ALL - Interim Guidelines 2011 Regimen B - TG

PAEDIATRIC ONCOLOGY DEPARTMENT COMBINED MILITARY HOSPITAL RAWALPINDI ALL Interim Guidelines, 2011
Bone marrow
(MRD)
(MRD) * Provided clotting test normal at diagnosis and no recent history of bleeding it is not necessary to repeat clotting prior to LP+ITmtx
IT methotrexate
Daunorubicin 25mg/m2 (infusion over 1 hour) IM Peg Asparaginase 1000iu/m2
* If clotting abnormal at diagnosis, discuss with consultant prior to LP+ITmtx
Vincristine 1.5mg/m2
(maximum dose 2mg)
Dexamethasone 6mg/m/day for 28

days then taper over 7 days divided into twice daily dose (Max.10mg/day)
*Clotting including fibrinogen required prior to central line insertion
Mercaptopurine 60mg/m2
(Once daily)
*All Chemotherapy use Diagnostic Weight ___________________Kg SA ______________________ Date___________________
CoTrimoxazole
Twice daily for two consecutive days per week
Day/cycle Week Date
1 1
8 2
15 3
22 4
29 5
For children with BMI >98th centile refer to protocol
KEY
- I ntravenous - Oral - Intrathecal/Bone Marrow (General Anaesthetic) - Intramuscular injection
Day 8 bone marrow result will only be used to upstage treatment in patients who do not have MRD results
Regimen B - Induction
Flowchart 1
Flowsheets are to be used as a treatment guide - always refer to current ALL interim guidelines, 2011
Count dependant
NOTE: DO NOT ADJUST MERCAPTOPURINE DOSES FOR NEUTROPENIA
IT Methotrexate
Cyclophosphamide 1.0g/m2
(Infusion over 30min with 0.5hr pre and 3.5hr post hydration. Ie total 4.5hrs)
Cytarabine 75mg/m2
(Once daily)
CoTrimoxazole
Twice daily dose for two consecutive days per week
*All Chemotherapy use Diagnostic Weight _______________Kg SA_________________
Day/cycle Week Date
1 6
8 7
15 8
22 9
29 10
Date_____________ For children with BMI >98th centile refer to protocol
Regimen B - standard BFM consolidation

Flowchart 2
Check thiopurine levels between weeks 12

IT Methotrexate
17
*All Chemotherapy use Diagnostic Weight ___________________Kg SA___________________ Date_________________ For children with BMI >98th centile refer to protocol
Vincristine 1.5mg/m2
(maximum dose 2mg)
Dexamethasone 6mg/m/day
divided into twice daily doses for 5 days (i.e. 3mg/m/dose 2 times daily)
(Once Daily)
Oral methotrexate 20mg/m2

(once weekly - same day each week)
CoTrimoxazole
NOTE: All children must stop Mercaptopurine & Methotrexate for 7 days prior to Delayed Intensification i.e. Week 18 No oral chemotherapy.
Day/cycle Week
1 11
8 12
15 13
22 14
29 15
36 16
43 17
50 18
Date
END OF TREATMENT Girls - 2 years from the start of interim maintenance Boys - 3 years from the start of interim maintenance
Date: Date:
Regimen B - Interim maintenance

Flowchart 3
Count dependant
Count dependent
IT methotrexate
Doxorubicin 25mg/m2 (Infusion over 1 hour) Vincristine 1.5mg/m2

(maximum dose 2mg)
divided into twice daily dose for 7 days (i.e. 5mg/m/dose 2 times daily)
IM Peg Asparaginase 1000iu/m2
Vincristine & Dexamethasone Day -1 Week 19 only if Neutrophils 0.75 and platelets 75
Cyclophosphamide 1.0g/m2
(Infusion over 30min with 0.5hr pre and 3.5hr post hydration. Ie total 4.5hrs)
Mercaptopurine 60mg/m2 (Once daily for 14 days) Cytarabine 75mg/m Co-trimoxazole

