Nama : RM :

RSUP Dr. Wahidin Sudirohusodo Tgl lahir : Jenis Kelamin : L / P

Divisi Hemato Onkologi BB : TB :
Departemen Ilmu Kesehatan Anak
LPB (m2) : Tgl Diagnosis :
Fakultas Kedokteran Universitas Hasanuddin

INDONESIAN PROTOCOL A. L. L. - STANDARD RISK Protocol SR - A

INDUCTION CONSOLIDATION
MEDICINES (WEEKS) Dosage
0 1 2 3 4 5 6 7 8 9 10 11 12
Mtx. it
VCR.iv : 1.5 mg/m2
Prednisone po : 60/40 mg/m2 Window
Prednisone 40 mg / m2
(window / induction) 60 mg/m2

Wait Recovery 1 week

( it aplastic occur )
HD - Mtx i.v : 2000 mg/m2 with
Leucovorin rescue 15 mg / m2 / dose
Daunorubicin*. iv. : 30 mg/m2
L - Asp.iv : 6000 u/m2
6 - MP.po : 50 mg/m2
Blast LCS
Blast PB
BMP

day
Date of therapy month
year
Body Weight ( kg )
Body Height ( cm )
Body Surface Area ( m2 )
* If not available change to Doxo 20 mg / m 2 / dose Peripheral Blast : if >1000 SR change to HR Blast in CSF at diagnosis

Age
Dosage
< 1 year 1 year 2 years ≥ 3 years
Mengetahui Mtx.it 6 mg / x 8 mg / x 10 mg / x 12 mg / x
Supervisor Divisi Hemato-Onkologi
Dexa it 0,6 mg 0,8 mg 1 mg 1 mg

Prof. Dr. dr. H. Dasril Daud, SpA (K)

Dr. dr. Nadirah R. Ridha, M.Kes, SpA
 RSUP Dr. Wahidin Sudirohusodo Nama : RM :
Divisi Hemato Onkologi Tgl lahir : Jenis Kelamin : L / P
Departemen Ilmu Kesehatan Anak BB : TB :
LPB (m2) : Tgl Diagnosis :
Fakultas Kedokteran Universitas Hasanuddin

INDONESIAN PROTOCOL A. L. L - SR - MAINTENANCE Protocol SR - A

MEDICINES Dosage MAINTENANCE - I ( WBC > 1,000; Platelete > 80.000 )

(WEEKS) 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62

Mtx. it
VCR. iv : 1.5 mg / m2
Pred. po: 40 mg / m2
6 - MP.po : 50 mg / m2
Mtx.po : 20 mg / m2

day
Date of therapy month
year
Body Weight ( kg )
Body Height ( cm )
Body Surface Area ( m2 )
MEDICINES Dosage MAINTENANCE - II ( WBC > 1,000; Platelete > 80.000 )
(WEEKS) 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111

Mtx. it
VCR.iv : 1.5 mg / m2
Pred. po: 40 mg / m2 BMP
6 - MP.po : 50 mg / m2
Mtx.po : 20 mg / m2

day
Date of therapy month
year
Body Weight ( kg )
Body Height ( cm )
Body Surface Area ( m2 )
Mengetahui
Supervisor Divisi Hemato-Onkologi

Prof. Dr. dr. H. Dasril Daud, SpA (K)

Dr. dr. Nadirah R. Ridha, M.Kes, SpA
 RSUP Dr. Wahidin Sudirohusodo Nama : RM :
Tgl lahir : Jenis Kelamin : L / P
Divisi Hemato Onkologi
BB : TB :
Departemen Ilmu Kesehatan Anak LPB (m2) : Tgl Diagnosis :
Fakultas Kedokteran Universitas Hasanuddin

INDONESIAN PROTOCOL A. L. L. - STANDARD RISK Protocol SR - B

INDUCTION CONSOLIDATION
MEDICINES (WEEKS) Dosage
0 1 2 3 4 5 6 7 8 9 10 11 12
Mtx. it
VCR.iv : 1.5 mg/m2
Dexa. po : 4 mg/m2 Dexamethason
Prednisone po : 60 mg/m2

Wait Recovery 1 week

( it aplastic occur )
HD - Mtx i.v : 2000 mg/m2 with
Leucovorin rescue 15 mg / m2 / dose
Daunorubicin*. iv. : 30 mg/m2
L - Asp.iv : 6000 u/m2
6 - MP.po : 50 mg/m2
Blast LCS
Blast PB
BMP

day
Date of therapy month
year
Body Weight ( kg )
Body Height ( cm )
Body Surface Area ( m2 )
* If not available change to Doxo 20 mg / m2 / dose Peripheral Blast : if >1000 SR change to HR Blast in CSF at diagnosis

