OMEDIT / 27_04_09 REGIONS RHONE-ALPES ET AUVERGNE - REFERENTIELS COMMUNS DE PROTOCOLES DE CHIMIOTHERAPIE Page 1 sur 37 OMEDIT RHONE ALPES - AUVERGNE RESEAUX DE CANCEROLOGIE RHONE-ALPES ET AUVERGNE GROUPE DE TRAVAIL REFERENTIELS COMMUNS DE PROTOCOLES DE CHIMIOTHERAPIE REFERENTIEL DE BON USAGE - CANCERS HEMATOLOGIQUES : LYMPHOMES ET MYELOMES Rappel : équivalence reconnue par l’INCa entre la forme orale et la forme IV de fludarabine I- CONDITIONNEMENTS DE GREFFE POUR LES LYMPHOMES ET LES MYELOMES A- PROTOCOLES ENREGISTRES EN RCP Intitulé du protocole Schéma thérapeutique Stade Groupe de référence Références bibliographiques MILPIED ET AL. [68] BEAM - Carmustine 300 mg/m² J1 - Cytarabine 200 à 400 mg/m² J2, J3, J4, J5 - Etoposide 200 à 400 mg/m² J2, J3, J4, J5 - Melphalan inj 140 mg/m² J6 - A - I LINCH ET AL. [58] CBV - Etoposide 250 mg/m² J1, J2, J3, J4 - Cyclophosphamide 1500 mg/m² J1, J2, J3, J4 - Carmustine 300 mg/m² J4 - A - I HAIOUN ET AL. [43] HAIOUN ET AL. [45] CBV - MITOXANTRONE - Mitoxantrone 30 ou 45 mg/m² J1 - Etoposide 250 mg/m² J2, J3, J4, J5 - Cyclophosphamide 1500 mg/m² J2, J3, J4, J5 - Carmustine 300 mg/m² J5 - A - I MORSCHHAUSER ET AL. [71] TAM - TBI - Cytarabine 3000 mg/m² J1, J2 - Melphalan inj 140 mg/m² J3 - A - Médicaments non inscrits sur la liste hors GHS MORSCHHAUSER ET AL. [71]
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OMEDIT / 27_04_09
REGIONS RHONE-ALPES ET AUVERGNE - REFERENTIELS COMM UNS DE PROTOCOLES DE CHIMIOTHERAPIE Page 1 sur 37
OMEDIT RHONE ALPES - AUVERGNE RESEAUX DE CANCEROLOGIE RHONE-ALPES ET AUVERGNE
GROUPE DE TRAVAIL REFERENTIELS COMMUNS DE PROTOCOLE S DE CHIMIOTHERAPIE
REFERENTIEL DE BON USAGE - CANCERS HEMATOLOGIQUES : LYMPHOMES ET MYELOMES
Rappel : équivalence reconnue par l’INCa entre la forme orale et la forme IV de fludarabine
I- CONDITIONNEMENTS DE GREFFE POUR LES LYMPHOMES ET LES MYELOMES A- PROTOCOLES ENREGISTRES EN RCP
Intitulé du protocole Schéma thérapeutique Stade Groupe de référence
- A - Médicaments non inscrits sur la liste hors GHS
GIRALT ET AL. [35]
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B- PROTOCOLES DISCUTES EN RCP (DE 1er NIVEAU OU DE RECOURS) PRESCRIPTION A DEFAUT, PAR EXCEPTION ET EN L’ABSENC E D’ALTERNATIVE THERAPEUTIQUE POUR LE PATIENT
Intitulé du protocole Schéma thérapeutique Stade Groupe de référence
3 injections à 14 j d’intervalle et une 4 ème 28 j après
Traitement de maintenance Cytarabine susp intrathécale
50 mg dose totale S17, S21, S25, S29 4 injections à 28 jours d’intervalle
Méningite lymphomateuse
En curatif A - I GLANTZ ET AL.
