Table 1 Therapy on DFCI Adult ALL Consortium Protocol 01–175

From: Long-term outcome of a pediatric-inspired regimen used for adults aged 18–50 years with newly diagnosed acute lymphoblastic leukemia

Time Frame

Treatment

Induction 4

Vincristine 2 mg weekly, days 1, 8, 15 and 22

Weeks

Prednisone 40 mg/m2/day, days 1–28

 

Doxorubicin 30 mg/m2/dose, days 1and 2

 

Methotrexate 4 g/m2 (8–24 h after doxorubicin) with leucovorin rescue on day 3

 

E coli L-asparaginase 25 000 IU/m2 IM × 1 dose, day 5

 

IT cytarabine 50 mg, day 0a (prior to initiation of systemic therapy)

 

IT methotrexate/cytarabine/hydrocortisone,b days 15 and 29

CNS therapy

Vincristine 2 mg × 1 dose

3 Weeks

6-mercaptopurine (6-MP) 50 mg/m2/day orally, × 14 consecutive days

 

Doxorubicin 30 mg/m2 × 1 dose

 

IT methotrexate/cytarabine twice weekly × 4 doses

 

Cranial radiationc

Intensification

Every 3-week cycles:

30 Weeks

Vincristine 2 mg, day 1

 

Dexamethasone 18 mg/m2/day b.i.d., orally, days 1–5

 

Doxorubicin 30 mg/m2, day 1 of each cycle to a (cumulative dose 300 mg/m2)

 

6-MP 50 mg/m2/day orally × 14 consecutive days

 

E. coli asparaginase

 

Individualized dosing: 12 500 IU/m2/dose (starting dose)d

 

Methotrexate 30 mg/m2 i.v. or IM weekly, 1 day after asparaginase (no weekly methotrexate until doxorubicin completed).

 

IT methotrexate/cytarabine/hydrocortisone at start of a cycle

 

IT therapy consisting of methotrexate/cytarabine at start of a cycle every 18 weeks

Continuation 74 weeks

Every 3-week cycles: Same as intensification except no asparaginase and dexamethasone dose reduced to 6 mg/m2/day

  1. Abbreviations: ALL, acute lymphoblastic leukemia; CSF, cerebrospinal fluid; CNS, central nervous system; IM, intramuscular; IT, intrathecal.
  2. aPatients with CNS leukemia at diagnosis (CNS-2 and CNS-3) received twice weekly doses of IT cytarabine until CSF was clear of blast cells on three consecutive examinations.
  3. bIT methotrexate 12 mg; cytarabine 40 mg; hydrocortisone 50 mg.
  4. cPatients received cranial radiation 1800 cGy delivered as 180 cGy fractions daily for 10 days. The dose was 24 Gy for patients with CNS-2 or CNS-3, regardless of CNS signs or symptoms.
  5. dAsparaginase dose adjustments based on nadir serum asparaginase activity measurements.
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