Protocols - Hemorio

- onset of apheresis with CD34 ≥10/µL. Forecast for the onset of the collection D16 (D13-D22).
- ICE:
- Etoposide 100 mg/m 2 D1-D3;
- ifosfamide 5 g/m 2 in a continuous venous infusion at D2;
- mesna 5 g/m 2 in a continuous venous infusion at D2. Dilute with ifosfamide;
- carboplatin at the dose AUC 5 at D2, calculated by the formula 5 x (creatinine clearance + 25). Maximum
dose of 800 mg.
- mabthera 375 mg/m 2 D1 in case of LNH CD20 positive (desirable);
- G-CSF 5 µg/kg every 12 hours from D5;
- onset of apheresis with CD34 ≥10/µL. Forecast for the onset of the collection D14.
- Minimum collection of 2 x 10 6 cells CD34/Kg.
Conditioning and prophylaxis regimen
- Escalated CBV:
- cyclophosphamide 1800 mg/m 2 /day from D-6 to D-3 (total dose of 7200 mg/m 2 );
- Etoposide 400 mg/m 2 every 12 hours from D-6 to D-4 (total dose of 2400 mg/m 2 );
- BCNU 450 mg/m 2 at D-2.
- CBV standard:
- cyclophosphamide 1500 mg/m 2 /day from D-6 to D-3 (total dose of 6000 mg/m 2 );
- Etoposide 200 mg/m 2 every 12 hours from D-6 to D-4 (total dose of 2400 mg/m 2 );
- BCNU 300 mg/m 2 at D-2.
- the choice of regimen with increased or standard doses must be taken by the transplant team;
- mesna 1/6 of the daily dose of cyclophosphamide, starting one hour before each infusion of
cyclophosphamide and every 4 h after the infusion for more five doses (six doses in the total);
- furosemide 10 mg 1 hour, 4 hours and 8 hours after each dose of cyclophosphamide;
- fluconazole 200 mg IV every 12 hours from D-2 until the engraftment;
- acyclovir 250 mg/m 2 IV every 12 hours from D-2 until the engraftment;
- albendazole 400 mg VO for three consecutive days at the hospitalization;
- allopurinol 300 mg VO by day during the conditioning;
- ursodesoxycolic acid 300 mg VO every 12 hours;
- ondansetron 0.15 mg/kg every 6 h in the course of the chemotherapy and until necessary;
- hyperhydration with SG 5% with additives at the volume of 3000 ml/m 2 /day;
- G-CSF 5 µg/kg/day, starting at D+5.
Complimentary radiotherapy: The pre-transplant radiotherapy must be avoided because it increases the
risk of pneumonitis. The radiotherapy located after the autologous transplantation must be evaluated at
the subjects with pre-transplant “bulky disease” or persistence of the located disease after the transplant.
Usage of mabthera in LNH CD20 positive: It is desirable the addition of mabthera to the rescue /
mobilization chemotherapy protocol in subjects with LNH CD20 positive (R-ESHAP or R-ICE). The
maintenance with mabthera monthly for up to 6 months is also desirable (the maintenance length is not
totally established yet).
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