PROTOCOL - Prince of Songkla Universitymedinfo2.psu.ac.th/social/doc/2014-05-01-11-23-11.pdf · Protocol for treatment Induct ion: and cytochemistry chemotherapy or radiation 0, I,

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PROTOCOL

I

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L ACUTE LEUKEMIA

11 Acute lloll-Iympboblastic

leukemia (ANLL)

A) Previously untreated case ICvtosmLe arabinoside 2

100 mglm

tnt) Consolidation therapy Cytosine arabinoside

2 mgm

100 mgm 2

2 60 mgm

Maintenance therapy

Regimen A (llfUVU Consolidation lhorapy)

Regimen B (vtnp arabinoside

6-Thiogaunine 2

40 mgm

2

Pbase 2

single dose 1000 mg)

2 75 mgm

2 60 mgm

2 10 mgm

15 rog)

irradiation 240y

Consolidation 2

Pbase 1 14 mgro

single dose 2 mg)

2 25 mgro

2 10 mgm

2

Pbase 2 650 mgm

2 75 mgm

2

Thioguanine mgm

2

Maintenance 6middotMercaptopurine mgm

2 Methotrexate mgm

J

3

2J Non-Hodgkin Lymphoma (NHL)

A) Low grade NHL

Protocol for treatment

Arm-I COP without maintenance

Vincristine

2 750 mgm

2 14 mgm

2 100 mgm

Arm-ll COP with IFN maintenance

as Arm-I regimen)

maintenance IInterferon alfa-2A Mu

Arm-ill I-COP with IFN maintenance

Vincristine

Prednisolone

j ITnterferrn a1fa-2A

2 750 mgm

2 14 mgm

2 100 mgm

6Mu

maintenance maintenance as Arm-II regimen

B) Intermediate grade (lG)

and Hlgb grade (HG)

NHL

Arm-I CHOP-I

Adriamycin mgm

2 Vincristine 14 mgm

2 Prednisolone 60 mgm

alfa-2B Mu

Maintenance alfa-2B Mu

2

middot 4

Arm-n CHOP with COP maintenance

2 Cyclophosphamide 50 mgm

2 50 mgm


2

Maintenance Cyclophosphamide

2 Vincristine 14 mghn

2

mgm

60 mgm

Arm-ill CHOP without maintenance

Induction regimen as Arm-IT

C) Other types of NHL Cyclophosphamide


2 60 mgm

2 mgm

D) Failure Progrion Relapse or Stable disease

Option 1 ENAP regimen

2 100 mgm

2 10 mgm

2 I~rtnltn arabinoside 100 mgm

2 Prednisolone 100 mghn

Option 2 MINE regimen -----------------~~--------------------~ Mesna mg

2 133 mgm

2 8 mgm

2 Etoposide mgm

6

Option 3 CMPP regimen

2 650 mgm

50mg

2 Procarbazine 100 mgm

Prednisolone 100 mg

22 Hodgkin bull disease (HD)

A) Previously untreated case

2C-MOPP regimen 750 mgrn


2 100 mgm

2 mgm

B) Failure Progression of disease table disease or Relapse

2ABV regirntn 50 mgm

2Vinblastine mgm

2 10 mgm

6

MYELOPROLIFERATIVE DISEASES

31 Chronic myelogenous leukemia (CML) chronic pbase

2-12 mgday PO

32 Ioterferon protocol in CML chronic ph

Phase I IHYdroxyurea mgkgday PO

Phase II Patients will be randomized into 2 groups

Arm-I 5 MuAlfa-2B

9 If WEC gt 15 x 10 fL add hydroxyurea

2 Mfll1fl1Ut)1JM 3-6 L~VJ L~1J Ara-C 20 mgJl day

Arm-2 Ioterferon alfa-2B 5 Mu

2 Ara-C 20 mgm

33 CML blastic ph

Option 1 Palliative chemotherapy

2 1C1ltolane arabinoside 20 mgm

Option 2 To assess the efficacy of combination of low dose cytosine

arabinoside and IFN in treatment of CML patients with blastic crisis

Ioterferon alfa-2B 5 Mu

2 20 mglmAra-C

804 Other myeloproliferative diseases -----------------------------------------4

mgday PO

Option 2

Phase I

Option I

Interferon alfa-2B

Phase 2 IMamtain with interfon alfa-2B

7

4 MULTIPLE MYEWMA (MM)

41 Previously untreated cases

A) Conventional therapy

bull

Melphalan

Prednisolone

B) Interferon protocol for MM

Maintenance regimens

Arm-I

Arm-n

Arm-ill

Melphalan

Prednisolone

Interferon alfa-2B

Interferon alfa-2B

Interferon alfa-2B

Dexamethasone

mgday

mgday

2 mgm

42 Failure Progressing Relapsing or Stable disease

Option 1

Option 2

IR~peat cycle every 6 weeks

O4mg

2 9 mgm

40 mgday

6 mgm2

60 mgday

Interferon alfa-2B 3 Mu SC thrice a week

8

PROTOCOL FOR MANAGEMENT OF LUNG CANCER

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A1

A2

A8

81

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A4 (Etoposide orally)

B1

B2

bull

CispJatin

Etoposide

Carboplatin

Etoposide

IfosfarrUde + Al or A2

2 25 mgm

2 100 mgm

2 25 mgm

2 100 mgm

2 2 gm

Ifosfamide + Cisplatin + Etoposide

Ifosfamide + Carboplatin + Etoposide

VP - 16 50 mg

2 Mitomycin 8 mgm

2 VinblllBtine 45 mgm

2 CispJatin 100 mgm

2 Mitomycin 8 mgrn

2 Vinblastine 45 mgm

Carboplatin (~1IlflIJ HtJ1flfl~llJ ll~))

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CANCER PROTOCOL bullDIVISION OF HEMATOLOGY

DEPERTMENT OF INTERNAL MEDICINE

FACULTY OF MEDICINE PRINCE OF SONGKLA UNIVERSITY

1 ACUTE LEUKEMIA

11 Acute non-lymphoblastic leukemia (ANLL) shyA) Previously untreated case

El iglbil ity criteria

~ Adult patient 15 to 60 years old Morphologic proof of ANLL FAB types MI through M7

~ I as determined by morphologyI

No previous treatment with

- ECOG performance status of

- Adequate hepatic and renal - No evidence of Infections

Protocol for treatment Induct ion

and cytochemistry

chemotherapy or radiation

0 I 2 and 3

function

Cytosine arabinoside 100 mgm 2 cont Inuous IV infusion day s 1-7

Adrlamycln 45 mg m2 IV days 1- 3

Repeat cycle middotevery 4 weeks

Criteria for evaluation

Complete remission (CR)

Normal physical status - normal spleen I iver and lymph

node

Normal peripheral blood - Hb ) II gm dL Neutrophils) 15 x 109L

Platelet count) 100 x 109L

MI marrow status - lt 5 blast

) 15 erythroid elements ) 25 normal granulocyte precursors in

a nonhypocellular marrow

Failure complete remission cannot be achieved within

Induct ion courses

~

2

Postremission therapy

Postremis s ion chemotherapy began 4 weeks after CR It consists of consolidation and maintenance therapy

Consolidation therapy

Cytosine arabinoside 100 mgm 2 continuous IV infusion

days 1-5

Adriamycin 60 mgm 2 I V day s 1

Maintenance therapy

Maintenance chemotharapy began 4 weeks after consoli shydation therapy They will be randomized into 2 regimens to

assess their efficacy in term of survival and disease-free

duration

Regimen A

The intensification therapy with the same regimen as consolidation therapy should be given every 6 months

Regimen B

Cytosine arabinoside 20 mgm 2 SC day s 1-7

6-Thiogaunine 40 mgm2 PO days 1-

Repeat every 4 weeks

Maintenance therapy will be continued for at least years or until relapse occurs

Bone marrow aspiration to detect relapse should be

performed routinely every 3 months for the first 2 years of

follow up period

Drug Toxicity Grading according to WHO criteria

C~iteria for relapse ~

- Appearance of circulating leukemic cells or

- gt 5 blasts in the bone marrow

B) Elder Iy case

S tudy ob~ec t ive To evluate the efficacy of low dose cytosine arabinoshy

side in treatment of a~ute non-lymphoblastIc leukemia in elderly

patients in term of response rate and survival

EligibilIty criteria

Adult patientgt 60 years old

Morphologic proof of ANLL PAB -types Ml through M7

2

2

as determined by morphology and cytochemistry

- No previous treatment with chemotherapy or radiation

ECOG performance status of 0 I 2 and 3

- Adequate hepatic and renal function

- No evidence of Infections


cytosine arabinoside 20 mg m2 SC days 1-7


C) Relapse or Refractory cas~s

Option 1 Relapse occurs after 6 months from CR

Cytosine arabinoside 100 mg m2 continuous IV infus ion

Ad r iamyc in 45 mgm 2

days 1-7

IV days 1-3

Repeat cycle every 4 weeks

Option 2 Refractory case or Relapse within 6 months from CR

Etoposide 100 mg m 2 IV infusion in I hr days 1-5

Mitoxantrone 10 mgm2 IV day 1-3


12 Acute lymphoblastic leukemia (ALL)

Open prospecti ve multicenter study

Songklanagarind hospital

Chulaiongkorn hospital

Maharaj Nakorn-Chiangmai hospital

Pramongkutkloa ho spi tal

Rajavithi hospital

Ramathibodi hospital

Study obJectives

I To determine the complete remission rate survival and disease-free su rvival of adult ALL treated with modified

Hoelzers chemotherapy regimen

2 To determine the factors that are progn os tic for the

achievement of complete remission and disease-free duration

Eligibility criteria ~

- AduLt patient age ~ 15 and ~ 65 years old I

3

- Morphologic proof of ALL FAB types Ll L2 L3 as determined by morphology and cytochemistry

- No previou s treatment with chemotherapy or radiation

- ECOC performance sta tus of 0 1 2 and 3


- Free of infections


Induction

Phase I

Vincristine 14 middotmgm 2 [V day 181522

(maximal single dose(2- mg)J

Adriamycinmiddot 15 m~[v day 1815 2 2

Prednisolone 60 mg m2 PO day 1-28

plusmn L-asparaginase 5000 Um 2 IV day 1-14

Phase 2

Cyclophosphamide 650 mgm 2 IV day 294357

(maximal single dose 1000 mg)

Ara-C 75 nignG _ [-V day 31-3438-4145-48

52- 55

6-Mercaptopurine 60 mg m2 PO day 29-57

Methotrexate 10 mgm 2 IT day 31384552

(maximum 15 mg)

CNS irradiation 24 Cy day 29-57

Criteria Cor evaluation r


Normal physical status - normal spleen liver and lymph

node

Normal peripheral blood - Hb ) 11 gmdL

Neutrophils ) 15 x 10L


Ml marrow status - lt 5 blast ) 15 erythroid elements ) 25

- normal granulocyte precursors in


Fa i lure complete remission cannot be achieved within

induction cOUrses

I 4

2

Consolidation

Phase Vincristine I 4 mg m2 IV day 181522

(maximal single dose 2 mg) Adriamycin 25 mg m2 IV day 18 1522

Dexamethasone 10 mg m2 PO day 1- 28

Phase 2

Cyclophosphamide 650 mgm 2 IV day 29 Ara-C 75 mgm2 I V day 31-3438- 41

6-Thloguanlne 60 mgm2 PO day 29-42

Maintenance

6-Mercaptopurine 60 mgm 2 PO daily week 10-18

Methotrexate 20 mg m2 PO weekly and 29-130

The patient will be followed every months after completing

chemotherapy Bone marrow aspiration should be performed every 3

months


2 MALIGNANT LYMPflOMA 21 Non-Hodgkin Lymphoma (NHL)

A) Low grade NHL

Open randomized prospective multicenter study

Songklanagarind hospital Songkhla

Chulalongkorn hospital Bangkok

Maharaj Nakorn-Chiangmai hospital Chaingmal

Pramongkutkloa hospi tal Bangkok Rajavithi hospital Bangkok

Ramathibodi hospital Bangkok

Study objectives

To evaluate the addition for combination alfa Intershyferon (IFN) to a three-drug chemotherapy regimen (COP) for low-

grade NHL with respect to objective response rate toxicity

duration of response and survival

EIlglbillry criteria - Biopsy proven diagnosl$ of malignant lymphoma of one

of the following histologic subtypes as per the

International Working Formulation

Diffuse lymphoma small lymphocytic

Diffuse lymphoma plasmacytoid lymphocytic

~-

5

x

Follicular predominantly small-cleaved

Follicular mixed small c leaved and large-cell

Mantle zone lymphoma Monocytoid B-cell lymphoma

- At least stage II (Ann Arbors) diseases

- At least one objective measurable diseases parameter - WBC count) 40 x 10 f L and platelet count) 100

