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Systemic Anti-Cancer Therapy Regimen Library

Home > LYM NHL B-cell - O-CHOP21 [oBINUTUZumab, CYCLOPHOSPHamide, DOXOrubicin, vinCRISTine and prEDNISone]

LYM NHL B-cell - O-CHOP21 [oBINUTUZumab, CYCLOPHOSPHamide, DOXOrubicin, vinCRISTine and prEDNISone]

Treatment Overview

This regimen consists of 6 cycles of O-CHOP followed by 2 cycles of oBINUTUZumab monotherapy.

Cycle 1 - 21 days - O-CHOP

Cycle length:
21

oBINUTUZumab:

  • For patients receiving the first dose of oBINUTUZumab and considered at very high risk of infusion-related reaction (e.g. lymphocytes > 25 x109/L) consider additional premedication with montelukast 10 mg and famotidine 20 mg ONE hour prior to oBINUTUZumab, and consider additional doses of dexamethasone, montelukast and famotidine 12 hours prior to oBINUTUZumab.
  • Consider withholding routine anti-hypertensives for 12 hours prior to, during, and for one hour after each oBINUTUZumab infusion.

loratadine, days 8 and 15:

  • May be omitted if no infusion-related reaction (IRR) occurred during the previous infusion.

Intravenous dexamethasone, days 8 and 15:

  • Must be given if a Grade 3 IRR occurred during the previous infusion OR the lymphocyte count > 25 x 109/L prior to next treatment.
  • May be omitted if no or a Grade 1–2 IRR occurred during the previous infusion.

Cycles 2 to 6 - 21 days - O-CHOP

Cycle length:
21

oBINUTUZumab: Consider withholding routine anti-hypertensives for 12 hours prior to, during, and for one hour after each oBINUTUZumab infusion.


loratadine: May be omitted if no infusion-related reaction (IRR) occurred during the previous infusion.

Cycles 7 to 8 - 21 days - oBINUTUZumab monotherapy

Cycle length:
21

oBINUTUZumab: Consider withholding routine anti-hypertensives for 12 hours prior to, during, and for one hour after each oBINUTUZumab infusion.


loratadine: May be omitted if no infusion-related reaction (IRR) occurred during the previous infusion.


Intravenous dexamethasone:

  • Must be given if a Grade 3 IRR occurred during the previous infusion OR the lymphocyte count > 25 x 109/L prior to next treatment.
  • May be omitted if no or a Grade 1–2 IRR occurred during the previous infusion.

Cycle details

Cycle 1 - 21 days - O-CHOP

Medication Dose Route Days Max Duration
prEDNISone 100 mg flat dosing Once daily oral administration 1 to 5
paracetamol * 1000 mg flat dosing oral administration 1, 8, 15
loratadine * 10 mg oral administration 1, 8, 15
dexamethasone * 20 mg flat dosing intravenous 8, 15 15 minutes
oBINUTUZumab 1000 mg flat dosing intravenous 1, 8, 15 6 hours
DOXOrubicin 50 mg/m² intravenous 1 15 minutes
vinCRISTine 1.4 mg/m² Cap dose per administration at: 2 mg intravenous 1 10 minutes
CYCLOPHOSPHamide 750 mg/m² intravenous 1 60 minutes

oBINUTUZumab:

  • For patients receiving the first dose of oBINUTUZumab and considered at very high risk of infusion-related reaction (e.g. lymphocytes > 25 x109/L) consider additional premedication with montelukast 10 mg and famotidine 20 mg ONE hour prior to oBINUTUZumab, and consider additional doses of dexamethasone, montelukast and famotidine 12 hours prior to oBINUTUZumab.
  • Consider withholding routine anti-hypertensives for 12 hours prior to, during, and for one hour after each oBINUTUZumab infusion.

loratadine, days 8 and 15:

  • May be omitted if no infusion-related reaction (IRR) occurred during the previous infusion.

Intravenous dexamethasone, days 8 and 15:

  • Must be given if a Grade 3 IRR occurred during the previous infusion OR the lymphocyte count > 25 x 109/L prior to next treatment.
  • May be omitted if no or a Grade 1–2 IRR occurred during the previous infusion.

