Red Cross Children's Hospital Oncology Service

Red Cross Children's Hospital high risk ALL protocol

(South Africa)

ACUTE LYMPHOBLASTIC LEUKAEMIA - HIGH RISK AND ALL/LYMPHOMA

I INDUCTION (5 weeks - doses not delayed/reduced for myelosuppression)

Day 0-27 Prednisone 6Omg/m2 P0

Day 0,7,14,21 Vincristine 1.5mg/m2 IV

Daunorubicin 25mg/m2 IV

Day 0 Cytosine arabinoside IT Age 1 2 3+ years

Dose 30 50 7Omg

Day 3-24 Asparaginase 6000 u/rn2 IM x 9 (Mon, Wed,Fri)Day 14,28 Methotrexate IT Age <1 1 2 3+ years

Dose 6 8 10 l2mg

Day 28 Bone Marrow

Rest 7 days or until N >500 and P1 >100 000

II CONSOLIDATION (5 weeks - may delay on d14 only if N <500 or P1 <100)

Day 0-27 6MP 6Omg/m2 P0 daily

Day 0,14 Cyclophosphamide lOOOmg/m2 IV

Day 0-3,7-10,14-17,21-24 Ara-C 75mg/m2 IV/SC daily x 16Day 0,7,14,21 MTX IT (dose as above)

Day 0-14 Cranial DXR 180 rads daily x 10

Day 28 Rest 7 days or until N >1000 and P1 >100 000

III INTERIM MAINTENANCE (8 weeks - may delay if N <1000 or P1 (100 000)

Day 0-41 6MP 6Omg/m2 P0 daily

Day 0-35 MTX l5mg/m2 P0 weekly x 6Day 42 Rest 14d (whether or not phase III drugs completed or until N >1000 and P1 >100 000)

IV DELAYED INTENSIFICATION (6 weeks)

REINDUCTION (not interrupted for myelosuppression alone)

Day 0-20 Dexamethasone lOmg/m2 P0 daily, taper over 7 days

Day 0,7,14 Vincristine 1.5mg/m2 IV

Adriamycin 25mg/m2 IV

Day 0-14+ Asparaginase 6000 u/m2 IM x 6 (Mon, Wed, Fri)

Day 20 Rest 7 days or until N >1000 & P1 >100 000

RECONSOLIDATION (not interrupted for myelosuppression alone)

Day 28 Cyclophosphamide lOOOmg/m2 IV

Day 28-42 Thioguanine 6Omg/m2 P0 daily

Day 28-31, 35-38 Ara C 75mg/m2 IV/SC daily x 8

Day 28,35 MTX IT (dose as above)

Day 42 Rest 7 days or until N >1000 & P1 >100 000

V MAINTENANCE 12 week cycles x 8 interrupt if N <1000 or P1 <100 000

Day 0 MTX IT (dose as above)

Day 0-4,28-32,56-60 Prednisone 4Omg/m2 P0

Day 0,28,56 Vincristine 1.5mg/m2 IV

Day 0-83 6MP 75mg/m2 P0 daily } Adjust doses to keep

Day 7-77 MTX 2Omg/m2 P0 weekly x 11 } N 1000-2000 & P1 >100

Repeat cycle x 8

Treatment interruptions due to myelosuppression count as days of maintenance; those due to infection do not and must be made up (CCGS109 mod of BMF protocol)

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Last Updated 4/06

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