B-cell acute lymphoblastic leukemia, pediatric - historical
The purpose of this page is to provide references to regimens that are obsolete, outdated, or of historical interest only. Is there a regimen missing from this list? See the main pediatric B-ALL page for current regimens.
Last updated on 2024-07-23: 17 regimens on this page
17 variants on this page
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Upfront induction therapy
Aminopterin monotherapy
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Farber et al. 1948 | 1947-1948 | Non-randomized pilot |
Note: This regimen is of major historical interest, being one of the first published cancer chemotherapy experiments in man that led to an active non-clinical-trial intervention (to be distinguished from the trial of diopterin and teropterin published in Science in 1947). This agent is no longer available but was used clinically for several decades.
Chemotherapy
References
- Farber S, Mercer RD, Sylvester RF, Wolff JA, Diamond LK. Temporary remissions in acute leukemia in children produced by folic acid antagonist, 4-aminopteroyl-glutamic acid. N Engl J Med. 1948 Jun 3;238(23):787-93. link to original article PubMed
COMP
COMP: Cyclophosphamide, Oncovin (Vincristine), Methotrexate, Prednisone
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Anderson et al. 1983 | 1977-1979 | Phase 3 (E-de-esc) | Modified LSA2-L2 | Did not meet primary endpoint of FFS |
Note: This is a component of a sequential treatment protocol; to our knowledge there are no references to support using it as a stand-alone treatment.
Chemotherapy
- Cyclophosphamide (Cytoxan) 1200 mg/m2 IV once on day 1
- Vincristine (Oncovin) 2 mg/m2 (maximum dose of 2 mg) IV once per day on days 3, 10, 17, 24
- Methotrexate (MTX) 180 mg/m2 IV push once on day 12, then 120 mg/m2 IV over 4 hours (total dose: 300 mg/m2)
Glucocorticoid therapy
- Prednisone (Sterapred) 15 mg/m2 (maximum dose of 15 mg) PO four times per day on days 3 to 30, then tapered off over days 31 to 37
37-day course
References
- Anderson JR, Wilson JF, Jenkin DT, Meadows AT, Kersey J, Chilcote RR, Coccia P, Exelby P, Kushner J, Siegel S, Hammond D. Childhood non-Hodgkin's lymphoma: the results of a randomized therapeutic trial comparing a 4-drug regimen (COMP) with a 10-drug regimen (LSA2-L2). N Engl J Med. 1983 Mar 10;308(10):559-65. link to original article dosing details in manuscript have been reviewed by our editors PubMed
Cytarabine, Daunorubicin, L-Asparaginase, Teniposide, Vincristine, Prednisone
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Rivera et al. 1991 | 1984-02 to 1988-09 | Non-randomized part of RCT |
Evans et al. 1998 | 1988-1991 | Non-randomized part of RCT |
Chemotherapy
- Cytarabine (Ara-C) 300 mg/m2 IV once per day on days 22, 25, 29
- Daunorubicin (Cerubidine) 25 mg/m2 IV once per day on days 2, 8, +/- 15
- Asparaginase (Colaspase) 100,000 units IM once per day on days 3, 4, 6, 8, 10, 12, +/- 15, +/- 17, +/- 19
- Teniposide (Vumon) 200 mg/m2 IV once per day on days 22, 25, 29
- Vincristine (Oncovin) 1.5 mg/m2 IV once per day on days 1, 8, 15, 22
Glucocorticoid therapy
- Prednisone (Sterapred) 40 mg/m2 (route not specified) once per day on days 1 to 29
42-day course
Subsequent treatment
- High-dose MTX
References
- Rivera GK, Raimondi SC, Hancock ML, Behm FG, Pui CH, Abromowitch M, Mirro J Jr, Ochs JS, Look AT, Williams DL, Murphy SB, Dahl GV, Kalwinsky DK, Evans WE, Kun LE, Simone JV, Crist WM. Improved outcome in childhood acute lymphoblastic leukaemia with reinforced early treatment and rotational combination chemotherapy. Lancet. 1991 Jan 12;337(8733):61-6. link to original article containds dosing details in manuscript PubMed
- Evans WE, Relling MV, Rodman JH, Crom WR, Boyett JM, Pui CH. Conventional compared with individualized chemotherapy for childhood acute lymphoblastic leukemia. N Engl J Med. 1998 Feb 19;338(8):499-505. link to original article PubMed
Daunorubicin, Vincristine, Prednisolone
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Mathé et al. 1967 | Not reported | Non-randomized | ||
Halazun et al. 1974 (ALGB 6801) | 1968-1971 | Phase 3 (E-RT-esc) | Vincristine & Prednisone | Did not meet primary endpoint of CR rate |
Note: While the title and text of Mathé et al. 1967 described the use of prednisone, the treatment schema in Figure 2 reported prednisolone (with dosing); this dosing is replicated here.