Mengetahui Age
Dosage
Supervisor Divisi Hemato-Onkologi < 1 year 1 year 2 years ≥ 3 years
Mtx.it 6 mg / x 8 mg / x 10 mg / x 12 mg / x
Dexa it 0,6 mg 0,8 mg 1 mg 1 mg

Prof. Dr. dr. H. Dasril Daud, SpA (K)

Dr. dr. Nadirah R. Ridha, M.Kes, SpA
 RSUP Dr. Wahidin Sudirohusodo
Nama : RM :
Divisi Hemato Onkologi Tgl lahir : Jenis Kelamin : L / P
Departemen Ilmu Kesehatan Anak BB : TB :
Fakultas Kedokteran Universitas Hasanuddin LPB (m2) : Tgl Diagnosis :

INDONESIAN PROTOCOL A. L. L - SR - MAINTENANCE Protocol SR - B

MEDICINES Dosage MAINTENANCE - I ( WBC > 1,000; Platelete > 80.000 )

(WEEKS) 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62

Mtx. it
VCR. iv : 1.5 mg / m2
Dexa.po : 4 mg / m2
6 - MP.po : 50 mg / m2
Mtx.po : 20 mg / m2

day
Date of therapy month
year
Body Weight ( kg )
Body Height ( cm )
Body Surface Area ( m2 )
MEDICINES Dosage MAINTENANCE - II ( WBC > 1,000; Platelete > 80.000 )
(WEEKS) 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111

Mtx. it
VCR. iv : 1.5 mg / m2
Dexa.po : 4 mg / m2 BMP
6 - MP.po : 50 mg / m2
Mtx.po : 20 mg / m2

day
Date of therapy month
year
Body Weight ( kg )
Body Height ( cm )
Body Surface Area ( m2 )
Mengetahui
Supervisor Divisi Hemato-Onkologi
Prof. Dr. dr. H. Dasril Daud, SpA (K)
Dr. dr. Nadirah R. Ridha, M.Kes, SpA
 RSUP Dr. Wahidin Sudirohusodo
Divisi Hemato Onkologi
Departemen Ilmu Kesehatan Anak Protocol HR - C
Fakultas Kedokteran
Universitas Hasanuddin

INDONESIAN PROTOCOL A. L. L - HR, RELAPS

Name : Birth date: M/F MR: Date of Dx:

MEDICINES Dosage INDUCTION CONSOLIDATION REINDUCTION

(WEEKS) 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Mtx.it
VCR.iv : 1.5 mg / m2
DEXA.po : 6 mg / m2
HD - Mtx i.v : 2000 mg/m2 with

Wait Recovery 1 week

( it aplastic occur )
Leucovorin rescue 15 mg / m2 / dose
Daunorubicine*.iv : 30 mg / m2
Cyclo. i.v 1000 mg / m2
Citarabin i.v: 75 mg / m2
L - Asp.iv : 6000 u / m2
6 - MP.po : 50 mg / m2
BMP

day
Date of therapy month
year
Body Weight ( kg )
Body Height ( cm )
Body Surface Area ( m2 )
* If not available change to Doxo 20 mg / m 2 / dose

Mengetahui PRED / DEXA DOSAGE ( mg / m2 ) PRED / DEXA DOSAGE ( mg / m2 ) Age Dosages Mtx.it Dexa it
Supervisor Divisi Hemato-Onkologi Days Days < 1 year 6 mg / x 0,6 mg
LEUCOCYTE LEUCOCYTE
1 2 3 4 5 1 2 3 4 5 1 year 8 mg / x 0,8 mg
Prof. Dr. dr. H. Dasril Daud, SpA (K)
Dr. dr. Nadirah R. Ridha, M.Kes, SpA < 20.000 60 / 6 60 / 6 60 / 6 60 / 6 60 / 6 > 50.000 - < 100.000 10 / 1 20 / 2 30 / 3 40 / 4 60 / 6 2 years 10 mg / x 1 mg
> 20.000 - < 50.000 20 / 2 30 / 3 40 / 4 50 / 5 60 / 6 > 100.000 5 / 0.5 10 / 1 20 / 2 40 / 4 60 / 6 ≥ 3 years 12 mg / x 1 mg
 RSUP Dr. Wahidin Sudirohusodo
Divisi Hemato Onkologi
Departemen Ilmu Kesehatan Anak Protocol HR - C
Fakultas Kedokteran
Universitas Hasanuddin

INDONESIAN PROTOCOL A. L. L - HR
Name : Birth date: M/F MR: Date of Dx:

