Cheatsheet #1: AIDS-related malignancies - Kaposi sarcoma and Non-Hodgkin lymphoma

Kaposi sarcoma
1. ABV: doxorubicin 20mg/m2 iv D1, bleomycin 10mg/m2 iv D1, vincristine 1mg iv D1 repeat cycle every 14d
2. BV: bleomycin 15 IU/m2 iv D1, vincristine 2mg IV D1. Repeat cycle every 3 wk
3. Daunoxome: liposomal daunorubicin 40mg/m2 iv D1. Repeat cycle every 2 wk
4. Docetaxel: Docetaxel 25mg/m2 iv D1 repeat cycle weekly x 8
5. Doxil: liposomal doxorubicin 20mg/m2 iv D1 repeat cycle every 3 wk
6. Paclitaxel: paclitaxel 100mg/m2 iv over 3h D1 repeat cycle every 2 wk
7. Vinorelbine: vinorelbine 30mg/m2 iv D1 repeat cycle every 14 days

Non-Hodgkin’s lymphoma
1. CDE:
Cyclophosphamide 187.5-200mg/m2/d CIVI D1-4
Doxorubicin 12.5mg/m2/d CIVI D1-4
Etoposide 60mg/m2/d CIVI D1-4
Repeat cycle every 28d

2. CHOP
Cyclophosphamide750mg/m2 iv D1
Doxorubicin 50mg/m2 iv D1
Vincristine 1.4mg/m2 D1 (maximum dose 2mg)
Prednisone 100mg po daily D1-5
Repeat cycle every 21d

3. CODOX-M/IVAC
a. Low risk patients only: CODOX-M only
Cyclophosphamide 800mg/m2 iv D1
Cyclophosphamide 200mg/m2 iv D2-5
Doxorubicin 40mg/m2 iv D1
Vincristine 1.5mg/m2 iv D1 and 8 (cycle 1)
Vincristine 1.5mg/m2 iv D1/8/15 (cycle 2)
Methoterxate 1200mg/m2 iv over 1h followed by 240mg/m2/h x 23 h with leucovorin
Cytarabine 70mg intrathecal (IT) on D1 and 3
Methotrexate 12mg IT on day 15

b. High risk patients:
i. CODOX-M alternate with IVAC
Cyclophosphamide 800mg/m2 iv D1
Cyclophosphammide 200mg/m2 iv D1
Vincristine 1.5mg/m2 iv D1 & 8 (cycle 1)
Vincristine 1.5mg/m2 iv on D1/8/15 (cycle 2)
Methotrexate 1200mg/m2 iv over 1h followed by 240mg/m2/h x 23h with leucovorin
Cytarabine 70mg IT on D1&3
Methotrexate 12mg IT on D15

ii. IVAC alternate with CODOX-M
Ifosfamide 1500mg/m2 iv on D1-5 (with Mesna)
Etoposide 60mg/m2 iv on D1-5
Cytarabine 2000mg/m2 iv q12h x 4 on D1 and 2g/m2 iv on D1/8/15 (cycle 2)
Methotrexate 12mg IT on day 5

4. Dose adjusted EPOCH
Etoposide 50mg/m2/d CIVI on D1-4
Doxorubicin 10mg/m2/d CIVI on D1-4
Vincristine 0.4mg/m2/d CIVI on D1-4
Cyclophosphamide (cycle 1) 375mg/m2 iv on D5 (CD4+ cells >= 100/mm3), 187mg/m2 iv on D5 (CD4+ cells <100/mm3)
Cyclophosphamide (subsequent cycles) increase by 187mg/m2 if nadir ANC>500/microL; decrease by 187mg/m2 if nadir ANC<500/microL or PLT<250k/microL
Prednisolone 60mg/m2/d PO daily on D1-5
Repeat cycle q21d

5. EPOCH
Etoposide 50mg/m2/d CIVI on D1-4
Doxorubicin 10mg/m2/d CIVI on D1-4
Vincristine 0.4mg/m2/d CIVI on D1-4
Cyclophosphamide 750mg/m2 iv D5
Prednisone 60mg/m2/d PO daily D1-5
Repeat cycle every 21 days

6. Hyper-CVAD
Odd numbered cycles:
Cyclophosphamide 300mg/m2 iv q12h x 6 starting D1
Mesna 600mg/m2/d CIVI daily x 3d
Vincristine 2mg iv on D4 and 11
Doxorubicin 50mg/m2 iv on day 4
Dexamethasone 40mg iv/po on D1-4 and 11-14

Even numbered cycles:
Methotrexate 1000mg/m2 CIVI D1
Cytarabine 3000mg/m2 iv q12h x 4 on D2&3
Leucovorin 50mg iv x 1 starting 12h after completion of methotrexate followed by 15mg iv q6h until methotrexate level <0.1mM

7. m-BACOD
Methotrexate 200mg/m2 iv on day 15
Bleomycin 4U/m2 iv on D1
Doxorubicin 25mg/m2 iv on D1
Cyclophosphamide 300mg/m2 iv on D1
Vincristine 1.4mg/m2 iv on D1
Dexamethasone 3mg/m2 PO daily on D1-5
Cytarabine 50mg IT on D1/8/15/22

8. m-CHOP
Cyclophosphamide 375mg/m2 iv on D1
Doxorubicin 25mg/m2 iv on D1
Vincristine 1.4mg/m2 (maximum dose 2mg) iv on D1
Prednisone 100mg PO daily D1-5