Therapeutic intent salvage chemotherapy prior to bone marrow transplant bmt hodgkins lymphoma patients will not receive rituximab as below. Cisplatin is administered in 500ml sodium chloride 0. Salvage chemotherapy for relapsedrefractory hodgkins or nonhodgkins. Responding patients received highdose chemotherapy and asct. The age and number of previous chemotherapy treatments correlated in terms of cfugm r. Icd10 codes code with prefix c8186 regimen details day drug dose route 14 dexamethasone 40mg iv or po. Only 50% of patients with relapsed hodgkin lymphoma hl can be cured with intensive induction chemotherapy, followed by highdose chemotherapy hdct and autologous stem cell transplant asct. Furthermore, dhap is the standard salvage regimen for hl see below and cd20negative nhl in many countries in europe. One patient in pr after dhap and vim did not proceed and went off protocol. In modern oncology, many regimens combine several chemotherapy drugs in combination chemotherapy. D dexamethasone a steroid ha highdose cytarabine ara c. Salvage chemotherapy for relapsedrefractory hodgkins or nonhodgkins lymphoma first line therapy in combination with alternating rchop in patients with mantle cell lymphoma with stage iiiiv disease up to 65 years of age. Eshap is most often associated with treatment of nonhodgkins lymphoma.
Bc cancer systemic therapy program has placed summaries of specific treatment protocols on the website. Chop and dhap plus rituximab followed by autologous stem. Appendix b page 1 of 61 abvd d indications firstline therapy for hodgkins lymphoma drug regimen doxorubicin bleomycin vinblastine dacarbazine 25 mgm2 by slow iv push days 1 and 15 10 um2 by slow iv push days 1 and 15 6 mgm2 by quick iv push days 1 and 15 375 mgm2 in 500 ml ns over 75 minutes days 1 and 15 cycle frequency repeat every 28 days for a total of 48 cycles. Greater manchester cancer pathway lymphoma guidelines.
All antineoplastic drugs and essential supportive drugs in this protocol are included on the world health organisation who model list of essential medicines 21st list june 2019. Rdhap is a combination chemotherapy treatment used to treat nonhodgkin lymphoma. Patients receiving salvage chemotherapy for relapsed. The drugs are run through a pump, which gives you the chemotherapy over a set time. Eshap and reshap indication chemosensitive relapsed refractory hodgkin and nonhodgkin lymphoma. Pdf randomized comparison of gemcitabine, dexamethasone. Eshap acronym chemotherapy regimen for nonhodgkins. Nccn continues to add to the library of chemotherapy order templates to improve the safe use of drugs and biologics in cancer care. The majority of drugs used in cancer chemotherapy are cytostatic, many via cytotoxicity a fundamental philosophy of medical. Provincial health services authority phsa improves the health of british columbians by seeking provincewide solutions to specialized health care needs in. Although uncommon after rchop 12%, 57% of patients were in complete response after rdhap.
Relapsed or refractory hodgkin and nonhodgkin lymphoma. Chemo orders and consents penn state cancer institute. Sequential chemotherapy by chop and dhap regimens followed by highdose therapy with stem cell transplantation induces. The purpose of this protocol is to standardize hydration schedules and administration of cisplatin. Dhap any use of the information is subject, at all times, to ccos terms and conditions. As we strive to keep these documents uptodate, revisions are frequent and ongoing, we ask that you always obtain a new. R dhap is a combination chemotherapy treatment used to treat nonhodgkin lymphoma. Guide to combination cancer chemotherapy regimens dominic a. This analysis reports on 72 patients with relapsed or refractory nonhodgkin lymphoma who were treated with rdhap salvage chemotherapy regimen followed by highdose chemotherapy and stem cell. In the rdhap arm one patient went off protocol in pr after 2 cycles of chemotherapy and received an allogeneic stemcell transplantation.
Select link for more information and access to the full who model list of essential medicines. The information contained in the nccn templates is based on the nccn clinical practice guidelines in oncology. Rchop chemotherapy is a combination of several cancer drugs. A chemotherapy regimen is a regimen for chemotherapy, defining the drugs to be used, their dosage, the frequency and duration of treatments, and other considerations. Sequential chemotherapy by chop and dhap regimens followed. A phase ii trial in the north central cancer treatment group thomas e. Ensure histology is confirmed prior to administration of chemotherapy and document in notes.
Secondary end points included eventfree and overall survival, treatment toxicity, and quality of life. Results the median age of the 396 patients enrolled rice, n 202. Randomized comparison of gemcitabine, dexamethasone. Effective salvage therapy for lymphoma with cisplatin in combination with highdose arac and dexamethasone dhap. For a blank protocol care plan template please click here. Salvage chemotherapy with rituximab dhap for relapsed non. Protocol violation voluntary patient withdrawal withdrawn during. Prognosis of relapsed peripheral tcell lymphomas ptcls is poor, and the optimal salvage therapy is still not determined. Dhap nonhodgkin lymphoma chemotherapy regimen doctors.