Chemotherapy
- Daunorubicin (Cerubidine) 20 mg/m2 IV once per day on days 1 & 2
- Vincristine (Oncovin) 1.5 mg/m2 IV once on day 1
Glucocorticoid therapy
- Prednisolone (Millipred) 100 mg/m2 PO once per day on days 1 to 7
7-day cycles, continued until CR achieved or severe toxicity
References
- Mathé G, Hayat M, Schwarzenberg L, Amiel JL, Schneider M, Cattan A, Schlumberger JR, Jasmin C. Acute lymphoblastic leukaemia treated with a combination of prednisone, vincristine, and rubidomycin: Value of pathogen-free rooms. Lancet. 1967 Aug 19;2(7512):380-2. link to original article dosing details in manuscript have been reviewed by our editors PubMed
- ALGB 6801: Halazun JF, Wagner HR, Gaeta JF, Sinks LF. Proceedings: Daunorubicin cardiac toxicity in children with acute lymphocytic leukemia. Cancer. 1974 Feb;33(2):545-54. link to original article does not contain dosing details in manuscript PubMed
Doxorubicin, L-asparaginase, Methotrexate, Vincristine, Prednisone
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Vrooman et al. 2013 (DFCI 00-01) | 2000-2004 | Non-randomized part of phase 3 trial |
Note: the MTX dose reported in the manuscript appears to be erroneous, but is replicated here.
Chemotherapy
- Doxorubicin (Adriamycin) 30 mg/m2 IV once per day on days 0 & 1
- Methotrexate (MTX) 4 mg/m2 IV once, given 8 to 24 hours after doxorubicin
- Asparaginase (Elspar) 25,000 units/m2 IM once (day not specified)
- Vincristine (Oncovin) 1.5 mg/m2 (maximum dose of 2 mg) IV once per day on days 0, 7, 14, 21
Glucocorticoid therapy
- Prednisone (Sterapred) 40 mg/m2/day IV or PO on days 0 to 28
Supportive therapy
- High-risk patients: Dexrazoxane (Zinecard) 300 mg/m2 IV once per day on days 0 & 1
29-day course
Subsequent treatment
- Intensification
References
- DFCI 00-01: Vrooman LM, Stevenson KE, Supko JG, O'Brien J, Dahlberg SE, Asselin BL, Athale UH, Clavell LA, Kelly KM, Kutok JL, Laverdière C, Lipshultz SE, Michon B, Schorin M, Relling MV, Cohen HJ, Neuberg DS, Sallan SE, Silverman LB. Postinduction dexamethasone and individualized dosing of Escherichia Coli L-asparaginase each improve outcome of children and adolescents with newly diagnosed acute lymphoblastic leukemia: results from a randomized study--Dana-Farber Cancer Institute ALL Consortium Protocol 00-01. J Clin Oncol. 2013 Mar 20;31(9):1202-10. Epub 2013 Jan 28. link to original article link to PMC article dosing details in manuscript have been reviewed by our editors PubMed NCT00165178
Doxorubicin, Methotrexate, Vincristine, Prednisone
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Clavell et al. 1986 (Protocol 81-01) | 1981-1985 | Non-randomized |
Note: the induction portion of this protocol begins on day 5. There was a methotrexate randomization which is not reported here.