2
NOTE: DO NOT ADJUST MERCAPTOPURINE DOSES FOR NEUTROPENIA
* All chemotherapy use weight from start of Delayed Intensification Days/cycle Week 1 19 8 20 15 21 22 22 29 23 36 24 43 ____________Kg 25 SA_____________ Date______________ For children with BMI >98th centile refer to protocol
Date
Regimen B - Delayed intensification

Flowchart 4
IMPORTANT!
IT Methotrexate Week 27 book post Anthracycline echo for next clinic visit.
Vincristine 1.5mg/m
(maximum dose 2mg)
(once daily)

Co-trimoxazole Twice daily for two consecutive days per week
Day/cycle Week Date
1 26
8 27
15 28
22 29
29 30
36 31
43 32
50 33
57 34
64 35
71 36
78 37
All chemotherapy prescribing: Do not adjust doses on the basis of weight change any more frequently than every 3 months
Regimen B. Maintenance cycle 1.

Flowchart 5a
IT Methotrexate
POST ANTHRACYCLINE ECHO DUE WITH LP + ITMTX
Vincristine 1.5mg/m
(maximum dose 2mg)
(once daily)

Day/cycle Week Date
1 38
8 39
15 40
22 41
29 42
36 43
43 44
50 45
57 46
64 47
71 48
78 49
Regimen B. Maintenance cycle 2

Flowchart 5b
IT Methotrexate
Vincristine 1.5mg/m
(maximum dose 2mg)
(once daily)

Day/cycle Week Date
1 50
8 51
15 52
22 53
29 54
36 55
43 56
50 57
57 58
64 59
71 60
78 61

Flowchart 5c
IT Methotrexate
Vincristine 1.5mg/m
(maximum dose 2mg)
(once daily)

Day/cycle Week Date
1 62
8 63
15 64
22 65
29 66
36 67
43 68
50 69
57 70
64 71
71 72
78 73

Flowchart 5d
IT Methotrexate
Vincristine 1.5mg/m
(maximum dose 2mg)
(once daily)

Day/cycle Week Date
1 74
8 75
15 76
22 77
29 78
36 79
43 80
50 81
57 82
64 83
71 84
78 85

Flowchart 5e
IT Methotrexate
Vincristine 1.5mg/m
(maximum dose 2mg)
(once daily)

Day/cycle Week Date
1 86
8 87
15 88
22 89
29 90
36 91
43 92
50 93
57 94
64 95
71 96
78 97

Flowchart 5f
IT Methotrexate
Vincristine 1.5mg/m
(maximum dose 2mg)
(once daily)

Day/cycle Week Date
1 98
8 99
15 100
22 101
29 102
36 103
43 104
50 105
57 106
64 107
71 108
78 109

Flowchart 5g
End of treatment (EOT) for girls is Day 35 (ie end of week 114)
IT Methotrexate
Vincristine 1.5mg/m
(maximum dose 2mg)
(once daily)

Day/cycle Week Date
1 110
8 111
15 112
22 113
29 114
36 115
43 116
50 117
57 118
64 119
71 120
78 121
END OF TREATMENT DATE (GIRLS) 2 YEARS FROM START OF INTERIM MAINTENANCE _______________________

Flowchart 5h
IT Methotrexate
Vincristine 1.5mg/m
(maximum dose 2mg)
(once daily)

Day/cycle Week Date
1 122
8 123
15 124
22 125
29 126
36 127
43 128
50 129
57 130
64 131
71 132
78 133

Flowchart 5i
IT Methotrexate
Vincristine 1.5mg/m
(maximum dose 2mg)
(once daily)

Day/cycle Week Date
1 134
8 135
15 136
22 137
29 138
36 139
43 140
50 141
57 142
64 143
71 144
78 145

Flowchart 5j
IT Methotrexate
Vincristine 1.5mg/m
(maximum dose 2mg)
(once daily)

Day/cycle Week Date
1 146
8 147
15 148
22 149
29 150
36 151
43 152
50 153
57 154
64 155
71 156
78 157

