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Table 5 UKALL XI treatment regimen

From: The impact of therapy for childhood acute lymphoblastic leukaemia on intelligence quotients; results of the risk-stratified randomized central nervous system treatment trial MRC UKALL XI

Induction Vincristine 1·5 mg/m2 i.v. days 1, 7, 14, 21
Weeks 1-4 Prednisolone 40 mg/m2 p.o. days 1-28
  L-Asparaginase 6000 U/m2 s.c./i.m. t.i.w. nine doses
  IT MTX days 1, 8
Intensification Vincristine 1·5 mg/m2 i.v. day 1
Weeks 5-7 Prednisolone 40 mg/m2 p.o. days 1-7 then 7 d taper
  Etoposide 100 mg/m2 i.v. days 1-5
  Cytarabine 100 mg/m2 i.v. given 12 hourly days 1-5
  Daunorubicin 45 mg/m2 days 1, 2
  Thioguanine 80 mg/m2 p.o. days 1-5
  IT MTX day 1
Intensification Vincristine 1·5 mg/m2 i.v. day 1
Weeks 20-22 Prednisolone 40 mg/m2 p.o. days 1-5
  Etoposide 100 mg/m2 i.v. days 1-5
  Cytarabine 100 mg/m2 i.v. given 12 hourly days 1-5
  Daunorubicin 45 mg/m2 days 1, 2
  Thioguanine 80 mg/m2 p.o. days 1-5
  IT MTX day 1
CNS-directed treatment weeks 8-19: Randomization WBC ≤ 50 × 109/l IT MTX weekly (weeks 9-12) or HDM 6 g/m2 (≥ 4 years old) or 8 g/m2 (< 4 years old) weeks 9, 11, 13 + IT MTX weeks 9, 11, 13, 14. HDM
IV over 24 hours, folinic acid rescue commenced at 36 hours from start at 15 g/m2 3-hourly, reduced to 15 g/m2 6-hourly once serum MTX level < 2 × 106 mol/l and stopped once serum MTX level below 1 × 107 mol/l.
CNS-directed treatment weeks 8-19: Randomization WBC ≥ 50 × 109/l HDM + IT MTX as above or 24 Gy cranial radiotherapy in 15 fractions of 1·6 Gy each in weeks 9-12 (except children of 1-2 years age who were allocated HDM)
  Plus IT MTX weeks 9-11
Interim continuation therapy Mercaptopurine 75 mg/m2 p.o. daily
Weeks 8-19 Methotrexate 20 mg/m2 p.o. weekly except when ITMTX given
and 23-34 Vincristine 1·5 mg/m2 i.v. every 4 weeks
  Prednisolone 40 mg/m2 p.o. daily × 5 d every 4 weeks.
Continuation therapy Weeks Same as above ± 3-monthly ITMTX
35 or 43-100 Age-adjusted
Third intensification Weeks 35-42 Dexamethasone 10 mg/m2 p.o. for 10 d then 4 d taper
  Vincristine 1·5 mg/m2 i.v. days 1, 7, 14, 21
  L-Asparaginase 6000 U/m2 s.c./i.m. t.i.w. nine doses
  IT MTX (age-adjusted) days 1, 28
  Cyclophosphamide 600 mg/m2 i.v. days 28, 42
  Cytarabine 75 mg/m2 i.v./s.c. days 28-31, 35-38, 42-45, 49-52
  Thioguanine 60 mg/m2 p.o. days 28-56
  1. 1. IT MTX, intrathecal methotrexate; HDM, high-dose intravenous methotrexate; t.i.w, given on alternate days for three days each week.