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Systemic Anti-Cancer Therapy Regimen Library

LEU ALL precursor B-cell BCR-ABL1+ - HyperCVAD with RITUximab and daSATinib Part A and B followed by Maintenance [over 60 years]

Treatment Overview

HyperCVAD with RITUximab and daSATinib Part A and B followed by Maintenance [over 60 years] is intended for those over 60 years, BCR-ABL1 positive and have CD20 expression greater than 10%.


Treatment overview

HyperCVAD Part A and B is given as alternating cycles of Part A and B as follows: 1A, 1B, 2A, 2B, 3A, 3B, 4A, 4B; every 21 days, or sooner if counts have recovered.

This is followed, in non-transplant patients, by Maintenance for 2 years, daSATinib is taken indefinitely.

General schema:


Intrathecal therapy is dependent on patients CNS risk, see Overview of Intrathecal CNS Prophylaxis in Additional details.

  • Use the appropriate HyperCVAD Part A and B regimen below for the patient's CNS disease risk.
  • If CNS is positive for disease, administer intrathecal chemotherapy as per institutional practice twice a week until the CNS is cleared, then continue with intrathecal therapy for High Risk.

daSATinib is taken continuously, the dose included in regimen may tailored to individual patient response and tolerability.

HyperCVAD with RITUximab and daSATinib [over 60 years] - Part A with CNS prophylaxis for Unknown Risk [default]

Alternates with a cycle of Part B every 21 days, or sooner if counts have recovered.

Use the Part A regimen specific for CNS risk of the patient.

Intrathecal therapy in this Part A regimen is intended for patients with Unknown Risk [default].

HyperCVAD with RITUximab and daSATinib [over 60 years] - Part A with CNS prophylaxis for High Risk

Alternates with a cycle of Part B every 21 days, or sooner if counts have recovered.

Use the Part A regimen specific for CNS risk of the patient.

Intrathecal therapy in this Part A regimen is intended for patients with High Risk.

HyperCVAD with RITUximab and daSATinib [over 60 years] - Part B with CNS prophylaxis for Unknown Risk [default]

Alternates with a cycle of Part A every 21 days, or sooner if counts have recovered.

Use the Part B regimen specific for CNS risk of the patient.

Intrathecal therapy in this Part B regimen is intended for patients with Unknown Risk [default].

HyperCVAD with RITUximab and daSATinib [over 60 years] - Part B with CNS prophylaxis for High Risk

Alternates with a cycle of Part A every 21 days, or sooner if counts have recovered.

Use the Part B regimen specific for CNS risk of the patient.

Intrathecal therapy in this Part B regimen is intended for patients with High Risk.

Maintenance with daSATinib

Follows HyperCVAD Cycle 4B.

Not used for transplant patients.

daSATinib is to be taken indefinitely.

Additional details

Section 1: Overview of Intrathecal CNS Prophylaxis

Supportive Care Factors

Factor Value
Antifungal prophylaxis: Variable
Antiviral prophylaxis for hepatitis B virus: Variable
Antiviral prophylaxis for herpes virus: Routine antiviral prophylaxis recommended
Constipation risk: Variable
Diarrhoea risk: Variable
Emetogenicity: Variable
Folinic acid rescue for high dose methotrexate: Variable
Gastroprotection: Gastroprotection is recommended
Growth factor support: Variable
Hydration: Variable
Hypersensitivity / Infusion related reaction risk: Variable
Mesna uroprotection: Variable
Ocular toxicity risk: Variable
Pneumocystis jirovecii pneumonia (PJP) prophylaxis: Routine antibiotic prophylaxis recommended
Tumour lysis syndrome prophylaxis: Variable

Gastroprotection:

  • Gastroprotective agents are only intended for short term use while patient is receiving corticosteroid treatment doses.
  • Gastroprotective agents such as proton pump inhibitors and H2 receptor antagonists are not recommended to be used with daSATinib because they may reduce exposure to daSATinib by increasing gastric pH. Do not use proton pump inhibitors with high dose metHOTREXATe. Consider using an antacid as an alternative.

References

Kantarjian H, Thomas D, O'Brien S, Cortes J, Giles F, Jeha S, Bueso-Ramos CE, Pierce S, Shan J, Koller C, Beran M, Keating M, Freireich EJ. Long-term follow-up results of hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (Hyper-CVAD), a dose-intensive regimen, in adult acute lymphocytic leukemia. Cancer. 2004 Dec 15;101(12):2788-801. doi: 10.1002/cncr.20668., PMID: 15481055

Thomas DA, Faderl S, O'Brien S, Bueso-Ramos C, Cortes J, Garcia-Manero G, Giles FJ, Verstovsek S, Wierda WG, Pierce SA, Shan J, Brandt M, Hagemeister FB, Keating MJ, Cabanillas F, Kantarjian H. Chemoimmunotherapy with hyper-CVAD plus rituximab for the treatment of adult Burkitt and Burkitt-type lymphoma or acute lymphoblastic leukemia. Cancer. 2006 Apr 1;106(7):1569-80. doi: 10.1002/cncr.21776., PMID: 16502413

Thomas DA, O'Brien S, Faderl S, Garcia-Manero G, Ferrajoli A, Wierda W, Ravandi F, Verstovsek S, Jorgensen JL, Bueso-Ramos C, Andreeff M, Pierce S, Garris R, Keating MJ, Cortes J, Kantarjian HM. Chemoimmunotherapy with a modified hyper-CVAD and rituximab regimen improves outcome in de novo Philadelphia chromosome-negative precursor B-lineage acute lymphoblastic leukemia. J Clin Oncol. 2010 Aug 20;28(24):3880-9. doi: 10.1200/JCO.2009.26.9456. Epub 2010 Jul 26., PMID: 20660823

Rausch CR, Jabbour EJ, Kantarjian HM, Kadia TM. Optimizing the use of the hyperCVAD regimen: Clinical vignettes and practical management. Cancer. 2020 Mar 15;126(6):1152-1160. doi: 10.1002/cncr.32606. Epub 2019 Dec 3., PMID: 31794095

Benjamini et al, Phase II trial of hyper CVAD and dasatinib in patients with relapsed Philadelphia chromosome positive acute lymphoblastic leukemia or blast phase chronic myeloid leukemia. Am J Hematol. 2014 Mar;89(3):282-7. doi: 10.1002/ajh.23624., PMID: 24779033

Regimen details sometimes vary slightly from the published literature after recommendation by expert committee consensus.

* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.

s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.