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Systemic Anti-Cancer Therapy Regimen Library

Home > LEU ALL BCR-ABL1+ - UKALL60+ with imatinib > LEU - UKALL60+ with imatinib Phase 1 Induction
This regimen is a component of LEU ALL BCR-ABL1+ - UKALL60+ with imatinib

UKALL60+ with imatinib Phase 1 Induction (LEU ALL BCR-ABL1+ - UKALL60+ with imatinib)

Treatment Overview

Cycle 1 - 28 days

Cycle length:
28

imatinib:

  • Take continuously during treatment.
  • Start at 400 mg orally ONCE daily, escalate to 600 mg orally ONCE daily within two weeks if tolerated.

dexamethasone: Some centres may choose to cap dose of dexamethasone at 6 mg daily.


Intrathecal metHOTREXATe:

  • Day of administration can be moved +/- 3 days.
  • For Ommaya reservoir reduce dose to 6 mg intraventricularly.

Cycle details

Cycle 1 - 28 days

Medication Dose Route Days Max Duration
imatinib 400 mg Once daily oral administration 1 to 28
dexamethasone 3 mg/m² Once daily oral administration 1, 2, 3
IDArubicin * 3 mg/m² intravenous 1 15 minutes
vinCRISTine 1 mg/m² Cap dose per administration at: 2 mg intravenous 1 10 minutes
metHOTREXATe 12 mg flat dosing intrathecal injection 8, 15, 22

imatinib:

  • Take continuously during treatment.
  • Start at 400 mg orally ONCE daily, escalate to 600 mg orally ONCE daily within two weeks if tolerated.

dexamethasone: Some centres may choose to cap dose of dexamethasone at 6 mg daily.


Intrathecal metHOTREXATe:

  • Day of administration can be moved +/- 3 days.
  • For Ommaya reservoir reduce dose to 6 mg intraventricularly.

Full details

Cycle 1 - 28 days

Day: 1

Medication Dose Route Max duration Details
imatinib 400 mg Once daily oral administration
Instructions:
  • Escalate to 600 mg orally ONCE daily within two weeks if tolerated.
  • Take each dose with food and a large glass of water
dexamethasone 3 mg/m² Once daily oral administration
Instructions:

Take with food in the morning.

Some centres may choose to cap dose at 6 mg.
IDArubicin * 3 mg/m² intravenous 15 minutes
Instructions:

Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration.
vinCRISTine 1 mg/m² Cap dose per administration at: 2 mg intravenous 10 minutes
Instructions:
  • Diluted in a minibag.
  • FOR INTRAVENOUS USE ONLY – fatal if given by any other routes.
  • Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration.

Day: 2

Medication Dose Route Max duration Details
imatinib 400 mg Once daily oral administration
Instructions:
  • Escalate to 600 mg orally ONCE daily within two weeks if tolerated.
  • Take each dose with food and a large glass of water
dexamethasone 3 mg/m² Once daily oral administration
Instructions:

Take with food in the morning.

Some centres may choose to cap dose at 6 mg.

Day: 3

Medication Dose Route Max duration Details
imatinib 400 mg Once daily oral administration
Instructions:
  • Escalate to 600 mg orally ONCE daily within two weeks if tolerated.
  • Take each dose with food and a large glass of water
dexamethasone 3 mg/m² Once daily oral administration
Instructions:

Take with food in the morning.

Some centres may choose to cap dose at 6 mg.

