What is the hyper-CVAD/methotrexate-cytarabine regimen for acute lymphoblastic leukemia (ALL)?

Updated: Oct 23, 2019
  • Author: Karen Seiter, MD; Chief Editor: Koyamangalath Krishnan, MD, FRCP, FACP  more...
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Answer

Answer

The following regimens can be used for patients diagnosed with ALL. Patients can also be admitted into clinical trials, which is strongly recommended.

Standard-intensity regimens (older adults):

Hyper-CVAD/methotrexate-cytarabine includes the following [5] :

Cycles 1, 3, 5, and 7 (3-4 wk between cycles):

  • Cyclophosphamide 300 mg/m2 IV over 2h every 12 h for six doses starting on day 1 plus mesna 600 mg/m2/day continuous IV infusion on days 1-3, starting 1 h before plus

  • Vincristine 2 mg IV on days 4 and 11 plus doxorubicin 50 mg/m2 IV on day 4 plus dexamethasone 40 mg PO on days 1-4 and 11-14

Cycles 2, 4, 6, and 8 (3-4 wk between cycles):

  • Methotrexate 200 mg/m2 IV over 2 h followed by 800 mg/m2 IV over 22 h on day 1 plus

  • Cytarabine 3 g/m2 (1 g/m2 for patients older than 60 y) IV over 2 h every 12 h for four doses starting on day 2 plus

  • Leucovorin 15 mg every 6 h for eight doses beginning 12 h after the completion of methotrexate infusion, and increased to 50 mg IV every 6 h if methotrexate levels are >20 µmol/L at 0 h, are >1.0 µmol/L at 24 h, or are >0.1 µmol/L at 48 h after the end of methotrexate infusion, until levels are <0.1 µmol/L plus

  • Methylprednisolone 50 mg IV every 12 h on days 1-3

Maintenance chemotherapy (for up to 2 y):

  • 6-mercaptopurine 50 mg PO 3 times daily plus  methotrexate 20 mg/m2 PO weekly plus  vincristine 2 mg IV monthly plus prednisone 200 mg PO daily for 5 d monthly (with vincristine)


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