Chemo Chart: UKALL 12 Intensification

Haematology / Page 1 of 9
UKALL 12
Intensification / Height / cm
Weight / kg
BSA / m2
Infusion rate
125 X BSA / = ml/hr
Commence 2 weeks after the completion of induction phase II / CBC / Day 1 / Limits / Hypersensitivities/Allergies
PRN antiemetics
Domperidone 20mg PO QID
 Cyclizine 50mg TDS PO/IV
 Lorazepam 2mg PO Q12H / Agent
Methotrexate low dose
Methotrexate high dose
DOSE MODIFIED:NoYes / Round
5mg
100mg
Date
WCC / > 3 X 109/l
Destination / Neuts
Plts
Reference: UKALL12 trial document
Day / Date / Time / Agent / Dose / Route / Instructions / Rate / Doctor / Nurse / Check / Start / Stop
-1 / 2200 / Ural Sachet® / 1 / PO / Dissolved in 20mL water
1 / t-5 hr / 0400 / 1000ml D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse as 125ml/m2/hr / ml/hr
1000ml D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse as 125ml/m2/hr / ml/hr
Ondansetron / 8 / mg / PO / Give 1 hour prior to chemotherapy
Dexamethasone / 8 / mg / IV / Give 1 hour prior to chemotherapy
T = 0
0900 / Methotrexate 300mg/m2 / mg / IV / 250mL 0.9% S over 1 hour / 250ml/hr
1000 / Methotrexate 2700mg/m2 / mg / IV / 1000 0.9% S over 23 hours / 44ml/hr
1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr

Consult the UKALL12 protocol before prescribing high dose Methotrexate.
Ensure estimated GFR is calculated prior to the Methotrexate infusion
Check urine pH with each void. Urine pH to be > 7.5 before starting Methotrexate, and kept between 7 and 8 during the infusion and folinic acid rescue.
Stop proton pump inhibitor the day prior to MTX infusion. Restart once MTX has cleared
Check antithrombin III and fibrinogen every 2 days while receiving colaspase – see protocol for further information

Patient Category:
Y J A P O 1 3 Z / OSP Group:
1 2 3 4 5 6 7 / Consultant:
NZMC Reg. No: / Special Authority
UKALL 12
Intensification / Height / cm
Weight / kg
BSA / m2
Infusion rate
125 X BSA / = ml/hr
Day / Date / Time / Agent / Dose / Route / Instructions / Rate / Doctor / Nurse / Check / Start / Stop
1 / 1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
2 / 1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
T =+240900 / Stop Methotrexate transfusion / Record amount infused.
1100 / Colaspase (L-Asparaginase) / 10 000 / IU / IM
1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
T =+36hr
2100 / Folinic acid 15mg/m2 / mg / IV / Slow bolus 36 hrs after start of MTX
2400 / Folinic acid 15mg/m2 / mg / IV / Slow bolus
UKALL 12
Intensification / Height / cm
Weight / kg
BSA / m2
3 / 1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
0300 / Folinic acid 15mg/m2 / mg / PO / Give IV if oral not tolerated
1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
0600 / Folinic acid 15mg/m2 / mg / PO / Give IV if oral not tolerated
1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
0900 / Methotrexate level / Aim <0.1micromol/l. If > 0.1micromol/l increase folinic acid to 50mg IV Q12H until the level is <0.1micromol/l. Notify labs if MTX levels will be required over a weekend.
0900 / Folinic acid 15mg/m2 / mg / PO / Give IV if oral not tolerated
1500 / Folinic acid 15mg/m2 / mg / PO / Give IV if oral not tolerated
2100 / Folinic acid 15mg/m2 / mg / PO / Give IV if oral not tolerated
4 / 0300 / Folinic acid 15mg/m2 / mg / PO / Give IV if oral not tolerated
0900 / Methotrexate level / Aim <0.1micromol/l. If > 0.1micromol/l increase folinic acid to 50mg IV Q12H until the level is <0.1micromol/l. Notify labs if MTX levels will be required over a weekend.
0900 / Folinic acid 15mg/m2 / mg / PO / Give IV if oral not tolerated
1500 / Folinic acid 15mg/m2 / mg / PO / Give IV if oral not tolerated
2100 / Folinic acid 15mg/m2 / mg / PO / Give IV if oral not tolerated
5 / 0300 / Folinic acid 15mg/m2 / mg / PO / Give IV if oral not tolerated
0900 / Methotrexate level / Aim <0.1micromol/l. If > 0.1micromol/l increase folinic acid to 50mg IV Q12H until the level is <0.1micromol/l. Chart on QMR4. Notify labs if MTX levels will be required over a weekend.

