Commonly used first-line chemotherapy regimens for BL in sub-Saharan Africa
| Regimen . | Reference . | Drugs* . | Notes . |
|---|---|---|---|
| Prephase | |||
| 39 | Cyclophosphamide 500 mg/m2 IV; day 1 | Children with malnutrition received cyclophosphamide 300 mg/m2 | |
| 40 | Methotrexate 12 mg IT; day 1 | ||
| 23 | Cyclophosphamide 300-400 mg/m2 IV; day 1 | ||
| Vincristine 1 mg/m2 (max, 2 mg) IV; day 1 | |||
| Prednisone 1.5 mg/kg PO; days 1-5 | |||
| Low-intensity | |||
| INCTR 03-06 protocol | 33 | Cyclophosphamide 1200 mg/m2 IV; day 1 | 15-d cycles if ANC ≥1.0 × 109 /L and platelets ≥75 × 109/L |
| Vincristine 1.4 mg/m2 (max, 2 mg) IV; day 1 | 3 cycles for low risk (single extra-abdominal site <10 cm) | ||
| Methotrexate 75 mg/m2 IV; day 1 | 6 cycles for high risk (all others) | ||
| Methotrexate 12 mg IT; days 1 and 8 | |||
| Cytarabine 50 mg IT; day 4 | |||
| With anthracyclines | |||
| CHOP | 23 | Cyclophosphamide 750 mg/m2 IV; day 1 | 21-d cycles × 6 cycles if ANC ≥1.0 × 109/L and platelets ≥75 × 109 /L |
| Doxorubicin 40 mg/m2 IV; day 1 | |||
| Vincristine 1 mg/m2 (max, 2 mg) IV; day 1 | |||
| Prednisone 1.5 mg/kg PO; days 1-5 | |||
| Methotrexate 12 mg IT; day 1 | |||
| JOOTRH protocol | 35 | Induction-consolidation | |
| Cyclophosphamide 1200 mg/m2 IV; days 1, 8, 15, 22, 28, 35 | |||
| Doxorubicin 60 mg/m2 IV; days 1, 22 | |||
| Vincristine 1.5 mg/m2 IV; days 1, 8, 15, 22, 28, 35 | |||
| Methotrexate 7.5 mg/m2 IT; days 1, 8, 15, 22 | |||
| Prednisone PO tapering dose | |||
| Maintenance | Maintenance | ||
| Cyclophosphamide 300 mg/m2 IV; day 1 | 28-d cycles × 24 mo | ||
| Vincristine 1.5 mg/m2 IV; day 1 | |||
| Malawi 2012-2014 protocol | 36 | Cyclophosphamide 40 mg/kg (max, 1.6 g) IV; days 1, 15, 28 | Doxorubicin given for only stage III/IV |
| Cyclophosphamide 60 mg/kg (max, 2.4 g) IV; day 8 | |||
| Doxorubicin 60 mg/m2 IV; days 15, 28 | |||
| Vincristine 1.5 mg/m2 (max, 2 mg) IV; days 1, 8, 15, 28 | |||
| Prednisone 60 mg/m2 PO; days 1-5 | |||
| Methotrexate 12.5 mg IT; day 1, 8, 15, 28 | |||
| With high-dose methotrexate | |||
| GFAOP 2001/2009 protocol | 39 | Induction | Induction |
| 40 | Cyclophosphamide 250 mg/m2 IV; days 1-3 | 15-d cycles × 2 cycles administered once (1) ANC ≥ 1.0 × 109 /L or ANC ≥ 0.5 × 109 /L and increasing; and (2) platelets ≥ 100 × 109 /L | |
| Vincristine 1.5 mg/m2 (max, 2 mg) IV; day 1 | Leucovorin given for 12 doses beginning 24 h after methotrexate | ||
| Methotrexate 1-3 g/m2 IV over 3 h; day 1 | Alkaline hydration administered 2 h before and 2 h after methotrexate | ||
| Leucovorin 15 mg/m2 4× daily PO/IV; days 2-4 | Methotrexate 1 g/m2 in 2001 protocol safely escalated to 3 g/m2 in 2009 protocol | ||
| Prednisone 60 mg/m2 PO; days 2-5 | For stage IV with <70% blasts in bone marrow: cyclophosphamide 500 mg/m2 IV, days 1-2; vincristine 2 mg/m2 IV (max 2 mg) IV, Day 1 | ||
| Methotrexate 12 mg IT; days 2 and 6 | |||
| Consolidation | Consolidation | ||
| Methotrexate 1-3 g/m2 IV over 3 h; day 1 | 2 cycles administered once (1) ANC ≥ 1.0 × 109/L or ANC ≥ 0.5 × 109/L and increasing; and (2) platelets ≥ 100 × 109 /L | ||
| Leucovorin 15 mg/m2 4× daily PO/IV; days 2-4 | Leucovorin given for 12 doses beginning 24 h after methotrexate | ||
| Cytarabine 50 mg/m2 2× daily SC; days 2-6 | Alkaline hydration administered 2 h before and 2 h after methotrexate | ||
| Methotrexate 12 mg IT; day 2 | Methotrexate 1 g/m2 in 2001 protocol safely escalated to 3 g/m2 in 2009 protocol | ||
| Cytarabine 50 mg IT; day 7 |
| Regimen . | Reference . | Drugs* . | Notes . |