Cycles 2 to 6 - 21 days - O-CHOP

Medication Dose Route Days Max Duration
prEDNISone 100 mg flat dosing Once daily oral administration 1 to 5
paracetamol * 1000 mg flat dosing oral administration 1
loratadine * 10 mg oral administration 1
oBINUTUZumab 1000 mg flat dosing intravenous 1 6 hours
DOXOrubicin 50 mg/m² intravenous 1 15 minutes
vinCRISTine 1.4 mg/m² Cap dose per administration at: 2 mg intravenous 1 10 minutes
CYCLOPHOSPHamide 750 mg/m² intravenous 1 60 minutes

oBINUTUZumab: Consider withholding routine anti-hypertensives for 12 hours prior to, during, and for one hour after each oBINUTUZumab infusion.


loratadine: May be omitted if no infusion-related reaction (IRR) occurred during the previous infusion.

Cycles 7 to 8 - 21 days - oBINUTUZumab monotherapy

Medication Dose Route Days Max Duration
paracetamol * 1000 mg flat dosing oral administration 1
loratadine * 10 mg oral administration 1
dexamethasone 20 mg flat dosing intravenous 1 15 minutes
oBINUTUZumab 1000 mg flat dosing intravenous 1 6 hours

oBINUTUZumab: Consider withholding routine anti-hypertensives for 12 hours prior to, during, and for one hour after each oBINUTUZumab infusion.


loratadine: May be omitted if no infusion-related reaction (IRR) occurred during the previous infusion.


Intravenous dexamethasone:

  • Must be given if a Grade 3 IRR occurred during the previous infusion OR the lymphocyte count > 25 x 109/L prior to next treatment.
  • May be omitted if no or a Grade 1–2 IRR occurred during the previous infusion.

Full details

Cycle 1 - 21 days - O-CHOP

Day: 1

Medication Dose Route Max duration Details
prEDNISone 100 mg flat dosing Once daily oral administration
Instructions:

Take in the morning with food, at least 30 to 60 minutes prior to oBINUTUZumab.
paracetamol * 1000 mg flat dosing oral administration
Instructions:

30 to 60 minutes prior to oBINUTUZumab.
loratadine * 10 mg oral administration
Instructions:

30 to 60 minutes prior to oBINUTUZumab.
oBINUTUZumab 1000 mg flat dosing intravenous 6 hours
Instructions:
  • Consider withholding routine anti-hypertensives for 12 hours prior to, during, and for one hour after oBINUTUZumab infusion.
  • Start at 50 mg/hour. If tolerated, rate can be increased by 50 mg/hour every 30 minutes to a maximum rate of 400 mg/hour.
DOXOrubicin 50 mg/m² intravenous 15 minutes
Instructions:
Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration.
vinCRISTine 1.4 mg/m² Cap dose per administration at: 2 mg intravenous 10 minutes
Instructions:
  • Diluted in a minibag.
  • FOR INTRAVENOUS USE ONLY – fatal if given by any other routes.
  • Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration.
CYCLOPHOSPHamide 750 mg/m² intravenous 60 minutes

Day: 2

Medication Dose Route Max duration Details
prEDNISone 100 mg flat dosing Once daily oral administration
Instructions:

Take in the morning with food.

Day: 3

Medication Dose Route Max duration Details
prEDNISone 100 mg flat dosing Once daily oral administration
Instructions:

Take in the morning with food.

Day: 4

Medication Dose Route Max duration Details
prEDNISone 100 mg flat dosing Once daily oral administration
Instructions:

Take in the morning with food.

Day: 5

Medication Dose Route Max duration Details
prEDNISone 100 mg flat dosing Once daily oral administration
Instructions:

Take in the morning with food.

Day: 8

Medication Dose Route Max duration Details
paracetamol * 1000 mg flat dosing oral administration
Instructions:

30 to 60 minutes prior to oBINUTUZumab.
loratadine * 10 mg oral administration
Instructions:

30 to 60 minutes prior to oBINUTUZumab.

  • May be omitted if no infusion-related reaction (IRR) occurred with the previous infusion.
dexamethasone * 20 mg flat dosing intravenous 15 minutes
Instructions:

ONE hour prior to oBINUTUZumab, or as per institutional practice.

  • Must be given if a grade 3 IRR occurred with the previous infusion OR the lymphocyte count > 25 x 109/L prior to next treatment.
  • May be omitted in patients with no or a grade 1 or 2 IRR during previous infusion.
oBINUTUZumab 1000 mg flat dosing intravenous 6 hours
Instructions:

Consider withholding routine anti-hypertensives for 12 hours prior to, during, and for one hour after oBINUTUZumab infusion.

If NO or a Grade 1 infusion-related reaction (IRR) occurred during previous infusion and the final infusion rate was ≥ 100 mg/hour:

  • Start at 100 mg/hour. If tolerated, rate can be increased by 100 mg/hour every 30 minutes, to a maximum rate of 400 mg/hour.

