要望番号；III➀-73
Note: Control renal function before administrating methotrexate. If GFR is
< 60 ml/min/1.73m2 delay methotrexate until GFR > 60 ml/min/1.73m2.
Rituximab 375 mg/m2 on D-2 (= D6 COP) and on D1, before starting
chemotherapy.
Premedicate with paracetamol and chlorpheniramine as per BNFC dosing
and administer as per local practice.
8.3 Group C1 INDUCTION: R-COPADM2 course n°2
R-COPADM2 (course n°2) is identical to R-COPADM1, EXCEPT
cyclophosphamide: 500 mg/m2/dose, every 12 hours on D 2-4 (total 6
doses).
It should start as soon as peripheral counts have recovered (ANC ~ 1.0 ×
109/l and platelets ~ 100 × 109/l), (but not less than D16), generally around
D18-21 and should be no more than 21 days after D1 of the first course.
Rituximab of D-2 should be given as soon as peripheral is starting to
recover (ANC ~ 0.5 × 109/l) and fever has resolved, so that COPADM2 can
start as soon as peripheral count has recovered. Note: If G- CSF is given
after the first R-COPADM course it should have been discontinued for at
least 48 hours prior to start R-COPADM2.
8.4. Group C1- B-AL, CNS neg CONSOLIDATION: R-CYVE course
n°3 and course n°4
First R-CYVE (course n°3) should start after R-COPADM2 when
peripheral counts have recovered with ANC ~ 1.0 × 109/l and platelets ~
100 × 109/l (usually by day 18, but not less than D16).
Rituximab 375 mg/m2 on D1, before chemotherapy.
Premedicate with paracetamol and chlorpheniramine as per BNFC dosing
and administer as per local practice.
8.5. Group C1 – CNS pos CONSOLIDATION: R-IT-CYVE 1 High
dose methotrexate
If CNS positive, the HDMTX + TIT course is given only after 1st (R)
CYVE (course n°3), about D18 when ANC ~ 0.5 × 109/l and platelets ~ 50
× 109/l and 48 hrs after any G-CSF injections or platelet transfusions.
Transaminases should be < ULN × 10.
Rituximab 375 mg/m2 on D1, before chemotherapy.
Premedicate with paracetamol and chlorpheniramine as per BNFC dosing
and administer as per local practice.

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