Systemic Anti-Cancer Therapy Regimen Library
APML4 [60 years and under] - Maintenance (LEU APL - APML4 induction, consolidation 1 and 2 followed by maintenance [60 years and under])
Treatment Overview
Starts 3 to 4 weeks after completion of Consolidation 2.
Cycles 1 to 8 - 90 days
tretinoin:
- Consider dose reduction of tretinoin to 25 mg/m2 daily in TWO divided doses in patients under 20 years of age to reduce risk of pseudotumour cerebri.
- Teratogenic—Ensure pregnant women are not exposed to tretinoin. Consult prescribing information.
metHOTREXATe: Adjust dose (between 5 mg/m2 and 15 mg/m2 ONCE a week) to target neutrophil count of 1 to 2 x 109/L.
mercaptOPURine:
- Adjust dose (between 50 mg/m2 and 90 mg/m2 ONCE daily) to target neutrophil count of 1 to 2 x 109/L.
- Consider thiopurine methyltransferase (TPMT) testing.
Cycle details
Cycles 1 to 8 - 90 days
Medication | Dose | Route | Days | Max Duration |
---|---|---|---|---|
tretinoin * | 45 mg/m² Daily in divided doses | oral administration | 1 to 14 | |
metHOTREXATe * | 5 mg/m² Once a week | oral administration | 15, 22, 29, 36, 43, 50, 57, 64, 71, 78, 85 |
|
mercaptOPURine | 50 mg/m² Once daily | oral administration | 15 to 90 |
tretinoin:
- Consider dose reduction of tretinoin to 25 mg/m2 daily in TWO divided doses in patients under 20 years of age to reduce risk of pseudotumour cerebri.
- Teratogenic—Ensure pregnant women are not exposed to tretinoin. Consult prescribing information.
metHOTREXATe: Adjust dose (between 5 mg/m2 and 15 mg/m2 ONCE a week) to target neutrophil count of 1 to 2 x 109/L.
mercaptOPURine:
- Adjust dose (between 50 mg/m2 and 90 mg/m2 ONCE daily) to target neutrophil count of 1 to 2 x 109/L.
- Consider thiopurine methyltransferase (TPMT) testing.
Full details
Cycles 1 to 8 - 90 days
Day: 1
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
tretinoin * | 45 mg/m² Daily in divided doses | oral administration |
Instructions:
Additional details:
Daily in TWO divided doses.
|
Day: 2
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
tretinoin * | 45 mg/m² Daily in divided doses | oral administration |
Instructions:
Additional details:
Daily in TWO divided doses.
|
Day: 3
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
tretinoin * | 45 mg/m² Daily in divided doses | oral administration |
Instructions:
Additional details:
Daily in TWO divided doses.
|
Day: 4
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
tretinoin * | 45 mg/m² Daily in divided doses | oral administration |
Instructions:
Additional details:
Daily in TWO divided doses.
|
Day: 5
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
tretinoin * | 45 mg/m² Daily in divided doses | oral administration |
Instructions:
Additional details:
Daily in TWO divided doses.
|
Day: 6
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
tretinoin * | 45 mg/m² Daily in divided doses | oral administration |
Instructions:
Additional details:
Daily in TWO divided doses.
|
Day: 7
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
tretinoin * | 45 mg/m² Daily in divided doses | oral administration |
Instructions:
Additional details:
Daily in TWO divided doses.
|
Day: 8
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
tretinoin * | 45 mg/m² Daily in divided doses | oral administration |
Instructions:
Additional details:
Daily in TWO divided doses.
|
Day: 9
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
tretinoin * | 45 mg/m² Daily in divided doses | oral administration |
Instructions:
Additional details:
Daily in TWO divided doses.
|
Day: 10
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
tretinoin * | 45 mg/m² Daily in divided doses | oral administration |
Instructions:
Additional details:
Daily in TWO divided doses.
|
Day: 11
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
tretinoin * | 45 mg/m² Daily in divided doses | oral administration |
Instructions:
Additional details:
Daily in TWO divided doses.
|
Day: 12
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
tretinoin * | 45 mg/m² Daily in divided doses | oral administration |
Instructions:
Additional details:
Daily in TWO divided doses.
|
Day: 13
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
tretinoin * | 45 mg/m² Daily in divided doses | oral administration |
Instructions:
Additional details:
Daily in TWO divided doses.
|
Day: 14
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
tretinoin * | 45 mg/m² Daily in divided doses | oral administration |
Instructions:
Additional details:
Daily in TWO divided doses.
|
Day: 15
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
metHOTREXATe * | 5 mg/m² Once a week | oral administration |
Instructions:
|
|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
|
Day: 16
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 17
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 18
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 19
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 20
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 21
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
|
Day: 22
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
metHOTREXATe * | 5 mg/m² Once a week | oral administration |
Instructions:
|
|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
|
Day: 23
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 24
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 25
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 26
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 27
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 28
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
|
Day: 29
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
metHOTREXATe * | 5 mg/m² Once a week | oral administration |
Instructions:
|
|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
|
Day: 30
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 31
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 32
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 33
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 34
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 35
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 36
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
metHOTREXATe * | 5 mg/m² Once a week | oral administration |
Instructions:
|
|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
|
Day: 37
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 38
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 39
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 40
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 41
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 42
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
|
Day: 43
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
metHOTREXATe * | 5 mg/m² Once a week | oral administration |
Instructions:
|
|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
|
Day: 44
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 45
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 46
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 47
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 48
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 49
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
|
Day: 50
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
metHOTREXATe * | 5 mg/m² Once a week | oral administration |
Instructions:
|
|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
|
Day: 51
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 52
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 53
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 54
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 55
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 56
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
|
Day: 57
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
metHOTREXATe * | 5 mg/m² Once a week | oral administration |
Instructions:
|
|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
|
Day: 58
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 59
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 60
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 61
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 62
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 63
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 64
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
metHOTREXATe * | 5 mg/m² Once a week | oral administration |
Instructions:
|
|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
|
Day: 65
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 66
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 67
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 68
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 69
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
|
Day: 70
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
|
Day: 71
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
metHOTREXATe * | 5 mg/m² Once a week | oral administration |
Instructions:
|
|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
|
Day: 72
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 73
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 74
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 75
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 76
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
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Day: 77
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
|
Day: 78
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
metHOTREXATe * | 5 mg/m² Once a week | oral administration |
Instructions:
|
|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
|
Day: 79
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
|
Day: 80
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
|
Day: 81
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
|
Day: 82
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
|
Day: 83
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
|
Day: 84
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
|
Day: 85
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
metHOTREXATe * | 5 mg/m² Once a week | oral administration |
Instructions:
|
|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
|
Day: 86
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
|
Day: 87
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
|
Day: 88
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
|
Day: 89
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
|
Day: 90
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 50 mg/m² Once daily | oral administration |
Instructions:
|
Additional details
Section 1: Teratogenic effects
Ensure pregnant women are not exposed to tretinoin. Consult prescribing information.
Supportive Care Factors
Factor | Value |
---|---|
Antiviral prophylaxis for herpes virus: | Routine antiviral prophylaxis may be considered |
Emetogenicity: | Minimal to low |
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.
References
Pharmaco (NZ) Ltd Vesanoid® New Zealand data sheet 21 April 2022 https://www.medsafe.govt.nz/profs/datasheet/v/Vesanoidcap.pdf (accessed 15 July 2022).
* 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.