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

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 click here to cast your vote for this specific regimen.
  • 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!

The ChemoExperts Team


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 [Epub ahead of print].

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