Linker Regimen

Regimen

Induction chemotherapy

• Daunorubicin 50 mg/m2/d iv d1-3
• Vincristine 2 mg iv d 1, 8, 15 and 22
• Prednisone 60 mg/m2/d po d1-28
• L-Asparaginase 6000 U/m2/d im d17-28

- If bone marrow on d14 has residual leukemia

• Daunorubicine 50 mg/m2 iv d15

- If bone marrow on d28 has residual leukemia

• Daunorubicine 50 mg/m2 iv d29 and 30
• Vincristine 2 mg iv d29 and 36
• Prednisone 60 mg/m2/d po d29-42
• L-Asparaginase 6000 U/m2/d im d29-35

Consolidation chemotherapy

Treatment A (cycle 1, 3, 5, 7)

• Daunorubicin 50 mg/m2/d iv d1-2
• Vincristine 2 mg iv d 1, 8
• Prednisone 60 mg/m2/d po d1-14
• L-Asparaginase 12000 U/m2 im d2, 4, 7, 9, 11, 14

Treatment B (cycle 2,4,6,8)

• Teniposide 165 mg/m2 iv d1, 4, 8, 11
• Cytarabine 300 mg/m2 iv d1, 4, 8, 11
• Treatment C (cycle 9)
• Methotraxate 690 mg/m2 iv over 42 hrs
• Leucovorin 15 mg/m2 iv q6h x 12 doses beginning at 42 hrs

Maintenance chemotherapy

• Methotrexate (MTX) 20 mg/m2 po qw x 30 months
• 6-Mercaptopurine (6-MP) 75 mg/m2 po qd x 30 months

CNS prophylaxis

Begin within 1 wk of CR

• Cranial radiation 1.8 Gy/d to 18 Gy
• Intrathecal methotrexate 12 mg qw x 6 wks

CNS treatment

In patients with CNS involvement, start intrathecal chemotherapy during induction chemotherapy.
Intrathecal methotrexate 12 mg qw x 10 wks, then qm x 9 months
Cranial radiation 1.8 Gy/d to 28 Gy

References

Linker CA et al. Improved results of treatment of adult acute lymphoblastic leukemia. Blood 1987; 69:1242.

Linker CA et al. Treatment of adult acute lymphoblastic leukemia with intensive cyclical chemotherapy: a follow-up report. Blood 1991; 78:2814.