What is the CALGB 9251 regimen for the treatment of Burkitt lymphoma/Burkitt-like lymphoma (BL/BLL)?

Updated: Dec 20, 2019
  • Author: Ali H Kanbar, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

The Cancer and Leukemia Group B (CALGB) launched a multidrug regimen pilot study (9251) of high-intensity, brief-duration chemotherapy. A brief schema of this protocol is discussed in this section. [59, 60]

Note: Courses II, IV, and VI and courses III, V, and VII are similar and described together. Courses II-VI are administered at 21-day intervals

Course I consists of cyclophosphamide 200 mg/m2/d IV on days 1-5; prednisone 60 mg/m2/d by mouth (PO) on days 1-7.

Courses II, IV, and VI comprise the following:

  • Ifosfamide 800 mg/m2 IV over 1 hour on days 1-5

  • Mesna 200 mg/m2 IV on days 1-5 (at 0, 4, and 8 h after ifosfamide)

  • Methotrexate 150 mg/m2 IV over 30 minutes on day 1, followed by 1.35 g/m2 IV over the next 23.5 hours (total dose: 1.5 g/m2)

  • Leucovorin 50 mg/m2 IV starting 36 hours after methotrexate, then 15 mg/m2 every 6 hours until serum methotrexate levels are < 5 × 10-8 M (0.05 μM)

  • Vincristine 2 mg IV bolus on day 1

  • Cytarabine (Ara-C) 150 mg/m2/day by continuous infusion over 48 hours (days 4-5)

  • Etoposide 80 mg/m2 IV over 1 hour on days 4-5

  • Dexamethasone 10 mg/m2 PO per day on days 1-5

Courses III, V, and VII comprise the following:

  • Cyclophosphamide 200 mg/m2 IV daily on days 1-5

  • Methotrexate 150 mg/m2 IV over 30 minutes on day 1, followed by 1.35 g/m2 IV over the next 23.5 hours (total dose: 1.5 g/m2)

  • Leucovorin 50 mg/m2 IV starting 36 hours after methotrexate, then 15 mg/m2 every 6 hours until serum methotrexate levels are < 5 × 10-8 M (0.05 μM)

  • Vincristine 2 mg IV bolus on day 1

  • Adriamycin (doxorubicin) 25 mg/m2 IV bolus on days 4-5

  • Dexamethasone 10 mg/m2 PO daily on days 1-5

Intrathecal chemotherapy consists of methotrexate 15 mg plus cytarabine 40 mg plus hydrocortisone 50 mg, all administered on day 1 of each course (II-VII).

Cranial radiation (amended in the 2004 update of the CALGB 9251: Only for those patients with previous bone marrow involvement): 2400 cGy in 12 fractions, administered at least 21 days after course VII.


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