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regimen-monograph
CHOMP
Intent
Curative
Regimen Category
Standard
Drugs Used
A - Regimen Name
CHOMP Regimen
Cyclophosphamide-Hydroxyldaunorubicin (DOXOrubicin)-ONCOVIN® (VinCRIStine)-Methrotrexate-Prednisone
Disease Site
Hematologic - Lymphoma - Non-Hodgkin's High Grade
Intent
Curative
Regimen Category
Standard : Standard therapy endorsed by the Disease Site Group or a regimen widely used by most Regional Cancer Centres in this disease site. The category is unrelated to the source or availability of funding.
Rationale and Uses
First line treatment of aggressive histology lymphoma with CNS involvement and therapy for Burkitt’s lymphoma.
B - Drug Regimen
PART A:
| cyclophosphamide
(Round to nearest 10 mg) |
1200 mg /m² | IV | Day 1 | ||||||||||
| DOXOrubicin
(Round to nearest 1 mg) |
40 mg /m² | IV | Day 1 | ||||||||||
|
Hold DOXOrubicin on cycle 1, when radiotherapy is given (continued on next page)
|
|||||||||||||
| vinCRIStine
(Round to nearest 0.1 mg; max 2 mg) |
1.4 mg /m² | IV | Day 1 | ||||||||||
| prednisone | 40 mg /m² | PO or 100 mg PO daily | Days 1 to 5 | ||||||||||
|
(Outpatient prescription in multiples of 50mg tablets)
|
|||||||||||||
| methotrexate
(Round to nearest 0.2mg ) |
12 mg | IT | Day 1 | ||||||||||
| methotrexate | 3000 mg /m² | IV over 6 hours | Day 10 | ||||||||||
| methotrexate
(Round to nearest 0.2 mg) |
12 mg | IT | Day 10 | ||||||||||
|
LEUCOVORIN RESCUE: |
|||||||||||||
| leucovorin | 25 mg /m² | IV | q6h for 12 doses | ||||||||||
|
Starting 24 hours from the start of the Methotrexate infusion (any doses ≥25mg by IV route- oral absorption is saturable)
|
|||||||||||||
D - Premedication and Supportive Measures
Antiemetic Regimen:
Moderate
Other Supportive Care:
- Urine alkalinization and hydration pre and post Methotrexate
- DO NOT administer High Dose Methotrexate, unless Leucovorin Rescue is available ON TIME.
- Allopurinol for tumour lysis syndrome
E - Dose Modifications
DO NOT ADMINISTER METHOTREXATE IF PRE-CHEMO LAB VALUES ARE:
- Creatinine Clearance < 1mL/sec
- Urine Output < 1.67mL/minute
- Urine SG > 1.010
- BUN above normal range
- Urine pH < 7.0
Doses should be modified according to the protocol by which the patient is being treated. The following recommendations are in use at some centres.
Dosage with toxicity
Hematologic Toxicities: See Appendix 6 for general recommendations. G-CSF support should be considered after first episode of febrile neutropenia or delay of dose > or = 1 week.
Neurotoxicity
|
Symptom
|
% usual dose of Vincristine
|
|
areflexia only
|
100 %
|
|
abnormal buttoning, writing
|
67 %
|
|
moderate motor neuropathy
(± cranial)
|
Hold until recovery then reduce dose by 50%
|
|
severe motor neuropathy
|
Omit
|
Hepatic Impairment
|
Bilirubin (µmol/L)
|
% usual dose
|
|
1-2 X ULN
|
REDUCE Vincristine to 50% dose and
REDUCE Doxorubicin to 50% dose
|
|
2-4 X ULN
|
REDUCE Vincristine to 25% dose and
REDUCE Doxorubicin to 25% dose
|
|
2-3 X ULN
|
REDUCE Methotrexate to 75% dose
|
|
> 3 X ULN
|
OMIT Methotrexate
|
|
> 4 X ULN
|
OMIT Doxorubicin dose (Suggested Action)
|
Renal Impairment
|
Creatinine Clearance
|
Actions
|
|
0.2-0.8mL/sec
|
REDUCE Methotrexate to 50% dose
|
|
< 0.2mL/sec
|
OMIT dose of Methotrexate
|
Cyclophosphamide: Renal failure may lead to the reduced excretion of metabolites and increased toxicity. Significant falls in clearance (25-80%) with increased exposure have been documented in patients with renal impairment. Dose reduction (25- 50%) should be considered in patients with mild to moderate renal impairment. Patients with moderate renal impairment receiving high doses or severe renally impaired patients (CrCl < 10 mL/min) are at particular risk and should be treated at a reduced dose and with extreme caution.