10- f L except for marrow invasion


- ECOG performance i tatus of 0 I 2 and 3


- No ev idence of infec t ions

( J I

PraLocol f~gtr treatment fArm-I COP wlthout maintenance Irrdh c t ion

Cyclophosphamide 750 mgm 2 IV day I

Vincristine I 4 mgm 2 IV day I

Prednis o lone 100 mg PO day 1- 5 Repeat cycle every 28 days x 8 courses

A rm- I I COP with rir~ maintenance shy

I

-1- COP as Arm-I regime~) Maintenance ( Interferon aIfa-2A 3 Mu SC thrice weekly for 12 months $ tar t ed from achievement of CR PR or SD to disease

progression re lapse or patient off s tudy therapy

Arm-I I I I-COP with IFN maintenance

Induction

Cyclophosphamide 750 mg m2 IV day

Vincristine I 4 mgm 2 IV day 1

Prednisolone 100 mg PO day 1-5

~ Interferon aIfa-2A 6 Mu SC day 22-26

Repeat cyc I e every 28 days x 8 courses

lIa In tenance v IFN main tenance as Arm~1 I reg 1m en

(

f- c I

6


Complete response (CR) - Disappearance of all measurable

or evaluable disease symptoms signs and

biochemical change related tumor

Partial response (PR) ~ A reduction gt 50 in the sum of

products of two perpendicular diameters of all

measurable lesions

Stable disease (SO) - A lt 50 reduction and lt 25 increase

in the sum of products of two perpendicular

diameters of all measurable lesions

Progression of disease of Relapse (PO) - An increase in the products of two perpendicular diameters of a

measured lesion by ) 25 over the size present at

entry of study and or the appearance of new areas

of disease


B) Intermediate grade (IG) and High grade (HG) NHL


(Asian Investigators Multi-center Studies AIMS-Thailand)



Maharaj Nakorn-Chiangmai hospital Chiangmai

Prarnongkutkloa hospital Bangkok

Rajavithi hospital Bangkok


Study objectives I To compare and contrast the duration of survival of

pat ients with IG HG NHL treated with the study CHOP-I CHOP with

COP maintenance or CHOP regimens

2 To compare and contrast the rates and duration of

objective response or stabie disease in patients with IGHG NHL

treated with thestudy CHOP-I CHOP with COP maintenance or CHOP

regimens

Eliglbiiity criteria - Biopsy proven diagnosis of malignant iymphoma of one

of the foilowing histoioglc subtypes as per the

International Working Formuiation (IWF)

7

Intermediate grade

Follicular predominantly large cell (IWF-D)

Diffuse small cleaved cell (IWF-E)

Diffuse mixed (IWF-F) Diffuse large cell (lIiF-G)

High grade

Diffuse immunoblastic (IWF-H)


- At least one objective measurable diseases parameter

- WBC count) 40 x 109 L and platelet count) 100

109L except for marrow invas ion


- ECOC performance s tatus of O I 2 and 3 - Adequate hepatic and renal function

- No evidence of infections


Arm- I CHOP- I

Induction

( Cyclophosphamide 750 mg m2 IV day I

Ad r i amy c in 50 mg m2 IV day I

Vincristine I 4 mg m2 IV day I

Predni so lone 60 mgm 2 PO d3y 1- 5

Interferon alfa-2B 5 Mu SC day 22-26

Repeat cy c I e eve ry 28 days x 8 courses

Maintenance __ -- -----~ ~terfer~n alfa-B 3 Mu ) three times a week for 52 weeks

from achievement of CR PR or SD or patient off study

therapy

Arm- I I CHOP wit h COP maintenance

Induction


Adr larn~c In 50 mg m2 IV day

Vincristine I 4 mgm2 IV day I

Predn I so lone 60 mgm 2 PO day 1-5

Repeat cycle every 28 days x 8 courses

Maintenance1 CyclophosphamIde 750 mg m2 IV day

Vlncrlstln~ 1 4 mg rc 2 IV day I I

8

x

Prednisolone 60 mgm 2 PO day 1-5

Repeat cycle every 28 days x 12 cOUrses

A rm- I I I CHOP without maintenance

Induction CHOP regimen as Arm-II

Criteria for evaluation Complete response (CR) - Disappearance of a 11 measurable

or evaluable disease symptoms signs and biochemical change related tumor

Partial response (PR) - A reduction gt 50 in the sum of products of two perpendicular diameters of all measurable lesions

Stable disease (SO) - A lt 50 reduction and lt 25 Increase In the sum of products of two perpendicular diameters of all measurable lesions

Progression of disease of Relapse (PO) - An increase In the prodUcts of two perpendicular diameters of a measured lesion by ) 25 over the size present at

entry of study andlor the appearance of new areas of disease


C) Other types of NUL

Cyclophosphamide 750 mgm 2 IV day Adr iamyc in 50 mgm2 IV day

Vincristine I 4 mgm 2 IV day

Prednisolone 60 mgm 2 PO days 1 5 Repea t cycle every 23 day s x 8 courses

DJ fai1uf bull Progression Relapse or Stable disease

Opt ion 1 ENAP reg fmen -~ EtopOSide 100 mgm 2 IV infus ion days 1- 3

Mitoxantrone 10 ill g 1m2 IV infusion days 1-2

Cytosine arabinoside 100 rog IV infus ion days 1-2

Prednisolone 100 mg PO days 1-3

Repeat cycle every 28 days

I 9

Op t ion 2 MINE regimen ltj

Me sna 400 mg IV every 4 hr day s 1-3 Ifosfamide 1 033 gm 2 IV days 1- 3

Mi toxan trone 8 mgm 2 IV day I

Etoposide 65 mgm 2 IV day s 1-3



Cyclophosphamide 650 mgm 2 IV day I 0

Methotrexate 50 mg IV day 1 Procarbazine 100 mg m2 PO day s 1-7

Prednisolone 100 mg PO da y s 1-7


22 Hodgkins disease A) Previously untreated case

C-MOPP regimen


Vincristine I 4 mgm 2 IV day I 8

Procabazine 100 mg m2 PO day 1- 14

Predn iso lone 40 mg m2 PO day 1-14


Criteria of evalution as NHL

B) Failure Progression of disease Stable disease or Relapse

ABV regimen

Adriamycin 50 mgm 2 IV day

Vinblastine 6 mg m2 IV day

Bleomycin 10 mg m2 IV day

Repeat cycle every 28 days X 8 courses

3 MYELOPROLIFERATIVE DISEASES 31 Chronic myeltlgenous leukemia (CML) chronic ophase

~usulfan 2-12 rogday degPQ---3-lti2usted to WEC count

32 Interteron protocol In CML chronic phase

Open randomized prospective multicenter study~O o

Songklanagarlnd hospital Songkhla

Chulalongkorn h~spital Bangkok

010

j

-- -

)

Pramongkutkloa hospl tal Banglok Rajavithi hospital Bangkok

Ramathibodi hospital Bangkok Srinagarind hospital Khon Kaen

Study objectives

1 To compare and contrast the hematologic cytogenetic

responses and survival in CML patients treated with interferon alfa-2B or IFN with low dose cytosine arabinoside

2 To assess the efficacy of combinationmiddot of low dose cytosine arabinoside and IFN in those patients not achieving complete hematologic response (CHR) or cytogenetic response (CCR) by IFN treatment alone

3 To study the side effect profiles of interferon alfa-2B in these study populations

Eligibility criteria - All patients age lt 65 years with chronic phase of Ph 1 shy

positive CML Previously untreated with cytotoxic drug (except In the

case of busuifan If iess than 7 days duration or hydroxyurea for less than 12 months)

- ECOG performance status 0-1 - Adequate hepatic and renal function

- No evidence of infections r

_ I I r Protocol for treatment

i IPhase Hydroxyurea 50 mgkgday PO

The dose should be adjusmiddotted unt i I the WBC Is lt 15 X 109

per litre

Phase II Patients wIll be randomized into 2 groups

Arm-I

Interferon alfa-2B 5 Mu SC thrice a week or that dose

which will maintain the WSC around -I x 10L until CCR I s produced and maintained for the duration of a minimum of 12

months

AI If WSC gt IS x 10L add hY9Joxxurea Patients not achieving a CHR within 3 months or CCR at

6 months will be considered for the addition of Aia-C 20

gt I I

bull f bull bull bullbull

- shy~

~~ itmiddot gt

-

mgm 2 day SC for 12 days each mon th un til a CCR is obta ined ~0

and then maintain for 12 months

Arm-2 Interferon alfa-2B 5 Mu SC thric e a week

Ara-C 20 mgm 2 SC for 12 days each month Hematologic response should be evaluated at the end of

3 months and cytogenetic response at the end of 6 months

Criteria for response

Hematological response Complete hematologic remission (CHR)

Normalization of peripheral WBC counts to levels lt 10 x 10

per litre with normal differential counts normal platelet

counts and disappearance of all clinical symptoms and signs

of disease including splenomegaly Partial hematologic remission (PHR)

Decrease in WBC to at least lt 20 x 10L ( ) 50 from preshy

tre~tment) and of platelet counts and reduction by more than 50 of splenomegaly

Cytogenetic response

Complete cytogenetic response (CR)

Hematologic and clinic~l remission with Ph chromosome in

marrow metaphase lt 1

Partial cytogenetic response (PR)

Ph chromosome suppression was to levels of 1-34

Minimal cytogenetic response (MR)

Suppression was to le ve ls o f 35 to 95 of metaphases

No cytogenetic respons e (NR)

Ph chromosome per s isted in ) 95 of analyzable metaphase s

Drug Toxicity Grading ac cor ding to WHO criterIa

33 CML blasti~ phase Optio 1 paillatl v-=--chemotherapy

j cytoslne arabnoside 20 mg m2 SC days 1-10


Option 2 Tqass sect~ the efficacy of comblnat ion of low dose

cytosine arabinoside and IFN In treatment of CML patients with 1

12

(J1(

blastic crisis Interferon alfa-2B 5 Mu SC thrice a week

Ara-C 20 mampm 2 SC for 10 days each month

Hematologic response should be evaluated at the end of


Cr iter ia for response Complete remission

Normal physical status Normal peripheral blood (Hb ) 11 gdL neutrophils ) 15

-

x 109 L platelet count) 100 x 109 L)

MI marrow status lt 5 blast ) 15 erythroid elements ) 25

normal granulocytic precursors In a nonhypocellular marrow

Failure complete remission cannot be obtained within 3

inducti on courses


34 Other myeloproliferative diseases (Polycythemia vera

Essential thrombocythemia) OptIon 1

Busulfan 2-12 mgday PO adjusted to WBC count

Opt ion 2 -

Phase I - Interferon alfa-2B 3 Mu SC thrice a week

Criteria for response Polycythemia v era

Complete response - A normalization of the hematocrit level laquo 48) in the absence of further phlboshy

tomy WBC count platelet count within 16

weeks of treatment and maintained for at least 2 months without clinical symptoms

or palpable spleen ~

Partial response - Persistence 6f any the following Hct ) 48 or Hb gt 16 gdL WBC ) 10 x 109L

platelet ) 400 x 109 L spleen 1-5 cm

below left costa l margin

I 13

No response - no change or disease progression

Essential thrombocythemia Complete response - A reduction of platelet count to lt 450 x

10middotL within 16 week of treatment and

maintained for at least 2 months without clinical symptoms or palpable spleen

Part ial response - A greater than 50 reduction in spleen and decrease in platelet count less than

the levels for CR No response - no change

Phase 2 - Maintain with interfon alfa-2B 5 Mu twice a week

after CR till 12 months

I 4 MULTIPLE MYELOMA (MM)

41 Previously untreate cases

A) Conventional therapy Melphalan 6 mgm 2 PO days 1-4 Prednisolone 60 mgday PO days 1- -I



Open randomized prospective multicenter study (Asian Investigators Multi-center Studies AIMS-Thailand)

