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©2013 UpToDate ® Print Email Cancer and Leukemia Group B (CALGB) study 9111 chemotherapy regimen for acute lymphoblastic leukemia in adults Course I: Induction (4 weeks) For patients <60 years old: Cyclophosphamide IV 1200 mg/m 2 Day 1 Daunorubicin IV 45 mg/m 2 /day Days 1-3 Vincristine IV 2 mg Days 1, 8, 15, 22 Prednisone PO 60 mg/m 2 /day Days 1-21 Asparaginase (E. coli) SC/IM 6000 units/m 2 Days 5, 8, 11, 15, 18, 22 For patients ≥60 years old: Cyclophosphamide IV 800 mg/m 2 Day 1 Daunorubicin IV 30 mg/m 2 /day Days 1-3 Vincristine IV 2 mg Days 1, 8, 15, 22 Prednisone PO 60 mg/m 2 /day Days 1-7 Asparaginase (E. coli) SC/IM 6000 units/m 2 Days 5, 8, 11, 15, 18, 22 All patients receive filgrastim (G-CSF) 5 mcg/kg subcutaneously once per day starting on day 4 and continuing until the ANC is >1000/microL on two consecutive determinations >24 hours apart. Course IIA: Early intensification (4 weeks; repeat once for Course IIB) Intrathecal methotrexate IT 15 mg Day 1 Cyclophosphamide IV 1000 mg/m 2 Day 1 Mercaptopurine PO 60 mg/m 2 /day Days 1-14 Cytarabine SC 75 mg/m 2 /day Days 1-4, 8-11 Vincristine IV 2 mg Days 15, 22 Asparaginase (E. coli) SC/IM 6000 units/m 2 Days 15, 18, 22, 25 Course III: CNS prophylaxis and interim maintenance (12 weeks) Cranial irradiation 2400 cGy Days 1-12 Intrathecal methotrexate IT 15 mg Days 1, 8, 15, 22, 29 Mercaptopurine PO 60 mg/m 2 /day Days 1-70 Methotrexate PO 20 mg/m 2 Days 36, 43, 50, 57, 64 Course IV: Late intensification (8 weeks) Doxorubicin IV 30 mg/m 2 Days 1, 8, 15 Vincristine IV 2 mg Days 1, 8, 15 Dexamethasone PO 10 mg/m 2 /day Days 1-14 Cyclophosphamide IV 1000 mg/m 2 Day 29 Thioguanine PO 60 mg/m 2 /day Days 29-42 Cytarabine SC 75 mg/m 2 /day Days 29-32, 36-39 Course V: Prolonged maintenance (until 24 months from diagnosis) Vincristine IV 2 mg Day 1 of every 4 weeks Prednisone PO 60 mg/m 2 /day Days 1-5 of every 4 weeks Mercaptopurine PO 60 mg/m 2 /day Days 1-28 Methotrexate PO 20 mg/m 2 Days 1, 8, 15, 22 ANC: absolute neutrophil count; IT: intrathecal; IV: intravenous; IM: intramuscular; PO: oral; SC: subcutaneous. Data from: Acute Leukemias VI: Prognostic factors and treatment strategies, Buchner T, Hiddeman W, Wormann B (Eds), Springer-Verlag, Berlin 1997. p.677; Larson RA, Dodge RK, Burns CP, Blood 1995; 85:2025; and Larson RA, Dodge RK, Linker CA, et al. Blood 1998; 92:1556-1564.