EPOCH-DA

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Revision as of 07:20, 29 August 2013 by Palmdoc (Talk | contribs) (Dose adjustments)

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Regimen

R-EPOCH-DA: Dose Adjusted EPOCH Regimen, Dunleavy, et al. 2013

Rituximab 375 mg/m2 IV over 3 hours once on day 1
Etoposide 50 mg/m2/day IV continuous infusion over 96 hours on days 1 to 4 (total dose per cycle: 200 mg/m2)
Prednisolone 60 mg/m2 PO BID on days 1 to 5
Vincristine  0.4 mg/m2/day IV continuous infusion over 96 hours on days 1 to 4 (total dose per cycle: 1.6 mg/m2)
Doxorubicin 10 mg/m2/day IV continuous infusion over 96 hours on days 1 to 4 (total dose per cycle: 40 mg/m2)
Cyclophosphamide 750 mg/m2 IV over 2 hours once on day 5

21-day cycles x 6 to 8 cycles

Supportive medications

Filgrastim (Neupogen) 300 mcg sc once per day, starting on day 6 and continuing until ANC > 5,000/uL past nadir
Trimethoprim/Sulfamethoxazole (Bactrim DS) 160/800 mg (or equivalent if allergic) PO once per day on 3 days per week

Dose adjustments

Start cycle 1 as described above.
Obtain CBCs twice per week for nadir measurements.
If nadir ANC >500, increase etoposide, doxorubicin, and cyclophosphamide by one level (20%) compared to previous cycle.
If nadir ANC <500, use same doses as last cycle.
If nadir platelet count <25,000, decrease etoposide, doxorubicin, and cyclophosphamide by 20% compared to the previous cycle.