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Clinical reference
All cards
ProtocolDraft — not reviewed

ALL treatment phases

Phase-by-phase map of a typical B-ALL regimen with the monitoring focus for each block.

Total duration
~2 years girls / ~3 years boys (regimen dependent)
MRD checkpoint
End of induction, day 29

Induction (≈4–5 weeks)

  • Steroid, vincristine, asparaginase ± anthracycline; intrathecal therapy from day 1.
  • Watch for TLS in the first week, steroid hyperglycaemia, and infection risk at count nadir.
  • Day 29 marrow with MRD drives risk-group assignment.

Consolidation and interim maintenance

  • CNS-directed therapy intensifies; high-dose methotrexate with leucovorin rescue in many arms.
  • Monitor methotrexate levels and urine pH; delayed clearance is a hydration/pH problem until proven otherwise.
  • Mucositis peaks here — proactive mouth care and analgesia planning.

Delayed intensification

  • Re-induction-like intensity: repeat anthracycline exposure, asparaginase, steroid pulses.
  • Track cumulative anthracycline dose and echo schedule.
  • Asparaginase reactions, pancreatitis and thrombosis are the key toxicities to pre-brief families about.

Maintenance

  • Daily oral mercaptopurine, weekly methotrexate, monthly vincristine plus steroid pulses.
  • Titrate to target ANC per protocol rather than stopping outright for mild cytopenia.
  • Check adherence and TPMT/NUDT15 status when unexpected deep myelosuppression occurs.
  • Mercaptopurine on an empty stomach, evening dosing, no dairy within an hour.

Sources and local override

  • Active trial or standard-of-care protocol document — Always dose from the patient's own roadmap.

Next review due 2027-02-01.