Systemic Anti-Cancer Therapy Regimen Library
UKALL14 [over 40 years] - Consolidation [Cycle 1] (LEU ALL - UKALL14 [over 40 years])
Treatment Overview
Starts after count recovery from Intensification/CNS prophylaxis, with neutrophils greater than 0.75 x 109/L and platelets greater than 75 x 109/L.
Cycle 1 - 21 days
cytarabine: Administer by subcutaneous injection (as above) or alternatively administer intravenously as per institutional practice
Intrathecal metHOTREXATe:
- Day of administration can be moved +/- 3 days.
- For Ommaya reservoir reduce dose to 6 mg intraventricularly.
pegasparagase:
- DO NOT use in BCR-ABL1+ (Philadelphia positive) patients.
- There is limited data available for use of pegaspargase in patients 65 years and older. Strongly consider not using pegaspargase in patients 65 years and older.
- Consideration can be given to reducing dose of pegaspargase to 500 international units/m2 for certain patients.
- Monitor patients for one hour after administration of pegaspargase in a setting with resuscitation equipment and other agents necessary to treat anaphylaxis (e.g. adrenaline, oxygen, intravenous steroids, antihistamines).
- See also Additional details for Further information on pegaspargase.
Cycle details
Cycle 1 - 21 days
| Medication | Dose | Route | Days | Max Duration |
|---|---|---|---|---|
| cytarabine | 75 mg/m² Once daily | subcutaneous injection | 1 to 5 | |
| etoposide (as phosphate) * | 100 mg/m² Once daily | intravenous | 1 to 5 | 60 minutes |
| metHOTREXATe | 12 mg flat dosing | intrathecal injection | 1 | |
| paracetamol * | 1000 mg flat dosing | oral administration | 5 | |
| loratadine * | 10 mg | oral administration | 5 | |
| famotidine * | 20 mg | oral administration | 5 | |
| pegaspargase * | 1000 international unit/m² | intravenous | 5 | 120 minutes |
cytarabine: Administer by subcutaneous injection (as above) or alternatively administer intravenously as per institutional practice
Intrathecal metHOTREXATe:
- Day of administration can be moved +/- 3 days.
- For Ommaya reservoir reduce dose to 6 mg intraventricularly.
pegasparagase:
- DO NOT use in BCR-ABL1+ (Philadelphia positive) patients.
- There is limited data available for use of pegaspargase in patients 65 years and older. Strongly consider not using pegaspargase in patients 65 years and older.
- Consideration can be given to reducing dose of pegaspargase to 500 international units/m2 for certain patients.
- Monitor patients for one hour after administration of pegaspargase in a setting with resuscitation equipment and other agents necessary to treat anaphylaxis (e.g. adrenaline, oxygen, intravenous steroids, antihistamines).
- See also Additional details for Further information on pegaspargase.
Full details
Cycle 1 - 21 days
Day: 1
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| cytarabine | 75 mg/m² Once daily | subcutaneous injection |
Instructions:
Or administer intravenously as per institutional practice. |
|
| etoposide (as phosphate) * | 100 mg/m² Once daily | intravenous | 60 minutes | |
| metHOTREXATe | 12 mg flat dosing | intrathecal injection |
Instructions:
|
Day: 2
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| cytarabine | 75 mg/m² Once daily | subcutaneous injection |
Instructions:
Or administer intravenously as per institutional practice. |
|
| etoposide (as phosphate) * | 100 mg/m² Once daily | intravenous | 60 minutes |
Day: 3
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| cytarabine | 75 mg/m² Once daily | subcutaneous injection |
Instructions:
Or administer intravenously as per institutional practice. |
|
| etoposide (as phosphate) * | 100 mg/m² Once daily | intravenous | 60 minutes |
Day: 4
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| cytarabine | 75 mg/m² Once daily | subcutaneous injection |
Instructions:
Or administer intravenously as per institutional practice. |
|
| etoposide (as phosphate) * | 100 mg/m² Once daily | intravenous | 60 minutes |
Day: 5
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| cytarabine | 75 mg/m² Once daily | subcutaneous injection |
Instructions:
Or administer intravenously as per institutional practice. |
|
| etoposide (as phosphate) * | 100 mg/m² Once daily | intravenous | 60 minutes | |
| paracetamol * | 1000 mg flat dosing | oral administration |
Instructions:
30 minutes prior to pegaspargase. |
|
| loratadine * | 10 mg | oral administration |
Instructions:
30 minutes prior to pegaspargase. |
|
| famotidine * | 20 mg | oral administration |
Instructions:
30 minutes prior to pegaspargase. |
|
| pegaspargase * | 1000 international unit/m² | intravenous | 120 minutes |
Instructions:
Additional details:
|
Additional details
Section 1: Further information on pegaspagase
- Pegaspargase (and asparaginase products) should only be administered by centres with appropriate expertise.
- There is limited data available for use of pegaspargase in patients 65 years and older. Strongly consider not using pegaspargase in patients 65 years and older.
- Consideration can be given to reducing dose of pegaspargase to 500 international units/m2 for certain patients.
- Prior to using pegaspargase perform a baseline abdominal ultrasound scan is recommended to examine the biliary tract, pancreas and hepatic echotexture. Pegasparagase is contraindicated in those with a history of severe significant hepatic impairment, including alcoholic liver disease, autoimmune or viral hepatitis, and steatohepatitis/NASH.
- If after pegaspargase there is any evidence of steatosis/liver disease, perform an ultrasound of the liver.
- Development of anti-asparaginase antibodies may be associated with low asparaginase activity levels. As a precaution, periodic measurement of the asparaginase activity level in serum or plasma is recommended.
- Routine monitoring for bone marrow suppression, coagulations abnormalities, pancreatitis, hepatic toxicity, hyperuricaemia, hyperglycaemia, ketoacidosis and hypertriglyceridaemia is required. See Additional information - pegaspargase.
- To reduce risk of hypersensitivity to pegaspargase avoid using other pegylated products e.g. pegFILGRASTIM if there is a suitable non-pegylated form.
Supportive Care Factors
| Factor | Value |
|---|---|
| Antifungal prophylaxis: | Routine antifungal prophylaxis recommended |
| Antiviral prophylaxis for herpes virus: | Routine antiviral prophylaxis recommended |
| Emetogenicity: | Low |
| Hypersensitivity / Infusion related reaction risk: | High - routine premedication recommended |
| Pneumocystis jirovecii pneumonia (PJP) prophylaxis: | Routine antibiotic prophylaxis recommended |
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
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.