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    Paediatric BFM (Standard Risk) M Protocol

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    Paediatric BFM (Standard Risk) M Protocol

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    amitaroramamc
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    46 views3 pages

    Paediatric BFM (Standard Risk) M Protocol

    Uploaded by

    amitaroramamc

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 3

    e ACUTE LYMPHOBLASTIC LEUKAEMIA

    PAEDIATRIC BFM (STANDARD RISK)


    M PROTOCOL

    A. Age > 1 year, < 10 years


    B. WBC < 20,000/cmm
    C. Prednisolone good response
    D. Pre B, CALLA immunophenotype (no T immunophenotype, no aberrant markers)
    E. No translocation t(9;22) or t(4;11)
    F. No CNS disease

    PREINDUCTION (1 week)

    1. Dexamethasone 6 mg/ m2 iv Days 1 & 2


    2. Prednisolone 60 mg/ m2 p/o daily Days 3 - 7
    3. Inj. Methotrexate IT stat Day 1

    INDUCTION

    Phase I: 2 - 5 weeks

    1. Vincristine 1.5 mg/ m2 iv weekly x 4 (Day 8,15,22,29)


    2. Daunorubicin 30 mg/ m2 iv weekly x 2 (Day 8,15)
    3. L'Asparaginase 5,000 U/ m2/day IV every third day x 8 doses (days12,15,18,21,24,27,30,33)
    ( minimum number of doses = 8)
    4. Prednisolone 60 mg/ m2 p/o daily x 3 weeks and then taper over 10 days
    5. Inj. Methotrexate IT stat day 15

    1 week after completion of Phase I, BM and CSF to assess remission status

    Phase II: 6 - 9 weeks

    1. Cyclophosphamide 1000 mg/ m2 iv Day 1 & Day 29 (ANC >1000cmm)


    2. AraC 75 mg/ m2 iv/sc daily x 4 days (Days 1 - 4) followed by 3 days rest.
    Repeat x Total 4 cycles of Ara-C
    3. Intrathecal Methotrexate weekly x 4
    a. < 1 year 6 mg b. 1 – 2 year 8 mg

    c. 2 – 3 year 10 mg d. > 3 year 12 mg


    4. Tab. 6 MP 60 mg/m2/day for 28 days

    NO CRANIAL PROPHYLAXIS

    2 WEEKS REST
    M PROTOCOL

    12 - 20 weeks
    1. Inj. Methotrexate 5gm/m2 10% over 30 min; 90% over 23.5 hours on Day +8,+22,+36,+50
    2. Inj. MTx (age adjusted) on Day +8,+22,+36,+50
    3. 6MP 25mg/m2/day for 8 weeks
    Inj. Folinic acid 15mg/ m2 start 18 hours after MTX Q6H for 3 doses

    N.B: MTX LEVELS -- If higher level is found then LCV rescue to start at 36 hours.
    24 Hours < 150mmol/L; 36 Hours < 3.0 mmol/L; 42 Hours < 1.0 mmol/L;
    48 Hours < 0.4 mmol/L

    TWO WEEKS REST

    REINDUCTION

    Phase I: 23 - 27 weeks

    1. Vincristine 1.5 mg/ m2 iv weekly x 4


    2. Adriamycin 30 mg/ m2 iv weekly x 4
    3. L'Asparaginase 10,000 U/ m2 /dose iv/im/sc given 10,000 U on days 1, 4, 7 & 11
    4. Dexamethasone 10 mg/ m2 p/o daily x 4 weeks and then taper over 10 days
    5. Inj. MTx IT stat day 1 and day 18

    Phase II: 28 - 30 weeks

    1. Cyclophosphamide 1000 mg/ m2 iv Day 1


    2. AraC 75 mg/ m2 iv/sc daily x 4 days (Day 1 - 4) followed by 3 days rest
    Repeat x Total 2 cycles of Ara-C
    3. Tab. 6 TG 60 mg/m2/day for 2 weeks

    TWO WEEKS REST

    MAINTENANCE

    33 - 137 weeks

    1. 6-Mercaptopurine 50 mg/ m2 p/o daily x 2 years (3 years for boys)


    2. Methotrexate 20 mg/ m2 p/o once a week x 2 years (3 years for boys)
    3. Inj.Vincristine 1.4 mg/m2 once a month x 2 years
    4. Tab. Dexa 6 mg/m2 daily for 5 days once a month x 2 years
    5. Inj. MTx IT stat once every three months x 2 years
    Ref : ALL – BFM 95
    Leukemia (2000) 14, 2307-2320 – UKALLXI Modified APRIL 2005
    Department of Haematology
    Christian Medical College & Hospital, Vellore

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