Skip to main content
Close

Case Study 5

For each question, choose the answer you think is correct. See the end of this page for the answers.

​DG is an 81-year-old female, diagnosed with stage 4a diffuse B cell lymphoma, scheduled to receive 6 cycles of LYCHOPR.

Weight: 52 kg Height: 159 cm

Lab results (taken 24 hours prior to first treatment)

  • WBC 6.1
  • ANC 3.7
  • Platelets 175
  • Creatinine 77
  • Bilirubin 12
  • AST 23
  • ALT 31
  • LDH 110
  • HBsAg - negative
  • HBCoreAb - negative
1. What doses should this patient receive?
  1. Cyclophosphamide 855 mg, DOXOrubicin 57 mg, vinCRIStine 2.1 mg, riTUXimab 570 mg, and predniSONE 75 mg PO daily × 5 days 
  2. Cyclophosphamide 1140 mg, DOXOrubicin 76 mg, vinCRIStine 2.1 mg, riTUXimab 570 mg, and predniSONE 75 mg PO daily × 5 days 
  3. Cyclophosphamide 1290 mg, DOXOrubicin 86 mg, vinCRIStine 2.4 mg, riTUXimab 645 mg, predniSONE 75 mg PO daily × 5 days 
  4. Cyclophosphamide 968 mg, DOXOrubicin 65 mg, vinCRIStine 1.8 mg, riTUXimab 483 mg, predniSONE 50 mg PO daily × 5 days 
2. This patient is going to receive her CHOP portion (i.e. cyclophosphamide, DOXOrubicin, vinCRIStine, and predniSONE) of the protocol on a different day than the riTUXimab. Which drugs does she have to receive first? How much time can elapse between the CHOP and riTUXimab treatment?
  1. Treatment can be scheduled at the patient’s convenience, as long as CHOP is started on the first day and the predniSONE is taken in the morning before receiving riTUXimab 
  2. The CHOP portion has to be given on Day 1 and the riTUXimab on Day 2 
  3. The CHOP portion has to be given on Day 1 and the riTUXimab within 48 hours of Day 1 
  4. The CHOP portion has to be given on Day 1 and the riTUXimab may be given on Day 1 or Day 2, but no later than 72 hours after CHOP. The patient must start her predniSONE on Day 1, and must make sure a dose of predniSONE is taken on the morning before receiving riTUXimab 
3. This patient needs to be monitored for hypersensitivity reactions due to which drug(s)?
  1. PredniSONE and vinCRIStine 
  2. PredniSONE and riTUXimab 
  3. VinCRIStine and riTUXimab
  4. RiTUXimab 

The correct answer is 1.

 

Rationale:


Based on the LYCHOPR protocol "Dose Modifications" section, DOXOrubicin and cyclophosphamide in cycle 1 should be dose reduced to 75% for patients > 75 years old, but may be escalated to 100% in subsequent cycles, depending on patient’s tolerance to the reduced dose. Doses are calculated as follows:


Cyclophosphamide dose = 750 mg/m2 x 0.75 x 1.52 m2 
     = 855 mg

DOXOrubicin dose = 50 mg/m2 x 0.75 x 1.52 m2 
     = 57 mg

VinCRIStine dose = 1.4 mg/m2 x 1.52 m2 
     = 2.1 mg

RiTUXimab dose = 375 mg/m2 x 1.52 m2 
     = 570 mg

Prednisone dose = 45 mg/m2 x 1.52 m2 
     = 68.4 mg (rounded to nearest 25 mg = 75 mg) daily x 5         days

 

The correct answer is 4.


Rationale: The LYCHOPR protocol states that cyclophosphamide, DOXOrubicin, vinCRIStine and predniSONE ("CHOP" portion of the protocol) are to be given on day 1. RiTUXimab may be given on either day 1 or 2 whenever possible, but no later than 72 hours after "CHOP". The daily dose of predniSONE should be taken on the morning of the riTUXimab day (i.e. before the riTUXimab administration).

The correct answer is 4.


Rationale: Under the LYCHOPR protocol "Precautions" section, point 4 indicates the need to monitor for hypersensitivity reactions to both etoposide and riTUXimab. However, this particular patient is receiving riTUXimab and DOXOrubicin, (not etoposide in place of DOXOrubicin), so riTUXimab is the only drug monitored. This does not preclude the fact that the patient could have hypersensitivity reactions to the other drugs in this protocol, but a higher percentage of patients react to riTUXimab and thus it is anticipated and monitored for.

SOURCE: Case Study 5 ( )
Page printed: . Unofficial document if printed. Please refer to SOURCE for latest information.

Copyright © BC Cancer Agency. All Rights Reserved.

    Copyright © 2017 Provincial Health Services Authority