Course I: Induction (4 weeks) |
For patients <60 years old: |
Cyclophosphamide | IV | 1200 mg/m2 | Day 1 |
Daunorubicin | IV | 45 mg/m2/day | Days 1-3 |
Vincristine | IV | 2 mg | Days 1, 8, 15, 22 |
Prednisone | PO | 60 mg/m2/day | Days 1-21 |
Asparaginase (E. coli) | SC/IM | 6000 units/m2 | Days 5, 8, 11, 15, 18, 22 |
For patients ≥60 years old: |
Cyclophosphamide | IV | 800 mg/m2 | Day 1 |
Daunorubicin | IV | 30 mg/m2/day | Days 1-3 |
Vincristine | IV | 2 mg | Days 1, 8, 15, 22 |
Prednisone | PO | 60 mg/m2/day | Days 1-7 |
Asparaginase (E. coli) | SC/IM | 6000 units/m2 | Days 5, 8, 11, 15, 18, 22 |
All patients receive filgrastim (G-CSF) 5 mcg/kg subcutaneously once per day starting on day 4 and continuing until the ANC is >1000/microL on two consecutive determinations >24 hours apart. |
Course IIA: Early intensification (4 weeks; repeat once for Course IIB) |
Intrathecal methotrexate | IT | 15 mg | Day 1 |
Cyclophosphamide | IV | 1000 mg/m2 | Day 1 |
Mercaptopurine | PO | 60 mg/m2/day | Days 1-14 |
Cytarabine | SC | 75 mg/m2/day | Days 1-4, 8-11 |
Vincristine | IV | 2 mg | Days 15, 22 |
Asparaginase (E. coli) | SC/IM | 6000 units/m2 | Days 15, 18, 22, 25 |
Course III: CNS prophylaxis and interim maintenance (12 weeks) |
Cranial irradiation | | 2400 cGy | Days 1-12 |
Intrathecal methotrexate | IT | 15 mg | Days 1, 8, 15, 22, 29 |
Mercaptopurine | PO | 60 mg/m2/day | Days 1-70 |
Methotrexate | PO | 20 mg/m2 | Days 36, 43, 50, 57, 64 |
Course IV: Late intensification (8 weeks) |
Doxorubicin | IV | 30 mg/m2 | Days 1, 8, 15 |
Vincristine | IV | 2 mg | Days 1, 8, 15 |
Dexamethasone | PO | 10 mg/m2/day | Days 1-14 |
Cyclophosphamide | IV | 1000 mg/m2 | Day 29 |
Thioguanine | PO | 60 mg/m2/day | Days 29-42 |
Cytarabine | SC | 75 mg/m2/day | Days 29-32, 36-39 |
Course V: Prolonged maintenance (until 24 months from diagnosis) |
Vincristine | IV | 2 mg | Day 1 of every 4 weeks |
Prednisone | PO | 60 mg/m2/day | Days 1-5 of every 4 weeks |
Mercaptopurine | PO | 60 mg/m2/day | Days 1-28 |
Methotrexate | PO | 20 mg/m2 | Days 1, 8, 15, 22 |