Systemic Anti-Cancer Therapy Regimen Library
LYM NHL B-cell PCNSL - R-MPV [RITUximab, metHOTREXATe, procarbazine and vinCRISTine] followed by high dose cytarabine
Treatment Overview
This regimen consists of two parts:
- Alternating cycles of R-MPV [RITUximab, metHOTREXATe, procarbazine and vinCRISTine] and R-MV [RITUximab, metHOTREXATe and vinCRISTine] Induction, followed by
- High dose cytarabine Consolidation.
Intrathecal therapy
- Required if CSF cytology/flow positive at diagnosis and after 2 cycles of Induction
- see LYM NHL B-cell - Intrathecal Triple Therapy [metHOTREXATe, cytarabine and hydrocortisone].
Alternating cycles of R-MPV and R-MV every 14 to 21 days (on count recovery) for
- 5 cycles if in complete remission after 5 cycles.
- 7 cycles if in partial remission after 5 cycles (administer as cycle 6 and 7).
Start after the completion of R-MPV/R-MV Induction +/- whole brain radiation therapy (WBRT), as per clinician discretion.
Every 28 days, or on count recovery, for 2 cycles.
Supportive Care Factors
| Factor | Value |
|---|---|
| Antiviral prophylaxis for hepatitis B virus: | Required for anti–HBc positive patients at risk of reactivation |
| Antiviral prophylaxis for herpes virus: | Variable |
| Constipation risk: | Variable |
| Emetogenicity: | Variable |
| Folinic acid rescue for high dose methotrexate: | Variable |
| Growth factor support: | Recommended for primary prophylaxis |
| Hydration: | Variable |
| Hypersensitivity / Infusion related reaction risk: | Variable |
| Ocular toxicity risk: | Variable |
| Pneumocystis jirovecii pneumonia (PJP) prophylaxis: | Variable |
| Tumour lysis syndrome prophylaxis: | Variable |
References
Medicines and Hepatitis B Reactivation Prescriber Update 38(1): 2-3 March 2017 https://medsafe.govt.nz/profs/PUArticles/March2017/MedicinesAndHepatitisB.htm
Rituximab and Hepatitis B Reactivation Prescriber Update 34(3):27 September 2013 https://www.medsafe.govt.nz/profs/PUArticles/Sept2013RituximabHepB.htm
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.