If a Grade 2 or higher IRR occurred during previous infusion:

  • Start at 50 mg/hour. If tolerated, rate can be increased by 50 mg/hour every 30 minutes to a maximum rate of 400 mg/hour.

Day: 15

Medication Dose Route Max duration Details
paracetamol * 1000 mg flat dosing oral administration
Instructions:

30 to 60 minutes prior to oBINUTUZumab.
loratadine * 10 mg oral administration
Instructions:

30 to 60 minutes prior to oBINUTUZumab.

  • May be omitted if no infusion-related reaction (IRR) occurred with the previous infusion.
dexamethasone * 20 mg flat dosing intravenous 15 minutes
Instructions:

ONE hour prior to oBINUTUZumab, or as per institutional practice.

  • Must be given if a grade 3 IRR occurred with the previous infusion OR the lymphocyte count > 25 x 109/L prior to next treatment.
  • May be omitted in patients with no or a grade 1 or 2 IRR during previous infusion.
oBINUTUZumab 1000 mg flat dosing intravenous 6 hours
Instructions:

Consider withholding routine anti-hypertensives for 12 hours prior to, during, and for one hour after oBINUTUZumab infusion.

If NO or a Grade 1 infusion-related reaction (IRR) occurred during previous infusion and the final infusion rate was ≥ 100 mg/hour:

  • Start at 100 mg/hour. If tolerated, rate can be increased by 100 mg/hour every 30 minutes, to a maximum rate of 400 mg/hour.

If a Grade 2 or higher IRR occurred during previous infusion:

  • Start at 50 mg/hour. If tolerated, rate can be increased by 50 mg/hour every 30 minutes to a maximum rate of 400 mg/hour.

Cycles 2 to 6 - 21 days - O-CHOP

Day: 1

Medication Dose Route Max duration Details
prEDNISone 100 mg flat dosing Once daily oral administration
Instructions:

Take in the morning with food, at least 30 to 60 minutes prior to oBINUTUZumab.
paracetamol * 1000 mg flat dosing oral administration
Instructions:

30 to 60 minutes prior to oBINUTUZumab.
loratadine * 10 mg oral administration
Instructions:

30 to 60 minutes prior to oBINUTUZumab.

  • May be omitted if no infusion-related reaction occurred with the previous infusion.
oBINUTUZumab 1000 mg flat dosing intravenous 6 hours
Instructions:

Consider withholding routine anti-hypertensives for 12 hours prior to, during, and for one hour after oBINUTUZumab infusion.

If NO or a Grade 1 infusion-related reaction (IRR) occurred during previous infusion and the final infusion rate was ≥ 100 mg/hour:

  • Start at 100 mg/hour. If tolerated, rate can be increased by 100 mg/hour every 30 minutes, to a maximum rate of 400 mg/hour.

If a Grade 2 or higher IRR occurred during previous infusion:

  • Start at 50 mg/hour. If tolerated, rate can be increased by 50 mg/hour every 30 minutes to a maximum rate of 400 mg/hour.

Short duration infusion ONLY for patients with follicular lymphoma and NO Grade 3 or higher IRR occurred during Cycle 1:

  • Start at 100 mg/hour for 30 minutes. If tolerated, increase rate to 900 mg/hour.
  • If an IRR of Grade 1-2 with ongoing symptoms, or a Grade 3 or higher occurs with the short duration infusion all subsequent infusions should be given at the standard rates (above).
DOXOrubicin 50 mg/m² intravenous 15 minutes
Instructions:
Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration.
vinCRISTine 1.4 mg/m² Cap dose per administration at: 2 mg intravenous 10 minutes
Instructions:
  • Diluted in a minibag.
  • FOR INTRAVENOUS USE ONLY – fatal if given by any other routes.
  • Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration.
CYCLOPHOSPHamide 750 mg/m² intravenous 60 minutes

Day: 2

Medication Dose Route Max duration Details
prEDNISone 100 mg flat dosing Once daily oral administration
Instructions:

Take in the morning with food.

Day: 3

Medication Dose Route Max duration Details
prEDNISone 100 mg flat dosing Once daily oral administration
Instructions:

Take in the morning with food.

Day: 4

Medication Dose Route Max duration Details
prEDNISone 100 mg flat dosing Once daily oral administration
Instructions:

Take in the morning with food.

Day: 5

Medication Dose Route Max duration Details
prEDNISone 100 mg flat dosing Once daily oral administration
Instructions:

Take in the morning with food.

