Table 2

IVAC regimen, with further modification for age older than 65

DayDrugDoseMethodTime
1 to 5 Etoposide 60 mg/m2 (in 500 mL N saline or 5% dextrose) IV Daily over 1 h 
 Ifosfamide  IV Daily over 1 h 
     Age 65 y or younger 1.5 g/m2   
     Age more than 65 y 1 g/m2   
 Mesna  IV  
     Age 65 y or younger 300 mg/m2 (mixed with ifosfamide)  Over 1 h 
  Then 300 mg/m2  Every 4 hours × 2 
     Age more than 65 y 200 mg/m2 (mixed with isosfamide)  Over 1 h 
  Then 200 mg/m2  Every 4 hours × 2 
1 to 2 Cytarabine  IV Over 3 h, 12 hourly; total of 4 doses 
     Age 65 y or younger 2 g/m2   
     Age more than 65 y 1 g/m2   
5 Methotrexate 12 mg IT  
6 Leucovorin 15 mg PO 24 h after IT methotrexate 
7 G-CSF 5 μg/kg SC Daily until granulocyte count > 1.0 × 109/L 
DayDrugDoseMethodTime
1 to 5 Etoposide 60 mg/m2 (in 500 mL N saline or 5% dextrose) IV Daily over 1 h 
 Ifosfamide  IV Daily over 1 h 
     Age 65 y or younger 1.5 g/m2   
     Age more than 65 y 1 g/m2   
 Mesna  IV  
     Age 65 y or younger 300 mg/m2 (mixed with ifosfamide)  Over 1 h 
  Then 300 mg/m2  Every 4 hours × 2 
     Age more than 65 y 200 mg/m2 (mixed with isosfamide)  Over 1 h 
  Then 200 mg/m2  Every 4 hours × 2 
1 to 2 Cytarabine  IV Over 3 h, 12 hourly; total of 4 doses 
     Age 65 y or younger 2 g/m2   
     Age more than 65 y 1 g/m2   
5 Methotrexate 12 mg IT  
6 Leucovorin 15 mg PO 24 h after IT methotrexate 
7 G-CSF 5 μg/kg SC Daily until granulocyte count > 1.0 × 109/L 

IVAC starts on day 1 on the first day after CODOX-M that the unsupported absolute granulocyte count is more than 1.0 × 109/L, with an unsupported platelet count of more than 75 × 109/L. Next cycle (CODOX-M) commences on the day that the unsupported absolute granulocyte count is more than 1.0 × 109/L, with an unsupported platelet count of more than 75 × 109/L.

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