Red Cross Children's Hospital high risk ALL protocol
(South Africa)
ACUTE LYMPHOBLASTIC LEUKAEMIA - HIGH RISK AND ALL/LYMPHOMA
I INDUCTION (5 weeks - doses not delayed/reduced for myelosuppression)
Day 0-27 Prednisone 6Omg/m2 P0
Day 0,7,14,21 Vincristine 1.5mg/m2 IV
Daunorubicin 25mg/m2 IV
Day 0 Cytosine arabinoside IT Age 1 2 3+ years
Dose 30 50 7Omg
Day 3-24 Asparaginase 6000 u/rn2 IM x 9 (Mon, Wed,Fri)Day 14,28 Methotrexate IT Age <1 1 2 3+ years
Dose 6 8 10 l2mg
Day 28 Bone Marrow
Rest 7 days or until N >500 and P1 >100 000
II CONSOLIDATION (5 weeks - may delay on d14 only if N <500 or P1 <100)
Day 0-27 6MP 6Omg/m2 P0 daily
Day 0,14 Cyclophosphamide lOOOmg/m2 IV
Day 0-3,7-10,14-17,21-24 Ara-C 75mg/m2 IV/SC daily x 16Day 0,7,14,21 MTX IT (dose as above)
Day 0-14 Cranial DXR 180 rads daily x 10
Day 28 Rest 7 days or until N >1000 and P1 >100 000
III INTERIM MAINTENANCE (8 weeks - may delay if N <1000 or P1 (100 000)
Day 0-41 6MP 6Omg/m2 P0 daily
Day 0-35 MTX l5mg/m2 P0 weekly x 6Day 42 Rest 14d (whether or not phase III drugs completed or until N >1000 and P1 >100 000)
IV DELAYED INTENSIFICATION (6 weeks)
REINDUCTION (not interrupted for myelosuppression alone)
Day 0-20 Dexamethasone lOmg/m2 P0 daily, taper over 7 days
Day 0,7,14 Vincristine 1.5mg/m2 IV
Adriamycin 25mg/m2 IV
Day 0-14+ Asparaginase 6000 u/m2 IM x 6 (Mon, Wed, Fri)
Day 20 Rest 7 days or until N >1000 & P1 >100 000
RECONSOLIDATION (not interrupted for myelosuppression alone)
Day 28 Cyclophosphamide lOOOmg/m2 IV
Day 28-42 Thioguanine 6Omg/m2 P0 daily
Day 28-31, 35-38 Ara C 75mg/m2 IV/SC daily x 8
Day 28,35 MTX IT (dose as above)
Day 42 Rest 7 days or until N >1000 & P1 >100 000
V MAINTENANCE 12 week cycles x 8 interrupt if N <1000 or P1 <100 000
Day 0 MTX IT (dose as above)
Day 0-4,28-32,56-60 Prednisone 4Omg/m2 P0
Day 0,28,56 Vincristine 1.5mg/m2 IV
Day 0-83 6MP 75mg/m2 P0 daily } Adjust doses to keep
Day 7-77 MTX 2Omg/m2 P0 weekly x 11 } N 1000-2000 & P1 >100
Repeat cycle x 8
Treatment interruptions due to myelosuppression count as days of maintenance; those due to infection do not and must be made up (CCGS109 mod of BMF protocol)
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Last Updated 4/06
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