You are using an outdated browser. We suggest you update your browser for a better experience. Click here for update.
Close this notification.
Skip to main content Skip to search

COVID-19: Get the latest updates or take a self-assessment.

Screen for hepatitis B virus in all cancer patients starting systemic treatment. Find out more about hepatitis B virus screening and management.

Drug Formulary information is intended for use by healthcare professionals. It is not intended to be medical advice. Some of the information, including information about funding for cancer drugs, does not apply to all patients. Cancer treatment plans are unique to each patient. If you are a patient, please speak with your healthcare team to understand how this information applies to you.

DANAFARBER(INT-PEG)

Cancer Type:
Hematologic, 
Leukemia - Acute Lymphoblastic (ALL)
Intent: Curative
Regimen Category: evidence-informed
Funding:
ODB - General Benefit
    mercaptopurine
ODB - General Benefit
    dexamethasone
New Drug Funding Program
    Pegaspargase (Outpatient) - Adult Acute Lymphoblastic Leukemia (ALL) Lymphoblastic Lymphoma Mixed or Biphenotypic Leukemia
A - Regimen Name

DANAFARBER(INT-PEG) Regimen
Dana Farber (intensification phase-PEG)


Disease Site
Hematologic
Leukemia - Acute Lymphoblastic (ALL)


Intent
Curative

Regimen Category
evidence-informed :

Regimen is considered appropriate as part of the standard care of patients; meaningfully  improves outcomes (survival, quality of life), tolerability or costs compared to alternatives (recommended by the Disease Site Team and national consensus body e.g. pan-Canadian Oncology Drug Review, pCODR).  Recommendation is based on an appropriately conducted phase III clinical trial relevant to the Canadian context OR (where phase III trials are not feasible) an appropriately sized phase II trial. Regimens where one or more drugs are not approved by Health Canada for any indication will be identified under Rationale and Use.

This Regimen Abstract is an abbreviated version of a Regimen Monograph and contains only top level information on usage, dosing, schedule, cycle length and special notes (if available). Information in regimen abstracts is accurate to the extent of the ST-QBP regimen master listings, and has not undergone the full review process of a regimen monograph. Full regimen monographs will be published for each ST-QBP regimen as they are developed.

The information provided in this document is intended for use only in the management of adults with leukemia, and for cancer centres with expertise in treating acute leukemia.


Supplementary Public Funding

mercaptopurine
ODB - General Benefit (mercaptopurine)

dexamethasone
ODB - General Benefit (dexamethasone)

pegaspargase
New Drug Funding Program (Pegaspargase (Outpatient) - Adult Acute Lymphoblastic Leukemia (ALL) Lymphoblastic Lymphoma Mixed or Biphenotypic Leukemia)

 
B - Drug Regimen

Philadelphia Chromosome (Ph) negative adult patients, age <60 years:

DOXOrubicin
30 mg /m² IV Day 1 (Cycles 1 to 7 only)
vinCRIStine
2 mg IV Day 1
dexamethasone
9 mg /m² PO BID; Days 1-5
mercaptopurine
50 mg /m² PO Days 1 to 14
pegaspargase

1000-2000 units /m² IV / IM Day 1

 pegaspargase maximum dose = 3750 units

methotrexate
30 mg /m² IV / IM Days 1, 8, 15 (Cycles 8 to 10 only)


Cycle 6 Intrathecal (methotrexate + cytarabine + hydrocortisone):

methotrexate
12 mg IT Day 1, Cycle 6 only

and

cytarabine
40 mg IT Day 1, Cycle 6 only

and

hydrocortisone
15 * mg IT Day 1, Cycle 6 only

*An alternative hydrocortisone dose of 50 mg IT may be used, based on local protocol
(Methotrexate, cytarabine and hydrocortisone can be admixed in the same syringe.  Also refer to local protocols.)
The regimen details vary based on Ph status and patient age. Refer to local protocols.

back to top
 
C - Cycle Frequency

REPEAT EVERY 21 DAYS

For a total of 10 cycles

 
D - Premedication and Supportive Measures

Antiemetic Regimen:

Moderate (D1 (Cycles 1-7))
Minimal (D8, 15 (Cycles 1-7))
Minimal (Cycle 8+)

Other Supportive Care:

Also refer to CCO Antiemetic Recommendations.

