Treatment
| Phase/drug . | Dose . | Schedule . |
|---|---|---|
| Induction (4 wk) | ||
| IT cytarabine | Age-adjusted§ | Day 0 |
| Vincristine | 1.5 mg/m2 (2 mg max) | Days 0, 7, 14, 21 |
| Asparaginase† IM | 6000 U/m2 | M, W, F ×9 doses |
| Prednisone | 40 mg/m2 per day | Days 0-27 |
| IT-MTX | Age-adjusted‖ | Days 7, 28¶ |
| Consolidation* (4 wk) | ||
| Vincristine | 1.5 mg/m2 (2 mg max) | Day 0 |
| Prednisone | Taper | Days 0-10 |
| Mercaptopurine or thioguanine | 75 mg/m2 per day or 60-50 mg/m2 per day# | Days 1-27 |
| IT-MTX or ITT | Age-adjusted‖ | Days 7, 14, 21** |
| Interim maintenance 1 (8 wk) | ||
| Vincristine | 1.5 mg/m2 (2 mg max) | Days 0, 28 |
| Prednisone | 40 mg/m2 per day | Days 0-4, 28-32 |
| Mercaptopurine or thioguanine | 75 mg/m2 per day or 60-50 mg/m2 per day# | Days 0-49 |
| Methotrexate | 20 mg/m2 per day PO | Weekly ×8 doses |
| Delayed intensification 1 (8 wk) | ||
| Vincristine | 1.5 mg/m2 (2 mg max) | Days 0, 7, 14 |
| Asparaginase† | 6000 U/m2 per dose | M, W, F ×6 doses |
| Dexamethasone PO | 10 mg/m2 per day | Days 0-6, 14-20 |
| Doxorubicin | 25 mg/m2 per day | Days 0, 7, 14 |
| Cytarabine IV or SQ | 75 mg/m2 per day | Days 28-31, 35-38 |
| Cyclophosphamide | 1000 mg/m2 | Day 28 |
| Thioguanine | 60 mg/m2 per day | Days 28-41 |
| IT-MTX or ITT | Age-adjusted‖ | Days 0, 28, 35 |
| Maintenance‡ (12-wk cycles) | ||
| Vincristine | 1.5 mg/m2 (2 mg max) | Days 0, 28, 56 |
| Prednisone | 40 mg/m2 per day | Days 0-4, 28-32, 56-60 |
| Mercaptopurine or thioguanine | 75 mg/m2 per day or 60-50 mg/m2 per day# | Daily |
| Methotrexate PO | 20 mg/m2 per dose | Weekly |
| IT-MTX or ITT | Age-adjusted‖ | Day 0 |
| Phase/drug . | Dose . | Schedule . |
|---|---|---|
| Induction (4 wk) | ||
| IT cytarabine | Age-adjusted§ | Day 0 |
| Vincristine | 1.5 mg/m2 (2 mg max) | Days 0, 7, 14, 21 |
| Asparaginase† IM | 6000 U/m2 | M, W, F ×9 doses |
| Prednisone | 40 mg/m2 per day | Days 0-27 |
| IT-MTX | Age-adjusted‖ | Days 7, 28¶ |
| Consolidation* (4 wk) | ||
| Vincristine | 1.5 mg/m2 (2 mg max) | Day 0 |
| Prednisone | Taper | Days 0-10 |
| Mercaptopurine or thioguanine | 75 mg/m2 per day or 60-50 mg/m2 per day# | Days 1-27 |
| IT-MTX or ITT | Age-adjusted‖ | Days 7, 14, 21** |
| Interim maintenance 1 (8 wk) | ||
| Vincristine | 1.5 mg/m2 (2 mg max) | Days 0, 28 |
| Prednisone | 40 mg/m2 per day | Days 0-4, 28-32 |
| Mercaptopurine or thioguanine | 75 mg/m2 per day or 60-50 mg/m2 per day# | Days 0-49 |
| Methotrexate | 20 mg/m2 per day PO | Weekly ×8 doses |
| Delayed intensification 1 (8 wk) | ||
| Vincristine | 1.5 mg/m2 (2 mg max) | Days 0, 7, 14 |
| Asparaginase† | 6000 U/m2 per dose | M, W, F ×6 doses |
| Dexamethasone PO | 10 mg/m2 per day | Days 0-6, 14-20 |
| Doxorubicin | 25 mg/m2 per day | Days 0, 7, 14 |
| Cytarabine IV or SQ | 75 mg/m2 per day | Days 28-31, 35-38 |
| Cyclophosphamide | 1000 mg/m2 | Day 28 |
| Thioguanine | 60 mg/m2 per day | Days 28-41 |
| IT-MTX or ITT | Age-adjusted‖ | Days 0, 28, 35 |
| Maintenance‡ (12-wk cycles) | ||
| Vincristine | 1.5 mg/m2 (2 mg max) | Days 0, 28, 56 |
| Prednisone | 40 mg/m2 per day | Days 0-4, 28-32, 56-60 |
| Mercaptopurine or thioguanine | 75 mg/m2 per day or 60-50 mg/m2 per day# | Daily |
| Methotrexate PO | 20 mg/m2 per dose | Weekly |
| IT-MTX or ITT | Age-adjusted‖ | Day 0 |
For interim maintenance 2 (8 wk) see interim maintenance 1; for delayed intensification 2 (8 wk) see delayed intensification 1.
IT indicates intrathecal; PO, by mouth; IM, intramuscular; IV, intravenous; SQ, subcutaneous; M, Monday; W, Wednesday; and F, Friday.
In 12 fractions, 2400 cGy to cranium and in 3 fractions, 600 cGy to spine for CNS-3; 2400 cGy in 8 fractions to both testes in consolidation for testicular disease at diagnosis.
Escherichia coli preparation, or Erwinia asparaginase for patients with allergic reactions.
Boys receive ∼ 4 more cycles than girls.
Age: 1-1.99 y, 30 mg; age 2-2.99 y, 50 mg; and age ≥ 3 y, 70 mg.
IT-MTX: age 1-1.99 y, 8 mg; age 2-2.99 y, 10 mg; and age ≥ 3 y, 12 mg; ITT: MTX the same as IT-MTX until age ≥ 9 y, 15 mg; hydrocortisone: same as age-adjusted MTX doses; cytarabine: 1-1.99 y, 16 mg; 2-2.99 y, 20 mg; 3-8.99 y, 24 mg; and ≥ 9 y, 30 mg.
Patients with CNS disease at diagnosis dosed on days 7, 14, 21, and 28.
Dose reduced from 60 to 50 mg/m2 per day in February 1998.
Patients with CNS disease at diagnosis on day 7 only.