Day: 4

Medication Dose Route Max duration Details
imatinib 400 mg Once daily oral administration
Instructions:
  • Escalate to 600 mg orally ONCE daily within two weeks if tolerated.
  • Take each dose with food and a large glass of water

Day: 5

Medication Dose Route Max duration Details
imatinib 400 mg Once daily oral administration
Instructions:
  • Escalate to 600 mg orally ONCE daily within two weeks if tolerated.
  • Take each dose with food and a large glass of water

Day: 6

Medication Dose Route Max duration Details
imatinib 400 mg Once daily oral administration
Instructions:
  • Escalate to 600 mg orally ONCE daily within two weeks if tolerated.
  • Take each dose with food and a large glass of water

Day: 7

Medication Dose Route Max duration Details
imatinib 400 mg Once daily oral administration
Instructions:
  • Escalate to 600 mg orally ONCE daily within two weeks if tolerated.
  • Take each dose with food and a large glass of water

Day: 8

Medication Dose Route Max duration Details
imatinib 400 mg Once daily oral administration
Instructions:
  • Escalate to 600 mg orally ONCE daily within two weeks if tolerated.
  • Take each dose with food and a large glass of water
metHOTREXATe 12 mg flat dosing intrathecal injection
Instructions:
  • Day of administration can be moved +/- 3 days.
  • Adhere to local institution policy for intrathecal administration.
  • For Ommaya reservoir reduce dose to 6 mg intraventricularly.

Day: 9

Medication Dose Route Max duration Details
imatinib 400 mg Once daily oral administration
Instructions:
  • Escalate to 600 mg orally ONCE daily within two weeks if tolerated.
  • Take each dose with food and a large glass of water

Day: 10

Medication Dose Route Max duration Details
imatinib 400 mg Once daily oral administration
Instructions:
  • Escalate to 600 mg orally ONCE daily within two weeks if tolerated.
  • Take each dose with food and a large glass of water

Day: 11

Medication Dose Route Max duration Details
imatinib 400 mg Once daily oral administration
Instructions:
  • Escalate to 600 mg orally ONCE daily within two weeks if tolerated.
  • Take each dose with food and a large glass of water

Day: 12

Medication Dose Route Max duration Details
imatinib 400 mg Once daily oral administration
Instructions:
  • Escalate to 600 mg orally ONCE daily within two weeks if tolerated.
  • Take each dose with food and a large glass of water

Day: 13

Medication Dose Route Max duration Details
imatinib 400 mg Once daily oral administration
Instructions:
  • Escalate to 600 mg orally ONCE daily within two weeks if tolerated.
  • Take each dose with food and a large glass of water

Day: 14

Medication Dose Route Max duration Details
imatinib 400 mg Once daily oral administration
Instructions:
  • Escalate to 600 mg orally ONCE daily within two weeks if tolerated.
  • Take each dose with food and a large glass of water

Day: 15

Medication Dose Route Max duration Details
imatinib 400 mg Once daily oral administration
Instructions:
  • Escalate to 600 mg orally ONCE daily within two weeks if tolerated.
  • Take each dose with food and a large glass of water
metHOTREXATe 12 mg flat dosing intrathecal injection
Instructions:
  • Day of administration can be moved +/- 3 days.
  • Adhere to local institution policy for intrathecal administration.
  • For Ommaya reservoir reduce dose to 6 mg intraventricularly.

Day: 16

Medication Dose Route Max duration Details
imatinib 400 mg Once daily oral administration
Instructions:
  • Escalate to 600 mg orally ONCE daily within two weeks if tolerated.
  • Take each dose with food and a large glass of water

Day: 17

Medication Dose Route Max duration Details
imatinib 400 mg Once daily oral administration
Instructions:
  • Escalate to 600 mg orally ONCE daily within two weeks if tolerated.
  • Take each dose with food and a large glass of water

Day: 18

Medication Dose Route Max duration Details
imatinib 400 mg Once daily oral administration
Instructions:
  • Escalate to 600 mg orally ONCE daily within two weeks if tolerated.
  • Take each dose with food and a large glass of water

Day: 19

Medication Dose Route Max duration Details
imatinib 400 mg Once daily oral administration
Instructions:
  • Escalate to 600 mg orally ONCE daily within two weeks if tolerated.
  • Take each dose with food and a large glass of water

Day: 20

Medication Dose Route Max duration Details
imatinib 400 mg Once daily oral administration
Instructions:
  • Escalate to 600 mg orally ONCE daily within two weeks if tolerated.
  • Take each dose with food and a large glass of water

