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Systemic Anti-Cancer Therapy Regimen Library

Home > LEU ALL precursor B-cell - AALL1131 [very high risk] > LEU - AALL1131 Maintenance [CNS1 and 2]
This regimen is a component of LEU ALL precursor B-cell - AALL1131 [very high risk]

AALL1131 [very high risk] - Maintenance for CNS 1/2+ (LEU ALL precursor B-cell - AALL1131 [very high risk])

Treatment Overview

Use Maintenance regimen specific for CNS status of patient.

The intrathecal therapy in this Maintenance regimen is intended for patients with CNS1+ or 2+ disease, for those who did not receive CNS radiation.


Not to be used for transplant patients.


Starts on day 57 of Interim maintenance 2 or on count recovery, whichever occurs later.

Frequency: 84 days, or on count recovery.

Count recovery is defined as:

  • Neutrophils greater than 0.75 x 109/L, and
  • Platelets greater than 75 x 109/L.

Total treatment time is 2 years from the start of Interim maintenance 1. Therapy may be stopped on anniversary date if the 5-day prednisone is completed for the cycle.

Cycles 1 to 2 - 84 days

Cycle length:
84

Oral metHOTREXATe:

  • Weekly dose is omitted on day 1 and 29 when intrathecal metHOTREXATe is given.
  • See COG protocol for dose adjustments based on neutrophil and platelet counts during Maintenance. 

mercaptOPURine:

  • See COG protocol for dose adjustments based on neutrophil and platelet counts during Maintenance. 
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.

Intrathecal metHOTREXATe:

  • Scheduled day 1 and 29 of the first 2 cycles of Maintenance for CNS 1+ and 2+ disease, for those who did not receive CNS radiation.
  • For Ommaya reservoir reduce dose to 6 mg intraventricularly.

Cycles 3 to 7 - 84 days

Cycle length:
84

Oral metHOTREXATe:

  • Weekly dose is omitted on day 1 when intrathecal metHOTREXATe is given.
  • See COG protocol for dose adjustments based on neutrophil and platelet counts during Maintenance. 

mercaptOPURine:

  • See COG protocol for dose adjustments based on neutrophil and platelets count during Maintenance. 
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.

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

Cycle details

Cycles 1 to 2 - 84 days

Medication Dose Route Days Max Duration
metHOTREXATe * 20 mg/m² Once a week oral administration 8, 15, 22,
36, 43, 50,
57, 64, 71,
78
mercaptOPURine 75 mg/m² Once daily oral administration 1 to 84
vinCRISTine * 1.5 mg/m² Cap dose per administration at: 2 mg intravenous 1 10 minutes
prEDNISone 20 mg/m² Twice daily oral administration 1 to 5
metHOTREXATe * 15 mg intrathecal injection 1, 29

Oral metHOTREXATe:

  • Weekly dose is omitted on day 1 and 29 when intrathecal metHOTREXATe is given.
  • See COG protocol for dose adjustments based on neutrophil and platelet counts during Maintenance. 

mercaptOPURine:

  • See COG protocol for dose adjustments based on neutrophil and platelet counts during Maintenance. 
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.

Intrathecal metHOTREXATe:

  • Scheduled day 1 and 29 of the first 2 cycles of Maintenance for CNS 1+ and 2+ disease, for those who did not receive CNS radiation.
  • For Ommaya reservoir reduce dose to 6 mg intraventricularly.

Cycles 3 to 7 - 84 days

Medication Dose Route Days Max Duration
metHOTREXATe * 20 mg/m² Once a week oral administration 8, 15, 22,
29, 36, 43,
50, 57, 64,
71, 78
mercaptOPURine 75 mg/m² Once daily oral administration 1 to 84
vinCRISTine * 1.5 mg/m² Cap dose per administration at: 2 mg intravenous 1 10 minutes
prEDNISone 20 mg/m² Twice daily oral administration 1 to 5
metHOTREXATe * 15 mg intrathecal injection 1

Oral metHOTREXATe:

  • Weekly dose is omitted on day 1 when intrathecal metHOTREXATe is given.
  • See COG protocol for dose adjustments based on neutrophil and platelet counts during Maintenance. 

mercaptOPURine:

  • See COG protocol for dose adjustments based on neutrophil and platelets count during Maintenance. 
  • Consider thiopurine methyltransferase (TPMT) testing and NUDT15 screening for specific patients.

