Treatment regimen used at AHC
| Treatment phase . | Drug . | Dose . | Route . | Schedule . |
|---|---|---|---|---|
| Prophase∗ | Prednisone | 60 mg/m2 | Oral | Days 1-7 |
| Methotrexate | Age adjusted† | IT | Day 1 | |
| Induction | Dexamethasone | 6 mg/m2 per day divided BID | Oral | Days 1-7 and 15-21 |
| Vincristine | 1.5 mg/m2 per dose | IV | Days 1, 8, 15, and 22 | |
| Escherichia coli asparaginase | 6000 units per square meter per dose | IV/IM | Days 4, 8, 15, 19, 22, and 26 | |
| Methotrexate | Age adjusted† | IT | Days 1 and 22 | |
| Intensification | Methotrexate | 100 mg/m2 per dose, escalate by 50 mg/m2 per dose as tolerated | IV | Every 11 days × 5 cycle |
| Mercaptopurine | 50 mg/m2 per dose | Oral | Days 4-10 of each cycle | |
| Methotrexate | Age adjusted† | IT | Day 1 of each cycle | |
| Reinduction‡ | Dexamethasone | 6 mg/m2 per day divided BID | Oral | Days 1-5 and 15-19 |
| Vincristine | 1.5 mg/m2 per dose | IV | Days 1, 8, 15, and 22 | |
| E coli asparaginase | 6000 units per square meter per dose | IV/IM | Days 4, 8, 15, 19, 22, 26 | |
| Methotrexate | Age adjusted† | IT | Day 1 | |
| Continuation§ | Dexamethasone | 5 mg/m2 per day divided BID | Oral | Days 1-5, every 8 weeks × 7 |
| Vincristine | 1.5 mg/m2 per dose | IV | Day 1, every 8 weeks × 7 | |
| Mercaptopurine | 75 mg/m2 per dose | Oral | Daily | |
| Methotrexate | 20 mg/m2 per dose | Oral | Weekly, except the week of IT MTX | |
| Methotrexate | Age adjusted† | IT | Weeks 1, 13, 25, and 37 |
| Treatment phase . | Drug . | Dose . | Route . | Schedule . |
|---|---|---|---|---|
| Prophase∗ | Prednisone | 60 mg/m2 | Oral | Days 1-7 |
| Methotrexate | Age adjusted† | IT | Day 1 | |
| Induction | Dexamethasone | 6 mg/m2 per day divided BID | Oral | Days 1-7 and 15-21 |
| Vincristine | 1.5 mg/m2 per dose | IV | Days 1, 8, 15, and 22 | |
| Escherichia coli asparaginase | 6000 units per square meter per dose | IV/IM | Days 4, 8, 15, 19, 22, and 26 | |
| Methotrexate | Age adjusted† | IT | Days 1 and 22 | |
| Intensification | Methotrexate | 100 mg/m2 per dose, escalate by 50 mg/m2 per dose as tolerated | IV | Every 11 days × 5 cycle |
| Mercaptopurine | 50 mg/m2 per dose | Oral | Days 4-10 of each cycle | |
| Methotrexate | Age adjusted† | IT | Day 1 of each cycle | |
| Reinduction‡ | Dexamethasone | 6 mg/m2 per day divided BID | Oral | Days 1-5 and 15-19 |
| Vincristine | 1.5 mg/m2 per dose | IV | Days 1, 8, 15, and 22 | |
| E coli asparaginase | 6000 units per square meter per dose | IV/IM | Days 4, 8, 15, 19, 22, 26 | |
| Methotrexate | Age adjusted† | IT | Day 1 | |
| Continuation§ | Dexamethasone | 5 mg/m2 per day divided BID | Oral | Days 1-5, every 8 weeks × 7 |
| Vincristine | 1.5 mg/m2 per dose | IV | Day 1, every 8 weeks × 7 | |
| Mercaptopurine | 75 mg/m2 per dose | Oral | Daily | |
| Methotrexate | 20 mg/m2 per dose | Oral | Weekly, except the week of IT MTX | |
| Methotrexate | Age adjusted† | IT | Weeks 1, 13, 25, and 37 |
BID, twice daily; IT, intrathecal; IV, intravenous; IM, intramuscular; MTX, methotrexate.
Initially for all patients and in 2020 only continued for patients who did not receive outside pre-treatment with steroids.
age ≤ 1 year: 8 mg, age 1 -2 years: 10 mg, age 3-8 years: 12 mg, age ≥ 9 years: 15 mg.
Re-induction was initiated in all patients in 2019.
Continuation phase ended 2 years after the end of intensification and blood counts were monitored routinely every 12 weeks and chemotherapy adjusted to maintain ANC ≥750 and platelet counts ≥75,000.