TABLE 33.6.
First-Line Rescue Protocola
| Cycle 1 | |
| Week 1 |
Baseline ALT ________ Units/Ll-Asparaginase, 400 Units/kg SC CCNUb 70 mg/m2 PO Prednisone, 2 mg/kg PO, once daily |
| Week 2 | Prednisone, 1.5 mg/kg PO, once daily |
| Week 3 | Prednisone, 1.0 mg/kg PO, once daily |
| Cycle 2 | |
| Week 1 |
Optional ALT ________ Units/Ll-Asparaginase, 400 U/kg SC CCNU 70 mg/m2 PO Prednisone, 1.0 mg/kg PO, EOD |
| Week 2 | Prednisone, 1.0 mg/kg PO, EOD |
| Week 3 | Prednisone, 1.0 mg/kg PO, EOD |
| Cycle 3–5 | |
| Week 1 |
Mandatory ALT ________ Units/L CCNU 70 mg/m2 PO Prednisone, 1.0 mg/kg PO, EOD |
| Week 2 | Prednisone, 1.0 mg/kg PO, EOD |
| Week 3 | Prednisone, 1.0 mg/kg PO, EOD |
ALT, Alanine aminotransferase.
a
Treatment discontinuation criteria: (1) After completion of protocol, two treatments beyond complete response (CR); (2) progressive disease; (3) increase in ALT activity >2× upper limit of normal (or 2× baseline if higher than baseline at initiation)—institute drug discontinuation and reinstitution/dose reduction dependent on normalization of ALT.
b
Prophylactic liver protectants recommended (e.g., Denamarin).