Songklanagarind hospital Songkhla Chulalongkorn hospital Bangkok


Pramongkutkloa hospital Bangkok



Study obJectives

I To compare a~d contrast the durations of objective

responses of patients with MM recieving the protocol maintenance

regimens 2 TO-compare and contrast the durations of survival of

patients with MM recleving the protocol maintenance regimens

Eligibility criteria

- Durie-Salmon stage II or III M~I

- ECOG performance status 0 I 2 and 3

- Patients may not have recleved any prior system Ie

14

middot r

middot

anti-MM therapy




Induction regimens

Melphalan 6 mgm 2 PO days 1-7

Prednisolone 60 mg m2 PO days 1-7

Repeat cyc le every 28 days for 6 cyc les

Criteria for resp ons e

Complete response - all of the following Disappearance

of serum andor urine M pr ote in on two

determinations at least 4 weeks apa r t Normal marrow with lt 5 plasma cells

normal peripheral blood and no sign s

or symptoms normal calcium and resolution of all soft tissue plasmacytoma

Objective response - all of the following Redu c tion of

serum M protein iovels to ~ 50 of baseline leve s on two determintions

at least 4 weeks apart decreased plasmacytoma by ~ 50 the sum of the

produ c ts of two perpendicular

diameters de c rease in bone pain

Stable disease - Failure to meet respon se c riteria of

complete remi ss ion objective response

and disease progression

Relapse or Progress ion - any of the following

- Inc rease In serum M prate In leve I to ) 50 abo ve

lowe s t remission level

Increase in urinary M protein level to) 50 abo v e

lowe~t remi ss ion level - Appearance of new ___ plasmacytomas or increase in

pla smacyto mas by 50

- Appearance of new lytic bone lesio ns or a ) 50

increase In the s ize of any existing lesion

Failur e or Resistance When compared with basel ine va lues

a ) 50 In th~ serum or urinar y M-pr o tein 1evels

15

7

measured on two determinations 2 weeks apart having

recieved 3 cycles of therapy

Maintenance regimens Patient rand omization into 3 groups

Arm-j

Interferon alfa-2B 3 Mu SC thrice a week from objective

response to disease relapse

Arm-II Interferon alfa-2B 3 Mu SC thrice a week for year

from objective response

Arm-Ill



Dexamethasone 25 mg m2 PO for 4 days every 28 days

from objective response to

disease relapse

Drug Toxi city Grading according to WHO criteria

42 Failure Progressing Relapsin g or Stable disease

Option 1 Pamiddottjents recieving either from 41 A) or 41 B)

Vincrist ine 04 mg IV continuous infu sion days 1- -l

Ad r I amyc in 9 mg m2 IV continuous infusion days

1-4

Dexamathasone 40 mg d PO days 1-4 9- I 2 17-2 0

Repeat cycle every 4 weeks x 6 courses

Option 2 p~r-ents~cieving regimen 41 A)

Melphalan 6 mg m 2 PO days 1-4

Prednisolone 60 mg day PO days 1-4


plus Interferon alfa-2B 3 Mu SC thrice a week

16

( shy

ifiit g J ~ IiW bull I ~

-shy0J

PROTOCOL FORmiddot WI IS TUMOR

st I FAVORABLE AND UNFDVCRAB HiSlDLOGY

5d A~d A~ d 5d

ACTINOMYCIN ~ v v

ISTINE vvvvvvvvvv V V

I ) 1 I I I J I NO FUR1HER Rr WEEKS 0 2 4 6 6 10 13 26

AMD + VCR 6 Mv

ACTINOMYCIN = 15 mltgIgd( 1 v ) c ) I

VINCRISTINE 1S mgtr-waek (Lv)

shy

PROTOCOL FOR I S TUMOR------------------ltltlt --lt-shy

st II FAVORABLE HISTOlOGY

~d gt ~d ~d ~d ~d ~d ~d ~ n n n

i u U U U ~ U U U

R1SiNt fVyvvvvvvv YVVVYV vvvvyenv yenltvvvv V VVVy v vvvvvv vvv VYV

WEEK 0 2 bull 6 6 12 22 )1 40 49 ~8 6~ ~ 7 9 I ~

AID VCR 15 Mo bull

bull ACTINOMYCIN 15 mcgkgd (1 v ) 2

bull VINCRISTINE = 15 mgM Week (iv)

~

bull ~ItI~~ -

bull f bull It

~~~~~~~ ~ i ltI

~ ~tI~ ~

PROTOCOL FOR WILMS TUMOR

s1 ill FAVORABLE HISTOLOGY

d d do ~ d ~d amplORIAMYCIN ~ ~~ ~ ~d bull ~ 0 ~

~d ~

ACTINOMYCIN ~ ~ W ~ ~ bull

VINCR ISTINE VV VVVV v vvy V I V V V V V Y V V V

bull I ( I 1 I I J I I bull I 1 f

WEE KS o 2 bull 0 B 10 12 19 26 ~ ~9 4~ ~2 ~e 6~

) ~ 7 9 II I ~

I

I i

lIMO + vcr + ADR 1 5 ~Io + RT 1000 cGy

ICTINO~YCIN = 15 mcgkgd ( iv )

I 2VINCRl iT INE = 1 5 mg M week (iv)

2ADRIAMYCIN 20 mg M d (i v l

shy

~1 I

l i

Y _ 1~

-= ~ ~ ~

I

PROTOCOL FOf~ WILM I S TUMOR

----------- - -

st TIl FAVORABLE HISTOLOGY

~

dO do dO dO dO

AORAMYCIN

u U U ~ ~ I ~O ~o bull ~ 0 ~ 0 ~ 0 ~O

AC1NOMYCIN ~ U U U ~ ~

VVVVVVVVVV V V I V VVINCRITINE V V V V

I I I I I I

WEEKS C 2 6 a 10 12 19 26 ~2 ~9 ~ ~2 ~B 6~

AMD + VCR + ADR 15 Mo + RT 000 cGy TU

+ DISTANT METASTASIS (PULMO~Al1Y) RT 1200 cGy

I lCTINOMYCIN 15 mcgkgd (iv)

I 2VINCRISTINE 15 mgM wcek (iv)

2ADRIAMYCIN 20 mgM d (iv)

I

cOshy

----- -

I

PROTOCOL FOR WILM S TUMOR

UNFAVORABLE HISTOLOGY st II-TIl

3 ~d 30 bull 3d

ADRIAMYCIN ~ ~ Q ~ 3~~d Ji)d J ~d 1)d )~d J~d J3d

CYCLOPHQSPHAMIO( ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 1 ~ 3d

ACTINOMYCIN ~ ~ ~ ~ ~ VvVVvvyvVV V vv V VV v w v

VINCRISTINE V V y V

If I 1 [ I J I I I [ I [ I J l

WEE KS deg 2 4 6 6 10 12 19 26 32 39 ~ 32 ~5191~

c

RTMD + VCR + ADR + CPM 15 10_ age

Pqe (M o ) TOTAL TUMOR DOSE

2 PCTINOMYCIN 15 mcg k~d ( iv)

BIRTH - Ii 1 26 0 - 1800

ADRIMYC IN ~ 20 mgM2~d (iv)

VINCRISTINE I 5 mgM i week (i v )

13 - 1middot~ 2160

CYCLOPHOSPHMIDE 10 mg kg d ( iv ) 19 30 2700

31 - 40 314 0

4 1 t 3780

11

) ~d

~ 3

~ ~

~

~

Vy V Y

I I I

36 63

(cGy)

q

Staeinz of NHL

Stage xtcni f tumor

A siqgle ltIor (c~~ronoCal) or sinlc ltlni1torlic

~re) (nod)l) ~ith the cycl u sion of oledistinw

1 A single turor (etranodal) lith reeional Lll

involvei~nt

Tvo sinele (extranodal) tu~ors ~ith or without

~e~ionQl LN involvewen on the same side of the

A resecta~le prinary Cl tract tu~or usua ll y In

the ilpocecil areal lith or ithout involvenent

of the C5s ~iate~ fCscnteri~ nodes oilly

TJo single tUlilors (etranodal) on oiJ~oslte ides

of the diaph=ag3

To or LlOre nodal oreaz above or belo the

diaj)hraga

~ll the pr~zry intrJthoracic tU~IDr

(nedias t ind gt pleur B 1gt thymic)

All extensive prioar~ intro2bdomin~1 ~sease

tll p~r3spin~1 Or e~idura l tumorc rC8~rdless of other tuors it~ (or sites)

IV Any of tle aoove with initial involvement of eNS

o~ bone m~rro~ or bbth

conp Protocal

CTX

l

Haincanance

crx

HI

mx

PRW

IITotal

ll shy

21200 3pound1 1 V

~2 1 V ~

2 mgJfl r-

3134 2

rrgJ~i I ~ V

(60l IV push 40 IV drip io

4 hr)

60 mgNJd PO off

Start 7-21 after last dose of IfTX 1 T

1000 rgH2 LV q 28 d

15 L

flgJ~ LV D1 q 28 d

625 2

OBit LT D 29

q 28 d

300 2

mgl LV D15

-q 28 d

60 2 3H d Po x 5 d D29 lt 28 d

duration of theran 13 months fl

Keep Ie l500cumm

I

2 HOdeJltin S

- Lfilphotla

l St-ee I - RdiotherlPY cr uep X-roy Ledly

b StltcE Il + III v I v

1 1-~lfJrtm~Jn1pJtmiddot X--y v

fYJ

11_1 ttJ02 S tc2UE

2 v

Cht~cmiddott~euror~rY l ~i1i5-J11)t ~ v

Deep X--~y ~ lr~e )

c

PrEeniscJ(2 2 ccfltJ () r 14 c lo) vL I-t 6---hshy

VCR J

- ( I J

-2 - DiJ-kdIi - o _f e r 14 t

600 j2n IV ~s~ ey l~

15 rbulljimiddotshy I V ush doy 1 W I ~

cu-se l middotLiijll~U li ll~ l(l 2 - 3 ~ bull I Y

8

6

Stieuro TJ l YJJrnu C-f~middot tEr y l J l-~middot~limiddot~J ~ fi0j middotDrP VI poJ

trut_e~t l1-lnhot)i-)JIIFl1 1114 5 U

lt Inri

1 -

o ~tJYi 4 d6maan~lbULJ MODIFIED CCC IU4 UNtiKLA I JltII

PHASE I PHASE II

o 7 14 21 28 r 14middot 21 2e 33 IIDAYSc middotmiddot

8M 8r~ 8M 11IIJIIJliIIjllJj CR i~N1AL RADIATION 1866 cGy

VCR 15 mg rt()t t t t [~ - - -

PRED 40 mgl Iff I dPO I

METHOTREATE reg io mg Age 24-36 Mo T MTX () T f T 12 mg Age gt3 yrs

6 MP 75 mg I ItI dPO

PHASE m o r I

2 I

3 4 5 I 6 1 a 9 I 10 I

II 120I WEEKS

~ ~)~ ~~

t 2 VCR 15 mg I in 8M

T MTX () 8) 10 or 12 mg 2 I

I I PRED 40 mglm I dPO FOR 5 DAYS

M M M M M I M M M M

I M M M

Ar-r o-I-h 0shy

CMTX 20mg 1M lwk PO) I ~

r= r ---shy-- __ _-----shy -shy --shy

I 2 6 MP 75 mgl M IdPO

~~~ ~~ I middot II bullgt~middot ~1~~ f~~~~gt~~~~~~~~middot[ REPEAT CYCLE EVERY d WEEKS FOR 3 YEARS ] i

I l

I

PROTOCOL fllfllIJltllq1mlaquom

uuJinHWU1tJfll1 ii JIll 390(l)l3946Q~rjjj 26 f11Jfl~flWj 2539

L ACUTE LEUKEMIA

11 Acute lloll-Iympboblastic

leukemia (ANLL)

A) Previously untreated case ICvtosmLe arabinoside 2

100 mglm

tnt) Consolidation therapy Cytosine arabinoside

2 mgm

100 mgm 2

2 60 mgm

Maintenance therapy

Regimen A (llfUVU Consolidation lhorapy)

Regimen B (vtnp arabinoside

6-Thiogaunine 2

40 mgm

2

Pbase 2


2 75 mgm

2 60 mgm

2 10 mgm

15 rog)

irradiation 240y

Consolidation 2

Pbase 1 14 mgro

single dose 2 mg)

2 25 mgro

2 10 mgm

2

Pbase 2 650 mgm

2 75 mgm

2

Thioguanine mgm

2


2 Methotrexate mgm

J

3


A) Low grade NHL



Vincristine

2 750 mgm

2 14 mgm

2 100 mgm


as Arm-I regimen)



Vincristine

Prednisolone


2 750 mgm

2 14 mgm

2 100 mgm

6Mu



and Hlgb grade (HG)

NHL

Arm-I CHOP-I

Adriamycin mgm



alfa-2B Mu


2

middot 4



2 50 mgm


2



2

mgm

60 mgm





2 60 mgm

2 mgm



2 100 mgm

2 10 mgm




2 133 mgm

2 8 mgm

2 Etoposide mgm

6


2 650 mgm

50mg


Prednisolone 100 mg





2 100 mgm

2 mgm



2Vinblastine mgm

2 10 mgm

6



2-12 mgday PO




Arm-I 5 MuAlfa-2B




2 Ara-C 20 mgm

33 CML blastic ph






2 20 mglmAra-C


mgday PO

Option 2

Phase I

Option I

Interferon alfa-2B


7




bull

Melphalan

Prednisolone



Arm-I

Arm-n

Arm-ill

Melphalan

Prednisolone

Interferon alfa-2B

Interferon alfa-2B

Interferon alfa-2B

Dexamethasone

mgday

mgday

2 mgm


Option 1

Option 2


O4mg

2 9 mgm

40 mgday

6 mgm2

60 mgday


8



A1

A2

A8

81

32


B1

B2

bull

CispJatin

Etoposide

Carboplatin

Etoposide


2 25 mgm

2 100 mgm

2 25 mgm

2 100 mgm

2 2 gm



VP - 16 50 mg

2 Mitomycin 8 mgm


2 CispJatin 100 mgm

2 Mitomycin 8 mgrn




~

)

