| Induction therapy (∼4 wk) | Vincristine q week Prednisone q day Doxorubicin × 1-2 doses Methotrexate × 1 dose (low or high dose) ± asparaginase IM × 1 dose IT ara-C × 2 doses |
| CNS treatment (∼2 wk) | SR: No cranial XRT3-150 or 1,800 cGy cranial XRT3-151 IT methotrexate/ara-C × 4 doses |
| HR/VHR: 1,800-2,800 cGy cranial XRT | |
| IT methotrexate/ara-C × 4 doses | |
| Intensification therapy (∼9 mo) | SR: Vincristine q 3 weeks 6-MP po3-152 × 14 days Prednisone3-153 po × 5 days Methotrexate IV/IM q week Asparaginase IM q week |
| IT methotrexate/ara-C q18 weeks | |
| HR: As described above, except doxorubicin q 3 weeks instead of methotrexate | |
| VHR: Same as HR, except preceded by one month of: High dose methotrexate IV weeks 1, 2 IT methotrexate weeks 1, 2 High dose ara-C week 3 Asparaginase IM q week Vincristine weeks 1-4 6-MP po × 14 days | |
| Continuation therapy (until 2 yr CCR) | Three week cycles of: Vincristine q 3 weeks 6-MP po × 14 days Prednisone3-153 po × 5 days Methotrexate IV/IM q week |
| Induction therapy (∼4 wk) | Vincristine q week Prednisone q day Doxorubicin × 1-2 doses Methotrexate × 1 dose (low or high dose) ± asparaginase IM × 1 dose IT ara-C × 2 doses |
| CNS treatment (∼2 wk) | SR: No cranial XRT3-150 or 1,800 cGy cranial XRT3-151 IT methotrexate/ara-C × 4 doses |
| HR/VHR: 1,800-2,800 cGy cranial XRT | |
| IT methotrexate/ara-C × 4 doses | |
| Intensification therapy (∼9 mo) | SR: Vincristine q 3 weeks 6-MP po3-152 × 14 days Prednisone3-153 po × 5 days Methotrexate IV/IM q week Asparaginase IM q week |
| IT methotrexate/ara-C q18 weeks | |
| HR: As described above, except doxorubicin q 3 weeks instead of methotrexate | |
| VHR: Same as HR, except preceded by one month of: High dose methotrexate IV weeks 1, 2 IT methotrexate weeks 1, 2 High dose ara-C week 3 Asparaginase IM q week Vincristine weeks 1-4 6-MP po × 14 days | |
| Continuation therapy (until 2 yr CCR) | Three week cycles of: Vincristine q 3 weeks 6-MP po × 14 days Prednisone3-153 po × 5 days Methotrexate IV/IM q week |
Summary of treatment on DFCI ALL Consortium protocols 81-01 to 91-01. High-risk criteria on protocols 81-01 to 91-01 included the presence of any one of the following: WBC >20,000/μL, age <1.99 years or >9.0 years, CNS involvement, anterior mediastinal mass, or T-cell immunophenotype. Very high-risk criteria used in 85-01 and 87-01 included the presence of any one of the following: WBC >100,000/μL, age <1 year, t(9;22). Very high-risk criteria used in 91-01 included only those patients less than 1 year of age.
Abbreviations: SR, standard risk; HR, high risk; VHR, very high risk; IM, intramuscularly; IT, intrathecal; ara-C, Cytosine arabinoside; XRT, radiation therapy; 6-MP, 6-mercaptopurine; IV, intravenous; po, per orum; CCR, complete continuous remission.
All SR patients on 87-01. Only SR girls on 91-01.
All SR patients on 81-01 and 85-01. Only SR boys on 91-01.
On 91-01, patients randomized to oral 6-MP or IV 6-MP.
On 91-01, dexamethasone instead of prednisone.