Chemo Experts, the easiest way to learn about cancer treatment
Find a Treatment:
Cancer Types
or
Treatments

Treatment Name: C10403 Interim Maintenance

C10403 Interim Maintenance is a Chemotherapy Regimen for Acute Lymphoid Leukemia (ALL)

Thank you for visiting our C10403 Interim Maintenance page.

  • If you are interested in seeing the full treatment regimen page for C10403 Interim Maintenance sooner rather than later, please cast your vote for C10403 Interim Maintenance.
  • Votes from users like you are important as they help us prioritize the order in which we build our content. The more requests we receive, the faster we will build it!

While we work on uploading the pages that matter to you most, we hope that links to journal article references for C10403 Interim Maintenance shown below will prove useful in the meantime.

Thank you for your continued support!

Sincerely,
The ChemoExperts Team

References

1) Curran E and Stock W. How I treat acute lymphoblastic leukemia in older adolescents and young adults. Blood 2015;125:3702-3710.

2) Stock W, Luger SM, Advani AS, et al. A pediatric regimen for older adolescents and young adults with acute lymphoblastic leukemia: results of CALGB 10403. Blood. 2019;133:1548-1559.

Created: February 16, 2019 Updated: February 16, 2019

What is Acute Lymphoid Leukemia (ALL)?

Acute Lymphoid Leukemia (ALL), also known as acute lymphoblastic leukemia, is a disease of the lymphoid cells found in the bone marrow. Lymphoid cells are responsible for developing into cells of the immune system called B-cells, T-cells, or Natural Killer cells. In ALL, immature lymphoid cells know as "blasts" replicate at a very fast rate. Sometimes blasts crowd out the normal cells in the bone marrow so that red blood cells or platelets are unable to develop.

Common symptoms of ALL include fatigue, infection, and bruising or bleeding. ALL is the most common cancer diagnosed in children, but is rare in adults. Most cases of ALL are considered "de novo" meaning that the cause is unknown; however, some cases can be linked to certain genetic syndromes. There is no staging system for ALL. Chromosomes are often analyzed to determine which mutations in the chromosomes exist. The effectiveness of the treatment may depend upon the specific chromosome mutations that are present.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose your therapy.

Common C10403 Interim Maintenance starting doses

  • Methotrexate 100 mg/m2 intravenous (I.V.) push on Day 1
    • Then Methotrexate 150 mg/m2 I.V. push on Day 11
    • Then Methotrexate 200 mg/m2 I.V. push on Day 21
    • Then Methotrexate 250 mg/m2 I.V. push on Day 31
    • Then Methotrexate 300 mg/m2 I.V. push on Day 41
  • If ANC > 750/μL and platelets > 75,000/μL, escalate methotrexate by 50 mg/m2 per dose as scheduled
  • If ANC ≥ 500/μL but ≤ 750/μL and/or platelets ≥ 50,000/μL but ≤ 75,000/μL, give same dose of methotrexate as given previously (no dose escalation)
  • If ANC < 500/μL or platelets < 50,000/μL, hold all chemotherapy and repeat blood counts in 4 days
    • If ANC recovers to ≥ 500/μL and platelets to ≥ 50,000/μL, give the same dose of methotrexate as given previously
    • If ANC is still < 500/μL or platelets still < 50,000/μL, give vincristine only and repeat counts in 7 days to begin next dose of methotrexate if counts are adequate. Do not make up missed dose of methotrexate
  • If ANC < 750/μL or platelets < 75,000/μL for more than 7 days after methotrexate, then discontinue Bactrim&reg; temporarily. If toxicity for more than 7 days recurs after the next dose, once ANC > 750/μL and platelets > 75,000/μL, then methotrexate should be given at 75% of the previous dose. If neutropenia does not recur after 2 doses of methotrexate at a reduced dose, increase methotrexate to the previous higher dose 
  • Vincristine 1.5 mg/m2 (maximum 2 mg) I.V. push or I.V. infusion over 10 to 15 minutes on Days 1, 11, 21, 31, and 41
  • Pegaspargase 2500 IU/m2 (maximum 3750 IU) I.V. infusion over 1 to 2 hours or intramuscular (I.M.) injection on Days 2 and 22
  • Methotrexate 15 mg intrathecal (I.T.) injection on Days 1 and 31

What are adolescents and young adults (AYAs)?

The age range for this population is generally considered to be those between 18 - 39 years old, although this age range may vary slightly.

What does Cure mean?

The word “cure” means there are no cancer cells left in the body and cancer will never come back. Depending on the cancer type and stage, this may be the true goal of therapy. However, it is very difficult to prove all cancer cells are gone. Even though images, like X-rays and MRI’s, and blood tests may not show any signs of cancer, there can be a small amount of cancer cells still left in the body. Because of this, the word “remission” is used more often. This means there are no signs or symptoms of cancer. Patients in remission are followed closely for any signs of cancer returning. Sometimes, more chemotherapy may be given while in remission to prevent the cancer from coming back.

Doctors usually do not consider a patient “cured” until the chance of cancer returning is extremely low. If cancer does return, it usually happens within 5 years of having a remission. Because of this, doctors do not consider a patient cured unless the cancer has not come back within 5 years of remission. The five-year cutoff does not apply to all cancers.

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium

What is Fibrinogen?

Fibrinogen is a clotting factor that gets converted to fibrin and plays a role in the final steps of clot formation. Fibrinogen may be supplemented during treatment in the form of cryoprecipitate, a human-derived product, that is transfused by I.V. infusion to increase fibrinogen levels and decrease the risk of bleeding.

What is amylase?

Amylase is an enzyme that is produced by the pancreas that helps the body break down and digest carbohydrates. When the pancreas is injured, amylase is leaked out into the blood. 

Amylase, along with lipase, can be monitored to check for possible injury to the pancreas, indicated by elevated levels of the enzymes in the blood.

What is Lipase?

Lipase is an enzyme that is produced by the pancreas that helps the body break down fats. When the pancreas is injured, lipase is leaked out into the blood. Lipase, along with amylase, can be monitored to check for possible injury to the pancreas, indicated by elevated levels of the enzymes in the blood.