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1628 Part XI: Malignant Lymphoid Diseases Chapter 98: Diffuse Large B-Cell Lymphoma and Related Diseases 1629

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2
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750 mg/m IV, doxorubicin 50 mg/m IV, vincristine 1.4 mg/m, and In an effort to improve upon the efficacy of CHOP, a number of
prednisone 100 mg orally administered daily for days 1 through 5 of intensified, multidrug combinations were developed. Early single-
each cycle (CHOP). Between 1972 and 1975, reports of CRs with institution, single-armed trials showed promising results, including
long-lasting PFS with these regimens heralded the advent of curative CR rates up to 80 percent and prolonged DFS rates of 60 percent. 50,51
therapy for patients with DLBCL, with CHOP administered every 21 Phase II trials of m-BACOD (moderate-dose methotrexate, bleomycin,
days for six to eight cycles emerging as the most popular regimen in the doxorubicin, cyclophosphamide, vincristine, dexamethasone), Pro-
United States for treatment of DLBCL (Table 98–4). MACE (prednisone, methotrexate, doxorubicin, cyclophosphamide,

TABLE 98–4. Combination Chemotherapy for Intermediate- and High-Grade Lymphoma
Days of Interval Between
Regimen Dose Route Treatment Treatment Cycles (Days) Cycles
R-CHOP-21
Rituximab 375 mg/m 2 IV 1 21 6–8
Cyclophosphamide 750 mg/m 2 IV 1
Doxorubicin 50 mg/m 2 IV 1
Vincristine 1.4 mg/m 2 IV 1
Prednisone 100 mg/day PO 1–5
CHOP-14
Cyclophosphamide 750 mg/m 2 IV 1 14 6–8
Doxorubicin 50 mg/m 2 IV 1
Vincristine 1.4 mg/m 2 IV 1
Prednisone 100 mg/day PO 1–5
Dose-adjusted R-EPOCH*
Rituximab 375 mg/m 2 IV 1 21 6–8
2
Etoposide 50 mg/m /day CIV 1–4 (96 hours)
Doxorubicin 10 mg/m /day CIV 1–4 (96 hours)
2
Vincristine 0.4 mg/day CIV 1–4 (96 hours)
Cyclophosphamide 750 mg/m /day IV 5
2
2
Prednisone 60 mg/m /day PO 1–5
ESHAP (for relapsed lymphoma)
Etoposide 40 mg/m 2 IV 1–4 21
Methylprednisone 500 mg/m 2 IV 1–5
Cytarabine 2 mg/m 2 IV 5
Cisplatin 25 mg/m 2 CIV 1–4
DHAP (for relapsed lymphoma)
Dexamethasone 40 mg/m 2 PO or IV 1–4 21
Cisplatin 100 mg/m 2 CIV 1
Cytarabine 2 gm/m 2 IVq12h × 2 doses 2
R±ICE (for relapsed lymphoma)
Rituximab 375 mg/m 2 IV 1 14
Mesna 5000 mg/m 2 IV l (day 2)
Carboplatin AUC = 5 (maximum 800 mg) IV 1 (day 2)
Etoposide 100 mg/m 2 IV 1–3
Neulasta 6 mg SQ 1 (day 4)

AUC, area under the curve; CIV, continuous intravenous infusion; I-CHOP, intensified-CHOP; SQ, subcutaneously.
*Doses of etoposide, doxorubicin, and cyclophosphamide are increased 20% over the dose in the previous cycle if the nadir of the absolute
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neutrophil count in the previous cycle was ≥0.5 × 10 /L.
The reader is advised to verify drugs, doses, and administration schedules of these regimens.

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