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©2013 UpToDate ® Print Email Children's Cancer Group treatment schema for Pediatric Acute Lymphoblastic Leukemia Standard therapy (CCG-BFM) Treatment Dose Consolidation phase (5 weeks) Prednisone 7.5 mg/m 2 , day 0; 3.75 mg/m 2 , days 1, 2 Cyclophosphamide 1000 mg/m 2 IV, days 0, 14 Mercaptopurine 60 mg/m 2 orally, days 0-27 Vincristine 1.5 mg/m 2 IV, days 14, 21, 42, 49 Cytarabine 75 mg/m 2 IV, days 1-4, 8-11, 15-18, 22-25 Intrathecal methotrexate* 12 mg, days 1, 8, 15, 22 Radiotherapy• Cranial, 1800 cGy; cranial, 2400 cGy, and spinal, 600 cGy Interim maintenance phase (8 weeks) Mercaptopurine 60 mg/m 2 orally, days 0-41 Methotrexate 15 mg/m 2 orally, days 0, 7, 14, 21, 28, 35 Delayed intensification phase (7 weeks) Reinduction phase (4 weeks) Dexamethasone 10 mg/m 2 orally, days 0-20, then taper for 7 days Vincristine 1.5 mg/m 2 IV, days 0,14, 21 Doxorubicin 25 mg/m 2 IV, days 0, 7, 14 Reconsolidation phase (3 weeks) Asparaginase 6000 units/m 2 IM, days 3, 5, 7, 10, 12, 14 Vincristine 1.5 mg/m 2 IV, days 42, 29 Cyclophosphamide 1000 mg/m 2 IV, days 28 Thioguanine 60 mg/m 2 orally, days 28-41 Cytarabine 75 mg/m 2 SC or IV, days 29-32, 36-39 Intrathecal methotrexate* 12 mg, days 29, 36 Long-term maintenance phase (12 weeks)Δ Vincristine 1.5 mg/m 2 IV, days 0, 28, 56 Prednisone 40 mg/m 2 orally, days 0-4, 28-32, 56-60 Mercaptopurine 75 mg/m 2 orally, days 0-83 Methotrexate 20 mg/m 2 orally, days 7, 14, 21, 28, 35, 42, 49, 56, 63, 70, 77 Intrathecal methotrexate* 12 mg, day 0 Augmented BFM therapy Treatment Dose Consolidation phase (9 weeks) Cyclophosphamide 1000 mg/m 2 IV, days 0, 28 Cytarabine 75 mg/m 2 SC or IV, days 1-4, 8-11, 29-32, 36-39 Mercaptopurine 60 mg/m 2 orally, days 0-13, 28-41 Vincristine 1.5 mg/m 2 IV, days 14, 21, 42, 49 Asparaginase 6000 units/m 2 IM, days 14,16, 18, 21, 23, 25, 42, 44, 46, 49, 51, 53 Intrathecal methotrexate* 12 mg, days 1, 8, 15, 22 Radiotherapy• Cranial, 1800 cGy; cranial, 2400 cGy, and spinal, 600 cGy; testicular, 2400 cGy Interim maintenance phase (8 weeks) Vincristine 1.5 mg/m 2 IV, days 0, 10, 20, 30, 40 Methotrexate 100 mg/mg 2 IV, days 0, 10, 20, 30, 40 (escalate by 50 mg/m 2 per dose) Asparaginase 15,000 units/m 2 IM, days 1, 11, 21, 31, 41 Delayed intensification I phase (8 weeks) Reinduction phase (4 weeks) Dexamethasone 10 mg/m 2 orally, days 0-20, then taper for 7 days Vincristine 1.5 mg/m 2 IV, days 0, 14, 21 Doxorubicin 25 mg/m 2 IV, days 0, 7, 14 Reconsolidation phase (4 weeks) Asparaginase 6000 units/m 2 IM, days 3, 5, 7, 10, 12, 14 Vincristine 1.5 mg/m 2 IV, days 42, 49 Cyclophosphamide 1000 mg/m 2 IV, day 28 Thioguanine 60 mg/m 2 orally, days 28-41 Cytarabine

Dexamethasone 10 mg/m 2 orally, days 0-20, then taper for 7 days Vincristine 1.5 mg/m 2 IV, days 0, 14, 21 Doxorubicin 25 mg/m 2 IV, days 0, 7, 14 Reconsolidation phase (4 weeks) Asparaginase 6000 units/m 2 IM, days 3, 5, 7, 10, 12, 14 Vincristine 1.5 mg/m 2 IV, days 42, 49 Cyclophosphamide 1000 mg/m 2 IV, day 28 Thioguanine 60 mg/m 2 orally, days 28-41 Cytarabine 75 mg/m 2  per day SC or IV, days 29-32, 36-39 Intrathecal methotrexate* 12 mg, days 29, 36 Asparaginase 6000 units/m 2 IV, days 42, 44, 46, 49, 51, 53 