Chemotherapy
- Doxorubicin (Adriamycin) 45 mg/m2 IV once on day 5
- Methotrexate (MTX) 40 mg/m2 IV once on day 5
- Vincristine (Oncovin) 1.5 mg/m2 (maximum dose of 2 mg) IV once per day on days 5, 12, 19, 26
Glucocorticoid therapy
- Prednisone (Sterapred) 40 mg/m2 IV or PO once per day on days 5 to 33
28-day course
References
- Protocol 81-01: Clavell LA, Gelber RD, Cohen HJ, Hitchcock-Bryan S, Cassady JR, Tarbell NJ, Blattner SR, Tantravahi R, Leavitt P, Sallan SE. Four-agent induction and intensive asparaginase therapy for treatment of childhood acute lymphoblastic leukemia. N Engl J Med. 1986 Sep 11;315(11):657-63. link to original article dosing details in manuscript have been reviewed by our editors PubMed
L-Asparaginase, Vincristine, Dexamethasone
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Veerman et al. 1996 (DCOG ALL-VI) | 1984-1988 | Non-randomized | ||
Bostrom et al. 2003 (CCG-1922) | 1993-1995 | Phase 3 (E-switch-ic) | L-asparaginase, Vincristine, Prednisone | Superior EFS |
Mitchell et al. 2005 (UK MRC ALL97) | 1997-2002 | Phase 3 (E-switch-ic) | L-asparaginase, Vincristine, Prednisolone | Superior EFS |
Veerman et al. 2009 (DCOG ALL-9) | 1997-2004 | Non-randomized |
Note: this is a component of a sequential treatment protocol; to our knowledge there are no references to support using it as a stand-alone treatment.
Chemotherapy
- Asparaginase (Elspar) 6000 IU/m2 IV once per day on days 29, 33, 36, 40
- Vincristine (Oncovin) 2 mg/m2 (maximum dose of 2.5 mg) IV once per day on days 1, 8, 15, 22, 29, 36
Glucocorticoid therapy
- Dexamethasone (Decadron) 6 mg/m2/day PO on days 1 to 28, then tapered over days 29 to 42
42-day course
References
- DCOG ALL-VI: Veerman AJ, Hählen K, Kamps WA, Van Leeuwen EF, De Vaan GA, Solbu G, Suciu S, Van Wering ER, Van der Does-Van der Berg A; Dutch Childhood Oncology Group. High cure rate with a moderately intensive treatment regimen in non-high-risk childhood acute lymphoblastic leukemia: results of protocol ALL VI from the Dutch Childhood Leukemia Study Group. J Clin Oncol. 1996 Mar;14(3):911-8. link to original article PubMed
- CCG-1922: Bostrom BC, Sensel MR, Sather HN, Gaynon PS, La MK, Johnston K, Erdmann GR, Gold S, Heerema NA, Hutchinson RJ, Provisor AJ, Trigg ME; Children's Cancer Group. Dexamethasone versus prednisone and daily oral versus weekly intravenous mercaptopurine for patients with standard-risk acute lymphoblastic leukemia: a report from the Children's Cancer Group. Blood. 2003 May 15;101(10):3809-17. Epub 2003 Jan 16. link to original article PubMed
- UK MRC ALL97: Mitchell CD, Richards SM, Kinsey SE, Lilleyman J, Vora A, Eden TO; Medical Research Council Childhood Leukaemia Working Party. Benefit of dexamethasone compared with prednisolone for childhood acute lymphoblastic leukaemia: results of the UK Medical Research Council ALL97 randomized trial. Br J Haematol. 2005 Jun;129(6):734-45. link to original article PubMed NCT00003437
- Update: Vora A, Mitchell CD, Lennard L, Eden TO, Kinsey SE, Lilleyman J, Richards SM; Medical Research Council; National Cancer Research Network Childhood Leukaemia Working Party. Toxicity and efficacy of 6-thioguanine versus 6-mercaptopurine in childhood lymphoblastic leukaemia: a randomised trial. Lancet. 2006 Oct 14;368(9544):1339-48. link to original article PubMed
- DCOG ALL-9: Veerman AJ, Kamps WA, van den Berg H, van den Berg E, Bökkerink JP, Bruin MC, van den Heuvel-Eibrink MM, Korbijn CM, Korthof ET, van der Pal K, Stijnen T, van Weel Sipman MH, van Weerden JF, van Wering ER, van der Does-van den Berg A; Dutch Childhood Oncology Group. Dexamethasone-based therapy for childhood acute lymphoblastic leukaemia: results of the prospective Dutch Childhood Oncology Group (DCOG) protocol ALL-9 (1997-2004). Lancet Oncol. 2009 Oct;10(10):957-66. Epub 2009 Sep 9. link to original article dosing details in manuscript have been reviewed by our editors PubMed NTR460
L-Asparaginase, Vincristine, Prednisolone
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Hann et al. 2000 (MRC UKALL XI) | 1990-1997 | Non-randomized part of RCT | ||
Mitchell et al. 2005 (UK MRC ALL97) | 1997-2002 | Phase 3 (C) | L-asparaginase, Vincristine, Dexamethasone | Inferior EFS |
Note: this is a component of a sequential treatment protocol; to our knowledge there are no references to support using it as a stand-alone treatment. The exact days of asparaginase administration were not described in Mitchell et al. 2005.
