ALL - Interim Guidelines 2011 Regimen B- TG

7/27/2019 ALL - Interim Guidelines 2011 Regimen B- TG

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PAEDIATRIC ONCOLOGY DEPARTMENT COMBINED MILITARY HOSPITAL RAWALPINDI

ALL Interim Guidelines, 2011

(MRD) (MRD)

1 8 15 22 29

1 2 3 4 5

Day 8 bone marrow result will only be used to upstage treatment in patients who do not have MRD results

Daunorubicin 25mg/m2

Mercaptopurine 60mg/m2

KEY

* Provided clotting test normal at diagnosisand no recent history of bleeding it is not

necessary to repeat clotting prior to

LP+ITmtx

* If clotting abnormal at diagnosis, discuss

with consultant prior to LP+ITmtx

*Clotting including fibrinogen required

prior to central line insertion

*All Chemotherapy use Diagnostic Weight

___________________Kg

SA ______________________

Date___________________

For children with BMI >98th centile refer to

protocol

M Peg Asparaginase 1000iu/m

(infusion over 1 hour)

Regimen B - InductionFlowchart 1

(Once daily)

- I ntravenous

- Oral- Intrathecal/Bone Marrow

(General Anaesthetic)

- Intramuscular injection

Bone marrow

Dexamethasone 6mg/m/day for 28

days then taper over 7 days

divided into twice daily dose

(Max.10mg/day)

Vincristine 1.5mg/m2

(maximum dose 2mg)

CoTrimoxazoleTwice daily for two consecutive days

per week

Day/cycle

Week

Date

IT methotrexate

Flowsheets are to be used as a treatment guide - always refer to current ALL interim guidelines, 2011


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1 8 15 22 29

6 7 8 9 10

*All Chemotherapy use

Diagnostic Weight

_______________Kg

SA_________________

Date_____________

For children with BMI >98th

centile refer to protocol

Flowchart 2

Regimen B - standard BFM consolidation

(Once daily)

Day/cycle

CoTrimoxazoleTwice daily dose for two consecutive

days per week

Week

Date

NOTE: DO NOT ADJUST

MERCAPTOPURINE DOSES FOR

NEUTROPENIA

Count dependant

IT Methotrexate

Cyclophosphamide 1.0g/m2

Cytarabine 75mg/m2


(Infusion over 30min with 0.5hr pre and

3.5hr post hydration. Ie total 4.5hrs)



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Check thiopurine levels between weeks 12 17

1 8 15 22 29 36 43 50

11 12 13 14 15 16 17 18

END OF TREATMENT

Girls - 2 years from the start of interim maintenance Date:

Boys - 3 years from the start of interim maintenance Date:

Flowchart 3Regimen B - Interim maintenance

*All Chemotherapy use

Diagnostic Weight

___________________Kg

SA___________________

Date_________________



NOTE: All children must stop

Mercaptopurine & Methotrexate

for 7 days prior to DelayedIntensification

i.e. Week 18 No oral

chemotherapy.

(once weekly - same day each week)

CoTrimoxazoleTwice daily dose for two consecutive

days per week


Oral methotrexate 20mg/m2

(maximum dose 2mg)

Day/cycle

IT Methotrexate


Week

Date

Dexamethasone 6mg/m/daydivided into twice daily doses for 5

days

(i.e. 3mg/m/dose 2 times daily)

(Once Daily)

Flowsheets are to be used as a treatment guide - always refer to current ALL interim guidelines 2011


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Count dependent

1 8 15 22 29 36 43

19 20 21 22 23 24 25

Co-trimoxazole

* All chemotherapy useweight from start of Delayed

Intensification

____________Kg

SA_____________

Date______________



IT methotrexate

Doxorubicin 25mg/m2


Flowchart 4

Regimen B - Delayed intensification

Vincristine & Dexamethasone

Day -1 Week 19 only if

Neutrophils 0.75 and platelets

75

NOTE: DO NOT ADJUST

MERCAPTOPURINE DOSES

FOR NEUTROPENIA

IM Peg Asparaginase 1000iu/m2

Twice daily dose for two consecutive

days per week

Date

3.5hr post hydration. Ie total 4.5hrs)

Week

Days/cycle

(Infusion over 1 hour)

Count dependant

divided into twice daily dose for 7 days


(maximum dose 2mg)

Dexamethasone 10mg/m/day

Cytarabine 75mg/m2


Cyclophosphamide 1.0g/m2

(Once daily for 14 days)

(Infusion over 30min with 0.5hr pre and



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1 8 15 22 29 36 43 50 57 64 71 78

26 27 28 29 30 31 32 33 34 35 36 37

IT Methotrexate

Vincristine 1.5mg/m

(maximum dose 2mg)

(once daily)

Day/cycle



divided into twice daily doses for 5 days


IMPORTANT!