With median followup of 67 months, median eventfree survival is 83 months, and median overall survival is not reached. How is the dhap regimen administered in hodgkin lymphoma. The list of disease and specialty groups below are links to available chemotherapy orders and consents frequently used in their treatment. Alemtuzumab and dhap adhap is effective for relapsed. It is best to read this information with our general information about chemotherapy and the type of cancer you have. Efficacy and safety of rituximab combined with eshap. Hodgkins lymphoma patients will not receive rituximab as.
This anion is involved in many metabolic pathways, including the calvin cycle in plants and glycolysis. Dhap in context of chemotherapy is an acronym for chemotherapy regimen that is used for. Salvage regimens with autologous transplantation for. Allogeneic stem cell transplant can be considered in high risk patients following discussion with a transplant centre. Indication relapsed or refractory hodgkins or nonhodgkins lymphoma.
Dhap is a combination chemotherapy treatment used to treat hodgkin. Upon initiation of chemotherapy, adjust iv rate to keep total iv fluids at 500 mlhr. Salvage chemotherapy with rituximab dhap for relapsed nonhodgkin lymphoma. Nonhodgkin lymphoma, salvage chemotherapy, transplant, rituximab.
Randomised phase iii study of rice versus rdhap in relapsed patients with cd20 diffuse large bcell lymphoma dlbcl followed by highdose therapy and a second randomisation to maintenance treatment with rituximab or not. Every 21 days for 6 cycles rchop given on cycles 1, 3 and 5. Mobilization of peripheral blood stem cells with highdose. Patients with stable disease who were not candidates for stem cell transplant or patients who had any response after 23 cycles of dhap may receive up to 6 cycles of treatment. After 23 cycles, responding patients may be considered for highdose chemotherapy and autologous stem cell transplant. Eventfree survival for patients in cr after ice was 83% at 23 months follow up for patients with hl. Cspm2 hydration protocol for cisplatin chemotherapy. Forthcoming section for nursing specific resources on caring for patients with lymphomas. Regimen reference order lymp rchop alternating with r. The overall response rate was 93% after rchop and 95% after rdhap. R rituxan a monoclonal antibody is commonly added to chemotherapy protocols. Dhap in context of chemotherapy is an acronym for chemotherapy regimen that is used for remission induction in cases of relapsed or refractory nonhodgkin lymphoma and hodgkins lymphoma. Eshap and reshap authorised by lymphoma lead dr graham collins published.
Nonhodgkin lymphoma rdhap rituximab dexamethasone cytarabine. Patients with stable disease who were not candidates for stem cell transplant or patients who had any response after 23 cycles of dhap may receive up. Rituximab improves the treatment results of dhapvimdhap. Rituximab, dexamethasone, cytarabine, and oxaliplatin r.
Etoposide, methylprednisolone, cisplatin, cytarabine. Instructions on how you can make a pdf version of this page using the print. Dhap agents involved dexamethasone 40 mg ivpo in 50 ml of ns days 1 4. Rdhap combines rituximab with cisplatin, cytarabine, and dexamethasone. For the intentiontotreat population, the response rate with gdp was 45. Salvage therapy for patients with refractoryrelapsed bcell nonhodgkin lymphoma nhl is based on polychemotherapy, followed by highdose therapy and autologous stem cell transplantation in eligible patients hdtasct. Relapsed or refractory hodgkins or nonhodgkins lymphoma. This patient received consolidation chemotherapy, rituximab, and asct. Prof elizabeth vandenberghe prof maccon keane page 1 of 6 the information contained in this document is a statement of consensus of nccp and ismo or ihs.
Patients with intermediate or highgrade nhl were to receive 6 rituximab doses and 6 eshap cycles. Salvage chemotherapy followed by highdose therapy and autologous stemcell transplantation. Dihydroxyacetone phosphate dhap, also glycerone phosphate in older texts is the anion with the formula hoch 2 c och 2 opo 32. Current strategies for salvage treatment for relapsed. Rituximab 375 mgm 2 was administered 1 week and 1 day before cycle 1 of standard eshap etoposide 40 mgm 2 on days 14. Cancer chemotherapy guidelines for management of sact induced diarrohea v3. Cancer chemotherapy guidelines for extravasation v5. Results for the intentiontotreat population, the response rate with gdp was 45. Nonhodgkin lymphoma rdhap rituximab dexamethasone cytarabine cisplatin.
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