Chemotherapy
- Asparaginase (Elspar) 6000 mcg/m2 IM or SC once per day on days 1, 3, 5, 8, 10, 12, 15, 17, 19
- Vincristine (Oncovin) 1.5 mg/m2 IV once per day on days 1, 7, 14, 21
Glucocorticoid therapy
- Prednisolone (Millipred) 40 mg/m2 PO once per day on days 1 to 28
CNS therapy
- Methotrexate (MTX) 12.5 mg/m2 IT once per day on days 1 & 8
28-day course
References
- MRC UKALL XI: Hann I, Vora A, Richards S, Hill F, Gibson B, Lilleyman J, Kinsey S, Mitchell C, Eden OB; UK Medical Research Council's Working Party on Childhood Leukaemia. Benefit of intensified treatment for all children with acute lymphoblastic leukaemia: results from MRC UKALL XI and MRC ALL97 randomised trials. Leukemia. 2000 Mar;14(3):356-63. link to original article PubMed
- UK MRC ALL97: Mitchell CD, Richards SM, Kinsey SE, Lilleyman J, Vora A, Eden TO; Medical Research Council Childhood Leukaemia Working Party. Benefit of dexamethasone compared with prednisolone for childhood acute lymphoblastic leukaemia: results of the UK Medical Research Council ALL97 randomized trial. Br J Haematol. 2005 Jun;129(6):734-45. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT00003437
- Update: Vora A, Mitchell CD, Lennard L, Eden TO, Kinsey SE, Lilleyman J, Richards SM; Medical Research Council; National Cancer Research Network Childhood Leukaemia Working Party. Toxicity and efficacy of 6-thioguanine versus 6-mercaptopurine in childhood lymphoblastic leukaemia: a randomised trial. Lancet. 2006 Oct 14;368(9544):1339-48. link to original article PubMed
L-Asparaginase, Vincristine, Prednisone
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Ortega et al. 1977 (CCG 101/143) | 1971 to not reported | Non-randomized (RT) | ||
van der Does-van den Berg et al. 1989 (DCLSG ALL V) | 1979-1982 | Phase 3 (C) | DOLP | Did not meet primary endpoint of EFS |
Eden et al. 1991 (MRC UKALL VIII) | 1979-1982 | Phase 3 (C) | DOLP | Did not meet primary endpoint of EFS |
Tubergen et al. 1993 (CCG-105) | 1983-1989 | Phase 3 (C) | DOLP | Not reported |
Mahoney et al. 1998 (POG 9005) | 1991-1993 | Non-randomized part of phase 3 RCT | ||
Bostrom et al. 2003 (CCG-1922) | 1993-1995 | Phase 3 (C) | L-asparaginase, Vincristine, Dexamethasone | Inferior EFS |
Matloub et al. 2006 (CCG-1952) | 1996-2000 | Non-randomized part of phase 3 RCT | ||
Avramis et al. 2002 (CCG 1962) | 1997-1998 | Randomized (C) | Pegaspargase, Vincristine, Prednisone | Did not meet secondary endpoint of EFS |
Chemotherapy
- Asparaginase (Elspar) 6000 units/m2 IM once per day on days 2, 5, 8, 12, 15, 19
- Vincristine (Oncovin) 1.5 mg/m2 (maximum dose of 2 mg) IV once per day on days 1, 5, 15, 22
Glucocorticoid therapy
- Prednisone (Sterapred) 40 mg/m2/day (maximum dose of 60 mg/day) PO in three divided doses per day on days 1 to 28
28-day course
Subsequent treatment
- POG 9005: 6-MP & MTX; HDMTX/IVMP intensification versus 6-MP & MTX; LDMTX/IVMP intensification
- CCG-1952: Consolidation
References
- CCG 101/143: Ortega JA, Nesbit ME Jr, Donaldson MH, Hittle RE, Weiner J, Karon M, Hammond D. L-Asparaginase, vincristine, and prednisone for induction of first remission in acute lymphocytic leukemia. Cancer Res. 1977 Feb;37(2):535-40. link to original article PubMed
- DCLSG ALL V: van der Does-van den Berg A, van Wering ER, Suciu S, Solbu G, van 't Veer MB, Rammeloo JA, de Koning J, van Zanen GE; Dutch Childhood Leukemia Study Group. Effectiveness of rubidomycin in induction therapy with vincristine, prednisone, and L-asparaginase for standard risk childhood acute lymphocytic leukemia: results of a Dutch phase III study (ALL V); A report on behalf of the Dutch Childhood Leukemia Study Group (DCLSG). Am J Pediatr Hematol Oncol. 1989 Summer;11(2):125-33. PubMed