Cycles 7 to 8 - 21 days - oBINUTUZumab monotherapy

Day: 1

Medication Dose Route Max duration Details
paracetamol * 1000 mg flat dosing oral administration
Instructions:

30 to 60 minutes prior to oBINUTUZumab.
loratadine * 10 mg oral administration
Instructions:

30 to 60 minutes prior to oBINUTUZumab.

  • May be omitted if no infusion-related reaction (IRR) occurred during the previous infusion.
dexamethasone 20 mg flat dosing intravenous 15 minutes
Instructions:

ONE hour prior to oBINUTUZumab, or as per institutional practice.

  • Must be given if a grade 3 IRR occurred with the previous infusion OR the lymphocyte count > 25 x 109/L prior to next treatment.
  • May be omitted in patients with no or a grade 1 or 2 IRR during previous infusion.
oBINUTUZumab 1000 mg flat dosing intravenous 6 hours
Instructions:

Consider withholding routine anti-hypertensives for 12 hours prior to, during, and for one hour after oBINUTUZumab infusion.

If NO or a Grade 1 infusion-related reaction (IRR) occurred during previous infusion and the final infusion rate was ≥ 100 mg/hour:

  • Start at 100 mg/hour. If tolerated, rate can be increased by 100 mg/hour every 30 minutes, to a maximum rate of 400 mg/hour.

If a Grade 2 or higher IRR occurred during previous infusion:

  • Start at 50 mg/hour. If tolerated, rate can be increased by 50 mg/hour every 30 minutes to a maximum rate of 400 mg/hour.

Short duration infusion ONLY for patients with follicular lymphoma and NO Grade 3 or higher IRR occurred during Cycle 1:

  • Start at 100 mg/hour for 30 minutes. If tolerated, increase rate to 900 mg/hour.
  • If an IRR of Grade 1-2 with ongoing symptoms, or a Grade 3 or higher occurs with the short duration infusion all subsequent infusions should be given at the standard rates (above).

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: Routine antiviral prophylaxis may be considered
Constipation risk: laxatives are usually prescribed
Emetogenicity: Variable
Gastroprotection: Gastroprotection may be considered
Growth factor support: Variable
Hypersensitivity / Infusion related reaction risk: High - routine premedication recommended
Pneumocystis jirovecii pneumonia (PJP) prophylaxis: Routine antibiotic prophylaxis may be considered
Tumour lysis syndrome prophylaxis: Tumour lysis syndrome prophylaxis is recommended

Emetogenicity:

  • O-CHOP: MEDIUM day 1, MINIMAL days 8 and 15.
  • oBINUTUZumab monotherapy: MINIMAL.

Growth factor support: Consider primary prophylaxis for patients over 64 years of age or other high-risk patients.


Tumour lysis syndrome prophylaxis: Recommended for cycle 1 and consider for subsequent cycles.

References

Vitolo, U., M. Trneny, D. Belada, et al. 2017. "Obinutuzumab or Rituximab Plus Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone in Previously Untreated Diffuse Large B-Cell Lymphoma." J Clin Oncol 35(31):3529-3537., PMID: 28796588

Hiddemann, W., A. M. Barbui, M. A. Canales, et al. 2018. "Immunochemotherapy With Obinutuzumab or Rituximab for Previously Untreated Follicular Lymphoma in the GALLIUM Study: Influence of Chemotherapy on Efficacy and Safety." J Clin Oncol 36(23):2395-2404., PMID: 29856692

Marcus, R., A. Davies, K. Ando, et al. 2017. "Obinutuzumab for the First-Line Treatment of Follicular Lymphoma." N Engl J Med 377(14):1331-1344., PMID: 28976863

Haage, T. R., A. Surov, D. Mougiakakos, et al. 2022. "Successful Use of Intravenous Immunoglobulins in an Obinutuzumab-related Acute Thrombocytopenia." Hemasphere 6(8):e751., PMID: 35935607

Fujiwara, Y., T. Urata, D. Niiya, et al. 2022. "Higher incidence of thrombocytopenia during obinutuzumab plus bendamustine therapy for untreated follicular lymphoma: a retrospective analysis by the Okayama Hematology Study Group." Int J Hematol 115(6):811-815., PMID: 35583725

Trotman, J., S.F. Barrington, D. Belada, et al. 2018. "Prognostic value of end-of-induction PET response after first-line immunochemotherapy for follicular lymphoma (GALLIUM): secondary analysis of a randomised, phase 3 trial." Lancet Oncol 19(11):1530-1542., PMID: 30309758

* 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.