~~l bull ~ bull

J

~ ~ ~

j gt~

-- --=-_ r~Cl-

J6Yi- _

____ _ _ __ _ _c- _ t--~

bull

1lt11


J ( ~ ~ -- -I SL lt ~ ---




~ lmiddot5L1 bull

) l ) C


u u ~ uuu uu

Llt+-~




1 ACUTE LEUKEMIA









and cytochemistry


0 I 2 and 3

function







node







Induct ion courses

~

2





days 1-5


Maintenance therapy



duration

Regimen A


Regimen B







follow up period





B) Elder Iy case







2

2













days 1-7

IV days 1-3












Rajavithi hospital


Study obJectives







3







Induction

Phase I






Phase 2



Ara-C 75 nignG _ [-V day 31-3438-4145-48

52- 55



(maximum 15 mg)





node








induction cOUrses

I 4

2

Consolidation




Phase 2



Maintenance





months



A) Low grade NHL







Study objectives









~-

5

x











( J I






I




Induction







(

f- c I

6







measurable lesions







of disease

















regimens




7

Intermediate grade




High grade










Arm- I CHOP- I

Induction









therapy


Induction








8

x






















I 9












C-MOPP regimen








ABV regimen











010

j

-- -

)



Study objectives













per litre


Arm-I



months



gt I I


- shy~

~~ itmiddot gt

-






























12

(J1(







-





inducti on courses





Opt ion 2 -










I 13




















Study obJectives









14

middot r

middot

anti-MM therapy




Induction regimens




























15

7




Arm-j





Arm-Ill





disease relapse






1-4








16

( shy


-shy0J



5d A~d A~ d 5d

ACTINOMYCIN ~ v v



AMD + VCR 6 Mv



shy



~d gt ~d ~d ~d ~d ~d ~d ~ n n n

i u U U U ~ U U U


WEEK 0 2 bull 6 6 12 22 )1 40 49 ~8 6~ ~ 7 9 I ~

AID VCR 15 Mo bull



~

bull ~ItI~~ -

bull f bull It

~~~~~~~ ~ i ltI

~ ~tI~ ~




~d ~




WEE KS o 2 bull 0 B 10 12 19 26 ~ ~9 4~ ~2 ~e 6~

) ~ 7 9 II I ~

I

I i





shy

~1 I

l i

Y _ 1~

-= ~ ~ ~

I


----------- - -


~

dO do dO dO dO

AORAMYCIN

u U U ~ ~ I ~O ~o bull ~ 0 ~ 0 ~ 0 ~O



I I I I I I

WEEKS C 2 6 a 10 12 19 26 ~2 ~9 ~ ~2 ~B 6~






I

cOshy

----- -

I



3 ~d 30 bull 3d




VINCRISTINE V V y V


WEE KS deg 2 4 6 6 10 12 19 26 32 39 ~ 32 ~5191~

c




BIRTH - Ii 1 26 0 - 1800



13 - 1middot~ 2160


31 - 40 314 0

4 1 t 3780

11

) ~d

~ 3

~ ~

~

~

Vy V Y

I I I

36 63

(cGy)

q

Staeinz of NHL

Stage xtcni f tumor




involvei~nt







of the diaph=ag3


diaj)hraga







conp Protocal

CTX

l

Haincanance

crx

HI

mx

PRW

IITotal

ll shy

21200 3pound1 1 V

~2 1 V ~

2 mgJfl r-

3134 2

rrgJ~i I ~ V


4 hr)

60 mgNJd PO off


1000 rgH2 LV q 28 d

15 L

flgJ~ LV D1 q 28 d

625 2

OBit LT D 29

q 28 d

300 2

mgl LV D15

-q 28 d

60 2 3H d Po x 5 d D29 lt 28 d


Keep Ie l500cumm

I

2 HOdeJltin S

- Lfilphotla




fYJ

11_1 ttJ02 S tc2UE

2 v


Deep X--~y ~ lr~e )

c


VCR J

- ( I J





8

6



lt Inri

1 -


PHASE I PHASE II



VCR 15 mg rt()t t t t [~ - - -




PHASE m o r I

2 I

3 4 5 I 6 1 a 9 I 10 I

II 120I WEEKS

~ ~)~ ~~


T MTX () 8) 10 or 12 mg 2 I


M M M M M I M M M M

I M M M

Ar-r o-I-h 0shy


r= r ---shy-- __ _-----shy -shy --shy



I l

2

Pbase 2


2 75 mgm

2 60 mgm

2 10 mgm

15 rog)

irradiation 240y

Consolidation 2

Pbase 1 14 mgro

single dose 2 mg)

2 25 mgro

2 10 mgm

2

Pbase 2 650 mgm

2 75 mgm

2

Thioguanine mgm

2


2 Methotrexate mgm

J

3


A) Low grade NHL



Vincristine

2 750 mgm

2 14 mgm

2 100 mgm


as Arm-I regimen)



Vincristine

Prednisolone


2 750 mgm

2 14 mgm

2 100 mgm

6Mu



and Hlgb grade (HG)

NHL

Arm-I CHOP-I

Adriamycin mgm



alfa-2B Mu


2

middot 4



2 50 mgm


2



2

mgm

60 mgm





2 60 mgm

2 mgm



2 100 mgm

2 10 mgm




2 133 mgm

2 8 mgm

2 Etoposide mgm

6


2 650 mgm

50mg


Prednisolone 100 mg





2 100 mgm

2 mgm



2Vinblastine mgm

2 10 mgm

6



2-12 mgday PO




Arm-I 5 MuAlfa-2B




2 Ara-C 20 mgm

33 CML blastic ph






2 20 mglmAra-C


mgday PO

Option 2

Phase I

Option I

Interferon alfa-2B


7




bull

Melphalan

Prednisolone



Arm-I

Arm-n

Arm-ill

Melphalan

Prednisolone

Interferon alfa-2B

Interferon alfa-2B

Interferon alfa-2B

Dexamethasone

mgday

mgday

2 mgm


Option 1

Option 2


O4mg

2 9 mgm

40 mgday

6 mgm2

60 mgday


8



A1

A2

A8

81

32


B1

B2

bull

CispJatin

Etoposide

Carboplatin

Etoposide


2 25 mgm

2 100 mgm

2 25 mgm

2 100 mgm

2 2 gm



VP - 16 50 mg

2 Mitomycin 8 mgm


2 CispJatin 100 mgm

2 Mitomycin 8 mgrn




~

)

~~l bull ~ bull

J

~ ~ ~

j gt~

-- --=-_ r~Cl-

J6Yi- _

____ _ _ __ _ _c- _ t--~

bull

1lt11


J ( ~ ~ -- -I SL lt ~ ---




~ lmiddot5L1 bull

) l ) C


u u ~ uuu uu

Llt+-~




1 ACUTE LEUKEMIA









and cytochemistry


0 I 2 and 3

function







node







Induct ion courses

~

2





days 1-5


Maintenance therapy



duration

Regimen A


Regimen B







follow up period





B) Elder Iy case







2

2













days 1-7

IV days 1-3












Rajavithi hospital


Study obJectives







3







Induction

Phase I






Phase 2



Ara-C 75 nignG _ [-V day 31-3438-4145-48

52- 55



(maximum 15 mg)





node








induction cOUrses

I 4

2

Consolidation




Phase 2



Maintenance





months



A) Low grade NHL







Study objectives









~-

5

x











( J I






I




Induction







(

f- c I

6







measurable lesions







of disease

















regimens




7

Intermediate grade




High grade










Arm- I CHOP- I

Induction









therapy


Induction








8

x






















I 9












C-MOPP regimen








ABV regimen











010

j

-- -

)



Study objectives













per litre


Arm-I



months



gt I I


- shy~

~~ itmiddot gt

-






























12

(J1(







-





inducti on courses





Opt ion 2 -










I 13




















Study obJectives









14

middot r

middot

anti-MM therapy




Induction regimens




























15

7




Arm-j





Arm-Ill





disease relapse






1-4








16

( shy


-shy0J



5d A~d A~ d 5d

ACTINOMYCIN ~ v v



AMD + VCR 6 Mv



shy



~d gt ~d ~d ~d ~d ~d ~d ~ n n n

i u U U U ~ U U U


WEEK 0 2 bull 6 6 12 22 )1 40 49 ~8 6~ ~ 7 9 I ~

AID VCR 15 Mo bull



~

bull ~ItI~~ -

bull f bull It

~~~~~~~ ~ i ltI

~ ~tI~ ~




~d ~




WEE KS o 2 bull 0 B 10 12 19 26 ~ ~9 4~ ~2 ~e 6~

) ~ 7 9 II I ~

I

I i





shy

~1 I

l i

Y _ 1~

-= ~ ~ ~

I


----------- - -


~

dO do dO dO dO

AORAMYCIN

u U U ~ ~ I ~O ~o bull ~ 0 ~ 0 ~ 0 ~O



I I I I I I

WEEKS C 2 6 a 10 12 19 26 ~2 ~9 ~ ~2 ~B 6~






I

cOshy

----- -

I



3 ~d 30 bull 3d




VINCRISTINE V V y V


WEE KS deg 2 4 6 6 10 12 19 26 32 39 ~ 32 ~5191~

c




BIRTH - Ii 1 26 0 - 1800



13 - 1middot~ 2160


31 - 40 314 0

4 1 t 3780

11

) ~d

~ 3

~ ~

~

~

Vy V Y

I I I

36 63

(cGy)

q

Staeinz of NHL

Stage xtcni f tumor




involvei~nt







of the diaph=ag3


diaj)hraga







conp Protocal

CTX

l

Haincanance

crx

HI

mx

PRW

IITotal

ll shy

21200 3pound1 1 V

~2 1 V ~

2 mgJfl r-

3134 2

rrgJ~i I ~ V


4 hr)

60 mgNJd PO off


1000 rgH2 LV q 28 d

15 L

flgJ~ LV D1 q 28 d

625 2

OBit LT D 29

q 28 d

300 2

mgl LV D15

-q 28 d

60 2 3H d Po x 5 d D29 lt 28 d


Keep Ie l500cumm

I

2 HOdeJltin S

- Lfilphotla




fYJ

11_1 ttJ02 S tc2UE

2 v


Deep X--~y ~ lr~e )

c


VCR J

- ( I J





8

6



lt Inri

1 -


PHASE I PHASE II



VCR 15 mg rt()t t t t [~ - - -




PHASE m o r I

2 I

3 4 5 I 6 1 a 9 I 10 I

II 120I WEEKS

~ ~)~ ~~


T MTX () 8) 10 or 12 mg 2 I


M M M M M I M M M M

I M M M

Ar-r o-I-h 0shy


r= r ---shy-- __ _-----shy -shy --shy



I l

3


A) Low grade NHL



Vincristine

2 750 mgm

2 14 mgm

2 100 mgm


as Arm-I regimen)



Vincristine

Prednisolone


2 750 mgm

2 14 mgm

2 100 mgm

6Mu



and Hlgb grade (HG)

NHL

Arm-I CHOP-I

Adriamycin mgm



alfa-2B Mu


2

middot 4



2 50 mgm


2



2

mgm

60 mgm





2 60 mgm

2 mgm



2 100 mgm

2 10 mgm




2 133 mgm

2 8 mgm

2 Etoposide mgm

6


2 650 mgm

50mg


Prednisolone 100 mg





2 100 mgm

2 mgm



2Vinblastine mgm

2 10 mgm

6



2-12 mgday PO




Arm-I 5 MuAlfa-2B




2 Ara-C 20 mgm

33 CML blastic ph






2 20 mglmAra-C


mgday PO

Option 2

Phase I

Option I

Interferon alfa-2B


7




bull

Melphalan

Prednisolone



Arm-I

Arm-n

Arm-ill

Melphalan

Prednisolone

Interferon alfa-2B

Interferon alfa-2B

Interferon alfa-2B

Dexamethasone

mgday

mgday

2 mgm


Option 1

Option 2


O4mg

2 9 mgm

40 mgday

6 mgm2

60 mgday


8



A1

A2

A8

81

32


B1

B2

bull

CispJatin

Etoposide

Carboplatin

Etoposide


2 25 mgm

2 100 mgm

2 25 mgm

2 100 mgm

2 2 gm



VP - 16 50 mg

2 Mitomycin 8 mgm


2 CispJatin 100 mgm

2 Mitomycin 8 mgrn




~

)

