TABLE 18.11 High Rok ir High Rik B-Cell Acute Lympobloei Lear Proc Pesrmeren sy ‘Grete nto oy cs igh 1% 1 Crmiioe Sg may SC or Vda 2S 36-9 Methane Agente Taye 2 ‘er nena Sa om fr Vi TSmgZn ped ds TS380 Te AGATE HNEONLASTIC LEUKEMIA TTABLE 18.10 Thorp for Sanand/Avorage Rk Acute Lymphoblastic Lukes inion @wet) ‘Gal desman fr 8 days 6g /a ay os vl me) 1V vincristine 13 ag/n on days 914 a 2D, IV Poglted mpgs G50 yc yD, ‘Agcadsted intrathecal cytarabine age | to es than 3 years 20am age 20 than 3 year SO mg aged yeas and olier 0 mp on Day ‘Agente ath mete (ge 1 than 2 ea my age 2 oes han 3 yar, 100 ‘lle than 3-409 yor 12 mg ler than yr gon dy 8a 3) Comaliatin wee) ‘ral emeraphopurne CS gyn /al on days 1-26 one) WV inciting 3 mg/m on ay 1 [Agente ac ave ital methoteat on das 1 8 15 for patients without CNS dene at Inerim maintenance 1 (8 weeks) IV ners 1S g/m max dose 2m om days 1 11,2831 IV metbotat stating dove 0 100 mgr / dose on day 1 thereter escalate by 50 mg/m? /dose on days 111, SI-and 4 @scontn xan and eet 30 ve tho Gy cso Injelisuppreson or cea) ‘Ageadhnted nrathcalmthtrese Ge Iction n day 31 Dates neo) Ce dame 4/8 e729 IV vincristine (13 mg/m on dys 18 nd 15) 1V pegged Lsaparagnase 200 /?om day 4 Dovorsicn 25mg) 1 push on day 18 and 1W eclophorphamide (1000 ge ove 30 ain on day 29) Oral Miganin 0 mg/day om dye 39-42) IV Cyanine (75 m/m day, on Says 29- 23nd 16-99) ged atl mathe and) on [e‘Ageedhatedinathesl methotenate ce Induction on day 31 Delays itestcaton (weeks) Ora dexamethasone (10 mg/m? eon ays 1=7 and 19-21 days) . TV vincristine (15 mg/m days 18a 15) 1 ppt L-aparaginase 2500 on day 0 DDonorabicin 25mm IV pan a days 18 and 3 IWeelophosphamide (0% mg/n ver 30 min on day 29) Ont eahiogeaie (60 g/m om day 39-2) IV Cytarabin (75 mg/m day, on days 29-32 and 36-29) Ageadhte tata methtrsae ae Induction) om day 1S 29 Invern Maintenance 2(8 weeks) IV ineritin. 1 mg/m (mae done 2p om days 1 11.20 Stand 1 eethotroate tating deve is two-thirds the minus rte dove atid in inten mantonnce I onda therenter alate by S/n /dowe on ys 1, 21,31, and 4 (acontinae ‘Scaation a resume at Sofas dove if here delay Bocuse of nlonspprestan or aco) Ipsos itathesal methotrexate ae Inductin) on dy | ane Maintenance (2-veek cycle el Ora dexamethasone mg sowe ID on Das 1-5, 29-33, a 57-6 terepeated IV Vincristine LS mg/m on day 1,29, and 87 stl? years fr gira 3 years Oral mercaptopurine 7 eng / done om days 84 forboye (ral mettre 20 mg/m doae weekly ft on the days when receive IF methotenate) from the tart nr, TY Mahuta age dst) om day 1 Independent adverse prognostic features in this group ate ‘= Age less than 3 months. ‘© High WBC. ‘= Slow response to ind i] forty Oral methotrexate 3 mg/m dose weekly lt en the days when receive IT methotrexate) from ho so iinerin Wataotoeste py set ony? Independent averse prognonic stures in this group ae: Age les than 3 months Tih WBC Siow response to induction Presence translocation ot 123, Infant ALL requires very intensive therapy with advanced supportive care. Many’ centers advocate allogeneic rem cell transplantation for infant ALL with an 11423 cytogenete anormal or a molecsiar MLL abnormality. although there are only very’ limite data to indicate that te superior to chemotherapy alone, The COG has Studied an intensive therapy and reported 5-year EFS rate of appronimately 48% in these patients regardless of the tise of stem cell transplant, suggesting thatthe routine use of stem cell fansplontation for fants with MLL- rearranged ALL isnot indicated PHILADELPHIA-POSITIVE ALL ALL is present in only