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