CODOX-M / IVAC is a combination of several medications used to treat advanced b-cell lymphoma such as Burkitt’s (BL).CODOX-M is given for first and third cycles and includes: Cyclophosphamid, Vincristine, Doxorubicin, Methotrexate. IVACis – given for second and fourth cycles. It consists of: Ifosfamide, Mesna, Etoposide, Cytarabine. These two regimens are normally used in combination with each other and are rarely given alone.
Magrath et al pioneered the use of the CODOX-M/IVAC regimen in children and adults with BL. This regimen incorporates 3 cycles of CODOX-M for patients with low-risk disease (a single extranodal site or completely resected intra-abdominal disease and a normal LDH) and 4 cycles of alternating CODOX-M/IVAC for patients with high-risk disease. CODOX-M/IVAC combines fractionated cyclophosphamide with higher doses of methotrexate (6720 mg/m2) and cytarabine (2000 mg/m2) than administered in the LMB and B-NHL trials, with the exception of LMB 86 in which patients received up to 8000 mg/m2 methotrexate. In the initial publication, 2-year EFS was 85% in children and 100% in adults, with all 20 adult patients achieving a CR.54 In an updated report, CRs were noted in 24 of 26 adult patients treated, with 22 patients alive and disease free, at a median follow-up of 47 months (range, 12-91 months).64 While the results of this study seem remarkable, it is important to recognize that this study involved a relatively young adult patient population, with a median age of 25 years, although 70% of patients had advanced-stage disease by both the St Jude and the Ann Arbor staging systems. In 14 patients with a median age of 47 years, the Magrath regimen produced responses in 86% of patients, with 72% alive and disease free after 21 months of follow-up. In this older group, myelosuppression was universal, and treatment-related deaths were reported in 5 patients.
Codox with IVAC is a well established standard-of-care protocol for agressive lymphomas, especially BL.
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