What is the hyper-CVAD chemotherapy regimen for mantle cell lymphoma (MCL)?

Updated: Mar 15, 2019
  • Author: Muhammad Rashid Abbasi, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Answer

The hyper-CVAD drug regimen is a total of 8 cycles: 4 cycles of course A and 4 cycles of course B. Each cycle is started upon hematologic recovery, usually every 3 weeks.

Course A is as follows:

  • Rituximab at 375 mg/m 2 on day 1 of each cycle
  • Cyclophosphamide at 300 mg/m 2 IV over 3 hours every 12 hours for 6 doses on days 1, 2, and 3 (mesna may be given as an uroprotectant at the same total dose as cyclophosphamide but given by continuous infusion starting with cyclophosphamide and ending 5 h after the last dose)
  • Methotrexate at 12 mg IT on day 2
  • Doxorubicin at 40 mg/m 2 IV on day 4
  • Vincristine at 2 mg IV on days 4 and 11
  • Dexamethasone at 40 mg/d PO/IV on days 1-4 and 11-14
  • Cytarabine at 70 mg IT on day 7

Course B is as follows:

  • Rituximab at 375 mg/m 2 on day 1 of each cycle
  • Methotrexate at 1000 mg/m 2 IV over 24 hours on day 1
  • Leucovorin at 25 mg/m 2 IV, 24 hours after the completion of the methotrexate infusion, every 6 hours for 6 doses
  • Sodium bicarbonate at 600 mg PO (starting day before methotrexate) 3 times day for 4 days
  • Cytarabine at 3 g/m 2 IV over 2 hours every 12 hours for 4 doses on days 2 and 3

Premedication and supportive measures are recommended in combination with the R-hyper-CVAD regimen. With high-dose methotrexate, give hydration with sodium bicarbonate for 48 hours. Prophylactic use of dexamethasone 0.1% (Maxidex ophthalmic solution), 1-2 drops every 4 hours while the patient is awake, for 7 days (during high-dose cytarabine administration) helps prevent conjunctivitis. Antibiotic prophylaxis may also be given. Additionally, doses should be modified according to the protocol being used.


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