- MRC UKALL VIII: Eden OB, Lilleyman JS, Richards S, Shaw MP, Peto J. Results of Medical Research Council Childhood Leukaemia Trial UKALL VIII (report to the Medical Research Council on behalf of the Working Party on Leukaemia in Childhood). Br J Haematol. 1991 Jun;78(2):187-96. link to original article PubMed
- CCG-105: Tubergen DG, Gilchrist GS, O'Brien RT, Coccia PF, Sather HN, Waskerwitz MJ, Hammond GD. Improved outcome with delayed intensification for children with acute lymphoblastic leukemia and intermediate presenting features: a Childrens Cancer Group phase III trial. J Clin Oncol. 1993 Mar;11(3):527-37. link to original article PubMed
- POG 9005: Mahoney DH Jr, Shuster J, Nitschke R, Lauer SJ, Winick N, Steuber CP, Camitta B. Intermediate-dose intravenous methotrexate with intravenous mercaptopurine is superior to repetitive low-dose oral methotrexate with intravenous mercaptopurine for children with lower-risk B-lineage acute lymphoblastic leukemia: a Pediatric Oncology Group phase III trial. J Clin Oncol. 1998 Jan;16(1):246-54. link to original article dosing details in manuscript have been reviewed by our editors PubMed
- CCG 1962: Avramis VI, Sencer S, Periclou AP, Sather H, Bostrom BC, Cohen LJ, Ettinger AG, Ettinger LJ, Franklin J, Gaynon PS, Hilden JM, Lange B, Majlessipour F, Mathew P, Needle M, Neglia J, Reaman G, Holcenberg JS, Stork L. A randomized comparison of native Escherichia coli asparaginase and polyethylene glycol conjugated asparaginase for treatment of children with newly diagnosed standard-risk acute lymphoblastic leukemia: a Children's Cancer Group study. Blood. 2002 Mar 15;99(6):1986-94. Erratum in: Blood 2002 Sep 1;100(5):1531. link to original article PubMed
- CCG-1922: Bostrom BC, Sensel MR, Sather HN, Gaynon PS, La MK, Johnston K, Erdmann GR, Gold S, Heerema NA, Hutchinson RJ, Provisor AJ, Trigg ME; Children's Cancer Group. Dexamethasone versus prednisone and daily oral versus weekly intravenous mercaptopurine for patients with standard-risk acute lymphoblastic leukemia: a report from the Children's Cancer Group. Blood. 2003 May 15;101(10):3809-17. Epub 2003 Jan 16. link to original article PubMed
- CCG-1952: Matloub Y, Lindemulder S, Gaynon PS, Sather H, La M, Broxson E, Yanofsky R, Hutchinson R, Heerema NA, Nachman J, Blake M, Wells LM, Sorrell AD, Masterson M, Kelleher JF, Stork LC; Children's Oncology Group. Intrathecal triple therapy decreases central nervous system relapse but fails to improve event-free survival when compared with intrathecal methotrexate: results of the Children's Cancer Group (CCG) 1952 study for standard-risk acute lymphoblastic leukemia, reported by the Children's Oncology Group. Blood. 2006 Aug 15;108(4):1165-73. Epub 2006 Apr 11. link to original article link to PMC article PubMed NCT00002744
Mercaptopurine & Methotrexate
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Frei et al. 1958 (ALGB 01) | Not reported | Randomized (E-switch-ic) | 6-MP & MTX; alternate dosing | Did not meet endpoints |
Frei et al. 1961 (ALGB 03) | 1957-1960 | Randomized (E-esc) | 1. 6-MP 2. MTX |
Did not meet endpoint of DOR |
Frei et al. 1965 | Not reported | Non-randomized |
Note: this is one of the first combination regimens in hematology/oncology.
