Systemic Anti-Cancer Therapy Regimen Library
UKALL14 [40 years and under] - Maintenance (LEU ALL - UKALL14 [40 years and under])
Treatment Overview
NOT to be used for transplant patients.
Starts after count recovery from Consolidation Cycle 4, with neutrophils greater than 0.75 x 109/L and platelets greater than 75 x 109/L.
Dosing of Maintenance therapy should be adjusted to maintain:
- Neutrophil count between 0.75 and 1.5 x 109/L.
- Platelet count between 75 and 150 x 109/L.
Cycles 1 to 8 - 84 days
Intrathecal metHOTREXATe:
- May be administered during Maintenance if neutrophils greater than 0.75 x 109/L and platelets greater than 75 x 109/L.
- For Ommaya reservoir reduce dose to 6 mg intraventricularly.
mercaptOPURine:
- Adjust dose to maintain neutrophils between 0.75 and 1.5 x 109/L and platelets between 75 and 150 x 109/L.
- Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.
Oral metHOTREXATe:
- Adjust dose to maintain neutrophils between 0.75 and 1.5 x 109/L and platelets between 75 and 150 x 109/L.
- Avoid trimethoprim + sulfamethoxazole on the days oral metHOTREXATe is administered.
Cycle details
Cycles 1 to 8 - 84 days
Medication | Dose | Route | Days | Max Duration |
---|---|---|---|---|
vinCRISTine | 1.4 mg/m² Cap dose per administration at: 2 mg | intravenous | 1 | 10 minutes |
metHOTREXATe | 12 mg flat dosing | intrathecal injection | 1 | |
prEDNISone | 60 mg/m² Once daily | oral administration | 1 to 5 | |
mercaptOPURine | 75 mg/m² Once daily | oral administration | 1 to 84 | |
metHOTREXATe * | 20 mg/m² Once a week | oral administration | 1, 8, 15, 22, 29, 36, 43, 50, 57, 64, 71, 78 |
Intrathecal metHOTREXATe:
- May be administered during Maintenance if neutrophils greater than 0.75 x 109/L and platelets greater than 75 x 109/L.
- For Ommaya reservoir reduce dose to 6 mg intraventricularly.
mercaptOPURine:
- Adjust dose to maintain neutrophils between 0.75 and 1.5 x 109/L and platelets between 75 and 150 x 109/L.
- Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.
Oral metHOTREXATe:
- Adjust dose to maintain neutrophils between 0.75 and 1.5 x 109/L and platelets between 75 and 150 x 109/L.
- Avoid trimethoprim + sulfamethoxazole on the days oral metHOTREXATe is administered.
Full details
Cycles 1 to 8 - 84 days
Day: 1
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
vinCRISTine | 1.4 mg/m² Cap dose per administration at: 2 mg | intravenous | 10 minutes |
Instructions:
|
metHOTREXATe | 12 mg flat dosing | intrathecal injection |
Instructions:
|
|
prEDNISone | 60 mg/m² Once daily | oral administration |
Instructions:
Take in the morning with food. |
|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
|
metHOTREXATe * | 20 mg/m² Once a week | oral administration |
Instructions:
|
Day: 2
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
prEDNISone | 60 mg/m² Once daily | oral administration |
Instructions:
Take in the morning with food. |
|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 3
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
prEDNISone | 60 mg/m² Once daily | oral administration |
Instructions:
Take in the morning with food. |
|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 4
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
prEDNISone | 60 mg/m² Once daily | oral administration |
Instructions:
Take in the morning with food. |
|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 5
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
prEDNISone | 60 mg/m² Once daily | oral administration |
Instructions:
Take in the morning with food. |
|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 6
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 7
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 8
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
|
metHOTREXATe * | 20 mg/m² Once a week | oral administration |
Instructions:
|
Day: 9
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 10
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 11
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 12
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 13
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 14
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 15
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
|
metHOTREXATe * | 20 mg/m² Once a week | oral administration |
Instructions:
|
Day: 16
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 17
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 18
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 19
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 20
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 21
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 22
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
|
metHOTREXATe * | 20 mg/m² Once a week | oral administration |
Instructions:
|
Day: 23
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 24
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 25
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 26
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 27
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 28
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 29
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
|
metHOTREXATe * | 20 mg/m² Once a week | oral administration |
Instructions:
|
Day: 30
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 31
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 32
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 33
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 34
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 35
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 36
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
|
metHOTREXATe * | 20 mg/m² Once a week | oral administration |
Instructions:
|
Day: 37
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 38
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 39
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 40
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 41
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 42
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 43
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
|
metHOTREXATe * | 20 mg/m² Once a week | oral administration |
Instructions:
|
Day: 44
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 45
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 46
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 47
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 48
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 49
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 50
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
|
metHOTREXATe * | 20 mg/m² Once a week | oral administration |
Instructions:
|
Day: 51
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 52
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 53
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 54
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 55
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 56
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 57
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
|
metHOTREXATe * | 20 mg/m² Once a week | oral administration |
Instructions:
|
Day: 58
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 59
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 60
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 61
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 62
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 63
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 64
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
|
metHOTREXATe * | 20 mg/m² Once a week | oral administration |
Instructions:
|
Day: 65
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 66
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 67
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 68
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 69
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 70
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 71
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
|
metHOTREXATe * | 20 mg/m² Once a week | oral administration |
Instructions:
|
Day: 72
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 73
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 74
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 75
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 76
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 77
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 78
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
|
metHOTREXATe * | 20 mg/m² Once a week | oral administration |
Instructions:
|
Day: 79
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 80
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 81
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 82
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 83
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Day: 84
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
mercaptOPURine | 75 mg/m² Once daily | oral administration |
Instructions:
|
Supportive Care Factors
Factor | Value |
---|---|
Antiviral prophylaxis for herpes virus: | Routine antiviral prophylaxis recommended |
Constipation risk: | Consider prescribing laxatives with this treatment |
Emetogenicity: | Minimal to low |
Gastroprotection: | Gastroprotection is 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.
Gastroprotection: Gastroprotection agents are only intended for short term use while patient is receiving corticosteroid treatment doses.
PJP prophylaxis: Avoid trimethoprim + sulfamethoxazole on the days oral metHOTREXATe is administered.
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.