Continue Folinic acid for at least 72hrs and continues as per UKALL12 protocol depending on Methotrexate levels (see appendix 1 of the UKALL12 protocol)

UKALL 12
Intensification / Height / cm
Weight / kg
BSA / m2
Infusion rate
125 X BSA / = ml/hr
Commence 2 weeks after the completion of induction phase II / CBC / Day 1 / Limits / Hypersensitivities/Allergies
PRN antiemetics
Domperidone 20mg PO QID
 Cyclizine 50mg TDS PO/IV
 Lorazepam 2mg PO Q12H / Agent
Methotrexate low dose
Methotrexate high dose
DOSE MODIFIED:NoYes / Round
5mg
100mg
Date
WCC / > 3 X 109/l
Destination / Neuts
Plts
Reference: UKALL12 trial document
Day / Date / Time / Agent / Dose / Route / Instructions / Rate / Doctor / Nurse / Check / Start / Stop
7 / 2200 / Ural Sachet® / 1 / PO / Dissolved in 20mL water
8 / t-5 hr / 0400 / 1000ml D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse as 125ml/m2/hr / ml/hr
1000ml D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse as 125ml/m2/hr / ml/hr
Ondansetron / 8 / mg / PO / Give IV if oral not tolerated.
Dexamethasone / 8 / mg / IV / In 100ml 0.9% saline over 15 mins
T = 0
0900 / Methotrexate 300mg/m2 / mg / IV / 250mL 0.9% S over 1 hour / 250ml/hr
1100 / Methotrexate 2700mg/m2 / mg / IV / 1000 0.9% S over 23 hours / 44ml/hr
1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr

Consult the UKALL12 protocol before prescribing high dose Methotrexate.
Ensure estimated GFR is calculated prior to the Methotrexate infusion
Check urine pH with each void. Urine pH to be > 7.5 before starting Methotrexate, and kept between 7 and 8 during the infusion and folinic acid rescue.

