Pola-R-CHP - Polatuzumab Vedotin 1.8 / Rituximab 375 / Cyclophosphamide 750 / Doxorubicin 50 / Prednisolone 100, diffuse large B-non-Hodgkin Lymphoma, cycle 1-6

Protocol-ID: 1920 V1.0 (Standard), Pola-R-CHP (POLVED1.8/RITU375/CYCL750/DOXO50/PRED100), DLBCL, C1-6

Indication(s)

NHL, B-Cell Type, Diffuse Large Cell; ICD-10 C83.3

Protocol classification

Classification: current standard
Intensity: Standard dose
Therapy mode: First line
Therapy intention: curative

Cycles

Cycle length 21 days, recommended cycles: 6

Protocol sequences

POLARIX: Pola-R-CHP (POLVED1,8/RITU375/CYCL750/DOXO50/PRED100), DLBCL, C1-6 (PID1920) -|- RITU375, C7-8 (PID1921)

Risks

Emetogenicity (MASCC/ESMO): moderate (30-90%)
Neutropenia: very high (>41%)
Febrile Neutropenia: high (>20%)
Anemia Hb below 8g/dl: moderate (6-15%)
Diarrhea: CTC AE °1-2: 27%; °3-4: 4%
Headache: CTC AE °1-2: 12%; °3-4: 1%
Neuropathy: CTC AE °1-2: 52%; °3-4: 2%
Asthenia: CTC AE °1-2: 10%; °3-4: 2%
Constipation: CTC AE °1-2: 28%; °3-4: 1%
Pyrexia: CTC AE °1-2: 14%; °3-4: 2%

Therapy

Day	Substance	Dosage	Appl.	Inf. time	Procedure
HYD Hydration: Balanced Crystalloid Solution
Access: peripheral venous
Hydration before, during, or after antitumor therapy
1	Balanced Crystalloid Solution	500 ml	i.v.	60 min	60 min before Polatuzumab Vedotin

Day	Substance	Dosage	Solution	Appl.	Inf. time	Procedure
AE Antiemesis: Emetogenicity moderate, GRAN i.v., DEXA i.v.
Access: peripheral venous
ASCO 2015, DGHO 2016, DKG 2016, MASCC/ESMO 2016, if palonosetron not available
1	Granisetron	1 mg	NaCl 0.9% 50 ml	i.v.	5 min	15 min before Cyclophosphamide (d1)
or other 5-HT3 receptor antagonist

Day	Substance	Dosage	Solution	Appl.	Inf. time	Procedure
ASR Prevention of Acute Systemic Reactions: Rituximab (paracetamol, Dimetinden, Prednisolone i.v.)
Access: peripheral venous
1	Paracetamol	1000 mg		p.o.		60 min before Polatuzumab Vedotin
1	Dimetinden	4 mg	NaCl 0.9% 50 ml	i.v.	5 min	30 min before Polatuzumab Vedotin
1	Prednisolone	100 mg	NaCl 0.9% 50 ml	i.v.	15 min	60 min before Polatuzumab Vedotin

Day	Substance	Dosage	Appl.	Inf. time	Procedure
SUP Supportive therapy: Mesna i.v., hour 0 (pre), p.o. 2 h, 6 h after onset Cyclophosphamide
Access: peripheral venous
Mesna 0h,2h,6h, prophylaxis of urinary tract toxicity by Cyclophosphamide. At the time of oxazaphosphorin injection, 20% of the oxazaphosphorin dose is injected simultaneously as Mesna. 2 and 6 h after onset, oral Medication of 40% of the oxazaphosporin dose, summary of product characteristics.
1	Mesna	150 mg/m² BSA	i.v.	1 min	1 min before Cyclophosphamide (d1)
1	Mesna	300 mg/m² BSA	p.o.		1 h after Cyclophosphamide (d1)
1	Mesna	300 mg/m² BSA	p.o.		5 h after Cyclophosphamide (d1)

Day	Substance	Dosage	Solution	Appl.	Inf. time	Procedure
ANTX Antineoplastic therapy: Pola-R-CHP
Access: central venous
2-5	Prednisolone	100 mg		p.o.		1-0-0-0
1	Polatuzumab vedotin	1.8 mg/kg bw	NaCl 0.9% 150 ml	i.v.	90 min	Sequence
If the previous infusion was well tolerated, the subsequent dose of polatuzumab vedotin may be administered as a 30-minute infusion.
1	Rituximab	375 mg/m² BSA	NaCl 0.9% 500 ml	i.v.	4 h	Sequence
Init. Infusion rate 50mg/h; it can be increased by 50mg/h every 30min to max. 400mg/h. Further infusions: init. Infusion speed 100mg/h, which can be increased by 100mg/h every 30min to max. 400mg/h.
1	Cyclophosphamide	750 mg/m² BSA	NaCl 0.9% 500 ml	i.v.	1 h	Sequence
1	Doxorubicin	50 mg/m² BSA	Dextrose 5% 250 ml	i.v.	30 min	Sequence

Day	Substance	Dosage	Appl.	Inf. time	Procedure
HW Hematopoietic growth factors: FN risk over 20%, G-CSF long-acting
Access: - none -
Risk of febrile neutropenia (FN) >20%, ASCO 2015, DKG 2016
2	Pegfilgrastim	6 mg	subc	Bolus	24 h after Doxorubicin (d1)
or other long-acting G-CSF

Substance links

Links to substances are found here.

