INDONESIAN PROTOCOL ACUTE LYMPHOBLASTIC LEUKEMIA (ALL) 2013

STANDARD RISK

Name : …………………………………………………. Date of Birth : ……… M/F MR : …………… Date of Dx. : ………………

INDUCTION CONSOLIDATION
MEDICINES (WEEKS) Dosage
0 1 2 3 4 5 6 7 8 9 10 11 12
Mtx. it
VCR.iv : 1.5 mg/m2
Prednisone po : 60/40 mg/m2 Window
Prednisone 40 mg / m2

Wait Recovery 1 week

(window / induction) 60 mg/m2

( it aplastic occur )
HD - Mtx i.v : 1000 mg/m2 with
Leucovorin rescue 15 mg / m2 / dose
Daunorubicin*. iv. : 30 mg/m2
L - Asp.iv : 7500 IU/m2 SK
6 - MP.po : 50 mg/m2
Blast LCS
Blast PB
BMP

day
Date of therapy month
year
Body Weight ( kg )
Body Height ( cm )
Body Surface Area ( m 2 )
* If not available change to Doxo 20 mg / m2 / dose Blast
Peripheral Blast : if >1000 SR change to HR in CSF at diagnosis
Supervisor, Dexa Dosage ( mg / m 2 ) Age
Dosage
Days < 1 year 1 year 2 years ≥ 3 years
Leukocyte ( mm 3 )
1 2 3 4 5 Mtx.it 6 mg / x 8 mg / x 10 mg / x 12 mg /x
< 20.000 6 6 6 6 6
………………………….. > 20.000 - < 50.000 2 3 4 5 6
CNS (+) à MTX triple, 2x seminggu dilakukan sampai negatif 3x berturut-turut
Apabila terjadi relaps CNS akan dikelola secara khusus.
DNR dosis 30 mg/m2, bila tidak ada DNR dapat digantikan Doxo 20 mg/m2

Protokol SR 2013 - Fase Induksi menggunakan Prednison dan pada Fase Maintenance menggunakan Dexametason

Fase Konsolidasi : Setelah MTX HD - leucovorin diberikan 2 hari (8 x tiap 6 jam)

Setelah fase konsolidasi - tidak dilakukan BMP

38
Sub Bagian Hematologi INDONESIAN PROTOCOL ACUTE LYMPHOBLASTIC LEUKEMIA (ALL) 2013
IKA FK UNAND MAINTENANCE - STANDARD RISK

Name : …………………………………………………. Date of Birth: ………………… M/F MR : …………… Date of Dx. : ………………
MEDICINES Dosage MAINTENANCE - I ( WBC > 1,000; Platelete > 80.000 )
(WEEKS) 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61

Mtx. it
VCR. iv : 1.5 mg / m 2
Dexa.po : 4 mg / m 2
6 - MP.po : 50 mg / m 2
Mtx.po : 20 mg / m 2

day
Date of therapy month
year
Body Weight ( kg )
Body Height ( cm )
Body Surface Area ( m 2 )
MEDICINES Dosage MAINTENANCE - II ( WBC > 1,000; Platelete > 80.000 )
(WEEKS) 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 ### ### ### ### ### ### ###

VCR. iv : 1.5 mg / m 2
Dexa.po : 4 mg / m 2
6 - MP.po : 50 mg / m 2
Mtx.po : 20 mg / m 2 BMP
day
Date of therapy month
year
Body Weight ( kg )
Body Height ( cm )
Body Surface Area ( m 2 )

Supervisor,
39
…………………………..
Sub Bagian Hematologi INDONESIAN PROTOCOL ACUTE LYMPHOBLASTIC LEUKEMIA (ALL) 2013
IKA FK UNAND/RSUP.DR.M.Djamil HIGH RISK

Name : …………………………………………………. Birth date: ………………… M / F MR : …………… Date of Dx. : ………………

MEDICINES Dosage INDUCTION CONSOLIDATION INTENSIFICATION

(WEEKS) 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Mtx.it
VCR.iv : 1.5 mg / m2
DEXA.po : 6 mg / m2

Wait Recovery 1 week

HD - Mtx i.v : 1000 mg/m2 with

( it aplastic occur )
Leucovorin rescue 15 mg /m2/dose
Daunorubicine*.iv : 30 mg / m2
Cyclo. i.v 1000 mg / m2
Citarabin i.v: 75 mg / m2
L - Asp.iv : 7500 u / m2
6 - MP.po : 50 mg / m2
BMP

day
Date of therapy month
year
Body Weight ( kg )
Body Height ( cm )
Body Surface Area ( m 2 )
* If not available change to Doxo 20 mg / m2 / dose