Week 27 book post Anthracycline echo for

next clinic visit.

Week

Date

Co-trimoxazole

Twice daily for two consecutive daysper week


Flowchart 5a

Regimen B. Maintenance cycle 1.

All chemotherapy prescribing:

Do not adjust doses on the basis of weight

change any more frequently than every 3

months




6/16


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1 8 15 22 29 36 43 50 57 64 71 78

50 51 52 53 54 55 56 57 58 59 60 61Week

Date

Co-trimoxazole


IT Methotrexate

Vincristine 1.5mg/m

(maximum dose 2mg)






(once daily)

Flowchart 5c

Regimen B. Maintenance cycle 3




months


Day/cycle



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1 8 15 22 29 36 43 50 57 64 71 78

62 63 64 65 66 67 68 69 70 71 72 73

IT Methotrexate

Vincristine 1.5mg/m

(maximum dose 2mg)

Day/cycle






(once daily)

Flowchart 5d





months


Week

Date

Co-trimoxazole




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1 8 15 22 29 36 43 50 57 64 71 78

74 75 76 77 78 79 80 81 82 83 84 85Week

Date

Co-trimoxazole


IT Methotrexate

Vincristine 1.5mg/m

(maximum dose 2mg)






(once daily)

Flowchart 5e





months


Day/cycle



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1 8 15 22 29 36 43 50 57 64 71 78

86 87 88 89 90 91 92 93 94 95 96 97

IT Methotrexate

Vincristine 1.5mg/m

(maximum dose 2mg)

Day/cycle






(once daily)

Flowchart 5f





months


Week

Date

Co-trimoxazole




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1 8 15 22 29 36 43 50 57 64 71 78

98 99 100 101 102 103 104 105 106 107 108 109Week

Date

Co-trimoxazole


IT Methotrexate

Vincristine 1.5mg/m

(maximum dose 2mg)






(once daily)

Flowchart 5g





months


Day/cycle



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End of treatment (EOT) for girls is Day 35 (ie end of week 114)

1 8 15 22 29 36 43 50 57 64 71 78

110 111 112 113 114 115 116 117 118 119 120 121

END OF TREATMENT DATE (GIRLS)

2 YEARS FROM START OF INTERIM MAINTENANCE _______________________

IT Methotrexate

Vincristine 1.5mg/m(maximum dose 2mg)

Day/cycle






(once daily)

Flowchart 5h





months


Week

Date

Co-trimoxazole

Twice daily for two consecutive days

per week



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1 8 15 22 29 36 43 50 57 64 71 78

122 123 124 125 126 127 128 129 130 131 132 133Week

Date

Co-trimoxazole


per week

IT Methotrexate

Vincristine 1.5mg/m

(maximum dose 2mg)






(once daily)

Flowchart 5i





months


Day/cycle



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1 8 15 22 29 36 43 50 57 64 71 78

134 135 136 137 138 139 140 141 142 143 144 145

IT Methotrexate

Vincristine 1.5mg/m

(maximum dose 2mg)

Day/cycle






(once daily)

Flowchart 5j





months


Week

Date

Co-trimoxazole


per week



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1 8 15 22 29 36 43 50 57 64 71 78

146 147 148 149 150 151 152 153 154 155 156 157Week

Date

Co-trimoxazole


per week

IT Methotrexate

Vincristine 1.5mg/m

(maximum dose 2mg)






(once daily)

Flowchart 5k





months


Day/cycle



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End of treatment (EOT) for boys: week 166 at D64 cycle 12

1 8 15 22 29 36 43 50 57

158 159 160 161 162 163 164 165 166

END OF TREATMENT DATE (BOYS)

3 YEARS FROM START OF INTERIM MAINTENANCE _______________________

IT Methotrexate

Vincristine 1.5mg/m(maximum dose 2mg)

Day/cycle






(once daily)

Flowchart 5m





months


Week

Date

Co-trimoxazole


per week


ALL - Interim Guidelines 2011 Regimen B- TG

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