• Phase 1: Induction Therapy (35 days) - The purpose of this phase is to induce remission.  Day 1 was August 10th.
  

  Drug	How it will be Given	Day
  Cytarabine	By spinal tap	1
  Vincristine	Intravenous (through port after it was installed)	1, 8, 15, 22
  PEG Asparaginase	Needle in leg	6
  Dexamethasone	By mouth (twice daily)	1 - 28

• Phase 2: Consolidation (8 weeks) - Day 1 is September 14th ( day '29' is Oct 21st)
  

  Drug	How it will be Given	Day
  Cyclophosphamide	Through Port (over 30 minutes)	1, 29 (admitted for 24 hours and dependant on his levels)
  Cytarabine	Through Port	1 - 4, 8 - 11, 29 - 32, 36 - 39
  Mercaptopurine	By Mouth	1 - 14, 29 - 42
  Vincristine	Through Port	15, 22, 43, 50
  PEG Asparaginase	Needle in leg	15, 43
  Methotrexate	By spinal tap	1, 8, 15, 22

• Phase 3: Interim Maintenance (8 weeks) - Day 1 of Phase 3 through 7 will depend on Kullan's levels at the time that the previous is done.  As well, treatment is suspended if he gets an infection as he will be admitted for the duration of the infection.
  

  Drug	How it will be Given	Day
  Methotrexate	Through Port (each dose is increased from the previous one)	1, 11, 21, 31, 41
  Vincristine	Through Port	1, 11, 21, 31, 41
  PEG Asparaginase	Needle in leg	2, 22
  Methotrexate	By Spinal tap	1, 31

• Phase 4: Delayed Intensification (8 weeks)
  

  Drug	How it will be Given	Day
  Vincristine	Through Port	1, 8, 15, 43, 50
  Dexamethasone	By mouth (twice a day)	1 - 21
  Doxorubicin	Through Port	1, 8, 15
  PEG Asparaginase	Needle in Leg	4 or 5 or 6 and 43
  Cyclophosphamide	Through Port (over 30 minutes)	29 (admitted for 24 hours and dependant on his levels)
  Cytarabine	Through Port	29 - 32, 36 - 39
  Thioguanine	By mouth	29 - 42
  Methotrexate	By spinal tap	1, 29, 36

• Phase 5: Interim Maintenance (8 weeks)
  (same as Phase 3)

• Phase 6: Delayed Intensification (8 weeks)
  (same as Phase 4)

• Phase 7: Maintenance Therapy - Each Maintenance course lasts 12 weeks (84 days) and is repeated until 3 years from the start of Interim Maintenance #1 (beginning of Phase 3)
  

  Drug	How it will be Given	Day
  Vincristine	Through Port	once every four weeks
  Dexamethasone	By Mouth (twice a day)	five days each month
  Methotrexate	By Mouth	once a week
  Mercaptopurine	By Mouth	1 - 84
  Methotrexate	By spinal tap	once every 12 weeks

Additional medicines will be given such as antibiotics to help stop infection as well as medications to lower the side effects of chemotherapy.

Side Effects

This information is taken from the book, "Childhood Cancer, Information for the Patient and Family"

PEG Asparaginase - Pain at the injection site, tiredness, fever.  Can be toxic to the pancreas.  A possibility of blood clots.

Cyclophosphamide - Nausea and vomiting occur and are related to the dose of the drug administered.  Hair loss and bone marrow depression are common.  Mouth sores may occur.  This drug is metabolized extensively by the liver, and these metabolites are excreted in the urine.  Some of these metabolites are toxic to the bladder wall and can cause irritation and inflammation.

Cytarabine - Nausea and vomiting occur and are related to the dose of the drug.  Bone marrow depression, mouth and gut ulceration, diarrhea and hair loss are common.

Dexamethasone -  Bone mineral loss resulting in bony aches and pains and alterations in mood and behavior.  (Food cravings and huge appetite result in weight gain)

Doxorubicin - Nausea and vomiting are common and dose dependant.  Bone marrow suppression occurs and is maximal 10 - 14 days after receiving the drug.  Mouth ulceration, diarrhea and hair loss is common.  This drug is toxic to the heart.  This toxicity occurs with cumulative doses.

Mercaptopurine - This drug may cause mild injury to the liver.

Methotrexate - The drug has toxic effects on the liver and can be toxic to the kidneys.

Thioguanine - Nausea, vomiting, diarrhea, loss of appetite, skin rash and itchiness are common side effects.

Vincristine - Hair loss is common.  This drug may have toxic effects on the liver and is toxic to the nerves.  (It usually appears as a tingling or burning sensation in the hands and feet and he may be somewhat clumsy)  This toxicity may be reversible often over a long time.  Constipation and abdominal discomfort is common.