Hyper-CVAD is an intensive chemotherapy regimen used primarily for aggressive lymphoid malignancies, such as acute lymphoblastic leukemia (ALL) and mantle cell lymphoma. It alternates between two cycles:
- Hyper-CVAD (Cycle A):
- Cyclophosphamide (high-dose)
- Vincristine
- Doxorubicin (“Adriamycin”)
- Dexamethasone (high-dose)
- High-Dose Methotrexate + Cytarabine (Cycle B):
- Methotrexate (with leucovorin rescue)
- Cytarabine (high-dose)
Key Considerations for Oncology Pharmacists:
- Toxicity Monitoring: High risk of myelosuppression, tumor lysis syndrome, mucositis, and neurotoxicity (vincristine).
- Supportive Care: Aggressive hydration, uric acid management (allopurinol/rasburicase), and infection prophylaxis (PJP, antifungal, antiviral).
- Methotrexate Rescue: Requires timely leucovorin and renal function monitoring.
- Cytarabine Neurotoxicity: Watch for cerebellar symptoms (ataxia, slurred speech).
Often combined with rituximab (R-Hyper-CVAD) for CD20+ diseases. Dose adjustments may be needed for elderly/frail patients.