Concomitant therapy supplements

Prednisolon in der Allergieprophylaxe entspricht Prednisolon in der Therapie an Tag 1. Tumorlysesyndrom-Risikoeinteilung nach Cairo 2010 beachten, bei LDH-Erhöhung ohne Tumor-Bulk Protokoll "Tumorlysesyndrom-Prophylaxe, mittleres Risiko" verwenden. Bei LDH-Erhöhung über das zweifache des oberen Grenzwertes und Tumor-Bulk Protokoll "Tumorlysesyndrom-Prophylaxe, hohes Risiko" benutzen.

Warnings

If an infusion-related reaction occurs in a patient, slow the infusion rate of Polatuzumab Vedotin or discontinue use. Discontinue use immediately and permanently if a life-threatening reaction occurs in a patient. Doxorubicin: increased risk of cardiomyopathy, maximum cumulative dose 450-550 mg/m² KOF. In mediastinal irradiation, arterial hypertension for more than 5 years, age over 70 years or previous cardiac damage, maximum 400 mg/m². For DOXO extravasation: dry cold (not just before or after Dexrazoxane infusion) on day of extravasation. Dexrazoxane i.v. for 3 days: 2 days 1000 mg/m², 3rd day 500 mg/m², do not use in parallel with DMSO. First infusion as soon as possible and within the first 6 hours.

Notes

Die Patienten sind während der Infusion von Polatuzumab Vedotin und für mindestens 90 Minuten nach Beendigung der Initialdosis auf infusionsbedingte Reaktionen/Überempfindlichkeitsreaktionen zu überwachen. Wenn die vorherige Infusion gut vertragen wurde, sind die Patienten während der Infusion und für mindestens 30 Minuten nach Beendigung der Infusion zu überwachen. Dexamethason zur Antiemese an den Tagen 2-3 durch Prednisolon der Antitumortherapie abgedeckt. Die Kombination aus einem Anthrazyklin und Cyclophosphamid kann bei einzelnen Patienten hoch emetogen sein und eine Zugabe eines Neurokininrezeptor-Antagonists erfordern. Hierbei muss auf die Erhöhung der Plasmakonzentration von Prednisolon geachtet und dieses eventuell angepasst werden.

Controls:

Blood count: 1x weekly
Echocardiography, ECG, chest X-ray Cardiotoxicity of doxorubicin, review of cardiac function before/under therapy recommended.
Hepatitis B (HBV) Test: HBsAg and anti-HBc Rituximab: Hep-B reactivation possible. If Hep-B serology is positive, initiate measures to prevent hepatitis B reactivation.
IgG Rituximab: Risk of Infection: It is recommended that immunoglobulin levels be determined prior to initiating treatment with rituximab.
Day 1: Na⁺, K⁺, Ca²⁺, Mg²⁺
Day 1: Creatinine, glomerular filtration rate (GFR)
Day 1: GOT, GPT, GGT, Bilirubin, AP, Cholinesterase
Day 1: Urine status

Original author

Tilly H (2021)

Origin

Centre Henri-Becquerel, Rouen Cedex, France, POLARIX trial

References

Tilly H, Polatuzumab Vedotin in Previously Untreated Diffuse Large B-Cell Lymphoma. N Engl J Med 2022 Jan 27;386(4):351-363. doi: 10.1056/NEJMoa2115304. PMID: 34904799. [PMID] [DOI]
Morschhauser F, Five-Year Outcomes of the POLARIX Study Comparing Pola-R-CHP and R-CHOP in Patients With Diffuse Large B-Cell Lymphoma. J Clin Oncol 2025 Dec 10;43(35):3698-3705. doi: 10.1200/JCO-25-00925. PMID: 40991874. [PMID] [DOI]

Recommendations

02/2026: European Society for Medical Oncology
02/2026: National Comprehensive Cancer Network

Important notice

The copyrighted protocols are treatment recommendations. The information contained in this compilation on cytostatic drugs, concomitant medication and other therapeutic procedures, as well as dosage and application information, is continuously reviewed with all due care by the authors and editors involved. Nevertheless, the publishers and authors do not assume any liability for the correctness - also with regard to possible printing errors.

Diagnosis, indication for therapy and treatment of malignant diseases must be carried out in each individual case by the hematologist and oncologist on his or her own responsibility. The treating physician is obligated to this personal responsibility to weigh in each case before a diagnostic or therapeutic measure, indication, contraindications, dosage and application under consideration of the specialized information or other documents of the manufacturers. This applies in particular to rarely used preparations or preparations that are new to the market.

The protocols may not be changed in terms of content. Any further use of the protocols in physical or non-physical form, such as copying, distribution, disclosure, export to other media, or publication, even in excerpt form, is not permitted. Use by and for artificial intelligence is prohibited. Copyright 2014-2026 Prof. Dr. H. Link.

The publishers and authors assume no liability for the accuracy of the contents. The application is at the own responsibility of the treating physician.