Day: 21

Medication Dose Route Max duration Details
imatinib 400 mg Once daily oral administration
Instructions:
  • Escalate to 600 mg orally ONCE daily within two weeks if tolerated.
  • Take each dose with food and a large glass of water

Day: 22

Medication Dose Route Max duration Details
imatinib 400 mg Once daily oral administration
Instructions:
  • Escalate to 600 mg orally ONCE daily within two weeks if tolerated.
  • Take each dose with food and a large glass of water
metHOTREXATe 12 mg flat dosing intrathecal injection
Instructions:
  • Day of administration can be moved +/- 3 days.
  • Adhere to local institution policy for intrathecal administration.
  • For Ommaya reservoir reduce dose to 6 mg intraventricularly.

Day: 23

Medication Dose Route Max duration Details
imatinib 400 mg Once daily oral administration
Instructions:
  • Escalate to 600 mg orally ONCE daily within two weeks if tolerated.
  • Take each dose with food and a large glass of water

Day: 24

Medication Dose Route Max duration Details
imatinib 400 mg Once daily oral administration
Instructions:
  • Escalate to 600 mg orally ONCE daily within two weeks if tolerated.
  • Take each dose with food and a large glass of water

Day: 25

Medication Dose Route Max duration Details
imatinib 400 mg Once daily oral administration
Instructions:
  • Escalate to 600 mg orally ONCE daily within two weeks if tolerated.
  • Take each dose with food and a large glass of water

Day: 26

Medication Dose Route Max duration Details
imatinib 400 mg Once daily oral administration
Instructions:
  • Escalate to 600 mg orally ONCE daily within two weeks if tolerated.
  • Take each dose with food and a large glass of water

Day: 27

Medication Dose Route Max duration Details
imatinib 400 mg Once daily oral administration
Instructions:
  • Escalate to 600 mg orally ONCE daily within two weeks if tolerated.
  • Take each dose with food and a large glass of water

Day: 28

Medication Dose Route Max duration Details
imatinib 400 mg Once daily oral administration
Instructions:
  • Escalate to 600 mg orally ONCE daily within two weeks if tolerated.
  • Take each dose with food and a large glass of water

Supportive Care Factors

Factor Value
Antifungal prophylaxis: Routine antifungal prophylaxis recommended
Antiviral prophylaxis for herpes virus: Routine antiviral prophylaxis recommended
Constipation risk: Variable
Diarrhoea risk: Variable
Emetogenicity: Variable
Gastroprotection: Gastroprotection is recommended
Pneumocystis jirovecii pneumonia (PJP) prophylaxis: Routine antibiotic prophylaxis recommended
Tumour lysis syndrome prophylaxis: Tumour lysis syndrome prophylaxis is recommended

Antifungal prophylaxis: Inhibition of CYP3A4 by azole antifungals may lead to reduced vinCRISTine and imatinib clearance and increased toxicities. Strategies to avoid this interaction may include a washout period after azole administration or using a non-azole antifungal for prophylaxis. If an azole is used the imatinib dose must be reduced – consult prescribing information.


Antiviral prophylaxis for hepatitis B virus: Guidance is limited to high-risk anti-cancer medicines. Clinicians will need to assess individual patient risk for other anti-cancer medicines.


Constipation/Diarrhoea risk: vinCRISTine may cause constipation and imatinib may cause diarrhoea. Monitor gastrointestinal symptoms.


Emetogenicity:

  • MEDIUM day 1;
  • imatinib: MEDIUM to HIGH > 400 mg; MINIMAL to LOW ≤400 mg; however, based on New Zealand clinical experience emetogenicity for imatinib doses greater than 400 mg may also only be Minimal to low.

Gastroprotection: Gastroprotective agents are only intended for short term use while patient is receiving corticosteroid treatment doses.

References

REX Medical Limited. Imatinib New Zealand Data Sheet 5 June 2020. https://www.medsafe.govt.nz/profs/datasheet/i/imatinibcap.pdf (Accessed 17 October 2020).

* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.

s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.