Phase | Treatment | Dose |
---|---|---|
Induction | Vincristine | 1.5 mg/m2 IV (max, 2 mg) on D8, D15, D22, D29 |
 | Prednisone | 60 mg/m2/d PO on D1–8, 40 mg/m2/d on D8–28 |
 | Daunorubicin§ | 40 mg/m2 IV on D8, D9, D10, D15 |
 | L-Asparaginase§ | 10,000 U/m2 IM or IV on D20, D22, D24, D26, D29, D31, D33, D35 |
 | intrathecal therapy* | before D4, D8, and D15 |
R3 course | Cytarabine | 2 g/m2 IV bid on D1–D2 |
 | Etoposide | 150 mg/m2 IV on D3, D4, D5 |
 | Dexamethasone | 20 mg/m2 PO on D2–D5 |
 | intrathecal therapy* | D5 |
COPADM course | Vincristine | 1.5 mg/m2 (max, 2 mg) IV on D1 |
 | Methotrexate | 8000 mg/m2 (24-hour IV infusion with leucovorin rescue) on D1 |
 | Doxorubicin | 60 mg/m2 IV on D2 |
 | Cyclophosphamide | 375 mg/m2 bid on D2–D3 |
 | Prednisone | 60 mg/m2 PO on D1–D5 |
Stem-cell transplantation | age >4 years: TBI | 2 Gy bid on D-9 to D-7 |
 | age <4 years: Busulfan | 30 mg/m2/6 hours PO on D-10 to D-7 |
 | All patients: Cytarabine | 3 g/m2 bid on D-5 to D-4 |
 | Melphalan | 140 mg/m2IV on D-2 |
 | Transplantation | IV day 0 |
Maintenance after autologous transplantation | 6-mercaptopurine Vincristine | 75 mg/m2/d 2 years after complete remission 1.5 mg/m2 monthly for 12 months |