Successful Treatment of Acute Lymphoblastic Leukemia in a Child with Trisomy 21 and Complex Congenital Heart Disease with Mechanical Prosthetic Valve
Table 1
Modified chemotherapy regimen used for our subject using the standard-risk ALL0331 backbone with modifications.
Chemotherapeutic drug
Route
Dose
Days
Phase i: induction
Intrathecal ara-C
IT
70 mgs
Day 1
*Intrathecal methotrexate
IT
15 mgs
Day 8, 29
Vincristine
IV
1.5 mgs/m2
Day 1, 8, 15, 22
PEG-asparaginase
IM
1500 iu/m2
Day 4
**Prednisone
PO
60 mg/m2
Day 1–28
**PO Prednisone as per CCG 1961 added instead of dexamethasone.
Phase ii: standard consolidation
*Intrathecal methotrexate
IT
15 mgs
Day 1, 8, 15
Vincristine
IV
1.5 mgs/m2
Day 1
6-Mercaptopurine
PO
75 mgs/m2
Day 1–28
Phase iii: standard interim maintenance
Dexamethasone
PO
6 mgs/m2
Days 1–5
Days 29–33
Vincristine
IV
1.5 mgs/m2
Days 1 and 29
6-Mercaptopurine
PO
75 mgs/m2
Days 1–50
*Intrathecal methotrexate
IT
15 mgs
Day 29
Phase iv: augmented delayed intensification
Vincristine
IV
1.5 mgs/m2
Days 1, 8, 15, 43, 50
PEG-asparaginase
IM
1500 iu/m2
Days 4 or 5 or 6 and 43
Cyclophosphamide
IV
1000 mgs/m2
Day 29
Cytarabine
IV
75 mgs/m2
Days 29–32
Days 36–39
Thioguanine
PO
60 mgs/m2
Days 29–42
*Intrathecal methotrexate
IT
15 mgs
Day 8, 29, 43
Anthracyclines (doxorubicin) removed from the protocol due to the underlying cardiac dysfunction.
Phase v: maintenance (total 8 cycles each of 84 days)
Intrathecal methotrexate
IT
15 mgs
Day 1 of cycle 1 and 2
6-Mercaptopurine
PO
75 mgs/m2
Day 1–84
Methotrexate
PO
20 mgs/m2
weekly
Vincristine
IV
1.5 mgs/m2
Day 1, 29, 57
Dexamethasone
PO
6 mgs/m2
5 days every 4 weeks days 1–5, 29–33, 57–61
*Leucovorin PO 5 mg/m2 every 12 hrs 2 doses 48 and 60 hrs after each IT. Note: IT MTX doses are age adjusted. All intrathecals were administered under fluoroscopic guidance.