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Systemic Anti-Cancer Therapy Regimen Library

Home > LEU ALL precursor T-cell - GMALL T-LBL 1/2004 [over 55 years] > LEU - GMALL T-LBL 1/2004 Reinduction
This regimen is a component of LEU ALL precursor T-cell - GMALL T-LBL 1/2004 [over 55 years]

GMALL T-LBL 1/2004 [over 55 years] - Reinduction I and II (LEU ALL precursor T-cell - GMALL T-LBL 1/2004 [over 55 years])

Treatment Overview

Commencing week 22 Reinduction I [days 1 to 14] then Reinduction II [days 15 to 28].

Cycle 1 - 28 days

Cycle length:
28

Intrathecal metHOTREXATe: For Ommaya reservoir reduce dose to 6 mg intraventricularly.


cytarabine: Administer by subcutaneous injection (as above) or alternatively administer intravenously as per institutional practice.


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

Cycle details

Cycle 1 - 28 days

Medication Dose Route Days Max Duration
prEDNISone * 20 mg/m² Three times daily oral administration 1 to 14
vinCRISTine 1.4 mg/m² Cap dose per administration at: 2 mg intravenous 1, 7 10 minutes
DOXOrubicin * 50 mg/m² intravenous 1, 7 15 minutes
metHOTREXATe 12 mg flat dosing intrathecal injection 1, 15
cytarabine 30 mg flat dosing intrathecal injection 1, 15
hydrocortisone * 30 mg flat dosing intrathecal injection 1, 15
CYCLOPHOSPHamide 1000 mg/m² intravenous 15 60 minutes
cytarabine 75 mg/m² Once daily subcutaneous injection 17 to 20,
24 to 27
tioguanine 60 mg/m² Once daily oral administration 15 to 28

Intrathecal metHOTREXATe: For Ommaya reservoir reduce dose to 6 mg intraventricularly.


cytarabine: Administer by subcutaneous injection (as above) or alternatively administer intravenously as per institutional practice.


tioguanine: 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
prEDNISone * 20 mg/m² Three times daily oral administration
Instructions:

Take with food.
vinCRISTine 1.4 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.
DOXOrubicin * 50 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.
metHOTREXATe 12 mg flat dosing intrathecal injection
Instructions:

Adhere to local institution policy for intrathecal administration.

For Ommaya reservoir reduce dose to 6 mg intraventricularly.
cytarabine 30 mg flat dosing intrathecal injection
Instructions:

Adhere to local institution policy for intrathecal administration.
hydrocortisone * 30 mg flat dosing intrathecal injection
Instructions:

Adhere to local institution policy for intrathecal administration.

Day: 2

Medication Dose Route Max duration Details
prEDNISone * 20 mg/m² Three times daily oral administration
Instructions:

Take with food.

Day: 3

Medication Dose Route Max duration Details
prEDNISone * 20 mg/m² Three times daily oral administration
Instructions:

Take with food.

Day: 4

Medication Dose Route Max duration Details
prEDNISone * 20 mg/m² Three times daily oral administration
Instructions:

Take with food.

Day: 5

Medication Dose Route Max duration Details
prEDNISone * 20 mg/m² Three times daily oral administration
Instructions:

Take with food.

Day: 6

Medication Dose Route Max duration Details
prEDNISone * 20 mg/m² Three times daily oral administration
Instructions:

Take with food.

Day: 7

Medication Dose Route Max duration Details
prEDNISone * 20 mg/m² Three times daily oral administration
Instructions:

Take with food.
vinCRISTine 1.4 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.
DOXOrubicin * 50 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.

Day: 8

Medication Dose Route Max duration Details
prEDNISone * 20 mg/m² Three times daily oral administration
Instructions:

Take with food.

Day: 9

Medication Dose Route Max duration Details
prEDNISone * 20 mg/m² Three times daily oral administration
Instructions:

Take with food.

Day: 10

Medication Dose Route Max duration Details
prEDNISone * 20 mg/m² Three times daily oral administration
Instructions:

Take with food.

Day: 11

Medication Dose Route Max duration Details
prEDNISone * 20 mg/m² Three times daily oral administration
Instructions:

Take with food.

Day: 12

Medication Dose Route Max duration Details
prEDNISone * 20 mg/m² Three times daily oral administration
Instructions:

Take with food.

Day: 13

Medication Dose Route Max duration Details
prEDNISone * 20 mg/m² Three times daily oral administration
Instructions:

Take with food.

Day: 14

Medication Dose Route Max duration Details
prEDNISone * 20 mg/m² Three times daily oral administration
Instructions:

Take with food.

Day: 15

Medication Dose Route Max duration Details
metHOTREXATe 12 mg flat dosing intrathecal injection
Instructions:

Adhere to local institution policy for intrathecal administration.

