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Chemotherapy - Acute Lymphocytic Leukemia (ALL)

Chemotherapy for ALL usually begins with a three-drug schedule such as:

Option 1: Chemotherapy with prednisone, vincristine sulfate (Oncovin®), and an anthracycline drug (e.g., daunorubicin)

• How is it given: Prednisone is given orally in three divided doses, and Vincristine is given intravenously (IV), the drug is delivered into the veins.
• What is the duration: Prednisone and vincristine are given at weekly intervals for 4 weeks
• What are the side effects: Vincristine - hair loss, nervous system effects

Option 2: Chemotherapy with prednisone. vincristine (Oncovin ®), and L-asparaginase (Elspar®) or cyclophosphamide (Neosar®)

• How is it given:
  • Prednisone: orally
  • Vincristine: Intravenously (IV), the drug is delivered into the veins
  • L-asparaginase: IV or intramuscularly; subcutaneously, injected under the skin; or IV (least favorable due to allergic reactions with this route)
  • Cyclophosphamide: IV or orally
• What is the duration: Prednisone and vincristine are given at weekly intervals for 4 weeks; the schedule for L-asparaginase is more variable. Cyclophosphamide is given every 2 to 5 days, or by another schedule.
• What are the side effects:
  • Prednisone - immune system effects
  • Vincristine - hair loss, nervous system effects
  • L-asparaginase - anaphylactic (severe allergic) reactions, pancreas inflammation, blood clotting problems
  • Cyclophosphamide - infertility, severe bladder inflammation, cardiotoxicity (heart damage), immune system suppression, hair loss

Consolidation therapy for ALL (1-3 months in adults; 4-8 months in children) may involve treatment with combination chemotherapy or antimetabolites such as methotrexate and 6-mercaptopurine (6-MP):

Option 1: Chemotherapy with prednisone, vincristine (Oncovin®), L-asparaginase (Elspar®) and daunorubicin, followed by Cyclophosphamide (Neosar®), cytarabine (ara-C; Cytosar-U®), and 6-thioguanine (Tabloid®)

Option 2: Chemotherapy with methotrexate sodium plus 6-mercaptopurine (6-MP; Purinethol®)

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