[37]
DELRIEU ET AL. [18]
HAIOUN ET AL. [44]
MILPIED ET AL. [68]
TILLY ET AL. [93]
GHESQUIERES ET AL. [33]
METHOTREXATE +/- CYTARABINE +/- CORTICOIDE
- Méthotrexate intrathécal 15 mg dose totale
+/- Cytarabine intrathécale 30 mg dose totale
+/- Méthylprednisolone ou hydrocortisone intrathécale
15 mg dose totale
Méningite lymphomateuse
En prophylaxie et en curatif
A - Médicaments non inscrits sur la liste hors GHS
DIVINE ET AL. [22]
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B- PROTOCOLES DISCUTES EN RCP (DE 1er NIVEAU OU DE RECOURS) PRESCRIPTION A DEFAUT, PAR EXCEPTION ET EN L’ABSENC E D’ALTERNATIVE THERAPEUTIQUE POUR LE PATIENT
Intitulé du protocole Schéma thérapeutique Stade Groupe de référence
Références bibliographiques
BELHADJ ET AL. [7]
R-ACVBP
- Rituximab 375 mg/m² J1
- Doxorubicine 75 mg/m² J1
- Cyclophosphamide 1200 mg/m² J1
- Vindésine 2 mg/m² J1, J5 - Bléomycine
10 mg dose totale J1, J5 - Prednisone per os
60 mg/m² J1 à J5 Tous les 14 à 21 jours
CD20 + (1ère ligne)
B - Annexe INCa
MOUNIER ET AL. [73]
R-IFOSFAMIDE - ETOPOSIDE
- Rituximab 375 mg/m² J1 - Ifosfamide
1500 mg/m² J1 - Etoposide
300 mg/m² J1 Tous les 14 jours
CD20+ (1ère ligne)
B - Annexe INCa NCT00140595
MEY ET AL. [66]
MEY ET AL. [67]
R-DHAP
(En cas de contre-indication au cisplatine, possibilité d’utiliser du
carboplatine AUC 5, selon Calvert ou Chatelut : R-CARBO-DHAP )
- Rituximab 375 mg/m² J1
- Dexaméthasone inj 40 mg dose totale J1 à J4
- Cisplatine 100 mg/m² J1 - Cytarabine
4000 mg/m² J2 Tous les 21 jours
CD20+ En rechute
(≥ 2ème ligne) B - Annexe INCa
GISSELBRECHT ET AL. [36]
KEWALRAMANI ET AL. [54]
R-ICE
- Rituximab 375 mg/m² J1 - Etoposide
100 mg/m² J1, J2, J3 - Carboplatine
AUC 5 (Calvert ou Chatelut) J2 - Ifosfamide
5000 mg/m² J2 Tous les 14 jours
CD20+ En rechute
(≥ 2ème ligne) B - Annexe INCa
GISSELBRECHT ET AL. [36]
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Intitulé du protocole Schéma thérapeutique Stade Groupe de référence
Intitulé du protocole Schéma thérapeutique Stade Groupe de référence Références bibliographiques
IDARUBICINE INJ - 1ère ligne C - III -
IDARUBICINE PER OS - - C - III -
FLUDARABINE EN MONOTHERAPIE - -
C - Médicament non inscrit sur la liste
hors GHS -
R-FC - - C - Absent du
référentiel de l’INCa -
ALEMTUZUMAB - - C - Absent du
référentiel de l’INCa -
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III- LYMPHOMES T A- PROTOCOLES ENREGISTRES EN RCP Lymphomes cérébraux de phénotype T : se reporter au traitement des lymphomes cérébraux de phénotype B, détaillé dans le chapitre précédent
Intitulé du protocole Schéma thérapeutique Stade Groupe de référence
Références bibliographiques
CHOP
(Sous cette appellation standard sont également regroupées les
50 mg dose totale S1, S3 2 injections à 14 jours d’intervalle
Traitement de consolidation Cytarabine susp intrathécale
50 mg dose totale S5, S7, S9, S13 3 injections à 14 jours d’intervalle
et une 4 ème 28 jours après
Traitement de maintenance Cytarabine susp intrathécale
50 mg dose totale S17, S21, S25, S29 4 injections à 28 jours d’intervalle
Méningite lymphomateuse En curatif
A - I GLANTZ ET AL. [37]
DELRIEU ET AL. [18]
MILPIED ET AL. [68]
METHOTREXATE +/- CYTARABINE +/- CORTICOIDE
- Méthotrexate intrathécal 15 mg dose totale
+/- Cytarabine intrathécale 30 mg dose totale
+/- Méthylprednisolone ou hydrocortisone intrathécale
15 mg dose totale
Méningite lymphomateuse En prophylaxie et en curatif
A - Médicaments non inscrits sur la
liste hors GHS TILLY ET AL.
