Chemotherapy

Days 1–3: Daunorubicin 60mg/m2 IV

Days 1, 8, 15, and 22: Vincristine 1.4mg/m2 IV (maximum, 2mg)

Day 15: Pegaspargase 2,000IU/m2 IV

Days 1–28: Prednisone 60mg/m2 orally

Days 8 and 15: MTX 12mg IT

Days 1 and 29: Cyclophosphamide 1g/m2 IV\1

Days 1–4, 8–11, 29–32, and 36–39: Cytarabine 75mg/m2 IV

Days 15, 22, 43, and 50: Vincristine 1.4mg/m2 IV (maximum, 2mg)

Day 15: Pegaspargase 2,000IU/m2 IV

Days 15–29: Prednisone 20mg/m2 orally

Days 1–14 and 29–43: Mercaptopurine 60mg/m2 orally

Days 1, 8, 15, and 22: MTX 12mg IT

Days 1 and 15: MTX 1g/m2 IV (T-cell ALL, 2.5g/m2 IV) + leucovorin 15mg every 6 hours IV starting 36 hours from * start of MTX

Day 16: Pegaspargase 2,000IU/m2 IV

Days 16–30: Prednisone 20mg/m2 orally Consolidation

Days 1–5: Cytarabine 75mg/m2 IV + teniposide 60mg/m2 IV

Days 1, 8, and 15: Daunorubicin 25mg/m2 IV

Days 1, 8, 15, 43, and 50: Vincristine 1.4mg/m2 IV (maximum, 2mg)

Days 15–22 and 43–50: Dexamethasone 10mg/m2 orally

Day 15: Pegaspargase 2,000IU/m2 IV

Day 29: Cyclophosphamide 1g/m2

Days 29–32 and 36–39: Cytarabine 75mg/m2 IV

Days 26–42: Thioguanine 60mg/m2 orally

Days 1, 29, and 36: MTX 12mg IT

Monthly for 24 months from end of all consolidations

Days 1–5: Prednisone 60mg/m2 orally (year 1, monthly; year 2, every 2 months)

Day 1: Vincristine 1.4mg/m2 (maximum, 2mg) IV (year 1, monthly; year 2, every 2 months)

Days 1–28: Mercaptopurine 60mg/m2 orally

Days 1, 8, 15, and 22: MTX 20mg/m2 orally + MTX 12mg IT (year 1, once every 3 months).

Imatinib 600mg once daily from induction until end of standard maintenance regimen added for Philadelphia chromosome–positive patients.

Coagulopathy

Hyperfibrinogenemia (cryo for fibrinogen < 61, or if bleeding with platelets < 50)

Hyperglycemia

Hypertriglyceridemia (treat for TG > 900)

Necrotizing pancreatitis (consider NPO with IVF and CT for excessive vomiting/pain)

Liver toxicity (hyperbilirubinemia, transaminitis)