|---|---|---|---|
| Prephase | |||
| 39 | Cyclophosphamide 500 mg/m2 IV; day 1 | Children with malnutrition received cyclophosphamide 300 mg/m2 | |
| 40 | Methotrexate 12 mg IT; day 1 | ||
| 23 | Cyclophosphamide 300-400 mg/m2 IV; day 1 | ||
| Vincristine 1 mg/m2 (max, 2 mg) IV; day 1 | |||
| Prednisone 1.5 mg/kg PO; days 1-5 | |||
| Low-intensity | |||
| INCTR 03-06 protocol | 33 | Cyclophosphamide 1200 mg/m2 IV; day 1 | 15-d cycles if ANC ≥1.0 × 109 /L and platelets ≥75 × 109/L |
| Vincristine 1.4 mg/m2 (max, 2 mg) IV; day 1 | 3 cycles for low risk (single extra-abdominal site <10 cm) | ||
| Methotrexate 75 mg/m2 IV; day 1 | 6 cycles for high risk (all others) | ||
| Methotrexate 12 mg IT; days 1 and 8 | |||
| Cytarabine 50 mg IT; day 4 | |||
| With anthracyclines | |||
| CHOP | 23 | Cyclophosphamide 750 mg/m2 IV; day 1 | 21-d cycles × 6 cycles if ANC ≥1.0 × 109/L and platelets ≥75 × 109 /L |
| Doxorubicin 40 mg/m2 IV; day 1 | |||
| Vincristine 1 mg/m2 (max, 2 mg) IV; day 1 | |||
| Prednisone 1.5 mg/kg PO; days 1-5 | |||
| Methotrexate 12 mg IT; day 1 | |||
| JOOTRH protocol | 35 | Induction-consolidation | |
| Cyclophosphamide 1200 mg/m2 IV; days 1, 8, 15, 22, 28, 35 | |||
| Doxorubicin 60 mg/m2 IV; days 1, 22 | |||
| Vincristine 1.5 mg/m2 IV; days 1, 8, 15, 22, 28, 35 | |||
| Methotrexate 7.5 mg/m2 IT; days 1, 8, 15, 22 | |||
| Prednisone PO tapering dose | |||
| Maintenance | Maintenance | ||
| Cyclophosphamide 300 mg/m2 IV; day 1 | 28-d cycles × 24 mo | ||
| Vincristine 1.5 mg/m2 IV; day 1 | |||
| Malawi 2012-2014 protocol | 36 | Cyclophosphamide 40 mg/kg (max, 1.6 g) IV; days 1, 15, 28 | Doxorubicin given for only stage III/IV |
| Cyclophosphamide 60 mg/kg (max, 2.4 g) IV; day 8 | |||
| Doxorubicin 60 mg/m2 IV; days 15, 28 | |||
| Vincristine 1.5 mg/m2 (max, 2 mg) IV; days 1, 8, 15, 28 | |||
| Prednisone 60 mg/m2 PO; days 1-5 | |||
| Methotrexate 12.5 mg IT; day 1, 8, 15, 28 | |||
| With high-dose methotrexate | |||
| GFAOP 2001/2009 protocol | 39 | Induction | Induction |
| 40 | Cyclophosphamide 250 mg/m2 IV; days 1-3 | 15-d cycles × 2 cycles administered once (1) ANC ≥ 1.0 × 109 /L or ANC ≥ 0.5 × 109 /L and increasing; and (2) platelets ≥ 100 × 109 /L | |
| Vincristine 1.5 mg/m2 (max, 2 mg) IV; day 1 | Leucovorin given for 12 doses beginning 24 h after methotrexate | ||
| Methotrexate 1-3 g/m2 IV over 3 h; day 1 | Alkaline hydration administered 2 h before and 2 h after methotrexate | ||
| Leucovorin 15 mg/m2 4× daily PO/IV; days 2-4 | Methotrexate 1 g/m2 in 2001 protocol safely escalated to 3 g/m2 in 2009 protocol | ||
| Prednisone 60 mg/m2 PO; days 2-5 | For stage IV with <70% blasts in bone marrow: cyclophosphamide 500 mg/m2 IV, days 1-2; vincristine 2 mg/m2 IV (max 2 mg) IV, Day 1 | ||
| Methotrexate 12 mg IT; days 2 and 6 | |||
| Consolidation | Consolidation | ||
| Methotrexate 1-3 g/m2 IV over 3 h; day 1 | 2 cycles administered once (1) ANC ≥ 1.0 × 109/L or ANC ≥ 0.5 × 109/L and increasing; and (2) platelets ≥ 100 × 109 /L | ||
| Leucovorin 15 mg/m2 4× daily PO/IV; days 2-4 | Leucovorin given for 12 doses beginning 24 h after methotrexate | ||
| Cytarabine 50 mg/m2 2× daily SC; days 2-6 | Alkaline hydration administered 2 h before and 2 h after methotrexate | ||
| Methotrexate 12 mg IT; day 2 | Methotrexate 1 g/m2 in 2001 protocol safely escalated to 3 g/m2 in 2009 protocol | ||
| Cytarabine 50 mg IT; day 7 |
ANC, absolute neutrophil count; max, maximum; PO, oral; SC, subcutaneous; IT, intrathecal.
Methotrexate IT was age-adjusted below 3 years in all protocols.