Interim maintenance II phase (8 weeks) Vincristine 1.5 mg/m 2 IV, days 0, 10, 20, 30, 40 Methotrexate 100 mg/m 2 IV, days 0, 10, 20, 30, 40 (escalate by 50 mg/m 2 per dose) Asparaginase 15,000 units/m 2 IM, days 1, 11, 21, 31, 41 Intrathecal methotrexate* 12 mg, days 0, 20, 40 Delayed intensification II phase (8 wk) Same as for delayed intensification I phase Long-term maintenance phase (12 weeks)Δ Vincristine 1.5 mg/m 2 IV, days 0, 28, 56 Prednisone 60 mg/m 2 orally, days 0-14, 28-32, 56-60 Mercaptopurine 75 mg/m 2 orally, days 0-83 Methotrexate 20 mg/m 2 orally, days 7, 14, 21, 28, 35, 42, 49, 56, 63, 70, 77 Intrathecal methotrexate* 12 mg, day 0 Induction was as follows: vincristine, 1.5 mg/m 2 per week for 4 weeks; daunomycin, 25 mg/m 2 per week for 4 weeks; prednisone, 60 mg/m 2 per day for 28 days; asparaginase, 6000 units/m 2 IM 3 times a week for 9 doses; intrathecal cytarabine on day 0; and intrathecal methotrexate on day 14. IM: intramuscular, SC: subcutaneous, IV: intravenous * Patients with CNS disease at diagnosis did not receive intrathecal methotrexate on days 15 and 22 of consolidation therapy. • During the first 2 weeks of consolidation therapy, patients without CNS disease at diagnosis received 1800 cGy of cranial radiotherapy in 10 fractions; patients with CNS disease at diagnosis received 2400 cGy to the cranial midplane in 12 fractions and 600 cGy to the spinal cord in 3 fractions. In the augmented therapy group, patients with testicular enlargement at diagnosis received 2400 cGy bilateral testicular radiation in 8 fractions. Δ The cycles of maintenance therapy were repeated until the total duration of therapy, beginning with the first interim maintenance period, reached 2 years for girls and 3 years for boys.

Induction was as follows: vincristine, 1.5 mg/m 2 per week for 4 weeks; daunomycin, 25 mg/m 2 per week for 4 weeks; prednisone, 60 mg/m 2 per day for 28 days; asparaginase, 6000 units/m 2 IM 3 times a week for 9 doses; intrathecal cytarabine on day 0; and intrathecal methotrexate on day 14. IM: intramuscular, SC: subcutaneous, IV: intravenous * Patients with CNS disease at diagnosis did not receive intrathecal methotrexate on days 15 and 22 of consolidation therapy. • During the first 2 weeks of consolidation therapy, patients without CNS disease at diagnosis received 1800 cGy of cranial radiotherapy in 10 fractions; patients with CNS disease at diagnosis received 2400 cGy to the cranial midplane in 12 fractions and 600 cGy to the spinal cord in 3 fractions. In the augmented therapy group, patients with testicular enlargement at diagnosis received 2400 cGy bilateral testicular radiation in 8 fractions. Δ The cycles of maintenance therapy were repeated until the total duration of therapy, beginning with the first interim maintenance period, reached 2 years for girls and 3 years for boys. This research was originally published in Blood. Stock, W, La, M, Sanford, B, et al. What determines the outcomes for adolescents and young adults with acute lymphoblastic leukemia treated on cooperative group protocols? A comparison of Children's Cancer Group and Cancer and Leukemia Group B studies. Blood 2008; 112:1646. Copyright ©2008 American Society of Hematology.