Grupul Roman de Lucru pentru Studiul Leucemiilor Acute la adult (RWGALS)

Standardul national recomandat pentru profilaxia SNC in LAL fara radioterapie

Inductia II
CFA
AraC
6-MP
Inductia I
DXM
VCR
Dauno
Asparaginaza
G-CSF
6MP
Preinductie
DXM
CFA

1 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70

Depo Depo Depo Depo

cyte cyte cyte cyte

DXM = Dexametazona 10 mg/mp p.o., zilele 6 - 7, 13 - 16

VCR = Vincristin 2 mg i.v, zilele 6, 13, 20
Dauno = Daunorubicina 45 mg/mp i.v. zilele 6 - 7, 13 - 14
Asparaginaza = Peg* sau E.Coli Asparaginaza 5000 U/mp zilele 18, 20, 22, 24, 26
G-CSF 5 microg/kg s.c. din ziua 6 pana la Gr > 1000/mmc constant (dupa ziua 44)
CFA = Ciclofosfamida 1000 mg/mp ziua 26 si 46
AraC = Cytosar 75 mg/mp i v zilele 28 - 31, 35 - 38, 42 - 45
6-MP = Purinethol 60 mg/mp p.o ziua 26 – 46
Profilaxia SNC: Metotrexat 15 mg i.t ziua 1, 28, 35, 42
Iradiere 24 Gy, din ziua 24 pana in 44
GEN = examen genetic la diagnostic si evaluare boala minima reziduala ziua 26, 46 1
 PRIMUL AN DE TRATAMENT PENTRU LAL

CONSOLIDAREA II CONSOLIDAREA III CONSOLIDAREA VI

HDMTX HDMTX HDMTX
Asparaginaza Asparaginaza Asparaginaza
6MP 6MP 6MP

CONSOLIDARE IV
REINDUCTIA I AraC
Recoltare PRD MTX + 6MP VM26 SAU VP16
VDS sau VCR
CSH ADR
CONSOLIDARE V
MTX + 6MP CFA
CONSOLIDAREA I REINDUCTIA II AraC
DXM
CFA
VCS sau VCR
AraC
HDMTX
6TG
VP16 sau VM26
HD AraC
G-CSF MTX + 6MP MTX + 6MP

71. . . . . . . . . . . . .112 . . . . .. . . . . . . .154. . . .168 . . . . .. . . . . 210 . . . . . . . . . . . . . . .252 . . . . . . . . . . . . . . . .287 . . . . . . . . . . . . . . 322. . . . . . . . . . . . . . . . . . . 365

11 . . . . . . . . . . . 16 . . . . . . . . . . . 22 . . . 24 . . . . . . . . . 30 . . . . . . . . . . . . . 36 . . . . . . . . . . . . . . . 41 . . . . . . . . . . . . . 46 . . . . . . . . . . . . . 51. . 52

GEN GEN GEN GEN

Day 154 Day 189 Day 253 Day 365

week 22 week 27 week 36 week 52
Depo Depo Depo Depo
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2
 TRATAMENTUL IN AL DOILEA AN PENTRU LAL

VM26 sau VP16 + AraC VM26 sau VP16 + AraC

HDMTX + Asparaginaza

HDMTX + Asparaginaza

CFA + AraC CFA + AraC

6MP+MTX 6MP+MTX 6MP+MTX 6MP+MTX 6MP+MTX 6MP+MTX 6MP+MTX

53 . . . . . . . . . . . . . . . . . .58 . . . . . . . . . . . . . . .. . . .66 . . . . . . . . . . . . . . . . . .74 . . . . . . . . . . . . . . . . . .82 . . . . . . . . . . . . . . . . . .90 . . . . . . . . . . . . . . .. . . .98 . . . . . . . . . . . . . . . . . .104

Week 56 Week 64 week 80 week 88

Depo Depo Depo Depo

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GEN GEN GEN GEN