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Childhood Acute Lymphoblastic Leukemia Treatment (PDQ®)

  • Updated: 05/02/2014

Table 2. CNS-Directed Treatment Regimens for Newly Diagnosed Childhood ALL

Disease Status Standard Treatment Options 
Standard-risk ALL Intrathecal chemotherapy
Methotrexate alone
Methotrexate with cytarabine and hydrocortisone
CNS-directed systemic chemotherapy
Dexamethasone
L-asparaginasea
High-dose methotrexate with leucovorin rescue
Escalating-dose intravenous methotrexate (no leucovorin rescue)
High-risk ALL Intrathecal chemotherapy
Methotrexate alone
Methotrexate with cytarabine and hydrocortisone
CNS-directed systemic chemotherapy
Dexamethasone
L-asparaginasea
High-dose methotrexate with leucovorin rescue
Cranial radiation

ALL = acute lymphoblastic leukemia; CNS = central nervous system; CNS3 = cerebrospinal fluid with five or more white blood cells/µL, cytospin positive for blasts, or cranial nerve palsies.
aThe drug itself is not CNS-penetrant, but leads to cerebrospinal fluid asparagine depletion.