Suggested dose adjustment for HiDAC therapy as initial consolidation based on age, creatinine, and bilirubin
| . | Age < 55 y . | Age 55-70 y . | Age > 70 y . |
|---|---|---|---|
| Creatinine < 1.3 mg/dL and bilirubin < 2 mg/dL | 3 g/m2, 1 h, twice daily, 12 doses (100%) | 1.5 g/m2, 1 h, twice daily, 12 doses (50%) | 1.5 g/m2, 1 h, once daily, 6 doses (25%) |
| Creatinine 1.3-2 mg/dL or bulirubin 2-3 mg/dL | 1.5 g/m2, 1 h, twice daily, 12 doses (50%) | 1.5 g/m2, 1 h, once daily, 6 doses (25%) | |
| Creatinine > 2 mg/dL* or bilirubin > 3 mg/dL | 1.5 g/m2, 1 h, once daily, 6 doses (± 15%) |
| . | Age < 55 y . | Age 55-70 y . | Age > 70 y . |
|---|---|---|---|
| Creatinine < 1.3 mg/dL and bilirubin < 2 mg/dL | 3 g/m2, 1 h, twice daily, 12 doses (100%) | 1.5 g/m2, 1 h, twice daily, 12 doses (50%) | 1.5 g/m2, 1 h, once daily, 6 doses (25%) |
| Creatinine 1.3-2 mg/dL or bulirubin 2-3 mg/dL | 1.5 g/m2, 1 h, twice daily, 12 doses (50%) | 1.5 g/m2, 1 h, once daily, 6 doses (25%) | |
| Creatinine > 2 mg/dL* or bilirubin > 3 mg/dL | 1.5 g/m2, 1 h, once daily, 6 doses (± 15%) |
Doses used are based on typical regimen as used by the Eastern Cooperative Oncology Group. For other common regimens, such as that used by the CALGB96 consisting of 3 g/m2 over 3 hours, 2 times per day on days 1, 3, and 5, the suggested dose adjustments, in percentages, are indicated in parentheses.
Consider also hemodialysis.