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

Full details

Cycles 1 to 2 - 84 days

Day: 1

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
vinCRISTine * 1.5 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.
prEDNISone 20 mg/m² Twice daily oral administration
Instructions:

Take with food.
metHOTREXATe * 15 mg intrathecal injection
Instructions:
  • Adhere to local institution policy for intrathecal administration.
  • For Ommaya reservoir reduce dose to 6 mg intraventricularly.

Day: 2

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
prEDNISone 20 mg/m² Twice daily oral administration
Instructions:

Take with food.

Day: 3

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
prEDNISone 20 mg/m² Twice daily oral administration
Instructions:

Take with food.

Day: 4

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
prEDNISone 20 mg/m² Twice daily oral administration
Instructions:

Take with food.

Day: 5

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
prEDNISone 20 mg/m² Twice daily oral administration
Instructions:

Take with food.

Day: 6

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 7

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 8

Medication Dose Route Max duration Details
metHOTREXATe * 20 mg/m² Once a week oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Protect yourself from too much natural or artificial sunlight while being treated with this medicine.
  • Round dose to closest multiple of 2.5 mg tablets.
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 9

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 10

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 11

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 12

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 13

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 14

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 15

Medication Dose Route Max duration Details
metHOTREXATe * 20 mg/m² Once a week oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Protect yourself from too much natural or artificial sunlight while being treated with this medicine.
  • Round dose to closest multiple of 2.5 mg tablets.
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 16

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 17

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 18

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 19

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 20

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 21

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 22

Medication Dose Route Max duration Details
metHOTREXATe * 20 mg/m² Once a week oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Protect yourself from too much natural or artificial sunlight while being treated with this medicine.
  • Round dose to closest multiple of 2.5 mg tablets.
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 23

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 24

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 25

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 26

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 27

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 28

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 29

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
metHOTREXATe * 15 mg intrathecal injection
Instructions:
  • Adhere to local institution policy for intrathecal administration.
  • For Ommaya reservoir reduce dose to 6 mg intraventricularly.

Day: 30

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 31

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 32

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 33

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 34

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 35

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 36

Medication Dose Route Max duration Details
metHOTREXATe * 20 mg/m² Once a week oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Protect yourself from too much natural or artificial sunlight while being treated with this medicine.
  • Round dose to closest multiple of 2.5 mg tablets.
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 37

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 38

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 39

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 40

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 41

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 42

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 43

Medication Dose Route Max duration Details
metHOTREXATe * 20 mg/m² Once a week oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Protect yourself from too much natural or artificial sunlight while being treated with this medicine.
  • Round dose to closest multiple of 2.5 mg tablets.
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 44

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 45

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 46

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 47

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 48

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 49

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 50

Medication Dose Route Max duration Details
metHOTREXATe * 20 mg/m² Once a week oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Protect yourself from too much natural or artificial sunlight while being treated with this medicine.
  • Round dose to closest multiple of 2.5 mg tablets.
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 51

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 52

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 53

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 54

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 55

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 56

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 57

Medication Dose Route Max duration Details
metHOTREXATe * 20 mg/m² Once a week oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Protect yourself from too much natural or artificial sunlight while being treated with this medicine.
  • Round dose to closest multiple of 2.5 mg tablets.
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 58

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 59

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 60

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 61

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 62

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 63

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 64

Medication Dose Route Max duration Details
metHOTREXATe * 20 mg/m² Once a week oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Protect yourself from too much natural or artificial sunlight while being treated with this medicine.
  • Round dose to closest multiple of 2.5 mg tablets.
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 65

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 66

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 67

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 68

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 69

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 70

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 71

Medication Dose Route Max duration Details
metHOTREXATe * 20 mg/m² Once a week oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Protect yourself from too much natural or artificial sunlight while being treated with this medicine.
  • Round dose to closest multiple of 2.5 mg tablets.
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 72

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 73

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 74

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 75

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 76

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 77

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 78

Medication Dose Route Max duration Details
metHOTREXATe * 20 mg/m² Once a week oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Protect yourself from too much natural or artificial sunlight while being treated with this medicine.
  • Round dose to closest multiple of 2.5 mg tablets.
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 79

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 80

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 81

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 82

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 83

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 84

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Cycles 3 to 7 - 84 days

Day: 1

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
vinCRISTine * 1.5 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.
prEDNISone 20 mg/m² Twice daily oral administration
Instructions:

Take with food.
metHOTREXATe * 15 mg intrathecal injection
Instructions:
  • Adhere to local institution policy for intrathecal administration.
  • For Ommaya reservoir reduce dose to 6 mg intraventricularly.

