Sequential high-dose chemotherapy
|Sequential high-dose chemotherapy|
Sequential high-dose chemotherapy is a chemotherapy regimen consisting of several (2 to 4) sequential monochemotherapies with only one chemotherapeutic agent per course. The idea behind this approach is that when using single-agent chemotherapy, the doctor can easily escalate the dose of the drug to the maximum tolerable dose by the patient, avoiding additive hematological toxicity from chemotherapeutic combinations, and thus improving efficacy. It is mostly used as consolidation therapy for relapsed or refractory lymphomas and relapsed or refractory Hodgkin disease, after DHAP induction. There is also an ongoing trial of this approach in multiple myeloma.
|Course||Drug||Acronym for the chemotherapy regimen itself||Dose||Mode|
|First||Cyclophosphamide||HD-CYC||~4500–6000 mg/m2||IV infusion|
|Second||Methotrexate||HD-MTX||~2500–8000 mg/m2||IV infusion|
|Third||Cytarabine||HDAC or HD-AraC||~3000–6000 mg/m2||IV infusion|
|Fourth||Etoposide||HD-ETO||~2000 mg/m2||IV infusion|
Depending on the patient's performance status, his/her ability to tolerate chemotherapy, the type of lymphoma, the stage of disease and different prognostic factors, one or more courses of the full sequence can be omitted or dose reduced. After completion of the sequence, the patient will usually undergo pre-transplant conditioning chemotherapy regimen (such as BEAM) and then will get autologous stem cell transplantation as the final consolidation.
- Oyan B, Koc Y, Ozdemir E, Kars A, Turker A, Tekuzman G, Kansu E (2006). "High dose sequential chemotherapy and autologous stem cell transplantation in patients with relapsed/refractory lymphoma". Leuk Lymphoma. 47: 1545–52. doi:10.1080/10428190600570958. PMID 16966265.
- Josting A, Rudolph C, Mapara M, Glossmann JP, Sieniawski M, Sieber M, Kirchner HH, Dörken B, Hossfeld DK, Kisro J, Metzner B, Berdel WE, Diehl V, Engert A (2005). "Cologne high-dose sequential chemotherapy in relapsed and refractory Hodgkin lymphoma: results of a large multicenter study of the German Hodgkin Lymphoma Study Group (GHSG)". Ann Oncol. 16: 116–23. doi:10.1093/annonc/mdi003. PMID 15598948.
- High Dose Sequential Therapy and Autologous Stem Cell Rescue for Multiple Myeloma