Pediatric Inspired ALL Protocol -CALGB 10403 (for 15-39 years of age)
Remission Induction (Course I) -4 weeks
Days 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
Prednisolone
Vincristin
Doxorubicin
L-Asparaginase
IT-MTX
Dose and Route
Prednisolone 60 mg/m2 PO/day divided into 2 doses
Vincristin 1.5 mg/m2 IV (max. 2 mg)
Doxorubicin 25 mg/m2 IV
L-Asparaginase 6000 IU/m2 IM
IT Methotrexate 15 mg IT (Day 8, and 29, also administer at day 15 for CNS3 disease)
Pediatric Inspired ALL Protocol -CALGB 10403 (for 15-39 years of age)
Extended Remission Induction (If required) -2 weeks
Days 1 2 3 4 5 6 7 8 9 10 11 12 13 14
Prednisolone
Vincristin
Doxorubicin
L-Asparaginase
Dose and Route
Similar as Induction
Pediatric Inspired ALL Protocol -CALGB 10403 (for 15-39 years of age)
Consolidation (Course II) -7 weeks
Days 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Cyclophos.
Vincristin
Cytarabine
L-Asparaginase
6-MP
IT-MTX
Days 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50
Cyclophos.
Vincristin
Cytarabine
L-Asparaginase
6-MP
Dose and Route
Cyclophosphamide 1000 mg/m2 IV
Cytarabine 75 mg/m2 IV
L-Asparaginase 6000 IU/m2 IM
Vincristin 1.5 mg/m2 (max. 2 mg) IV
6-mercaptopurin (6-MP) 60 mg/m2 PO
Intrathecal Methotrexate (IT-MTX) 15 mg IT (9mit doses on day 15 and 22 for patients with
CNS3 disease)
Pediatric Inspired ALL Protocol -CALGB 10403 (for 15-39 years of age)
Interim Maintenance (Course III) -6 weeks
Days 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
IV-MTX
Vincristin
L-Asparaginase
IT-MTX
Days 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41
IV-MTX
Vincristin
L-Asparaginase
IT-MTX
Dose and Route
IV-Methotrexate 100 mg/m2 IV (escalate by 50 mg/m2/dose)
Vincristin, L-Asparaginase SC and IT-MTX=the same dose as above
Pediatric Inspired ALL Protocol -CALGB 10403 (for 15-39 years of age)
Delayed Intensification (Course IV) -7 weeks
Days 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Vincristin
Dexamethasone
Doxorubicin
L-Asparaginase
IT-MTX
Days 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50
Cyclophos.
Vincristin
Cytarabine
L-Asparaginase
6-MP
IT-MTX
Doses in Interim Maintenance
Cyclophosphamide 1000 mg/m2 IV
Vincristin 1.5 mg/m2 (maximum 2 mg) IV
Cytarabine 75 mg/m2 IV
Dexamethasone 10 mg/m2 PO divided into 2 doses
Doxorubicin 25 mg/m2 IV
L-Asparaginase 6000 IU IM
6-Mercaptopurin (6-MP) 60 mg/m2 PO
IT-MTX 15 mg/m2
Maintenance (Course V) -12 weeks
Drug Dose and Route Schedule
Vincristin 1.5 mg/m2 (max. 2mg) IV On day 1, 29 and 57
Dexamethasone 6 mg/m2/day PO in 2 divided doses Every 4 weeks on day 1-5, 29-33 and 57-61
6-MP 75 mg/m2/day PO On day 1-84
Methotrexate 20 mg/m2 PO weekly till day 78 (held on day 29 of the first 4
courses when IT-MTX is given)
IT-MTX 15 mg IT On day 1 and 29
Adult ALL Protocol CALGB 9111 (Age ≥40 years)
Remission Induction (Course I) -4 Weeks
Days 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
Prednisolone
Cyclophosphamide
Vincristin
Doxorubicin
L-Asparaginase
Doses and Route
Cyclophosphamide 1200 mg/m2 IV (decrease dose to 800 mg/m2 for patients age ≥60 years)
Doxorubicin 45 mg/m2 IV (decrease dose to 30 mg/m2 for patients age ≥60 years)
Vincristin 1.5 mg/m2 (maximum 2 mg) IV
Prednisolone 60 mg/m2 PO (give only on day 1-7 for patients age ≥60 years)
L-Asparaginase 6000 IU/m2 SC/IM
*Add GCSF 5 µg/kg SC daily starting on day 4 and continue until ANC≥1000 on 2 consecutive measurements 24
hour apart
Adult ALL Protocol CALGB 9111 (Age ≥40 years)
Early intensification (Course II) -4 Weeks
Days 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
6-MP
Cyclophosphamide
Vincristin
Cytarabine
L-Asparaginase
IT-MTX
Dose and Route
Cyclophosphamide 1000 mg/m2 IV
Vincristin 1.5 mg/m2 (max. 2 mg) IV
6-MP 60 mg/m2 PO
Cytarabine 75 mg/m2 SC
L-Asparaginase 6000 IU/m2 SC/IM
IT-MTX 15 mg IT
*Add GCSF 5 µg/kg SC daily starting on day 2 and continue for at least 14 days and until ANC≥5000.
