Maintenance Phase

A. Mature B-cell ALL—no maintenance

B. Ph+ ALL—allogeneic transplant if donor available; otherwise, IFN and Ara-C as below

-therapy is continued for 2 years i d'

re aj

Interferon alfa Ara-C

5 MIU/M2 10 mg

SQ SQ

QD QD

C. All other patients -therapy is continued for 2 years

6-Mercaptopurine Methotrexate Vincristine Prednisone

PO TID PO IV PO

QD weekly monthly days 1-5 monthly

OTHER MEDICATIONS

1. Trimethoprim/sulfamethoxazole DS 1 tab PO BID each weekend

2. Valacyclovir 500 mg PO QD or TIW

-above medications are continued for first 6 months of maintenance phase

REF: Kantarjian et al. J Clin Oncol 2000; 18:547-561

Methotrexate—25% dose reduction for creatinine 1.5-2 and 50% reduction for creatinine > 2; do not give if patient has an effusion ("reservoir effect")

Vincristine—vesicant-avoid extravasation; cumulative neurotoxicity—may produce severe constipation; maximum 2 mg per administration; dose reduced to 1 mg for bilirubin > 2

6-Mercaptopurine—reduce dose by 75% when used in conjunction with allopurinol

Doxorubicin—monitor cumulative dose for cardiac toxicity (not to exceed 550 mg/M2 or 450 mg/M2 with prior chest Radiotherapy); vesicant—avoid extravasation; dose reduced by 25% if bilirubin 2-3, 50% if bilirubin 3-4, and 75% if bilirubin > 4

Ara-C—high doses can cause CNS toxicity (cerebellar dysfunction); neurotoxicity increases as infusion time increases; dose reduced to 1 gm/M2 if age > 60, creatinine > 2, or if Methotrexate level at end of infusion is > 20 mmol/L

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