~~l bull ~ bull

J

~ ~ ~

j gt~

-- --=-_ r~Cl-

J6Yi- _

____ _ _ __ _ _c- _ t--~

bull

1lt11


J ( ~ ~ -- -I SL lt ~ ---




~ lmiddot5L1 bull

) l ) C


u u ~ uuu uu

Llt+-~




1 ACUTE LEUKEMIA









and cytochemistry


0 I 2 and 3

function







node







Induct ion courses

~

2





days 1-5


Maintenance therapy



duration

Regimen A


Regimen B







follow up period





B) Elder Iy case







2

2













days 1-7

IV days 1-3












Rajavithi hospital


Study obJectives







3







Induction

Phase I






Phase 2



Ara-C 75 nignG _ [-V day 31-3438-4145-48

52- 55



(maximum 15 mg)





node








induction cOUrses

I 4

2

Consolidation




Phase 2



Maintenance





months



A) Low grade NHL







Study objectives









~-

5

x











( J I






I




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(

f- c I

6







measurable lesions







of disease

















regimens




7

Intermediate grade




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therapy


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8

x






















I 9












C-MOPP regimen








ABV regimen











010

j

-- -

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Study objectives













per litre


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gt I I


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12

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Opt ion 2 -










I 13




















Study obJectives









14

middot r

middot

anti-MM therapy




Induction regimens




























15

7




Arm-j





Arm-Ill





disease relapse






1-4








16

( shy


-shy0J



5d A~d A~ d 5d

ACTINOMYCIN ~ v v



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~d gt ~d ~d ~d ~d ~d ~d ~ n n n

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~

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bull f bull It

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WEEKS C 2 6 a 10 12 19 26 ~2 ~9 ~ ~2 ~B 6~






I

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VINCRISTINE V V y V


WEE KS deg 2 4 6 6 10 12 19 26 32 39 ~ 32 ~5191~

c




BIRTH - Ii 1 26 0 - 1800



13 - 1middot~ 2160


31 - 40 314 0

4 1 t 3780

11

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involvei~nt







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l

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21200 3pound1 1 V

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rrgJ~i I ~ V


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3 4 5 I 6 1 a 9 I 10 I

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T MTX () 8) 10 or 12 mg 2 I


M M M M M I M M M M

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I l

middot 4



2 50 mgm


2



2

mgm

60 mgm





2 60 mgm

2 mgm



2 100 mgm

2 10 mgm




2 133 mgm

2 8 mgm

2 Etoposide mgm

6


2 650 mgm

50mg


Prednisolone 100 mg





2 100 mgm

2 mgm



2Vinblastine mgm

2 10 mgm

6



2-12 mgday PO




Arm-I 5 MuAlfa-2B




2 Ara-C 20 mgm

33 CML blastic ph






2 20 mglmAra-C


mgday PO

Option 2

Phase I

Option I

Interferon alfa-2B


7




bull

Melphalan

Prednisolone



Arm-I

Arm-n

Arm-ill

Melphalan

Prednisolone

Interferon alfa-2B

Interferon alfa-2B

Interferon alfa-2B

Dexamethasone

mgday

mgday

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O4mg

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40 mgday

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8



A1

A2

A8

81

32


B1

B2

bull

CispJatin

Etoposide

Carboplatin

Etoposide


2 25 mgm

2 100 mgm

2 25 mgm

2 100 mgm

2 2 gm



VP - 16 50 mg

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2 CispJatin 100 mgm

2 Mitomycin 8 mgrn




~

)

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J

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J6Yi- _

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u u ~ uuu uu

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1 ACUTE LEUKEMIA









and cytochemistry


0 I 2 and 3

function







node







Induct ion courses

~

2





days 1-5


Maintenance therapy



duration

Regimen A


Regimen B







follow up period





B) Elder Iy case







2

2













days 1-7

IV days 1-3












Rajavithi hospital


Study obJectives







3







Induction

Phase I






Phase 2



Ara-C 75 nignG _ [-V day 31-3438-4145-48

52- 55



(maximum 15 mg)





node








induction cOUrses

I 4

2

Consolidation




Phase 2



Maintenance





months



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Study objectives









~-

5

x











( J I






I




Induction







(

f- c I

6







measurable lesions







of disease

















regimens




7

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High grade










Arm- I CHOP- I

Induction









therapy


Induction








8

x






















I 9












C-MOPP regimen








ABV regimen











010

j

-- -

)



Study objectives













per litre


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months



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-






























12

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-





inducti on courses





Opt ion 2 -










I 13




















Study obJectives









14

middot r

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anti-MM therapy




Induction regimens




























15

7




Arm-j





Arm-Ill





disease relapse






1-4








16

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-shy0J



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ACTINOMYCIN ~ v v



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shy



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~

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I

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3 ~d 30 bull 3d




VINCRISTINE V V y V


WEE KS deg 2 4 6 6 10 12 19 26 32 39 ~ 32 ~5191~

c




BIRTH - Ii 1 26 0 - 1800



13 - 1middot~ 2160


31 - 40 314 0

4 1 t 3780

11

) ~d

~ 3

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q

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involvei~nt







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conp Protocal

CTX

l

Haincanance

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HI

mx

PRW

IITotal

ll shy

21200 3pound1 1 V

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3134 2

rrgJ~i I ~ V


4 hr)

60 mgNJd PO off


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15 L

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625 2

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3 4 5 I 6 1 a 9 I 10 I

II 120I WEEKS

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M M M M M I M M M M

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r= r ---shy-- __ _-----shy -shy --shy



I l

6


2 650 mgm

50mg


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2 100 mgm

2 mgm



2Vinblastine mgm

2 10 mgm

6



2-12 mgday PO




Arm-I 5 MuAlfa-2B




2 Ara-C 20 mgm

33 CML blastic ph






2 20 mglmAra-C


mgday PO

Option 2

Phase I

Option I

Interferon alfa-2B


7




bull

Melphalan

Prednisolone



Arm-I

Arm-n

Arm-ill

Melphalan

Prednisolone

Interferon alfa-2B

Interferon alfa-2B

Interferon alfa-2B

Dexamethasone

mgday

mgday

2 mgm


Option 1

Option 2


O4mg

2 9 mgm

40 mgday

6 mgm2

60 mgday


8



A1

A2

A8

81

32


B1

B2

bull

CispJatin

Etoposide

Carboplatin

Etoposide


2 25 mgm

2 100 mgm

2 25 mgm

2 100 mgm

2 2 gm



VP - 16 50 mg

2 Mitomycin 8 mgm


2 CispJatin 100 mgm

2 Mitomycin 8 mgrn




~

)

~~l bull ~ bull

J

~ ~ ~

j gt~

-- --=-_ r~Cl-

J6Yi- _

____ _ _ __ _ _c- _ t--~

bull

1lt11


J ( ~ ~ -- -I SL lt ~ ---




~ lmiddot5L1 bull

) l ) C


u u ~ uuu uu

Llt+-~




1 ACUTE LEUKEMIA









and cytochemistry


0 I 2 and 3

function







node







Induct ion courses

~

2





days 1-5


Maintenance therapy



duration

Regimen A


Regimen B







follow up period





B) Elder Iy case







2

2













days 1-7

IV days 1-3












Rajavithi hospital


Study obJectives







3







Induction

Phase I






Phase 2



Ara-C 75 nignG _ [-V day 31-3438-4145-48

52- 55



(maximum 15 mg)





node








induction cOUrses

I 4

2

Consolidation




Phase 2



Maintenance





months



A) Low grade NHL







Study objectives









~-

5

x











( J I






I




Induction







(

f- c I

6







measurable lesions







of disease

















regimens




7

Intermediate grade




High grade










Arm- I CHOP- I

Induction









therapy


Induction








8

x






















I 9












C-MOPP regimen








ABV regimen











010

j

-- -

)



Study objectives













per litre


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months



gt I I


- shy~

~~ itmiddot gt

-






























12

(J1(







-





inducti on courses





Opt ion 2 -










I 13




















Study obJectives









14

middot r

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anti-MM therapy




Induction regimens




























15

7




Arm-j





Arm-Ill





disease relapse






1-4








16

( shy


-shy0J



5d A~d A~ d 5d

ACTINOMYCIN ~ v v



AMD + VCR 6 Mv



shy



~d gt ~d ~d ~d ~d ~d ~d ~ n n n

i u U U U ~ U U U


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AID VCR 15 Mo bull



~

bull ~ItI~~ -

bull f bull It

~~~~~~~ ~ i ltI

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WEE KS o 2 bull 0 B 10 12 19 26 ~ ~9 4~ ~2 ~e 6~

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I

I i





shy

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l i

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I I I I I I

WEEKS C 2 6 a 10 12 19 26 ~2 ~9 ~ ~2 ~B 6~






I

cOshy

----- -

I



3 ~d 30 bull 3d




VINCRISTINE V V y V


WEE KS deg 2 4 6 6 10 12 19 26 32 39 ~ 32 ~5191~

c




BIRTH - Ii 1 26 0 - 1800



13 - 1middot~ 2160


31 - 40 314 0

4 1 t 3780

11

) ~d

~ 3

~ ~

~

~

Vy V Y

I I I

36 63

(cGy)

q

Staeinz of NHL

Stage xtcni f tumor




involvei~nt







of the diaph=ag3


diaj)hraga







conp Protocal

CTX

l

Haincanance

crx

HI

mx

PRW

IITotal

ll shy

21200 3pound1 1 V

~2 1 V ~

2 mgJfl r-

3134 2

rrgJ~i I ~ V


4 hr)

60 mgNJd PO off


1000 rgH2 LV q 28 d

15 L

flgJ~ LV D1 q 28 d

625 2

OBit LT D 29

q 28 d

300 2

mgl LV D15

-q 28 d

60 2 3H d Po x 5 d D29 lt 28 d


Keep Ie l500cumm

I

2 HOdeJltin S

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fYJ

11_1 ttJ02 S tc2UE

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c


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8

6



lt Inri

1 -


PHASE I PHASE II



VCR 15 mg rt()t t t t [~ - - -




PHASE m o r I

2 I

3 4 5 I 6 1 a 9 I 10 I

II 120I WEEKS

~ ~)~ ~~


T MTX () 8) 10 or 12 mg 2 I


M M M M M I M M M M

I M M M

Ar-r o-I-h 0shy


r= r ---shy-- __ _-----shy -shy --shy



I l

6



2-12 mgday PO




Arm-I 5 MuAlfa-2B




2 Ara-C 20 mgm

33 CML blastic ph






2 20 mglmAra-C


mgday PO

Option 2

Phase I

Option I

Interferon alfa-2B


7




bull

Melphalan

Prednisolone



Arm-I

Arm-n

Arm-ill

Melphalan

Prednisolone

Interferon alfa-2B

Interferon alfa-2B

Interferon alfa-2B

Dexamethasone

mgday

mgday

2 mgm


Option 1

Option 2


O4mg

2 9 mgm

40 mgday

6 mgm2

60 mgday


8



A1

A2

A8

81

32


B1

B2

bull

CispJatin

Etoposide

Carboplatin

Etoposide


2 25 mgm

2 100 mgm

2 25 mgm

2 100 mgm

2 2 gm



VP - 16 50 mg

2 Mitomycin 8 mgm


2 CispJatin 100 mgm

2 Mitomycin 8 mgrn




~

)

~~l bull ~ bull

J

~ ~ ~

j gt~

-- --=-_ r~Cl-

J6Yi- _

____ _ _ __ _ _c- _ t--~

bull

1lt11


J ( ~ ~ -- -I SL lt ~ ---




~ lmiddot5L1 bull

) l ) C


u u ~ uuu uu

Llt+-~




1 ACUTE LEUKEMIA









and cytochemistry


0 I 2 and 3

function







node







Induct ion courses

~

2





days 1-5


Maintenance therapy



duration

Regimen A


Regimen B







follow up period





B) Elder Iy case







2

2













days 1-7

IV days 1-3












Rajavithi hospital


Study obJectives







3







Induction

Phase I






Phase 2



Ara-C 75 nignG _ [-V day 31-3438-4145-48

52- 55



(maximum 15 mg)





node








induction cOUrses

I 4

2

Consolidation




Phase 2



Maintenance





months



A) Low grade NHL







Study objectives









~-

5

x











( J I






I




Induction







(

f- c I

6







measurable lesions







of disease

















regimens




7

Intermediate grade




High grade










Arm- I CHOP- I

Induction









therapy


Induction








8

x






















I 9












C-MOPP regimen








ABV regimen











010

j

-- -

)



Study objectives













per litre


Arm-I



months



gt I I


- shy~

~~ itmiddot gt

-






























12

(J1(







-





inducti on courses





Opt ion 2 -










I 13




















Study obJectives









14

middot r

middot

anti-MM therapy




Induction regimens




























15

7




Arm-j





Arm-Ill





disease relapse






1-4








16

( shy


-shy0J



5d A~d A~ d 5d

ACTINOMYCIN ~ v v



AMD + VCR 6 Mv



shy



~d gt ~d ~d ~d ~d ~d ~d ~ n n n

i u U U U ~ U U U


WEEK 0 2 bull 6 6 12 22 )1 40 49 ~8 6~ ~ 7 9 I ~

AID VCR 15 Mo bull



~

bull ~ItI~~ -

bull f bull It

