Toronto Protocol C

revised 2/84

Eligibility Criteria

• age 1-2 years of > or = 10 years
• WBC > 50,000
• L2 marrow morphology (>50% L2 blasts)
• lymphoma syndrome - one criterion from each of the clinical and laboratory groups is required for lymphoma.
  • clinical criteria
    • lymphadenopathy > 3 cm or node group > 5 cm
    • mediastinal mass
    • massive splenomegaly/hepatomegaly (down to umbilicus)
  • laboratory criteria
    • Hgb > 10 gm%
    • WBC > 50,000
    • E rosettas > 20%
• sanctuary disease - CNS or testicle

Phase I - Induction

• vincristine IV days 0, 7, 14, 21
• daunomycin IV days 0, 7, 14, 21
• L-asparaginase IM 9 doses (days 0, 3, 5, 7, 10, 12, 14, 17, 19)
• prednisone PO days 1-27
• Ara C IT day 0
• methotrexate IT days 14, 28

Phase II - CNS Intensification

• cyclophosphamide days 0, 14
• 6MP po days 0-27
• ara C IV days 1-4, 8-11, 15-18, 22-25
• methotrexate IT days 1, 8, 15, 22
• MT
• Septra

(one week no therapy)

Phase III - Interim Maintenance

• 6MP days 0-41
• methotrexate IV days 0. 14, 28, 42

Phase IV - Reinduction/Reintensification

• Vincristine days 0, 7, 14, 21
• Adriamycin days 0, 7, 14, 21
• L-asparaginase days 1, 4, 7, 10
• Dexamethasone days 0-27
• cyclophosphamide day 35
• 6 thiooguanine days 36-49
• ara C IV days 36-39, 43-46
• IT methotrexate days 39, 46
• gentamycin, nystatin, bactrim days 1-56

(one week no therapy)

Phase V - Maintenance

• vincristine days 0, 28, 56
• prednisone days 0-4, 28-32, 56-60
• IT methotrexate day 0
• IV methotrxate days 14, 28, 42, 56, 70
• 6MP days 0-83

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