Chemotherapy
- Mercaptopurine (6-MP) 1.5 mg/kg PO twice per day
- Methotrexate (MTX) by the following age-based criteria:
- Less than 2 years old: 1.25 mg PO once per day
- 2 to 10 years old: 2.5 mg PO once per day
- Older than 10 years old: 5 mg PO once per day
Continued indefinitely
References
- ALGB 01: Frei E 3rd, Holland JF, Schneiderman MA, Pinkel D, Selkirk G, Freireich EJ, Silver RT, Gold GL, Regelson W. A comparative study of two regimens of combination chemotherapy in acute leukemia. Blood. 1958 Dec;13(12):1126-48. link to original article PubMed
- ALGB 03: Frei E, Freireich EJ, Gehan E, Pinkel D, Holland JF, Selawry O, Haurani F, Spurr CL, Hayes DM, James GW, Rothberg H, Sodee DB, Rundles RW, Schroeder LR, Hoogstraten B, Wolman IJ, Traggis DG, Cooper T, Gendel BR, Ebaugh F, Taylor R. Studies of Sequential and Combination Antimetabolite Therapy in Acute Leukemia: 6-Mercaptopurine and Methotrexate. Blood. 1961;18(4):431-454. link to original article dosing details in manuscript have been reviewed by our editors
- Frei E 3rd, Karon M, Levin RH, Freireich EJ, Taylor RJ, Hananian J, Selawry O, Holland JF, Hoogstraten B, Wolman IJ, Abir E, Sawitsky A, Lee S, Mills SD, Burgert EO Jr, Spurr CL, Patterson RB, Ebaugh FG, James GW 3rd, Moon JH. The effectiveness of combinations of antileukemic agents in inducing and maintaining remission in children with acute leukemia. Blood. 1965 Nov;26(5):642-56. link to original article PubMed
Mercaptopurine & Prednisone
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Fernbach et al. 1966 | 1960-1962 | Randomized (C) | Cyclophosphamide & Prednisone | Did not meet endpoint |
Chemotherapy
- Mercaptopurine (6-MP) 2.5 mg/kg PO once per day on days 1 to 35
Glucocorticoid therapy
- Prednisone (Sterapred) 2.2 mg/kg/day (minimum dose of 20 mg and maximum dose of 60 mg) PO on days 1 to 28, then tapered over 7 days, divided into four doses per day
35-day course
References
- Fernbach DJ, Griffith KM, Haggard ME, Holcomb TM, Sutow WW, Vietti TJ, Windmiller J. Chemotherapy of acute leukemia in childhood: comparison of cyclophosphamide and mercaptopurine. N Engl J Med. 1966 Sep 1;275(9):451-6. link to original article dosing details in manuscript have been reviewed by our editors PubMed
Vincristine & Prednisone
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Halazun et al. 1974 (ALGB 6801) | 1968-1971 | Phase 3 (C) | Daunorubicin, Vincristine, Prednisone | Did not meet primary endpoint of CR rate |
References
- ALGB 6801: Halazun JF, Wagner HR, Gaeta JF, Sinks LF. Proceedings: Daunorubicin cardiac toxicity in children with acute lymphocytic leukemia. Cancer. 1974 Feb;33(2):545-54. link to original article does not contain dosing details in manuscript PubMed
Consolidation after upfront therapy
Mercaptopurine & Methotrexate
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Evans et al. 1986 | 1979-1982 | Randomized (E-switch-ooc) | WBRT, then 6-MP & MTX; conventional dosing | Not reported |
Note: although this is a randomized trial, the report focuses on this arm, which includes HD-MTX, and not the comparison.
