Systemic Anti-Cancer Therapy Regimen Library
LYM HL Classic Advanced - escBEACOPP [bleomycin, etoposide, DOXOrubicin, CYCLOPHOSPHamide, vinCRISTine, prEDNISone and procarbazine] interim PET-guided [under 60 years]
Treatment Overview
Number of cycles: 2 to 6 cycles depending on interim PET. See Additional details for number of cycles and choice of chemotherapy regimens +/- involved-site radiation therapy (ISRT).
escBEACOPP is initiated at Level 4; further cycles are given at this level or reduced by one dose level** for all subsequent cycles if any of the following toxic events occurred:
- leukopenia of CTCAE grade 4 for more than four days (white cell count less than 1 x 109/L);
- thrombocytopenia of CTCAE grade 4 on one or more days (platelet count less than 25 x 109/L);
- infection of CTCAE grade 4;
- or other side-effects of CTCAE grade 4;
- a treatment postponement of more than two weeks due to inadequate recovery of blood values occurred.
** Except If any toxic event occurred in two successive cycles, the remaining cycles are to be administered at Baseline dose.
For Cycles 1 to 6 or de-escalate to appropriate level as per WCC, platelet counts and WHO grade 4 toxicities, see above.
For Cycles 2 to 6 or de-escalate to appropriate level as per WCC, platelet counts and WHO grade 4 toxicities, see above.
For Cycles 3 to 6 or de-escalate to appropriate level as per WCC, platelet counts and WHO grade 4 toxicities, see above.
For Cycles 4 to 6 or de-escalate to appropriate level as per WCC, platelet counts and WHO grade 4 toxicities, see above.
For Cycles 3 to 6 based on de-escalations to this level, or if any toxic event occurs in any 2 successive cycles the following cycle(s) are at and remain at Baseline dosing.
Additional details
Section 1: Choice of chemotherapy regimen +/- ISRT
Choice of chemotherapy regimens +/- involved-site radiation therapy (ISRT) depends on initial staging and interim PET results as follows:
Supportive Care Factors
| Factor | Value |
|---|---|
| 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: | Recommended for primary prophylaxis |
| Hydration: | Variable |
| Irradiated blood components: | Irradiation of blood components is recommended |
| Mesna uroprotection: | Variable |
| Pneumocystis jirovecii pneumonia (PJP) prophylaxis: | Routine antibiotic prophylaxis recommended |
| Tumour lysis syndrome prophylaxis: | Tumour lysis syndrome prophylaxis may be considered |
Antiviral prophylaxis for hepatitis B virus: Guidance is limited to high-risk anti-cancer medicines. Clinicians will need to assess individual patient risk for other anti-cancer medicines.
Irradiated blood components: Required for Hodgkin lymphoma patients at all stages of disease and therapy. Continue indefinitely.
References
New Zealand Blood Service Transfusion Medicine Handbook Third Edition, 2016 https://www.nzblood.co.nz/assets/Transfusion-Medicine/PDFs/111G122.pdf (accessed 3/2/2022)
* 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.