HANDLE WITH CARE
RECOMMENDED INDUCTION REGIMENS:
WHEN USING CHEMOTHERAPEUTIC AGENTS IN COMBINATION FOR THE INDUCTION OF REMISSIONS IN PATIENTS WITH ACUTE LYMPHOCYTIC LEUKEMIA, REGIMENS ARE SOUGHT WHICH PROVIDE MAXIMUM CHANCE OF SUCCESS WHILE AVOIDING EXCESSIVE CUMULATIVE TOXICITY OR NEGATIVE DRUG INTERACTIONS.
ONE OF THE FOLLOWING COMBINATION REGIMENS INCORPORATING LEUCOGINASE RECOMMENDED FOR ACUTE LYMPHOCYTIC LEUKEMIA IN PEDIATRIC PATIENTS:
IN THE REGIMENS BELOW, DAY 1 IS CONSIDERED TO BE THE FIRST DAY OF THERAPY.
REGIMEN I
PREDNISONE 40 MG/SQUARE METER OF BODY SURFACE AREA PER DAY ORALLY IN THREE DIVIDED DOSES FOR 15 DAYS, FOLLOWED BY TAPERING OF THE DOSAGE AS FOLLOWS:
20 MG/SQUARE METER FOR 2 DAYS, 10 MG/SQUARE METER FOR 2 DAYS, 5 MG/SQUARE METER FOR 2 DAYS, 2.5 MG/SQUARE METER FOR 2 DAYS AND THEN DISCONTINUE.
VINCRISTINE SULFATE 2 MG/SQUARE METER OF BODY SURFACE AREA INTRAVENOUSLY ONCE WEEKLY ON DAYS 1, 8, AND 15 OF THE TREATMENT PERIOD. THE MAXIMUM SINGLE DOSE SHOULD NOT EXCEED 2.0 MG.
ASPARAGINASE 1,000 I.U./KG/DAY INTRAVENOUSLY FOR TEN SUCCESSIVE DAYS BEGINNING ON DAY 22 OF THE TREATMENT PERIOD.
REGIMEN II
PREDNISONE 40 MG/SQUARE METER OF BODY SURFACE AREA PER DAY ORALLY IN THREE DIVIDED DOSES FOR 28 DAYS (THE TOTAL DAILY DOSE SHOULD BE TO THE NEAREST 2.5 MG), FOLLOWING WHICH THE DOSAGE OF PREDNISONE SHOULD BE DISCONTINUED GRADUALLY OVER A 14 DAY PERIOD.
VINCRISTINE SULFATE 1.5 MG/SQUARE METER OF BODY SURFACE AREA INTRAVENOUSLY WEEKLY FOR FOUR DOSES, ON DAYS 1, 8, 15, AND 22 OF THE TREATMENT PERIOD. THE MAXIMUM SINGLE DOSE SHOULD NOT EXCEED 2.0 MG.
ASPARAGINASE 6,000 I.U./SQUARE METER OF BODY SURFACE AREA INTRAMUSCULARLY ON DAYS 4, 7, 10, 13, 16, 19, 22, 25, AND 28 OF THE TREATMENT PERIOD. WHEN A REMISSION IS OBTAINED WITH EITHER OF THE ABOVE REGIMENS, APPROPRIATE MAINTENANCE THERAPY MUST BE INSTITUTED. LEUCOGINASE SHOULD NOT BE USED AS PART OF A MAINTENANCE REGIMEN. THE ABOVE REGIMENS DO NOT PRECLUDE A NEED FOR SPECIAL THERAPY DIRECTED TOWARD THE PREVENTION OF CENTRAL NERVOUS SYSTEM LEUKEMIA.
WHEN RECOMMENDED ALONE THE DOSE IS AS BELOW :
THE USUAL DOSE :- 50-200 K.U./KG BODY WT. DAILY OR EVERY ALTERMATE DAY BY I.V. INFUSION.