Hyper-CVAD/MTX-Ara-C
Cycle 1,3,5,7 (3-4 wks/cycle)
Cyclophosphamide (Cytoxan) 300 mg/m2 iv over 2 hrs q12 hrs x 6 doses d1-3
Mesna 600 mg/m2/d civi d1-3 to start 1 h before cyclophosphamide till 12 hrs after completion of cyclophosphamide
Vincristine 2 mg iv d4, 11
Doxorubicin 50 mg/m2 iv over 24 hrs d4
Dexamethasone 40 mg po qd d1-4 and d11-14
Cycle 2,4,6,8 (3-4 wks/cycle)
Methotrexate (MTX) 200 mg/m2 iv over 2 hrs followed by 800 mg/m2 civi over 22 hrs d1
Cytarabine (Ara-C) 3 g/m2 (1 g/m2 for patients over 60 years old) iv over 2 hrs q12 hrs x 4 doses d2-3
Leucovorin 50 mg iv q6 hrs starting 12 hrs after completion of MTX till MTX level < 0.05 uM
Intrathecal chemotherapy
Prophylaxis
Methotrexate (MTX) 12 mg d2 of each cycle for a total of 3-4 treatments
Cytarabine (Ara-C) 100 mg d8 of each cycle for a total of 3-4 treatments
Therapeutic
Intrathecal chemotherapy twice a week (Methotrexate (MTX) 12 mg and Cytarabine (Ara-C) 100 mg respectively) till no more cancer cells in CSF, then decrease intrathecal chemotherapy to once a week x 4, followed by Methotrexate (MTX) 12 mg d2, Cytarabine (Ara-C) 100 mg d8 for the remaining chemotherapy cycles
Support care
Cipro 500 mg po bid
Fluconazole 200 mg po qd
Acyclovir 200 mg po bid
Filgrastim 10 mcg/kg sc qd to start on d5 of hyperCVAD and d4 of high dose methotraxate and cytarabine
Linker Regimen
Induction chemotherapy
Daunorubicin 50 mg/m2/d iv d1-3
Vincristine 2 mg iv d 1, 8, 15 and 22
Prednisone 60 mg/m2/d po d1-28
L-Asparaginase 6000 U/m2/d im d17-28
If bone marrow on d14 has residual leukemia
Daunorubicin 50 mg/m2 iv d15
If bone marrow on d28 has residual leukemia
Daunorubicin 50 mg/m2 iv d29 and 30
Vincristine 2 mg iv d29 and 36
Prednisone 60 mg/m2/d po d29-42
L-Asparaginase 6000 U/m2/d im d29-35
Consolidation chemotherapy
Treatment A (cycle 1, 3, 5, 7)
Daunorubicin 50 mg/m2/d iv d1-2
Vincristine 2 mg iv d 1, 8
Prednisone 60 mg/m2/d po d1-14
L-Asparaginase 12000 U/m2 im d2, 4, 7, 9, 11, 14
Treatment B (cycle 2,4,6,8)
Teniposide 165 mg/m2 iv d1, 4, 8, 11
Cytarabine (Ara-C) 300 mg/m2 iv d1, 4, 8, 11
Treatment C (cycle 9)
Methotraxate (MTX) 690 mg/m2 iv over 42 hrs
Leucovorin 15 mg/m2 iv q6h x 12 doses beginning at 42 hrs
Maintenance chemotherapy
Methotrexate (MTX) 20 mg/m2 po qw x 30 months
6-Mercaptopurine (6-MP) 75 mg/m2 po qd x 30 months
CNS prophylaxis
Begin within 1 wk of CR
Cranial radiation 1.8 Gy/d to 18 Gy
Intrathecal Methotrexate (MTX) 12 mg qw x 6 wks
CNS treatment
In patients with CNS involvement, start intrathecal chemotherapy during induction chemotherapy.
Intrathecal Methotrexate (MTX) 12 mg qw x 10 wks, then qm x 9 months
Cranial radiation 1.8 Gy/d to 28 Gy
CALGB 8811 regimen
Course I: Induction (4 wks)
Cyclophosphamide (Cytoxan) 1200 mg/m2 (800 mg/m2 if pts older than 60) iv d1
Daunorubicin 45 mg/m2/d (30 mg/m2/d if pts older than 60) iv d1-3
Vincristine 2 mg iv d1, 8, 15, 22
Prednisone 60 mg/m2/d po d1-21 (d1-7 if pts older than 60)
L-Asparaginase 6000 U/m2 sc d5, 8, 11, 15, 18, 22
Course II: Early intensification (4 wks/cycle x 2 cycles)
Intrathecal methotraxate (MTX) 15 mg d1
Cyclophosphamide (Cytoxan) 1000 mg/m2 iv d1
6-Mercaptopurine (6-MP) 60 mg/m2/d po d1-14
Cytarabine (Ara-C) 75 mg/m2/d sc d1-4, 8-11
Vincristine 2 mg iv d15, 22
L-Asparaginase 6000 IU/m2 sc d15, 18, 22, 25
Course III: CNS prophylaxis and interim maintenance (12 wks)
Cranial radiation 2,400 cGy d1-12
Intrathecal methotraxate (MTX) 15 mg d1, 8, 15, 22, 29
6-Mercaptopurine (6-MP) 60 mg/m2/d po d1-70
Methotraxate (MTX) 20 mg/m2 po d36, 43, 50, 57, 64
Course IV: Late intensification (8 wks)
Daunorubicin 30 mg/m2 iv d1, 8, 15
Vincristine 2 mg iv d1, 8, 15
Dexamethasone 10 mg/m2/d po d1-14
Cyclophosphamide 1000 mg/m2 iv d29
6-Thioguanine 60 mg/m2/d po d29-42
Cytarabine (Ara-C) 75 mg/m2/d sc d29-32, 36-39
Course V: Prolonged maintenance (until 24 months from diagnosis)
Vincristine 2 mg iv d1
Prednisone 60 mg/m2/d po d1-5
Methotraxate (MTX) 20 mg/m2 po d1, 8, 15, 22
6-Mercaptopurine (6-MP) 80 mg/m2/d po d1-28
Q4w