![Figure 1. Protocol GIMEMA LAL 0496. Induction: VCR indicates vincristine 1.4 mg/m2 (max 2 mg); DNM, daunorubicin 30 mg/m2/d (days 1-3); PDN, prednisone 60 mg/m2/d (days 1-60); L-ASP, asparaginase 6000 IU/m2 3 times a week (total, 10 doses); IT MTX, methotrexate 15 mg intrathecally; ·, at bone marrow recovery (polymorphonuclear neutrophil [PMN] count > 1.5 × 109/L [1500/μL], Plt count > 150 × 109/L [150 000/μL]). Intensification: ARA-C indicates cytosine-arabinoside 2 g/m2 (2 hours infusion) every 12 hours (4 doses); VP16, etoposide 150 mg/m2/d (days 1-3; 1 hour infusion; the course is repeated at bone marrow recovery; total, 2 courses). Central nervous system (CNS) prophylaxis. IT MTX indicates 15 mg intrathecally (twice in a week for 5 total doses); CNS radiotherapy, 2000 cGy after 0 or 1 course of ARA-C, 1800 after 2 courses of ARA-C; 6-MP, 6-mercaptopurine maintaining WBC count between 2.5 × 109/L and 3.0 × 109/L (2500 and 3000/μL). Maintenance: □ indicates vincristine 1.4 mg/m2 intravenously (max 2 mg), daunorubicin 30 mg/m2 intravenously for 2 days (stop after 18 months), prednisone 60 mg/m2/d for 7 days; ▨, vincristine 1.4 mg/m2 intravenously (max 2 mg), cyclophosphamide 600 mg/m2 intravenously, prednisone 60 mg/m2/d for 7 days; ▦, 6-mercaptopurine orally to maintain WBC count between 2.5 × 109/L and 3.0 × 109/L (2500 and 3000/μL), methotrexate 15 mg intramuscularly once a week (omitted when IT MTX is performed), methotrexate 15 mg intrathecally before each course.](https://ash.silverchair-cdn.com/ash/content_public/journal/blood/107/2/10.1182_blood-2005-04-1754/4/zh80020689750001.jpeg?Expires=1735611521&Signature=nehm4Dl9qGSGMLlTWZLPUyamsIpCaEnea4vthPk4BjQTgN07lvuSB4x5YhZqcSE95NhKTAvjs~VrXub1xL22zyP2tnAG6FSUrNoQBfdGEbdEougJi79Ap6GHMgZhDmwhgA7UFi3WJCY26KNrHoC64-hGj2cMWSE6jyByBE~Y49slJuS~hswwyyUcqvksVdlHf9yWxKvGFxr3ukpyl7c0LxaoxycaaZYhPyZRjpqDy7rm14W8gnjSC0ET1M~VXdVBULFPSD7B05D2UWRbL-9D4hKh8KDTKYaRxeEgc5FTsUM~1v4fQTfaoGLRXtj9ffkHvF0LUmDa0fLIe6RfIZHo0g__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA)
Protocol GIMEMA LAL 0496. Induction: VCR indicates vincristine 1.4 mg/m2 (max 2 mg); DNM, daunorubicin 30 mg/m2/d (days 1-3); PDN, prednisone 60 mg/m2/d (days 1-60); L-ASP, asparaginase 6000 IU/m2 3 times a week (total, 10 doses); IT MTX, methotrexate 15 mg intrathecally; ·, at bone marrow recovery (polymorphonuclear neutrophil [PMN] count > 1.5 × 109/L [1500/μL], Plt count > 150 × 109/L [150 000/μL]). Intensification: ARA-C indicates cytosine-arabinoside 2 g/m2 (2 hours infusion) every 12 hours (4 doses); VP16, etoposide 150 mg/m2/d (days 1-3; 1 hour infusion; the course is repeated at bone marrow recovery; total, 2 courses). Central nervous system (CNS) prophylaxis. IT MTX indicates 15 mg intrathecally (twice in a week for 5 total doses); CNS radiotherapy, 2000 cGy after 0 or 1 course of ARA-C, 1800 after 2 courses of ARA-C; 6-MP, 6-mercaptopurine maintaining WBC count between 2.5 × 109/L and 3.0 × 109/L (2500 and 3000/μL). Maintenance: □ indicates vincristine 1.4 mg/m2 intravenously (max 2 mg), daunorubicin 30 mg/m2 intravenously for 2 days (stop after 18 months), prednisone 60 mg/m2/d for 7 days; ▨, vincristine 1.4 mg/m2 intravenously (max 2 mg), cyclophosphamide 600 mg/m2 intravenously, prednisone 60 mg/m2/d for 7 days; ▦, 6-mercaptopurine orally to maintain WBC count between 2.5 × 109/L and 3.0 × 109/L (2500 and 3000/μL), methotrexate 15 mg intramuscularly once a week (omitted when IT MTX is performed), methotrexate 15 mg intrathecally before each course.