Flowchart 5k
End of treatment (EOT) for boys: week 166 at D64 cycle 12

IT Methotrexate
Vincristine 1.5mg/m
(maximum dose 2mg)
(once daily)

Day/cycle Week Date
1 158
8 159
15 160
22 161
29 162
36 163
43 164
50 165
57 166
END OF TREATMENT DATE (BOYS) 3 YEARS FROM START OF INTERIM MAINTENANCE _______________________

Flowchart 5m

ALL - Interim Guidelines 2011 Regimen B - TG

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PAEDIATRIC ONCOLOGY DEPARTMENT COMBINED MILITARY HOSPITAL RAWALPINDI ALL Interim Guidelines, 2011

Daunorubicin 25mg/m2 (infusion over 1 hour) IM Peg Asparaginase 1000iu/m2

* If clotting abnormal at diagnosis, discuss with consultant prior to LP+ITmtx

Dexamethasone 6mg/m/day for 28

*Clotting including fibrinogen required prior to central line insertion

*All Chemotherapy use Diagnostic Weight ___________________Kg SA ______________________ Date___________________

Day/cycle Week Date

For children with BMI >98th centile refer to protocol

NOTE: DO NOT ADJUST MERCAPTOPURINE DOSES FOR NEUTROPENIA

*All Chemotherapy use Diagnostic Weight _______________Kg SA_________________

Day/cycle Week Date

Date_____________ For children with BMI >98th centile refer to protocol

Regimen B - standard BFM consolidation

Check thiopurine levels between weeks 12

Oral methotrexate 20mg/m2

Regimen B - Interim maintenance

Doxorubicin 25mg/m2 (Infusion over 1 hour) Vincristine 1.5mg/m2

IM Peg Asparaginase 1000iu/m2

Mercaptopurine 60mg/m2 (Once daily for 14 days) Cytarabine 75mg/m Co-trimoxazole

NOTE: DO NOT ADJUST MERCAPTOPURINE DOSES FOR NEUTROPENIA

Regimen B - Delayed intensification

Oral methotrexate 20mg/m2

Co-trimoxazole Twice daily for two consecutive days per week

Day/cycle Week Date

Regimen B. Maintenance cycle 1.

POST ANTHRACYCLINE ECHO DUE WITH LP + ITMTX

Oral methotrexate 20mg/m2

Co-trimoxazole Twice daily for two consecutive days per week

Day/cycle Week Date

Regimen B. Maintenance cycle 2

Oral methotrexate 20mg/m2

Co-trimoxazole Twice daily for two consecutive days per week

Day/cycle Week Date

Regimen B. Maintenance cycle 3

Oral methotrexate 20mg/m2

Co-trimoxazole Twice daily for two consecutive days per week

Day/cycle Week Date

Regimen B. Maintenance cycle 4

Oral methotrexate 20mg/m2

Co-trimoxazole Twice daily for two consecutive days per week

Day/cycle Week Date

Regimen B. Maintenance cycle 5

Oral methotrexate 20mg/m2

Co-trimoxazole Twice daily for two consecutive days per week

Day/cycle Week Date

Regimen B. Maintenance cycle 6

Oral methotrexate 20mg/m2

Co-trimoxazole Twice daily for two consecutive days per week

Day/cycle Week Date

Regimen B. Maintenance cycle 7

Oral methotrexate 20mg/m2

Co-trimoxazole Twice daily for two consecutive days per week

Day/cycle Week Date

Regimen B. Maintenance cycle 8

Oral methotrexate 20mg/m2

Co-trimoxazole Twice daily for two consecutive days per week

Day/cycle Week Date

Regimen B. Maintenance cycle 9

Oral methotrexate 20mg/m2

Co-trimoxazole Twice daily for two consecutive days per week

Day/cycle Week Date

Regimen B. Maintenance cycle 10

Oral methotrexate 20mg/m2

*All Chemotherapy use Diagnostic Weight _Kg SA Date___

*All Chemotherapy use Diagnostic Weight _Kg SA___