[93]
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B- PROTOCOLES DISCUTES EN RCP (DE 1er NIVEAU OU DE RECOURS) PRESCRIPTION A DEFAUT, PAR EXCEPTION ET EN L’ABSENC E D’ALTERNATIVE THERAPEUTIQUE POUR LE PATIENT
Pas de protocole
C- PROTOCOLES NON AUTORISES
Intitulé du protocole Schéma thérapeutique Stade Groupe de référence
Références bibliographiques
IDARUBICINE INJ - 1ère ligne C - III -
IDARUBICINE PER OS - - C - III -
FLUDARABINE EN MONOTHERAPIE - -
C - Médicament non inscrit sur la
liste hors GHS -
R-FC - - C - Absent du référentiel de
l’INCa -
VINORELBINE - En rechute
(≥ 2ème ligne)
C - Médicament non inscrit sur la
liste hors GHS -
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IV- LYMPHOMES FOLLICULAIRES A- PROTOCOLES ENREGISTRES EN RCP
Intitulé du protocole Schéma thérapeutique Stade Groupe de référence
Références bibliographiques
R-CHOP
(Sous cette appellation standard sont également regroupées les
Patients ayant reçu au moins un traitement antérieur, qui
ont déjà subi ou sont inéligibles pour une greffe de
moelle osseuse (≥ 2ème ligne)
A - I ORLOWSKI ET AL. [75]
DIMOPOULOS ET AL. [21]
THALIDOMIDE - DEXAMETHASONE
- Thalidomide 200 mg/j en continu
- Dexaméthasone per os 40 mg dose totale J1, J2, J3, J4
Tous les 21 jours
En rechute (≥ 2ème ligne)
A - Médicaments non inscrits sur la liste hors GHS PALUMBO ET AL.
[78]
B- PROTOCOLES DISCUTES EN RCP (DE 1er NIVEAU OU DE RECOURS)
PRESCRIPTION A DEFAUT, PAR EXCEPTION ET EN L’ABSENC E D’ALTERNATIVE THERAPEUTIQUE POUR LE PATIENT
Intitulé du protocole Schéma thérapeutique Stade Groupe de référence
Références bibliographiques
BORTEZOMIB - DOXORUBICINE - DEXAMETHASONE
(PAD)
- Bortézomib 1,3 mg/m² J1, J4, J8, J11
- Doxorubicine 20 mg/m² J1, J4
- Dexaméthasone per os 40 mg dose totale J1 à J4
Tous les 28 jours
En rechute (≥ 2ème ligne)
B - Protocole absent du
référentiel de l’INCa
PALUMBO ET AL. [77]
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Intitulé du protocole Schéma thérapeutique Stade Groupe de référence
Références bibliographiques
HAROUSSEAU ET AL. [46]
JAGANNATH ET AL. [50]
BORTEZOMIB - DEXAMETHASONE
Cures n° 1 et 2 - Bortézomib
1,3 mg/m² J1, J4, J8, J11 - Dexaméthasone per os
40 mg dose totale J1 à J4 et J9 à J12 Tous les 21 jours
Cures n° 3 et 4 - Bortézomib
1,3 mg/m² J1, J4, J8, J11 - Dexaméthasone per os 40 mg dose totale J1 à J4
Tous les 21 jours
≥ 1ère ligne
B - Protocole absent du
référentiel de l’INCa
JAGANNATH ET AL. [51]
C- PROTOCOLES NON AUTORISES
Intitulé du protocole Schéma thérapeutique Stade Groupe de référence Références bibliographiques
IDARUBICINE PER OS - - C - III -
LENALIDOMIDE - DEXAMETHASONE - 1ère ligne
C - Protocole absent du référentiel de
l’INCa -
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