Systemic Anti-Cancer Therapy Regimen Library
LEU ALL - HyperCVAD with pegaspargase Part A and B followed by POMP Maintenance [under 40 years]
Treatment Overview
HyperCVAD with pegaspargase Part A and B followed by POMP Maintenance [under 40 years] can be considered for patients under 40 years who are not eligible for an intensive paediatric regimen.
- Patients with T-cell acute lymphoblastic leukaemia commence on this regimen from cycle 1A.
- Patients with precursor B-cell (CD20 negative) acute lymphoblastic leukaemia.
- If after cycle 1A of HyperCVAD, the patient is not in complete morphological remission they may commence on this regimen from cycle 1B.
- If after cycle 1B of HyperCVAD, the patient is MRD-positive they may commence on this regimen from cycle 2A.
Treatment overview
HyperCVAD with pegaspargase Part A and B is given as alternating cycles of Part A and B as follows: 1A, 1B, 2A, 2B, 3A, 3B, 4A, 4B; every 21 days, or sooner if counts have recovered.
This is followed, in non-transplant patients, by POMP Maintenance for 2 years.
General Schema:
Intrathecal therapy is dependent on patients CNS risk, see Overview of Intrathecal CNS Prophylaxis in Additional details.
- Use the appropriate HyperCVAD Part A and B regimen below for the patient's CNS disease risk.
- If CNS is positive for disease, administer intrathecal chemotherapy as per institutional practice twice a week until the CNS is cleared, then continue with intrathecal therapy for High Risk.
Alternates with a cycle of Part B every 21 days, or sooner if counts have recovered.
Use the Part A regimen specific for CNS risk of the patient.
Intrathecal therapy in this Part A regimen is intended for patients with Unknown Risk [default].
Alternates with a cycle of Part B every 21 days, or sooner if counts have recovered.
Use the Part A regimen specific for CNS risk of the patient.
Intrathecal therapy in this Part A regimen is intended for patients with High Risk.
Alternates with a cycle of Part A every 21 days, or sooner if counts have recovered.
Use the Part B regimen specific for CNS risk of the patient.
Intrathecal therapy in this Part B regimen is intended for patients with Unknown Risk [default].
Alternates with a cycle of Part A every 21 days, or sooner if counts have recovered.
Use the Part B regimen specific for CNS risk of the patient.
Intrathecal therapy in this Part B regimen is intended for patients with High Risk.
Follows HyperCVAD Cycle 4B.
Not used for transplant patients.
Additional details
Section 1: Overview of Intrathecal CNS Prophylaxis
Supportive Care Factors
| Factor | Value |
|---|---|
| Antifungal prophylaxis: | Variable |
| Antiviral prophylaxis for herpes virus: | Routine antiviral prophylaxis recommended |
| Constipation risk: | Variable |
| Emetogenicity: | Variable |
| Folinic acid rescue for high dose methotrexate: | Variable |
| Growth factor support: | Variable |
| Hydration: | Variable |
| Hypersensitivity / Infusion related reaction risk: | Variable |
| Mesna uroprotection: | Variable |
| Ocular toxicity risk: | Variable |
| Pneumocystis jirovecii pneumonia (PJP) prophylaxis: | Routine antibiotic prophylaxis recommended |
| Tumour lysis syndrome prophylaxis: | Variable |
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.
References
Pegaspargase added to hyperCVAD personal communication from Dr Vidya Mathavan, Waikato Hospital, 7 March 2022.
Regimen details sometimes vary slightly from the published literature after recommendation by expert committee consensus.
* 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.