 
J - Administrative Information

Approximate Patient Visit
0.5 to 0.75 hour (with additional time on intrathecal days)
Pharmacy Workload (average time per visit)
31.424 minutes
Nursing Workload (average time per visit)
52.806 minutes
 
K - References

Storring JM, Minden MD, Kao S, et al. Treatment of adults with BCR-ABL negative acute lymphoblastic leukaemia with a modified paediatric regimen. Br J Haematol 2009;146(1):76-85.

DeAngelo DJ, Stevenson KE, Dahlberg SE, et al.  Long-term outcome of a pediatric-inspired regimen used for adults aged 18-50 years with newly diagnosed acute lymphoblastic leukemia. Leukemia. 2015 Mar;29(3):526-34.

DeAngelo DJ et al. A Multicenter Phase II Study Using a Dose Intensified Pegylated-Asparaginase Pediatric Regimen in Adults with Untreated Acute Lymphoblastic Leukemia: A DFCI ALL Consortium Trial. Blood 2015 126:80 (Abstract).

PM-DFCI <60 ALL protocol Pegaspargase. Princess Margaret Cancer Centre. June 2021.

December 2021 Defined patient group in Drug regimen section; added pegaspargase NDFP form; added ODB funding (mercaptopurine, dexamethasone)


back to top
 
M - Disclaimer

Regimen Abstracts
A Regimen Abstract is an abbreviated version of a Regimen Monograph and contains only top level information on usage, dosing, schedule, cycle length and special notes (if available). It is intended for healthcare providers and is to be used for informational purposes only. It is not intended to constitute or be a substitute for medical advice, and all uses of the Regimen Abstract are subject to clinical judgment. Such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability, and Cancer Care Ontario disclaims all liability for the use of this information, and for any claims, actions, demands or suits that arise from such use.
Information in regimen abstracts is accurate to the extent of the ST-QBP regimen master listings, and has not undergone the full review process of a regimen monograph.  Full regimen monographs will be published for each ST-QBP regimen as they are developed.
Regimen Monographs
Refer to the New Drug Funding Program or Ontario Public Drug Programs websites for the most up-to-date public funding information.
The information set out in the drug monographs, regimen monographs, appendices and symptom management information (for health professionals) contained in the Drug Formulary (the "Formulary") is intended for healthcare providers and is to be used for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects of a particular drug, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for a given condition. The information in the Formulary is not intended to constitute or be a substitute for medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.
The format and content of the drug monographs, regimen monographs, appendices and symptom management information contained in the Formulary will change as they are reviewed and revised on a periodic basis. The date of last revision will be visible on each page of the monograph and regimen. Since standards of usage are constantly evolving, it is advised that the Formulary not be used as the sole source of information. It is strongly recommended that original references or product monograph be consulted prior to using a chemotherapy regimen for the first time.
Some Formulary documents, such as the medication information sheets, regimen information sheets and symptom management information (for patients), are intended for patients. Patients should always consult with their healthcare provider if they have questions regarding any information set out in the Formulary documents.
While care has been taken in the preparation of the information contained in the Formulary, such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability.
CCO and the Formulary’s content providers shall have no liability, whether direct, indirect, consequential, contingent, special, or incidental, related to or arising from the information in the Formulary or its use thereof, whether based on breach of contract or tort (including negligence), and even if advised of the possibility thereof. Anyone using the information in the Formulary does so at his or her own risk, and by using such information, agrees to indemnify CCO and its content providers from any and all liability, loss, damages, costs and expenses (including legal fees and expenses) arising from such person’s use of the information in the Formulary.