Day: 2

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
prEDNISone 20 mg/m² Twice daily oral administration
Instructions:

Take with food.

Day: 3

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
prEDNISone 20 mg/m² Twice daily oral administration
Instructions:

Take with food.

Day: 4

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
prEDNISone 20 mg/m² Twice daily oral administration
Instructions:

Take with food.

Day: 5

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.
prEDNISone 20 mg/m² Twice daily oral administration
Instructions:

Take with food.

Day: 6

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 7

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 8

Medication Dose Route Max duration Details
metHOTREXATe * 20 mg/m² Once a week oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Protect yourself from too much natural or artificial sunlight while being treated with this medicine.
  • Round dose to closest multiple of 2.5 mg tablets.
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 9

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 10

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 11

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 12

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 13

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 14

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 15

Medication Dose Route Max duration Details
metHOTREXATe * 20 mg/m² Once a week oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Protect yourself from too much natural or artificial sunlight while being treated with this medicine.
  • Round dose to closest multiple of 2.5 mg tablets.
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 16

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 17

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 18

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 19

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 20

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 21

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 22

Medication Dose Route Max duration Details
metHOTREXATe * 20 mg/m² Once a week oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Protect yourself from too much natural or artificial sunlight while being treated with this medicine.
  • Round dose to closest multiple of 2.5 mg tablets.
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 23

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 24

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 25

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 26

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 27

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 28

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 29

Medication Dose Route Max duration Details
metHOTREXATe * 20 mg/m² Once a week oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Protect yourself from too much natural or artificial sunlight while being treated with this medicine.
  • Round dose to closest multiple of 2.5 mg tablets.
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 30

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 31

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 32

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 33

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 34

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 35

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 36

Medication Dose Route Max duration Details
metHOTREXATe * 20 mg/m² Once a week oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Protect yourself from too much natural or artificial sunlight while being treated with this medicine.
  • Round dose to closest multiple of 2.5 mg tablets.
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 37

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 38

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 39

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 40

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 41

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 42

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 43

Medication Dose Route Max duration Details
metHOTREXATe * 20 mg/m² Once a week oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Protect yourself from too much natural or artificial sunlight while being treated with this medicine.
  • Round dose to closest multiple of 2.5 mg tablets.
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 44

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 45

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 46

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 47

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 48

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 49

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 50

Medication Dose Route Max duration Details
metHOTREXATe * 20 mg/m² Once a week oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Protect yourself from too much natural or artificial sunlight while being treated with this medicine.
  • Round dose to closest multiple of 2.5 mg tablets.
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 51

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 52

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 53

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 54

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 55

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 56

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 57

Medication Dose Route Max duration Details
metHOTREXATe * 20 mg/m² Once a week oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Protect yourself from too much natural or artificial sunlight while being treated with this medicine.
  • Round dose to closest multiple of 2.5 mg tablets.
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 58

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 59

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 60

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 61

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 62

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 63

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 64

Medication Dose Route Max duration Details
metHOTREXATe * 20 mg/m² Once a week oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Protect yourself from too much natural or artificial sunlight while being treated with this medicine.
  • Round dose to closest multiple of 2.5 mg tablets.
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 65

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 66

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 67

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 68

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 69

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 70

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 71

Medication Dose Route Max duration Details
metHOTREXATe * 20 mg/m² Once a week oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Protect yourself from too much natural or artificial sunlight while being treated with this medicine.
  • Round dose to closest multiple of 2.5 mg tablets.
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 72

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 73

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 74

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 75

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 76

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 77

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 78

Medication Dose Route Max duration Details
metHOTREXATe * 20 mg/m² Once a week oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Protect yourself from too much natural or artificial sunlight while being treated with this medicine.
  • Round dose to closest multiple of 2.5 mg tablets.
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 79

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 80

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 81

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 82

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 83

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

Day: 84

Medication Dose Route Max duration Details
mercaptOPURine 75 mg/m² Once daily oral administration
Instructions:
  • See COG protocol for dose adjustments based on neutrophil and platelet counts. 
  • Take each dose on an empty stomach – one hour before OR three hours after food or milk.
  • Round dose to closest multiple of 25 mg.

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: 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.