Supervisor, PRED / DEXA DOSAGE ( mg / m 2 ) PRED / DEXA DOSAGE ( mg / m 2 ) Age Dosages Mtx.it
Days Days < 1 ye 6 mg / x
LEUCOCYTE LEUCOCYTE
1 2 3 4 5 1 2 3 4 5 1 year 8 mg / x
< 20.000 60 / 6 60 / 6 60 / 6 60 / 6 60 / 6 > 50.000 - < 1 10 / 1 20 / 2 30 / 3 40 / 4 60 / 6 2 year 10 mg / x
………………………….. > 20.000 - < 50.000 20 / 2 30 / 3 40 / 4 50 / 5 60 / 6 > 100.000 5 / 0.5 10 / 1 20 / 2 40 / 4 60 / 6 ≥ 3 ye 12 mg / x

DNR dosis 30 mg/m2, bila tidak ada DNR dapat digantikan Doxo 20 mg/m2
Protokol High Risk : menggunakan dexamentason
Fase Konsolidasi : Setelah MTX HD - leucovorin diberikan 2 hari (8 x tiap 6 jam)

40
 INDONESIAN PROTOCOL ACUTE LYMPHOBLASTIC LEUKEMIA (ALL) 2013
MAINTENANCE - HIGH RISK

Name : ………………………………………… Date of Birth : ………………… M/F MR : …………… Date of Dx. : ………………

MEDICINES Dosage MAINTENANCE - I ( Leucocyte > 2,000; Thrombocyte > 50.000 )

(WEEKS) 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64

Mtx. It
Vcr.iv : 1.5 mg / m 2
Dexa.po : 6 mg / m 2
6 - MP.po : 50 mg / m 2
Mtx.po : 20 mg / m 2
BMP
day
Date of therapy month
year
Body Weight ( kg )
Body Height ( cm )
Body Surface Area ( m 2 )
MEDICINES Dosage MAINTENANCE - II ( Leucocyte > 2,000; Thrombocyte > 50.000 )
(WEEKS) 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110

Vcr.iv : 1.5 mg / m 2

Dexa.po : 6 mg / m 2
6 - MP.po : 50 mg / m 2
Mtx.po : 20 mg / m 2 BMP
day
Date of therapy month
year
Body Weight ( kg )
Body Height ( cm )
Body Surface Area ( m 2 )

Supervisor,

…………………………..

Fase Maintenance High Risk : dimulai dengan 6Mp dan MTX po karena minggu ke 17 pasien menerima MTX it pada Fase Intensifikasi
41
 Sub BagianINDONESIAN PROTOCOL ACUTE LYMPHOBLASTIC LEUKEMIA (ALL) 2013
IKA FK UNAND/RSUP.DR.M.Djamil HIGH RISK

Name : …………………………… Birth date: ………………… M/F

MEDICINES Dosage INDUCTION

(WEEKS) 0 1 2 3 4 5 6
Mtx.it
VCR.iv : 1.5 mg / m2
DEXA.po : 6 mg / m2
HD - Mtx i.v : 1000 mg/m2 with
Leucovorin rescue 15 mg /m2/dose
Daunorubicine*.iv : 30 mg / m2
Cyclo. i.v 1000 mg / m2
Citarabin i.v: 75 mg / m2
L - Asp.iv : 7500 u / m2
6 - MP.po : 50 mg / m2
BMP
day
Date of therapy month
year
Body Weight ( kg )
Body Height ( cm )
Body Surface Area ( m 2 )
* If not available change to Doxo 20 mg / m2 / dose

Supervisor, PRED / DEXA DOSAGE ( mg / m 2 )

Days
LEUCOCYTE LEUCOCYTE
1 2 3 4 5
< 20.000 60 / 6 60 / 6 60 / 6 60 / 6 60 / 6 > 50.000 - < 100.000
…………………………..
> 20.000 - < 50.000 20 / 2 30 / 3 40 / 4 50 / 5 60 / 6 > 100.000

DNR dosis 30 mg/m2, bila tidak ada DNR dapat digantikan Doxo 20 mg/m2
Protokol High Risk : menggunakan dexamentason
Fase Konsolidasi : Setelah MTX HD - leucovorin diberikan 2 hari (8 x tiap 6 jam)
IA (ALL) 2013
HIGH RISK

MR : …………… Date of Dx. : ………………

CONSOLIDATION INTENSIFICATION
7 8 9 10 11 12 13 14 15 16
Wait Recovery 1 week
( it aplastic occur )

PRED / DEXA DOSAGE ( mg / m 2 ) Age Dosages Mtx.it

Days < 1 year 6 mg / x
LEUCOCYTE
1 2 3 4 5 1 year 8 mg / x
> 50.000 - < 100.000 10 / 1 20 / 2 30 / 3 40 / 4 60 / 6 2 years 10 mg / x
5 / 0.5 10 / 1 20 / 2 40 / 4 60 / 6 ≥ 3 years 12 mg / x
FICATION
17