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Systemic Anti-Cancer Therapy Regimen Library

Home > LEU ALL - UKALL60+ [non-intensive] > LEU - UKALL60+ Phase 1 Induction
This regimen is a component of LEU ALL - UKALL60+ [non-intensive]

UKALL60+ [non-intensive] Phase 1 Induction (LEU ALL - UKALL60+ [non-intensive])

Treatment Overview

Cycle 1 - 28 days

Cycle length:
28

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


Intrathecal metHOTREXATe:

  • To be given once during Phase 1 Induction – timing at the discretion of the treating clinician.
  • For Ommaya reservoir reduce dose to 6 mg intraventricularly.

mercaptOPURine: Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.

Cycle details

Cycle 1 - 28 days

Medication Dose Route Days Max Duration
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 * 5 mg/m² Once a week oral administration 1, 8, 15,
22
mercaptOPURine * 25 mg/m² Once daily oral administration 1 to 28
metHOTREXATe 12 mg flat dosing intrathecal injection 2

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


Intrathecal metHOTREXATe:

  • To be given once during Phase 1 Induction – timing at the discretion of the treating clinician.
  • For Ommaya reservoir reduce dose to 6 mg intraventricularly.

mercaptOPURine: Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.

Full details

Cycle 1 - 28 days

Day: 1

Medication Dose Route Max duration Details
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.
metHOTREXATe * 5 mg/m² Once a week oral administration
Instructions:
  • Protect yourself from too much natural or artificial sunlight while being treated with this medicine.
  • Round dose to closest multiple of 2.5 mg tablets.
mercaptOPURine * 25 mg/m² Once daily oral administration
Instructions:
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.

Day: 2

Medication Dose Route Max duration Details
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.
mercaptOPURine * 25 mg/m² Once daily oral administration
Instructions:
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.
metHOTREXATe 12 mg flat dosing intrathecal injection
Instructions:
  • To be given once during each Phase 1 Induction – timing at the discretion of the treating clinician.
  • Adhere to local institution policy for intrathecal administration.
  • For Ommaya reservoir reduce dose to 6 mg intraventricularly.

Day: 3

Medication Dose Route Max duration Details
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.
mercaptOPURine * 25 mg/m² Once daily oral administration
Instructions:
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.

Day: 4

Medication Dose Route Max duration Details
mercaptOPURine * 25 mg/m² Once daily oral administration
Instructions:
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.

Day: 5

Medication Dose Route Max duration Details
mercaptOPURine * 25 mg/m² Once daily oral administration
Instructions:
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.

Day: 6

Medication Dose Route Max duration Details
mercaptOPURine * 25 mg/m² Once daily oral administration
Instructions:
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.

Day: 7

Medication Dose Route Max duration Details
mercaptOPURine * 25 mg/m² Once daily oral administration
Instructions:
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.

Day: 8

Medication Dose Route Max duration Details
metHOTREXATe * 5 mg/m² Once a week oral administration
Instructions:
  • Protect yourself from too much natural or artificial sunlight while being treated with this medicine.
  • Round dose to closest multiple of 2.5 mg tablets.
mercaptOPURine * 25 mg/m² Once daily oral administration
Instructions:
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.

Day: 9

Medication Dose Route Max duration Details
mercaptOPURine * 25 mg/m² Once daily oral administration
Instructions:
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.

Day: 10

Medication Dose Route Max duration Details
mercaptOPURine * 25 mg/m² Once daily oral administration
Instructions:
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.

Day: 11

Medication Dose Route Max duration Details
mercaptOPURine * 25 mg/m² Once daily oral administration
Instructions:
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.

Day: 12

Medication Dose Route Max duration Details
mercaptOPURine * 25 mg/m² Once daily oral administration
Instructions:
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.

Day: 13

Medication Dose Route Max duration Details
mercaptOPURine * 25 mg/m² Once daily oral administration
Instructions:
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.

Day: 14

Medication Dose Route Max duration Details
mercaptOPURine * 25 mg/m² Once daily oral administration
Instructions:
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.

Day: 15

Medication Dose Route Max duration Details
metHOTREXATe * 5 mg/m² Once a week oral administration
Instructions:
  • Protect yourself from too much natural or artificial sunlight while being treated with this medicine.
  • Round dose to closest multiple of 2.5 mg tablets.
mercaptOPURine * 25 mg/m² Once daily oral administration
Instructions:
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.

Day: 16

Medication Dose Route Max duration Details
mercaptOPURine * 25 mg/m² Once daily oral administration
Instructions:
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.

Day: 17

Medication Dose Route Max duration Details
mercaptOPURine * 25 mg/m² Once daily oral administration
Instructions:
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.

Day: 18

Medication Dose Route Max duration Details
mercaptOPURine * 25 mg/m² Once daily oral administration
Instructions:
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.

Day: 19

Medication Dose Route Max duration Details
mercaptOPURine * 25 mg/m² Once daily oral administration
Instructions:
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.

Day: 20

Medication Dose Route Max duration Details
mercaptOPURine * 25 mg/m² Once daily oral administration
Instructions:
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.

Day: 21

Medication Dose Route Max duration Details
mercaptOPURine * 25 mg/m² Once daily oral administration
Instructions:
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.

Day: 22

Medication Dose Route Max duration Details
metHOTREXATe * 5 mg/m² Once a week oral administration
Instructions:
  • Protect yourself from too much natural or artificial sunlight while being treated with this medicine.
  • Round dose to closest multiple of 2.5 mg tablets.
mercaptOPURine * 25 mg/m² Once daily oral administration
Instructions:
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.

Day: 23

Medication Dose Route Max duration Details
mercaptOPURine * 25 mg/m² Once daily oral administration
Instructions:
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.

Day: 24

Medication Dose Route Max duration Details
mercaptOPURine * 25 mg/m² Once daily oral administration
Instructions:
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.

Day: 25

Medication Dose Route Max duration Details
mercaptOPURine * 25 mg/m² Once daily oral administration
Instructions:
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.

Day: 26

Medication Dose Route Max duration Details
mercaptOPURine * 25 mg/m² Once daily oral administration
Instructions:
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.

Day: 27

Medication Dose Route Max duration Details
mercaptOPURine * 25 mg/m² Once daily oral administration
Instructions:
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.

Day: 28

Medication Dose Route Max duration Details
mercaptOPURine * 25 mg/m² Once daily oral administration
Instructions:
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.

Supportive Care Factors

Factor Value
Antifungal prophylaxis: Routine antifungal prophylaxis recommended
Antiviral prophylaxis for herpes virus: Routine antiviral prophylaxis recommended
Constipation risk: Consider prescribing laxatives with this treatment
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 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.


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.


Emetogenicity: MEDIUM day 1; MINIMAL to LOW days 2 to 28.


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


Tumour lysis syndrome prophylaxis: Avoid concomitant aLLOPURINol or febuxostat with mercaptOPURine.

References

No references

* 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.