~~~~~~~ ~ i ltI

~ ~tI~ ~




~d ~




WEE KS o 2 bull 0 B 10 12 19 26 ~ ~9 4~ ~2 ~e 6~

) ~ 7 9 II I ~

I

I i





shy

~1 I

l i

Y _ 1~

-= ~ ~ ~

I


----------- - -


~

dO do dO dO dO

AORAMYCIN

u U U ~ ~ I ~O ~o bull ~ 0 ~ 0 ~ 0 ~O



I I I I I I

WEEKS C 2 6 a 10 12 19 26 ~2 ~9 ~ ~2 ~B 6~






I

cOshy

----- -

I



3 ~d 30 bull 3d




VINCRISTINE V V y V


WEE KS deg 2 4 6 6 10 12 19 26 32 39 ~ 32 ~5191~

c




BIRTH - Ii 1 26 0 - 1800



13 - 1middot~ 2160


31 - 40 314 0

4 1 t 3780

11

) ~d

~ 3

~ ~

~

~

Vy V Y

I I I

36 63

(cGy)

q

Staeinz of NHL

Stage xtcni f tumor




involvei~nt







of the diaph=ag3


diaj)hraga







conp Protocal

CTX

l

Haincanance

crx

HI

mx

PRW

IITotal

ll shy

21200 3pound1 1 V

~2 1 V ~

2 mgJfl r-

3134 2

rrgJ~i I ~ V


4 hr)

60 mgNJd PO off


1000 rgH2 LV q 28 d

15 L

flgJ~ LV D1 q 28 d

625 2

OBit LT D 29

q 28 d

300 2

mgl LV D15

-q 28 d

60 2 3H d Po x 5 d D29 lt 28 d


Keep Ie l500cumm

I

2 HOdeJltin S

- Lfilphotla




fYJ

11_1 ttJ02 S tc2UE

2 v


Deep X--~y ~ lr~e )

c


VCR J

- ( I J





8

6



lt Inri

1 -


PHASE I PHASE II



VCR 15 mg rt()t t t t [~ - - -




PHASE m o r I

2 I

3 4 5 I 6 1 a 9 I 10 I

II 120I WEEKS

~ ~)~ ~~


T MTX () 8) 10 or 12 mg 2 I


M M M M M I M M M M

I M M M

Ar-r o-I-h 0shy


r= r ---shy-- __ _-----shy -shy --shy



I l

7




bull

Melphalan

Prednisolone



Arm-I

Arm-n

Arm-ill

Melphalan

Prednisolone

Interferon alfa-2B

Interferon alfa-2B

Interferon alfa-2B

Dexamethasone

mgday

mgday

2 mgm


Option 1

Option 2


O4mg

2 9 mgm

40 mgday

6 mgm2

60 mgday


8



A1

A2

A8

81

32


B1

B2

bull

CispJatin

Etoposide

Carboplatin

Etoposide


2 25 mgm

2 100 mgm

2 25 mgm

2 100 mgm

2 2 gm



VP - 16 50 mg

2 Mitomycin 8 mgm


2 CispJatin 100 mgm

2 Mitomycin 8 mgrn




~

)

~~l bull ~ bull

J

~ ~ ~

j gt~

-- --=-_ r~Cl-

J6Yi- _

____ _ _ __ _ _c- _ t--~

bull

1lt11


J ( ~ ~ -- -I SL lt ~ ---




~ lmiddot5L1 bull

) l ) C


u u ~ uuu uu

Llt+-~




1 ACUTE LEUKEMIA









and cytochemistry


0 I 2 and 3

function







node







Induct ion courses

~

2





days 1-5


Maintenance therapy



duration

Regimen A


Regimen B







follow up period





B) Elder Iy case







2

2













days 1-7

IV days 1-3












Rajavithi hospital


Study obJectives







3







Induction

Phase I






Phase 2



Ara-C 75 nignG _ [-V day 31-3438-4145-48

52- 55



(maximum 15 mg)





node








induction cOUrses

I 4

2

Consolidation




Phase 2



Maintenance





months



A) Low grade NHL







Study objectives









~-

5

x











( J I






I




Induction







(

f- c I

6







measurable lesions







of disease

















regimens




7

Intermediate grade




High grade










Arm- I CHOP- I

Induction









therapy


Induction








8

x






















I 9












C-MOPP regimen








ABV regimen











010

j

-- -

)



Study objectives













per litre


Arm-I



months



gt I I


- shy~

~~ itmiddot gt

-






























12

(J1(







-





inducti on courses





Opt ion 2 -










I 13




















Study obJectives









14

middot r

middot

anti-MM therapy




Induction regimens




























15

7




Arm-j





Arm-Ill





disease relapse






1-4








16

( shy


-shy0J



5d A~d A~ d 5d

ACTINOMYCIN ~ v v



AMD + VCR 6 Mv



shy



~d gt ~d ~d ~d ~d ~d ~d ~ n n n

i u U U U ~ U U U


WEEK 0 2 bull 6 6 12 22 )1 40 49 ~8 6~ ~ 7 9 I ~

AID VCR 15 Mo bull



~

bull ~ItI~~ -

bull f bull It

~~~~~~~ ~ i ltI

~ ~tI~ ~




~d ~




WEE KS o 2 bull 0 B 10 12 19 26 ~ ~9 4~ ~2 ~e 6~

) ~ 7 9 II I ~

I

I i





shy

~1 I

l i

Y _ 1~

-= ~ ~ ~

I


----------- - -


~

dO do dO dO dO

AORAMYCIN

u U U ~ ~ I ~O ~o bull ~ 0 ~ 0 ~ 0 ~O



I I I I I I

WEEKS C 2 6 a 10 12 19 26 ~2 ~9 ~ ~2 ~B 6~






I

cOshy

----- -

I



3 ~d 30 bull 3d




VINCRISTINE V V y V


WEE KS deg 2 4 6 6 10 12 19 26 32 39 ~ 32 ~5191~

c




BIRTH - Ii 1 26 0 - 1800



13 - 1middot~ 2160


31 - 40 314 0

4 1 t 3780

11

) ~d

~ 3

~ ~

~

~

Vy V Y

I I I

36 63

(cGy)

q

Staeinz of NHL

Stage xtcni f tumor




involvei~nt







of the diaph=ag3


diaj)hraga







conp Protocal

CTX

l

Haincanance

crx

HI

mx

PRW

IITotal

ll shy

21200 3pound1 1 V

~2 1 V ~

2 mgJfl r-

3134 2

rrgJ~i I ~ V


4 hr)

60 mgNJd PO off


1000 rgH2 LV q 28 d

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bull

CispJatin

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2 25 mgm

2 100 mgm

2 25 mgm

2 100 mgm

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VP - 16 50 mg

2 Mitomycin 8 mgm


2 CispJatin 100 mgm

2 Mitomycin 8 mgrn




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1 ACUTE LEUKEMIA









and cytochemistry


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Induct ion courses

~

2





days 1-5


Maintenance therapy



duration

Regimen A


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follow up period





B) Elder Iy case







2

2













days 1-7

IV days 1-3












Rajavithi hospital


Study obJectives







3







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Phase 2



Ara-C 75 nignG _ [-V day 31-3438-4145-48

52- 55



(maximum 15 mg)





node








induction cOUrses

I 4

2

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months



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Study objectives









~-

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x











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8

x






















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ABV regimen











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per litre


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14

middot r

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disease relapse






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VINCRISTINE V V y V


WEE KS deg 2 4 6 6 10 12 19 26 32 39 ~ 32 ~5191~

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13 - 1middot~ 2160


31 - 40 314 0

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u u ~ uuu uu

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1 ACUTE LEUKEMIA









and cytochemistry


0 I 2 and 3

function







node







Induct ion courses

~

2





days 1-5


Maintenance therapy



duration

Regimen A


Regimen B







follow up period





B) Elder Iy case







2

2













days 1-7

IV days 1-3












Rajavithi hospital


Study obJectives







3







Induction

Phase I






Phase 2



Ara-C 75 nignG _ [-V day 31-3438-4145-48

52- 55



(maximum 15 mg)





node








induction cOUrses

I 4

2

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months



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Study objectives









~-

5

x











( J I






I




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f- c I

6







measurable lesions







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regimens




7

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therapy


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8

x






















I 9












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ABV regimen











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15

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disease relapse






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VINCRISTINE V V y V


WEE KS deg 2 4 6 6 10 12 19 26 32 39 ~ 32 ~5191~

c




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13 - 1middot~ 2160


31 - 40 314 0

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bull

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1 ACUTE LEUKEMIA









and cytochemistry


0 I 2 and 3

function







node







Induct ion courses

~

2





days 1-5


Maintenance therapy



duration

Regimen A


Regimen B







follow up period





B) Elder Iy case







2

2













days 1-7

IV days 1-3












Rajavithi hospital


Study obJectives







3







Induction

Phase I






Phase 2



Ara-C 75 nignG _ [-V day 31-3438-4145-48

52- 55



(maximum 15 mg)





node








induction cOUrses

I 4

2

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months



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Study objectives









~-

5

x











( J I






I




Induction







(

f- c I

6







measurable lesions







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regimens




7

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therapy


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8

x






















I 9












C-MOPP regimen








ABV regimen











010

j

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per litre


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inducti on courses





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14

middot r

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15

7




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disease relapse






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16

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~

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I

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3 ~d 30 bull 3d




VINCRISTINE V V y V


WEE KS deg 2 4 6 6 10 12 19 26 32 39 ~ 32 ~5191~

c




BIRTH - Ii 1 26 0 - 1800



13 - 1middot~ 2160


31 - 40 314 0

4 1 t 3780

11

) ~d

~ 3

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~

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Vy V Y

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CTX

l

Haincanance

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21200 3pound1 1 V

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8

6



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3 4 5 I 6 1 a 9 I 10 I

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T MTX () 8) 10 or 12 mg 2 I


M M M M M I M M M M

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I l




1 ACUTE LEUKEMIA









and cytochemistry


0 I 2 and 3

function







node







Induct ion courses

~

2





days 1-5


Maintenance therapy



duration

Regimen A


Regimen B







follow up period





B) Elder Iy case







2

2













days 1-7

IV days 1-3












Rajavithi hospital


Study obJectives







3







Induction

Phase I






Phase 2



Ara-C 75 nignG _ [-V day 31-3438-4145-48

52- 55



(maximum 15 mg)





node








induction cOUrses

I 4

2

Consolidation




Phase 2



Maintenance





months



A) Low grade NHL







Study objectives









~-

5

x











( J I






I




Induction







(

f- c I

6







measurable lesions







of disease

















regimens




7

Intermediate grade




High grade










Arm- I CHOP- I

Induction









therapy


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8

x






















I 9












C-MOPP regimen








ABV regimen











010

j

-- -

)



Study objectives













per litre


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months



gt I I


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-






























12

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inducti on courses





Opt ion 2 -










I 13




















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14

middot r

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anti-MM therapy




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15

7




Arm-j





Arm-Ill





disease relapse






1-4








16

( shy


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ACTINOMYCIN ~ v v



AMD + VCR 6 Mv



shy



~d gt ~d ~d ~d ~d ~d ~d ~ n n n

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AID VCR 15 Mo bull



~

bull ~ItI~~ -

bull f bull It

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I

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3 ~d 30 bull 3d




VINCRISTINE V V y V


WEE KS deg 2 4 6 6 10 12 19 26 32 39 ~ 32 ~5191~

c




BIRTH - Ii 1 26 0 - 1800



13 - 1middot~ 2160


31 - 40 314 0

4 1 t 3780

11

) ~d

~ 3

~ ~

~

~

Vy V Y

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36 63

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involvei~nt







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conp Protocal

CTX

l

Haincanance

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HI

mx

PRW

IITotal

ll shy

21200 3pound1 1 V

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1000 rgH2 LV q 28 d

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8

6



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3 4 5 I 6 1 a 9 I 10 I

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M M M M M I M M M M

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Ar-r o-I-h 0shy


r= r ---shy-- __ _-----shy -shy --shy



I l





days 1-5


Maintenance therapy



duration

Regimen A


Regimen B







follow up period





B) Elder Iy case







2

2













days 1-7

IV days 1-3












Rajavithi hospital


Study obJectives







3







Induction

Phase I






Phase 2



Ara-C 75 nignG _ [-V day 31-3438-4145-48

52- 55



(maximum 15 mg)





node








induction cOUrses

I 4

2

Consolidation




Phase 2



Maintenance





months



A) Low grade NHL







Study objectives









~-

5

x











( J I






I




Induction







(

f- c I

6







measurable lesions







of disease

















regimens




7

Intermediate grade




High grade










Arm- I CHOP- I

Induction









therapy


Induction








8

x






















I 9












C-MOPP regimen








ABV regimen











010

j

-- -

)



Study objectives













per litre


Arm-I



months



gt I I


- shy~

~~ itmiddot gt

-






























12

(J1(







-





inducti on courses





Opt ion 2 -










I 13




















Study obJectives









14

middot r

middot

anti-MM therapy




Induction regimens




























15

7




Arm-j





Arm-Ill





disease relapse






1-4








16

( shy


-shy0J



5d A~d A~ d 5d

ACTINOMYCIN ~ v v



AMD + VCR 6 Mv



shy



~d gt ~d ~d ~d ~d ~d ~d ~ n n n

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WEEK 0 2 bull 6 6 12 22 )1 40 49 ~8 6~ ~ 7 9 I ~

AID VCR 15 Mo bull



~

bull ~ItI~~ -

bull f bull It