Adult ALL Protocol CALGB 9111 (Age ≥40 years)
CNS Prophylaxis and Maintenance (Course III) -12 Weeks
Days 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
6-MP
IT-MTX
Days 23 24 25 26 27 28 29 30 31 31 33 34 35 36 37 38 39 40 41 42 43 44
6-MP
PO-MTX
IT-MTX
Days 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66
6-MP
PO-MTX
Days 67 68 69 70
6-MP
Dose and Route
6-MP= 60 mg/m2 PO IT-MTX= 15 mg IT
PO-methotrexate (PO-MTX) =20 mg/m2 PO
*Cranial irradiation 2400 cGy on day 1-12
Late Intensification (Course IV) -8 weeks
Days 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Vincristin
Doxorubicin
Dexamethasone
Days 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 47 49 50 51 52 53 54 55 56
Cyclophos.
Cytarabine
6-TG
Dose and Route
Cyclophosphamide 1000 mg/m2/d IV Dexamethasone 10 mg/m2/day
Doxorubicin 30 mg/m2/d IV 6-TG 60 mg/m2/d PO
Vincristin 1.5 mg/m2/d (max. 2 mg) IV
Cytarabine 75 mg/m2/d SC
Maintenance (Course V) -Until 24-Months Post Diagnosis
Vincristin 2 mg IV on day 1 of every 4 weeks 6-MP 60 mg/m2/d PO on day 1-28
Prednisolone 60 mg /m2/d PO on day 1-5 of Methotrexate 20 mg/m2/d on day 1, 8, 15 and
every 4 weeks 22
AML Intensive Chemotherapy Regimen
7 +3 Regimen for Induction
Drug Dose and Schedule
Cytarabine 100 mg/m2 daily continuous IV infusion from
Day 1-7
Doxorubicin 50 mg /m2 IV daily from Day 1-3 or Day 5-7
IDAC (intermediate dose cytarabine for AML consolidation
Cytarabine 1.5-2 g/m2 IV BID Day 1, 3, and 5 of each cycle and
Dilute in 1000 ml of NS and infuse repeat cycle every 28 days (total
of 3 or 4 cycles)
over 3-4 hours
Note:
Follow for kerato-conjunctivitis daily and give patients artificial tear and topical steroid if symptomatic
Look for cerebellar toxicity as well (with daily coordination tests)
FLAG-Ida Regimen for Relapsed AML
Drug Dose and route Schedule
Fligrastim (G-CSF) 5 µg/kg/d SC Day 0-5 and continue until neutrophil recovery
Idarubicin 10 mg/m2/d IV Day 1-3
Fludarabine 30 mg/m2/d Day 1-5
Cytarabine 2000 mg/m2/d Day 1-5
Azacitidine for patients ineligible for intensive chemotherapy
Azacitidine 75 mg/m2/d SC on day 1-7 every 28 days (continue until progression)
Low Dose Cytarabine an alternative to Azacitidine
Cytarabine 20 mg/m2/d SC on day 1-10 every 28 days
