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Days 0-4 and 10-14 DCTER induction [cycle 1]

Dexamethasone 6 mg/m2/day (0.2 mg/kg/day) thrice daily for 4 days Cytarabine 200 mg/m2/day (6.7 mg/kg/day) continuous infusion for 4 days Thioguanine 100 mg/m2/day (3.3 mg/kg/day) twice daily for 4 days Etoposide 100 mg/m2/day (3.3 mg/kg/day) continuous infusion for 4 days Rubidomycin (daunorubicin) 20 mg/m2/day (0.67 mg/kg/day) continuous infusion for 4 days

Cytarabine intrathecal (age-based doses) on day 0 and 10 (0-1 year, 20 mg; 1-2 years, 30 mg; 2-3 years, 50 mg; >3 years, 70 mg)

After the two cycles of DCTER chemotherapy postremission therapy is administered as follows:

1. Conventional chemotherapy a. Course 1. Days 0-2 cytarabine, 3 g/m2/dose (100 mg/kg) IV over 3 hours every

12 hours x 4 doses; L-asparaginase 6000 units/m2 (200 units/kg) IM, hour 42. Days 7-9 cytarabine and L-asparaginase repeated exactly as administered days 0-2.

b. Courses 2 and 3. Two 28-day cycles 6-thioguanine 75 mg/m2 (2.5 mg/kg) PO daily, days 0-27; vincristine 1.5 mg/m2 (0.05 mg/kg) IV, day 0; cytarabine 75 mg/m2 (2.5 mg/kg) IV every day x 4, days 0-3; cyclophosphamide 75 mg/m2 (2.5 mg/kg) IV every day x 4, days 0-3; 5-azacytidine 100 mg/m2 (3.3 mg/kg) IV every day x 4, days 0-3.

c. Course 4. Cytarabine 25 mg/m2/dose (0.83 mg/kg) SC or IV every 6 hours x 5 days, days 0-4; daunomycin 30 mg/m2 (1 mg/kg) IV, day 0; etoposide 150 mg/m2

(5 mg/kg) IV/dose x 2, days 0 and 3; 6-thioguanine 50 mg/m2/dose (1.67 mg/kg) PO every 12 hours x 5 days, days 0-4; dexamethasone 2 mg/m2/dose (0.067 mg/kg) PO every 8 hours x 4 days, days 0-3.

2. Allogeneic HLA-matched donor stem cell transplant.

Notes:Doses in parentheses are used for children less than 3 years of age.

From Woods WG, Kobrinsky N, Buckley JD, et al. Timed-sequential induction therapy improves postremission outcome in acute myeloid leukemia: a report from the Children's Cancer Group. Blood 1996;87:4979-89, with permission.

Table 14-21. Therapy for Newly Diagnosed AML-Protocol (MRC 10)

Course 1

Course 2

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