~~~~~~~ ~ i ltI

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shy

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I I I I I I

WEEKS C 2 6 a 10 12 19 26 ~2 ~9 ~ ~2 ~B 6~






I

cOshy

----- -

I



3 ~d 30 bull 3d




VINCRISTINE V V y V


WEE KS deg 2 4 6 6 10 12 19 26 32 39 ~ 32 ~5191~

c




BIRTH - Ii 1 26 0 - 1800



13 - 1middot~ 2160


31 - 40 314 0

4 1 t 3780

11

) ~d

~ 3

~ ~

~

~

Vy V Y

I I I

36 63

(cGy)

q

Staeinz of NHL

Stage xtcni f tumor




involvei~nt







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conp Protocal

CTX

l

Haincanance

crx

HI

mx

PRW

IITotal

ll shy

21200 3pound1 1 V

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3134 2

rrgJ~i I ~ V


4 hr)

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1000 rgH2 LV q 28 d

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11_1 ttJ02 S tc2UE

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Deep X--~y ~ lr~e )

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VCR J

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8

6



lt Inri

1 -


PHASE I PHASE II



VCR 15 mg rt()t t t t [~ - - -




PHASE m o r I

2 I

3 4 5 I 6 1 a 9 I 10 I

II 120I WEEKS

~ ~)~ ~~


T MTX () 8) 10 or 12 mg 2 I


M M M M M I M M M M

I M M M

Ar-r o-I-h 0shy


r= r ---shy-- __ _-----shy -shy --shy



I l













days 1-7

IV days 1-3












Rajavithi hospital


Study obJectives







3







Induction

Phase I






Phase 2



Ara-C 75 nignG _ [-V day 31-3438-4145-48

52- 55



(maximum 15 mg)





node








induction cOUrses

I 4

2

Consolidation




Phase 2



Maintenance





months



A) Low grade NHL







Study objectives









~-

5

x











( J I






I




Induction







(

f- c I

6







measurable lesions







of disease

















regimens




7

Intermediate grade




High grade










Arm- I CHOP- I

Induction









therapy


Induction








8

x






















I 9












C-MOPP regimen








ABV regimen











010

j

-- -

)



Study objectives













per litre


Arm-I



months



gt I I


- shy~

~~ itmiddot gt

-






























12

(J1(







-





inducti on courses





Opt ion 2 -










I 13




















Study obJectives









14

middot r

middot

anti-MM therapy




Induction regimens




























15

7




Arm-j





Arm-Ill





disease relapse






1-4








16

( shy


-shy0J



5d A~d A~ d 5d

ACTINOMYCIN ~ v v



AMD + VCR 6 Mv



shy



~d gt ~d ~d ~d ~d ~d ~d ~ n n n

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WEEK 0 2 bull 6 6 12 22 )1 40 49 ~8 6~ ~ 7 9 I ~

AID VCR 15 Mo bull



~

bull ~ItI~~ -

bull f bull It

~~~~~~~ ~ i ltI

~ ~tI~ ~




~d ~




WEE KS o 2 bull 0 B 10 12 19 26 ~ ~9 4~ ~2 ~e 6~

) ~ 7 9 II I ~

I

I i





shy

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l i

Y _ 1~

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I


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dO do dO dO dO

AORAMYCIN

u U U ~ ~ I ~O ~o bull ~ 0 ~ 0 ~ 0 ~O



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WEEKS C 2 6 a 10 12 19 26 ~2 ~9 ~ ~2 ~B 6~






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cOshy

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3 ~d 30 bull 3d




VINCRISTINE V V y V


WEE KS deg 2 4 6 6 10 12 19 26 32 39 ~ 32 ~5191~

c




BIRTH - Ii 1 26 0 - 1800



13 - 1middot~ 2160


31 - 40 314 0

4 1 t 3780

11

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VINCRISTINE V V y V


WEE KS deg 2 4 6 6 10 12 19 26 32 39 ~ 32 ~5191~

c




BIRTH - Ii 1 26 0 - 1800



13 - 1middot~ 2160


31 - 40 314 0

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1000 rgH2 LV q 28 d

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VINCRISTINE V V y V


WEE KS deg 2 4 6 6 10 12 19 26 32 39 ~ 32 ~5191~

c




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13 - 1middot~ 2160


31 - 40 314 0

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I I I I I I

WEEKS C 2 6 a 10 12 19 26 ~2 ~9 ~ ~2 ~B 6~






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cOshy

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3 ~d 30 bull 3d




VINCRISTINE V V y V


WEE KS deg 2 4 6 6 10 12 19 26 32 39 ~ 32 ~5191~

c




BIRTH - Ii 1 26 0 - 1800



13 - 1middot~ 2160


31 - 40 314 0

4 1 t 3780

11

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21200 3pound1 1 V

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1000 rgH2 LV q 28 d

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8

x






















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I I I I I I

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I

cOshy

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3 ~d 30 bull 3d




VINCRISTINE V V y V


WEE KS deg 2 4 6 6 10 12 19 26 32 39 ~ 32 ~5191~

c




BIRTH - Ii 1 26 0 - 1800



13 - 1middot~ 2160


31 - 40 314 0

4 1 t 3780

11

) ~d

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Vy V Y

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l

Haincanance

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21200 3pound1 1 V

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3134 2

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1000 rgH2 LV q 28 d

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3 4 5 I 6 1 a 9 I 10 I

II 120I WEEKS

~ ~)~ ~~


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M M M M M I M M M M

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I l

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therapy


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8

x






















I 9












C-MOPP regimen








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j

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per litre


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14

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15

7




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disease relapse






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16

( shy


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5d A~d A~ d 5d

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~d gt ~d ~d ~d ~d ~d ~d ~ n n n

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I I I I I I

WEEKS C 2 6 a 10 12 19 26 ~2 ~9 ~ ~2 ~B 6~






I

cOshy

----- -

I



3 ~d 30 bull 3d




VINCRISTINE V V y V


WEE KS deg 2 4 6 6 10 12 19 26 32 39 ~ 32 ~5191~

c




BIRTH - Ii 1 26 0 - 1800



13 - 1middot~ 2160


31 - 40 314 0

4 1 t 3780

11

) ~d

~ 3

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~

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Vy V Y

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36 63

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involvei~nt







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CTX

l

Haincanance

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mx

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21200 3pound1 1 V

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rrgJ~i I ~ V


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1000 rgH2 LV q 28 d

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8

6



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2 I

3 4 5 I 6 1 a 9 I 10 I

II 120I WEEKS

~ ~)~ ~~


T MTX () 8) 10 or 12 mg 2 I


M M M M M I M M M M

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I 9












C-MOPP regimen








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j

-- -

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Study objectives













per litre


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12

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-





inducti on courses





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Study obJectives









14

middot r

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anti-MM therapy




Induction regimens




























15

7




Arm-j





Arm-Ill





disease relapse






1-4








16

( shy


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5d A~d A~ d 5d

ACTINOMYCIN ~ v v



AMD + VCR 6 Mv



shy



~d gt ~d ~d ~d ~d ~d ~d ~ n n n

i u U U U ~ U U U


WEEK 0 2 bull 6 6 12 22 )1 40 49 ~8 6~ ~ 7 9 I ~

AID VCR 15 Mo bull



~

bull ~ItI~~ -

bull f bull It

~~~~~~~ ~ i ltI

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WEE KS o 2 bull 0 B 10 12 19 26 ~ ~9 4~ ~2 ~e 6~

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shy

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I I I I I I

WEEKS C 2 6 a 10 12 19 26 ~2 ~9 ~ ~2 ~B 6~






I

cOshy

----- -

I



3 ~d 30 bull 3d




VINCRISTINE V V y V


WEE KS deg 2 4 6 6 10 12 19 26 32 39 ~ 32 ~5191~

c




BIRTH - Ii 1 26 0 - 1800



13 - 1middot~ 2160


31 - 40 314 0

4 1 t 3780

11

) ~d

~ 3

~ ~

~

~

Vy V Y

I I I

36 63

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q

Staeinz of NHL

Stage xtcni f tumor




involvei~nt







of the diaph=ag3


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conp Protocal

CTX

l

Haincanance

crx

HI

mx

PRW

IITotal

ll shy

21200 3pound1 1 V

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2 mgJfl r-

3134 2

rrgJ~i I ~ V


4 hr)

60 mgNJd PO off


1000 rgH2 LV q 28 d

15 L

flgJ~ LV D1 q 28 d

625 2

OBit LT D 29

q 28 d

300 2

mgl LV D15

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60 2 3H d Po x 5 d D29 lt 28 d


Keep Ie l500cumm

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11_1 ttJ02 S tc2UE

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c


VCR J

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8

6



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1 -


PHASE I PHASE II



VCR 15 mg rt()t t t t [~ - - -




PHASE m o r I

2 I

3 4 5 I 6 1 a 9 I 10 I

II 120I WEEKS

~ ~)~ ~~


T MTX () 8) 10 or 12 mg 2 I


M M M M M I M M M M

I M M M

Ar-r o-I-h 0shy


r= r ---shy-- __ _-----shy -shy --shy



I l












C-MOPP regimen








ABV regimen











010

j

-- -

)



