Bonn protocol

From OncoWiki
Jump to: navigation, search

Indication

Primary CNS Lymphoma

Regimen

Cycle A (3 wks)

  • Methotrexate (MTX) 5 g/m2 (3 g/m2 for patients over 65 years old) civi over 24 hrs d1
  • Vincristine 2 mg iv d1
  • Ifosfamide 800 mg/m2/d iv over 1 h d2-5
  • Dexamethasone (Decadron) 10 mg/m2/d po d2-5
  • Prednisolone 2.5 mg intraventricularly qd d2-4
  • Methotrexate (MTX) 3 mg intraventricularly qd d2-4
  • Cytarabine (Ara-C) 30 mg intraventricularly d5

Cycle B (3 wks)

  • Methotrexate (MTX) 5 g/m2 (3 g/m2 for patients over 65 years old) civi over 24 hrs d1
  • Vincristine 2 mg iv d1
  • Cyclophosphamide (Cytoxan) 200 mg/m2/d iv over 1 h d2-5
  • Dexamethasone (Decadron) 10 mg/m2/d po d2-5
  • Prednisolone 2.5 mg intraventricularly qd d2-4
  • Methotrexate (MTX) 3 mg intraventricularly qd d2-4
  • Cytarabine (Ara-C) 30 mg intraventricularly d5

Cycle C (3 wks)

  • Ara-C 3 g/m2/d iv over 3 hrs d1-2
  • Vindesine 5 mg iv d1
  • Dexamethasone (Decadron) 20 mg/m2/d po d3-7
  • Prednisolone 2.5 mg intraventricularly qd d3-6
  • Methotrexate (MTX) 3 mg intraventricularly qd d3-6
  • Cytarabine (Ara-C) 30 mg intraventricularly d7

Sequence of cycles: A (d1-5), B (d22-26), C (d43-49). Repeat cycles A, B and C once for a total of 6 cycles. Schema (outside link)

References

Pels, H et al. Primary Central Nervous System Lymphoma: Results of a Pilot and Phase II Study of Systemic and Intraventricular Chemotherapy With Deferred Radiotherapy. J Clin Oncol 2003; 21:4489
ABSTRACT
Purpose: To evaluate response rate, response duration, overall survival (OS), and toxicity in primary CNS lymphoma (PCNSL) after systemic and intraventricular chemotherapy with deferred radiotherapy.

Patients and Methods: From September 1995 to July 2001, 65 consecutive patients with PCNSL (median age, 62 years) were enrolled onto a pilot and phase II study evaluating chemotherapy without radiotherapy. A high-dose methotrexate (MTX; cycles 1, 2, 4, and 5) and cytarabine (ARA-C; cycles 3 and 6)–based systemic therapy (including dexamethasone, vinca-alkaloids, ifosfamide, and cyclophosphamide) was combined with intraventricular MTX, prednisolone, and ARA-C.

Results: Sixty-one of 65 patients were assessable for response. Of these, 37 patients (61%) achieved complete response, six (10%) achieved partial response, and 12 (19%) progressed under therapy. Six (9%) of 65 patients died because of treatment-related complications. Follow-up is 0 to 87 months (median, 26 months). The Kaplan-Meier estimates for median time to treatment failure (TTF) and median OS were 21 months and 50 months, respectively. For patients older than 60 years, median survival was 34 months, and the median TTF was 15 months. In patients younger than 61 years, median survival and median TTF have not been reached yet; the 5-year survival fraction is 75%. Systemic toxicity was mainly hematologic. Ommaya reservoir infection occurred in 12 patients (19%), and permanent cognitive dysfunction possibly as a result of treatment occurred in only two patients (3%).

Conclusion: Primary chemotherapy based on high-dose MTX and ARA-C is highly efficient in PCNSL. Response rate and response duration in this series are comparable to the response rates and durations reported after combined radiotherapy and chemotherapy. Neurotoxicity was infrequent.