Preceding treatment
- L-Asparaginase, Vincristine, Prednisone induction
Chemotherapy
- Mercaptopurine (6-MP) 50 mg/m2 PO once per day on days 1 to 42
- Methotrexate (MTX) 25 mg/m2 PO once per day on days 1, 8, 15, 22, 29, 36
- Methotrexate (MTX) as follows:
- Cycle 1: 1000 mg/m2 IV continuous infusion over 24 hours, started on days 1, 8, 15
- Cycles 2 to 14: 1000 mg/m2 IV continuous infusion over 24 hours, started on day 15
42-day cycle for 20 cycles
References
- Evans WE, Crom WR, Abromowitch M, Dodge R, Look AT, Bowman WP, George SL, Pui CH. Clinical pharmacodynamics of high-dose methotrexate in acute lymphocytic leukemia: identification of a relation between concentration and effect. N Engl J Med. 1986 Feb 20;314(8):471-7. link to original article dosing details in manuscript have been reviewed by our editors PubMed
Maintenance after upfront therapy
Methotrexate monotherapy
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Selawry & Holland 1965 (ALGB 6313) | 1963 | Randomized (E-switch-ic) | MTX; oral | Superior RFS |
Burgert et al. 1969 (ALGB 6311) | Not reported | Randomized (E-switch-ic) | MTX; oral | Did not meet endpoint |
Preceding treatment
- Vincristine & Prednisone induction
Chemotherapy
- Methotrexate (MTX) 30 mg/m2 IM once per day on days 1 & 4 (twice per week)
7-day cycles
References
- ALGB 6313: Selawry OS, Holland JF; Acute Leukemia Group B. New treatment schedule with improved survival in childhood leukemia: intermittent parenteral vs daily oral administration of methotrexate for maintenance of induced remission. JAMA. 1965 Oct 4;194(1):75-81. link to original article congaints dosing details in manuscript PubMed
- ALGB 6311: Burgert EO, Valvo F, Petzold G, Holland JF; Acute Leukemia Group B. Acute lymphocytic leukemia in children: maintenance therapy with methotrexat administered intermittently. JAMA. 1969 Feb 3;207(5):923-8. link to original article PubMed
Relapsed or refractory
Cyclophosphamide monotherapy
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Fernbach et al. 1962 | 1959-1960 | Non-randomized |
Note: This was the dosing used in the final n=26 patients enrolled.
References
- Fernbach DJ, Sutow WW, Thurman WG, Vietti TJ. Clinical evaluation of cyclophosphamide: a new agent for the treatment of children with acute leukemia. JAMA. 1962 Oct 6;182:30-7. link to original article dosing details in manuscript have been reviewed by our editors PubMed
Daunorubicin & Prednisone
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Holton et al. 1969 | Not reported | Non-randomized |
Chemotherapy
- Daunorubicin (Cerubidine) 25 mg/m2 IV push once per day on days 1 to 3, 8 to 10, 15, 22, (29), (36)
Glucocorticoid therapy
- Prednisone (Sterapred) 20 mg/m2 PO three times per day on days 1 to 28, then tapered off over days 29 to 35
6-week course
References
- Holton CP, Vietti TJ, Nora AH, Donaldson MH, Stuckey WJ Jr, Watkins WL, Lane DM. Clinical study of daunomycin and prednisone for induction of remission in children with advanced leukemia. N Engl J Med. 1969 Jan 23;280(4):171-4. link to original article dosing details in manuscript have been reviewed by our editors PubMed
L-Asparaginase, Vincristine, Prednisone
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Anderson et al. 1981 | Not reported in abstract | Phase 3 (C) | L-Asparaginase, Vindesine, Prednisone | Did not meet primary endpoint of ORR |
Note: There are no dosing details in the abstract; the full manuscript is not available for review online.
Chemotherapy
Glucocorticoid therapy
References
- Anderson J, Krivit W, Chilcote R, Pyesmany A, Chard R, Hammond D. Comparison of the therapeutic response of patients with childhood acute lymphoblastic leukemia in relapse to vindesine versus vincristine in combination with prednisone and L-asparaginase: a phase III trial. Cancer Treat Rep. 1981 Nov-Dec;65(11-12):1015-9. dosing details not available in abstract PubMed