For Ommaya reservoir reduce dose to 6 mg intraventricularly.
cytarabine 30 mg flat dosing intrathecal injection
Instructions:

Adhere to local institution policy for intrathecal administration.
hydrocortisone * 30 mg flat dosing intrathecal injection
Instructions:

Adhere to local institution policy for intrathecal administration.
CYCLOPHOSPHamide 1000 mg/m² intravenous 60 minutes
Instructions:

Consider hydration with at least 2000 to 3000 ml over 24 hours as oral or IV fluid on day(s) of CYCLOPHOSPHamide and for 24 hours after or as per institutional practice.
tioguanine 60 mg/m² Once daily oral administration
Instructions:
  • Swallow whole with a glass of water.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.
  • Round dose to closest multiple of 20 mg.

Day: 16

Medication Dose Route Max duration Details
tioguanine 60 mg/m² Once daily oral administration
Instructions:
  • Swallow whole with a glass of water.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.
  • Round dose to closest multiple of 20 mg.

Day: 17

Medication Dose Route Max duration Details
cytarabine 75 mg/m² Once daily subcutaneous injection
Instructions:

Or administer intravenously as per institutional practice.
tioguanine 60 mg/m² Once daily oral administration
Instructions:
  • Swallow whole with a glass of water.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.
  • Round dose to closest multiple of 20 mg.

Day: 18

Medication Dose Route Max duration Details
cytarabine 75 mg/m² Once daily subcutaneous injection
Instructions:

Or administer intravenously as per institutional practice.
tioguanine 60 mg/m² Once daily oral administration
Instructions:
  • Swallow whole with a glass of water.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.
  • Round dose to closest multiple of 20 mg.

Day: 19

Medication Dose Route Max duration Details
cytarabine 75 mg/m² Once daily subcutaneous injection
Instructions:

Or administer intravenously as per institutional practice.
tioguanine 60 mg/m² Once daily oral administration
Instructions:
  • Swallow whole with a glass of water.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.
  • Round dose to closest multiple of 20 mg.

Day: 20

Medication Dose Route Max duration Details
cytarabine 75 mg/m² Once daily subcutaneous injection
Instructions:

Or administer intravenously as per institutional practice.
tioguanine 60 mg/m² Once daily oral administration
Instructions:
  • Swallow whole with a glass of water.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.
  • Round dose to closest multiple of 20 mg.

Day: 21

Medication Dose Route Max duration Details
tioguanine 60 mg/m² Once daily oral administration
Instructions:
  • Swallow whole with a glass of water.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.
  • Round dose to closest multiple of 20 mg.

Day: 22

Medication Dose Route Max duration Details
tioguanine 60 mg/m² Once daily oral administration
Instructions:
  • Swallow whole with a glass of water.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.
  • Round dose to closest multiple of 20 mg.

Day: 23

Medication Dose Route Max duration Details
tioguanine 60 mg/m² Once daily oral administration
Instructions:
  • Swallow whole with a glass of water.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.
  • Round dose to closest multiple of 20 mg.

Day: 24

Medication Dose Route Max duration Details
cytarabine 75 mg/m² Once daily subcutaneous injection
Instructions:

Or administer intravenously as per institutional practice.
tioguanine 60 mg/m² Once daily oral administration
Instructions:
  • Swallow whole with a glass of water.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.
  • Round dose to closest multiple of 20 mg.

Day: 25

Medication Dose Route Max duration Details
cytarabine 75 mg/m² Once daily subcutaneous injection
Instructions:

Or administer intravenously as per institutional practice.
tioguanine 60 mg/m² Once daily oral administration
Instructions:
  • Swallow whole with a glass of water.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.
  • Round dose to closest multiple of 20 mg.

Day: 26

Medication Dose Route Max duration Details
cytarabine 75 mg/m² Once daily subcutaneous injection
Instructions:

Or administer intravenously as per institutional practice.
tioguanine 60 mg/m² Once daily oral administration
Instructions:
  • Swallow whole with a glass of water.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.
  • Round dose to closest multiple of 20 mg.

Day: 27

Medication Dose Route Max duration Details
cytarabine 75 mg/m² Once daily subcutaneous injection
Instructions:

Or administer intravenously as per institutional practice.
tioguanine 60 mg/m² Once daily oral administration
Instructions:
  • Swallow whole with a glass of water.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.
  • Round dose to closest multiple of 20 mg.

Day: 28

Medication Dose Route Max duration Details
tioguanine 60 mg/m² Once daily oral administration
Instructions:
  • Swallow whole with a glass of water.
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.
  • Round dose to closest multiple of 20 mg.

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

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 days 1, 7 and 15; MINIMAL to LOW days 16 to 28.


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

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.