F - Adverse Effects
Refer to cyclophosphamide, DOXOrubicin, vinCRIStine, prednisone, methotrexate, leucovorin drug monograph(s) for additional details of adverse effects
G - Interactions
Refer to cyclophosphamide, DOXOrubicin, vinCRIStine, prednisone, methotrexate, leucovorin drug monograph(s) for additional details
H - Drug Administration and Special Precautions
Refer to cyclophosphamide, DOXOrubicin, vinCRIStine, prednisone, methotrexate, leucovorin drug monograph(s) for additional details
I - Recommended Clinical Monitoring
Recommended Clinical Monitoring
- Clinical toxicity assessment (including gastrointestinal, stomatitis, local toxicity, cardiotoxicity, neurotoxicity, constipation and cystitis).
- Routine blood glucose test.
- CBC before each cycle. Interim counts should be done in first cycle and repeated if dose modification necessary.
- Baseline and regular cardiac examination for patients with cardiac risk factors (including prior therapy with Epirubicin, Mitoxantrone, or other cardiotoxic drug) and cumulative doxorubicin doses > 450mg/m2.
- Baseline liver & renal function tests and urinalysis; monitor renal & hepatic function tests and serum electrolytes before, during and after each dose of Methotrexate (high dose).
- Monitor input and output of fluids and urine with each dose of Methotrexate (high dose).
- Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for Adverse Events) version
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K - References
Bernstein JI, Coleman CN, Strickler JG et al. Combined modality therapy for adults with small noncleaved cell lymphoma (Burkitt’s and non-Burkitt’s types). J Clin Oncol, 1986; 4: 847-858
M - Disclaimer
Regimen Abstracts
A Regimen Abstract is an abbreviated version of a Regimen Monograph and contains only top level information on usage, dosing, schedule, cycle length and special notes (if available). It is intended for healthcare providers and is to be used for informational purposes only. It is not intended to constitute or be a substitute for medical advice, and all uses of the Regimen Abstract are subject to clinical judgment. Such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability, and Cancer Care Ontario disclaims all liability for the use of this information, and for any claims, actions, demands or suits that arise from such use.
Information in regimen abstracts is accurate to the extent of the ST-QBP regimen master listings, and has not undergone the full review process of a regimen monograph. Full regimen monographs will be published for each ST-QBP regimen as they are developed.
Regimen Monographs
Refer to the New Drug Funding Program or Ontario Public Drug Programs websites for the most up-to-date public funding information.
The information set out in the drug monographs, regimen monographs, appendices and symptom management information (for health professionals) contained in the Drug Formulary (the "Formulary") is intended for healthcare providers and is to be used for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects of a particular drug, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for a given condition. The information in the Formulary is not intended to constitute or be a substitute for medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.
The format and content of the drug monographs, regimen monographs, appendices and symptom management information contained in the Formulary will change as they are reviewed and revised on a periodic basis. The date of last revision will be visible on each page of the monograph and regimen. Since standards of usage are constantly evolving, it is advised that the Formulary not be used as the sole source of information. It is strongly recommended that original references or product monograph be consulted prior to using a chemotherapy regimen for the first time.
Some Formulary documents, such as the medication information sheets, regimen information sheets and symptom management information (for patients), are intended for patients. Patients should always consult with their healthcare provider if they have questions regarding any information set out in the Formulary documents.
While care has been taken in the preparation of the information contained in the Formulary, such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability.
CCO and the Formulary’s content providers shall have no liability, whether direct, indirect, consequential, contingent, special, or incidental, related to or arising from the information in the Formulary or its use thereof, whether based on breach of contract or tort (including negligence), and even if advised of the possibility thereof. Anyone using the information in the Formulary does so at his or her own risk, and by using such information, agrees to indemnify CCO and its content providers from any and all liability, loss, damages, costs and expenses (including legal fees and expenses) arising from such person’s use of the information in the Formulary.
Last Updated: July 21, 2026