Study objectives













per litre


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months



gt I I


- shy~

~~ itmiddot gt

-






























12

(J1(







-





inducti on courses





Opt ion 2 -










I 13




















Study obJectives









14

middot r

middot

anti-MM therapy




Induction regimens




























15

7




Arm-j





Arm-Ill





disease relapse






1-4








16

( shy


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5d A~d A~ d 5d

ACTINOMYCIN ~ v v



AMD + VCR 6 Mv



shy



~d gt ~d ~d ~d ~d ~d ~d ~ n n n

i u U U U ~ U U U


WEEK 0 2 bull 6 6 12 22 )1 40 49 ~8 6~ ~ 7 9 I ~

AID VCR 15 Mo bull



~

bull ~ItI~~ -

bull f bull It

~~~~~~~ ~ i ltI

~ ~tI~ ~




~d ~




WEE KS o 2 bull 0 B 10 12 19 26 ~ ~9 4~ ~2 ~e 6~

) ~ 7 9 II I ~

I

I i





shy

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l i

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dO do dO dO dO

AORAMYCIN

u U U ~ ~ I ~O ~o bull ~ 0 ~ 0 ~ 0 ~O



I I I I I I

WEEKS C 2 6 a 10 12 19 26 ~2 ~9 ~ ~2 ~B 6~






I

cOshy

----- -

I



3 ~d 30 bull 3d




VINCRISTINE V V y V


WEE KS deg 2 4 6 6 10 12 19 26 32 39 ~ 32 ~5191~

c




BIRTH - Ii 1 26 0 - 1800



13 - 1middot~ 2160


31 - 40 314 0

4 1 t 3780

11

) ~d

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~

Vy V Y

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36 63

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q

Staeinz of NHL

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involvei~nt







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CTX

l

Haincanance

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21200 3pound1 1 V

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VINCRISTINE V V y V


WEE KS deg 2 4 6 6 10 12 19 26 32 39 ~ 32 ~5191~

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13 - 1middot~ 2160


31 - 40 314 0

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VINCRISTINE V V y V


WEE KS deg 2 4 6 6 10 12 19 26 32 39 ~ 32 ~5191~

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13 - 1middot~ 2160


31 - 40 314 0

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21200 3pound1 1 V

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I

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3 ~d 30 bull 3d




VINCRISTINE V V y V


WEE KS deg 2 4 6 6 10 12 19 26 32 39 ~ 32 ~5191~

c




BIRTH - Ii 1 26 0 - 1800



13 - 1middot~ 2160


31 - 40 314 0

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21200 3pound1 1 V

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I

cOshy

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3 ~d 30 bull 3d




VINCRISTINE V V y V


WEE KS deg 2 4 6 6 10 12 19 26 32 39 ~ 32 ~5191~

c




BIRTH - Ii 1 26 0 - 1800



13 - 1middot~ 2160


31 - 40 314 0

4 1 t 3780

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21200 3pound1 1 V

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7




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I I I I I I

WEEKS C 2 6 a 10 12 19 26 ~2 ~9 ~ ~2 ~B 6~






I

cOshy

----- -

I



3 ~d 30 bull 3d




VINCRISTINE V V y V


WEE KS deg 2 4 6 6 10 12 19 26 32 39 ~ 32 ~5191~

c




BIRTH - Ii 1 26 0 - 1800



13 - 1middot~ 2160


31 - 40 314 0

4 1 t 3780

11

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Haincanance

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21200 3pound1 1 V

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1000 rgH2 LV q 28 d

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2 I

3 4 5 I 6 1 a 9 I 10 I

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16

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I I I I I I

WEEKS C 2 6 a 10 12 19 26 ~2 ~9 ~ ~2 ~B 6~






I

cOshy

----- -

I



3 ~d 30 bull 3d




VINCRISTINE V V y V


WEE KS deg 2 4 6 6 10 12 19 26 32 39 ~ 32 ~5191~

c




BIRTH - Ii 1 26 0 - 1800



13 - 1middot~ 2160


31 - 40 314 0

4 1 t 3780

11

) ~d

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Vy V Y

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Haincanance

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21200 3pound1 1 V

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3134 2

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60 mgNJd PO off


1000 rgH2 LV q 28 d

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625 2

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2 I

3 4 5 I 6 1 a 9 I 10 I

II 120I WEEKS

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M M M M M I M M M M

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~

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~~~~~~~ ~ i ltI

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I I I I I I

WEEKS C 2 6 a 10 12 19 26 ~2 ~9 ~ ~2 ~B 6~






I

cOshy

----- -

I



3 ~d 30 bull 3d




VINCRISTINE V V y V


WEE KS deg 2 4 6 6 10 12 19 26 32 39 ~ 32 ~5191~

c




BIRTH - Ii 1 26 0 - 1800



13 - 1middot~ 2160


31 - 40 314 0

4 1 t 3780

11

) ~d

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~

Vy V Y

I I I

36 63

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conp Protocal

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l

Haincanance

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mx

PRW

IITotal

ll shy

21200 3pound1 1 V

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2 mgJfl r-

3134 2

rrgJ~i I ~ V


4 hr)

60 mgNJd PO off


1000 rgH2 LV q 28 d

15 L

flgJ~ LV D1 q 28 d

625 2

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300 2

mgl LV D15

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60 2 3H d Po x 5 d D29 lt 28 d


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8

6



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VCR 15 mg rt()t t t t [~ - - -




PHASE m o r I

2 I

3 4 5 I 6 1 a 9 I 10 I

II 120I WEEKS

~ ~)~ ~~


T MTX () 8) 10 or 12 mg 2 I


M M M M M I M M M M

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Ar-r o-I-h 0shy


r= r ---shy-- __ _-----shy -shy --shy



I l



~d gt ~d ~d ~d ~d ~d ~d ~ n n n

i u U U U ~ U U U


WEEK 0 2 bull 6 6 12 22 )1 40 49 ~8 6~ ~ 7 9 I ~

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~

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bull f bull It

~~~~~~~ ~ i ltI

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I i





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I I I I I I

WEEKS C 2 6 a 10 12 19 26 ~2 ~9 ~ ~2 ~B 6~






I

cOshy

----- -

I



3 ~d 30 bull 3d




VINCRISTINE V V y V


WEE KS deg 2 4 6 6 10 12 19 26 32 39 ~ 32 ~5191~

c




BIRTH - Ii 1 26 0 - 1800



13 - 1middot~ 2160


31 - 40 314 0

4 1 t 3780

11

) ~d

~ 3

~ ~

~

~

Vy V Y

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Haincanance

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21200 3pound1 1 V

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2 mgJfl r-

3134 2

rrgJ~i I ~ V


4 hr)

60 mgNJd PO off


1000 rgH2 LV q 28 d

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625 2

OBit LT D 29

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VCR 15 mg rt()t t t t [~ - - -




PHASE m o r I

2 I

3 4 5 I 6 1 a 9 I 10 I

II 120I WEEKS

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T MTX () 8) 10 or 12 mg 2 I


M M M M M I M M M M

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bull ~ItI~~ -

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WEE KS o 2 bull 0 B 10 12 19 26 ~ ~9 4~ ~2 ~e 6~

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I I I I I I

WEEKS C 2 6 a 10 12 19 26 ~2 ~9 ~ ~2 ~B 6~






I

cOshy

----- -

I



3 ~d 30 bull 3d




VINCRISTINE V V y V


WEE KS deg 2 4 6 6 10 12 19 26 32 39 ~ 32 ~5191~

c




BIRTH - Ii 1 26 0 - 1800



13 - 1middot~ 2160


31 - 40 314 0

4 1 t 3780

11

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~

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involvei~nt







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CTX

l

Haincanance

crx

HI

mx

PRW

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ll shy

21200 3pound1 1 V

~2 1 V ~

2 mgJfl r-

3134 2

rrgJ~i I ~ V


4 hr)

60 mgNJd PO off


1000 rgH2 LV q 28 d

15 L

flgJ~ LV D1 q 28 d

625 2

OBit LT D 29

q 28 d

300 2

mgl LV D15

-q 28 d

60 2 3H d Po x 5 d D29 lt 28 d


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I

2 HOdeJltin S

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fYJ

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c


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8

6



lt Inri

1 -


PHASE I PHASE II



VCR 15 mg rt()t t t t [~ - - -




PHASE m o r I

2 I

3 4 5 I 6 1 a 9 I 10 I

II 120I WEEKS

~ ~)~ ~~


T MTX () 8) 10 or 12 mg 2 I


M M M M M I M M M M

I M M M

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I l

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I I I I I I

WEEKS C 2 6 a 10 12 19 26 ~2 ~9 ~ ~2 ~B 6~






I

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VINCRISTINE V V y V


WEE KS deg 2 4 6 6 10 12 19 26 32 39 ~ 32 ~5191~

c




BIRTH - Ii 1 26 0 - 1800



13 - 1middot~ 2160


31 - 40 314 0

4 1 t 3780

11

) ~d

~ 3

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~

~

Vy V Y

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36 63

(cGy)

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Staeinz of NHL

Stage xtcni f tumor




involvei~nt







of the diaph=ag3


diaj)hraga







conp Protocal

CTX

l

Haincanance

crx

HI

mx

PRW

IITotal

ll shy

21200 3pound1 1 V

~2 1 V ~

2 mgJfl r-

3134 2

rrgJ~i I ~ V


4 hr)

60 mgNJd PO off


1000 rgH2 LV q 28 d

15 L

flgJ~ LV D1 q 28 d

625 2

OBit LT D 29

q 28 d

300 2

mgl LV D15

-q 28 d

60 2 3H d Po x 5 d D29 lt 28 d


Keep Ie l500cumm

I

2 HOdeJltin S

- Lfilphotla




fYJ

11_1 ttJ02 S tc2UE

2 v


Deep X--~y ~ lr~e )

c


VCR J

- ( I J





8

6



lt Inri

1 -


PHASE I PHASE II



VCR 15 mg rt()t t t t [~ - - -




PHASE m o r I

2 I

3 4 5 I 6 1 a 9 I 10 I

II 120I WEEKS

~ ~)~ ~~


T MTX () 8) 10 or 12 mg 2 I


M M M M M I M M M M

I M M M

Ar-r o-I-h 0shy


r= r ---shy-- __ _-----shy -shy --shy



I l

----- -

I



3 ~d 30 bull 3d




VINCRISTINE V V y V


WEE KS deg 2 4 6 6 10 12 19 26 32 39 ~ 32 ~5191~

c




BIRTH - Ii 1 26 0 - 1800



13 - 1middot~ 2160


31 - 40 314 0

4 1 t 3780

11

) ~d

~ 3

~ ~

~

~

Vy V Y

I I I

36 63

(cGy)

q

Staeinz of NHL

Stage xtcni f tumor




involvei~nt







of the diaph=ag3


diaj)hraga







conp Protocal

CTX

l

Haincanance

crx

HI

mx

PRW

IITotal

ll shy

21200 3pound1 1 V

~2 1 V ~

2 mgJfl r-

3134 2

rrgJ~i I ~ V


4 hr)

60 mgNJd PO off


1000 rgH2 LV q 28 d

15 L

flgJ~ LV D1 q 28 d

625 2

OBit LT D 29

q 28 d

300 2

mgl LV D15

-q 28 d

60 2 3H d Po x 5 d D29 lt 28 d


Keep Ie l500cumm

I

2 HOdeJltin S

- Lfilphotla




fYJ

11_1 ttJ02 S tc2UE

2 v


Deep X--~y ~ lr~e )

c


VCR J

- ( I J





8

6



lt Inri

1 -


PHASE I PHASE II



VCR 15 mg rt()t t t t [~ - - -




PHASE m o r I

2 I

3 4 5 I 6 1 a 9 I 10 I

II 120I WEEKS

~ ~)~ ~~


T MTX () 8) 10 or 12 mg 2 I


M M M M M I M M M M

I M M M

Ar-r o-I-h 0shy


r= r ---shy-- __ _-----shy -shy --shy



I l

Staeinz of NHL

Stage xtcni f tumor




involvei~nt







of the diaph=ag3


diaj)hraga







conp Protocal

CTX

l

Haincanance

crx

HI

mx

PRW

IITotal

ll shy

21200 3pound1 1 V

~2 1 V ~

2 mgJfl r-

3134 2

rrgJ~i I ~ V


4 hr)

60 mgNJd PO off


1000 rgH2 LV q 28 d

15 L

flgJ~ LV D1 q 28 d

625 2

OBit LT D 29

q 28 d

300 2

mgl LV D15

-q 28 d

60 2 3H d Po x 5 d D29 lt 28 d


Keep Ie l500cumm

I

2 HOdeJltin S

- Lfilphotla




fYJ

11_1 ttJ02 S tc2UE

2 v


Deep X--~y ~ lr~e )

c


VCR J

- ( I J





8

6



lt Inri

1 -


PHASE I PHASE II



VCR 15 mg rt()t t t t [~ - - -




PHASE m o r I

2 I

3 4 5 I 6 1 a 9 I 10 I

II 120I WEEKS

~ ~)~ ~~


T MTX () 8) 10 or 12 mg 2 I


M M M M M I M M M M

I M M M

Ar-r o-I-h 0shy


r= r ---shy-- __ _-----shy -shy --shy



I l

conp Protocal

CTX

l

Haincanance

crx

HI

mx

PRW

IITotal

ll shy

21200 3pound1 1 V

~2 1 V ~

2 mgJfl r-

3134 2

rrgJ~i I ~ V


4 hr)

60 mgNJd PO off


1000 rgH2 LV q 28 d

15 L

flgJ~ LV D1 q 28 d

625 2

OBit LT D 29

q 28 d

300 2

mgl LV D15

-q 28 d

60 2 3H d Po x 5 d D29 lt 28 d


Keep Ie l500cumm

I

2 HOdeJltin S

- Lfilphotla




fYJ

11_1 ttJ02 S tc2UE

2 v


Deep X--~y ~ lr~e )

c


VCR J

- ( I J





8

6



lt Inri

1 -


PHASE I PHASE II



VCR 15 mg rt()t t t t [~ - - -




PHASE m o r I

2 I

3 4 5 I 6 1 a 9 I 10 I

II 120I WEEKS

~ ~)~ ~~


T MTX () 8) 10 or 12 mg 2 I


M M M M M I M M M M

I M M M

Ar-r o-I-h 0shy


r= r ---shy-- __ _-----shy -shy --shy



I l

2 HOdeJltin S

- Lfilphotla




fYJ

11_1 ttJ02 S tc2UE

2 v


Deep X--~y ~ lr~e )

c


VCR J

- ( I J





8

6



lt Inri

1 -


PHASE I PHASE II



VCR 15 mg rt()t t t t [~ - - -




PHASE m o r I

2 I

3 4 5 I 6 1 a 9 I 10 I

II 120I WEEKS

~ ~)~ ~~


T MTX () 8) 10 or 12 mg 2 I


M M M M M I M M M M

I M M M

Ar-r o-I-h 0shy


r= r ---shy-- __ _-----shy -shy --shy



I l


PHASE I PHASE II



VCR 15 mg rt()t t t t [~ - - -




PHASE m o r I

2 I

3 4 5 I 6 1 a 9 I 10 I

II 120I WEEKS

~ ~)~ ~~


T MTX () 8) 10 or 12 mg 2 I


M M M M M I M M M M

I M M M

Ar-r o-I-h 0shy


r= r ---shy-- __ _-----shy -shy --shy



I l

Documents

PROTOCOL - Prince of Songkla Universitymedinfo2.psu.ac.th/social/doc/2014-05-01-11-23-11.pdf · Protocol for treatment Induct ion: and cytochemistry chemotherapy or radiation 0, I,