UKALL 12
Intensification / Height / cm
Weight / kg
BSA / m2
Infusion rate
125 X BSA / = ml/hr
Day / Date / Time / Agent / Dose / Route / Instructions / Rate / Doctor / Nurse / Check / Start / Stop
8 / 1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
9 / 1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
T =+240900 / Stop Methotrexate transfusion / Record amount infused.
1100 / Colaspase (L-Asparaginase) / 10 000 / IU / IM
1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
T =+36hr
2100 / Folinic acid 15mg/m2 / mg / IV / Slow bolus 36 hrs after start of MTX
2400 / Folinic acid 15mg/m2 / mg / IV / Slow bolus
UKALL 12
Intensification / Height / cm
Weight / kg
BSA / m2
9 / 1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
10 / 0300 / Folinic acid 15mg/m2 / mg / PO / Give IV if oral not tolerated
1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
0600 / Folinic acid 15mg/m2 / mg / PO / Give IV if oral not tolerated
1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
0900 / Methotrexate level / Aim <0.1micromol/l. If > 0.1micromol/l increase folinic acid to 50mg IV Q12H until the level is <0.1micromol/l. Notify labs if MTX levels will be required over a weekend.
0900 / Folinic acid 15mg/m2 / mg / PO / Give IV if oral not tolerated
1500 / Folinic acid 15mg/m2 / mg / PO / Give IV if oral not tolerated
2100 / Folinic acid 15mg/m2 / mg / PO / Give IV if oral not tolerated
11 / 0300 / Folinic acid 15mg/m2 / mg / PO / Give IV if oral not tolerated
0900 / Methotrexate level / Aim <0.1micromol/l. If > 0.1micromol/l increase folinic acid to 50mg IV Q12H until the level is <0.1micromol/l. Chart on QMR4. Notify labs if MTX levels will be required over a weekend.
0900 / Folinic acid 15mg/m2 / mg / PO / Give IV if oral not tolerated
UKALL 12
Intensification / Height / cm
Weight / kg
BSA / m2
Infusion rate
125 X BSA / = ml/hr
Commence 2 weeks after the completion of induction phase II / CBC / Day 1 / Limits / Hypersensitivities/Allergies
PRN antiemetics
Domperidone 20mg PO QID
 Cyclizine 50mg TDS PO/IV
 Lorazepam 2mg PO Q12H / Agent
Methotrexate low dose
Methotrexate high dose
DOSE MODIFIED:NoYes / Round
5mg
100mg
Date
WCC / > 3 X 109/l
Destination / Neuts
Plts
Reference: UKALL12 trial document
Day / Date / Time / Agent / Dose / Route / Instructions / Rate / Doctor / Nurse / Check / Start / Stop
21 / 2200 / Ural Sachet® / 1 / PO / Dissolved in 20mL water
22 / t-5 hr / 0400 / 1000ml D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse as 125ml/m2/hr / ml/hr
1000ml D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse as 125ml/m2/hr / ml/hr
Ondansetron / 8 / mg / PO / Give IV if oral not tolerated.
Dexamethasone / 8 / mg / IV / In 100ml 0.9% saline over 15 mins
T = 0
0900 / Methotrexate 300mg/m2 / mg / IV / 250mL 0.9% S over 1 hour / 250ml/hr
1100 / Methotrexate 2700mg/m2 / mg / IV / 1000 0.9% S over 23 hours / 44ml/hr
1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr

Consult the UKALL12 protocol before prescribing high dose Methotrexate.
Ensure estimated GFR is calculated prior to the Methotrexate infusion
Check urine pH with each void. Urine pH to be > 7.5 before starting Methotrexate, and kept between 7 and 8 during the infusion and folinic acid rescue.

UKALL 12
Intensification / Height / cm
Weight / kg
BSA / m2
Infusion rate
125 X BSA / = ml/hr
Day / Date / Time / Agent / Dose / Route / Instructions / Rate / Doctor / Nurse / Check / Start / Stop
22 / 1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
23 / 1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
T =+240900 / Stop Methotrexate transfusion / Record amount infused.
1100 / Colaspase (L-Asparaginase) / 10 000 / IU / IM
1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
T =+36hr
2100 / Folinic acid 15mg/m2 / mg / IV / Slow bolus 36 hrs after start of MTX
2400 / Folinic acid 15mg/m2 / mg / IV / Slow bolus
UKALL 12
Intensification / Height / cm
Weight / kg
BSA / m2
23 / 1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
24 / 0300 / Folinic acid 15mg/m2 / mg / PO / Give IV if oral not tolerated
1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
0600 / Folinic acid 15mg/m2 / mg / PO / Give IV if oral not tolerated
1L D4S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
0900 / Methotrexate level / Aim <0.1micromol/l. If > 0.1micromol/l increase folinic acid to 50mg IV Q12H until the level is <0.1micromol/l. Notify labs if MTX levels will be required over a weekend.
0900 / Folinic acid 15mg/m2 / mg / PO / Give IV if oral not tolerated
1500 / Folinic acid 15mg/m2 / mg / PO / Give IV if oral not tolerated
2100 / Folinic acid 15mg/m2 / mg / PO / Give IV if oral not tolerated
25 / 0300 / Folinic acid 15mg/m2 / mg / PO / Give IV if oral not tolerated
0900 / Methotrexate level / Aim <0.1micromol/l. If > 0.1micromol/l increase folinic acid to 50mg IV Q12H until the level is <0.1micromol/l. Chart on QMR4. Notify labs if MTX levels will be required over a weekend.
0900 / Folinic acid 15mg/m2 / mg / PO / Give IV if oral not tolerated
Authorised by P GanlyPharmacist: B Harden / Updated: July 2014
T:\Pictures\CDHB\Red_Book\UKALL 12 Intensification.docx / Review: June 2015
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