What is the hyper-CVAD 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 hyper-CVAD (modified fractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone) regimen consists of alternating A (1, 3, 5, and 7) and B (2, 4, 6, and 8) cycles. The second and subsequent cycles are administered when the patient's white blood cell (WBC) count is more than 3,000/mm3, and the platelet count is higher than 60,000/mm3 (between 14 and 21 d).

Cycle A comprises the following:

  • Cyclophosphamide 300 mg/m2 intravenously (IV) over 2 hours every 12 hours for 6 doses, on days 1-3

  • Mesna 600 mg/m2 by continuous IV infusion over 24 hours, starting 1 hour before cyclophosphamide and continuing for 12 hours after the last dose of cyclophosphamide

  • Vincristine 2 mg/dose IV push over 2-3 minutes for 2 doses on days 4 and 11

  • Doxorubicin 50 mg/m2 IV over 2 hours on day 4

  • Dexamethasone 40 mg/day orally (PO) or IV for 8 doses on days 1-4 and on days 11-14

  • Filgrastim 10 mcg/kg/day subcutaneously (SC) starting 24 hours after the last dose of chemotherapy and continuing until the WBC count is >3000/mm3

Cycle B comprises the following:

  • Methotrexate 1000 mg/m2 by continuous IV infusion over 24 hours on day 1

  • Cytarabine 3,000 mg/m2 IV over 2 hours every 12 hours for 4 doses, on days 2-3

  • Calcium leucovorin 50 mg IV over 20 minutes administered 12 hours after methotrexate infusion is completed, followed 6 hours later by leucovorin 15 mg IV every 6 hours for 8 total doses or until blood methotrexate concentration is < 0.1 µmol/L

  • Filgrastim 10 mcg/kg/day SC starting 24 hours after the last dose of chemotherapy and continuing until the WBC count is > 3000/mm3

Calcium leucovorin doses should be escalated to 50 mg IV every 6 hours if serum methotrexate concentrations are the following:

  • Greater than 20 µmol/L at the end of the methotrexate infusion (hour 24)

  • Greater than 1 µmol/L at 24 hours after the end of the methotrexate infusion (hour 48)

  • Greater than 0.1 µmol/L at 48 hours after the end of the methotrexate infusion (hour 72)


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