Hyper-CVAD
Checked 2026-09-09
Adult acute lymphoblastic leukaemia (with a tyrosine kinase inhibitor if Philadelphia-positive), Burkitt lymphoma and younger patients with mantle cell lymphoma
Also called hyperCVAD, Hyper-CVAD/MA.
One cycle
every 21 days × 8 · about 24 weeks in totalComponents
| Drug | Dose | Route | Days | Note |
|---|---|---|---|---|
Cyclophosphamide (course A) Alkylating agent (oxazaphosphorine prodrug) | 300 mg/m² every 12 hours for 6 doses, with mesna | IV | D1-3 | |
Vincristine (course A) Vinca alkaloid (microtubule inhibitor) | 2 mg | IV | D4, 11 | |
Doxorubicin (course A) Cytotoxic chemotherapy (anthracycline) | 50 mg/m² | IV | D4 | |
Dexamethasone (course A) Glucocorticoid | 40 mg daily | Oral | D1, 2, 3, 4, 11, 12, 13, 14 | |
Methotrexate (course B) Antifolate (DHFR inhibitor) | 1,000 mg/m² with leucovorin rescue | IV | D1 (24 h infusion) | |
Cytarabine (course B) Pyrimidine nucleoside analogue (antimetabolite) | 3,000 mg/m² every 12 hours for 4 doses | IV | D2, 3 |
Cycles
8 (alternating A and B courses)
21-day cycle
Emetogenicity
High (>90%)
G-CSF
Built into the protocol
Notes
- Courses A (hyper-CVAD) and B (high-dose methotrexate and cytarabine) alternate; intrathecal prophylaxis is given with each course.
- Cytarabine dose is reduced for age over 60 or renal impairment.
Used in
Source
Kantarjian, JCO 2000: hyper-CVAD in adult ALL
Reference doses for a typical adult from the cited protocol or label. Doses are adjusted for renal and hepatic function, age, performance status and prior toxicity, and institutional protocols vary. Verify against the current label and your local protocol before treating. Not medical advice.
Other regimens for these cancers
R-CHOP
Diffuse large B-cell lymphoma, first line (6 cycles; 3-4 with radiotherapy for limited stage)
every 21 days × 6
Bendamustine + rituximab (BR)
Indolent lymphoma and mantle cell lymphoma first line; fit CLL without del(17p) where targeted agents are unavailable
every 28 days × 6
Blinatumomab
B-ALL: MRD-positive, relapsed/refractory, or consolidation in frontline regimens (E1910, AALL1731)
every 42 days × 2
Inotuzumab ozogamicin
Relapsed or refractory CD22-positive B-ALL
every 21 days
Fludarabine + cyclophosphamide lymphodepletion, then CD19 CAR-T
Relapsed or refractory large B-cell lymphoma (second line if refractory or relapse within 12 months), B-ALL, follicular and mantle cell lymphoma
every 6 days
Imatinib
Chronic-phase CML; adjuvant GIST for 3 years after resection of high-risk tumours; metastatic GIST
every 28 days
DA-EPOCH-R
Primary mediastinal B-cell lymphoma, high-grade B-cell lymphoma with MYC and BCL2 rearrangements, Burkitt lymphoma in adults, and HIV-associated lymphomas
every 21 days × 6