MEDICINES Dosage INDUCTION CONSOLIDATION REINDUCTION

(WEEKS) 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Mtx.it
VCR.iv : 1.5 mg / m2
DEXA.po : 6 mg / m2
HD - Mtx i.v : 2000 mg/m2 with

Wait Recovery 1 week

( it aplastic occur )
Leucovorin rescue 15 mg / m2 / dose
Daunorubicine*.iv : 30 mg / m2
Cyclo. i.v 1000 mg / m2
Citarabin i.v: 75 mg / m2
L - Asp.iv : 6000 u / m2
6 - MP.po : 50 mg / m2
BMP
day
Date of therapy month
year
Body Weight ( kg )
Body Height ( cm )
Body Surface Area ( m2 )
* If not available change to Doxo 20 mg / m2 / dose

Mengetahui PRED / DEXA DOSAGE ( mg / m2 ) PRED / DEXA DOSAGE ( mg / m2 ) Age Dosages Mtx.it Dexa it
Supervisor Divisi Hemato-Onkologi Days Days < 1 year 6 mg / x 0,6 mg
LEUCOCYTE LEUCOCYTE
1 2 3 4 5 1 2 3 4 5 1 year 8 mg / x 0,8 mg
Prof. Dr. dr. H. Dasril Daud, SpA (K)
Dr. dr. Nadirah R. Ridha, M.Kes, SpA < 20.000 60 / 6 60 / 6 60 / 6 60 / 6 60 / 6 > 50.000 - < 100.000 10 / 1 20 / 2 30 / 3 40 / 4 60 / 6 2 years 10 mg / x 1 mg
> 20.000 - < 50.000 20 / 2 30 / 3 40 / 4 50 / 5 60 / 6 > 100.000 5 / 0.5 10 / 1 20 / 2 40 / 4 60 / 6 ≥ 3 years 12 mg / x 1 mg
 RSUP Dr. Wahidin Sudirohusodo Nama : RM :
Divisi Hemato Onkologi Tgl lahir : Jenis Kelamin : L / P
Departemen Ilmu Kesehatan Anak
BB : TB :
LPB (m2) : Tgl Diagnosis :
Fakultas Kedokteran
Universitas Hasanuddin

INDONESIAN PROTOCOL A. L. L - HR - MAINTENANCE Protocol HR - C

MEDICINES Dosage MAINTENANCE - I ( Leucocyte > 2,000; Thrombocyte > 50.000 )

(WEEKS) 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64

Mtx. It
Vcr.iv : 1.5 mg / m2
Dexa.po : 6 mg / m2
6 - MP.po : 50 mg / m2
Mtx.po : 20 mg / m2
BMP
day
Date of therapy month
year
Body Weight ( kg )
Body Height ( cm )
Body Surface Area ( m2 )
MEDICINES Dosage MAINTENANCE - II ( Leucocyte > 2,000; Thrombocyte > 50.000 )
(WEEKS) 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110

Mtx. It
Vcr.iv : 1.5 mg / m2
Dexa.po : 6 mg / m2 BMP
6 - MP.po : 50 mg / m 2

Mtx.po : 20 mg / m2

day
Date of therapy month
year
Body Weight ( kg )
Body Height ( cm )
Body Surface Area ( m2 )
Mengetahui
Supervisor Divisi Hemato-Onkologi
Prof. Dr. dr. H. Dasril Daud, SpA (K)
Dr. dr. Nadirah R. Ridha, M.Kes, SpA
Dr. dr. Nadirah R. Ridha, M.Kes, SpA
 Nama : RM :
RSUP Dr. Wahidin Sudirohusodo Tgl lahir : Jenis Kelamin : L / P
Divisi Hemato Onkologi BB : TB :
Departemen Ilmu Kesehatan Anak LPB (m2) : Tgl Diagnosis :
Fakultas Kedokteran Universitas Hasanuddin

INDONESIAN PROTOCOL A. L. L - HR, Relaps

Protocol HR - C

MEDICINES Dosage INDUCTION CONSOLIDATION REINDUCTION

(WEEKS) 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Mtx.it
VCR.iv : 1.5 mg / m2
DEXA.po : 6 mg / m2
HD - Mtx i.v : 2000 mg/m2 with

Wait Recovery 1 week

( it aplastic occur )
Leucovorin rescue 15 mg / m2 / dose
Daunorubicine*.iv : 30 mg / m2
Cyclo. i.v 1000 mg / m2
Citarabin i.v: 75 mg / m2
L - Asp.iv : 6000 u / m2
6 - MP.po : 50 mg / m2
BMP

day
Date of therapy month
year
Body Weight ( kg )
Body Height ( cm )
Body Surface Area ( m2 )
* If not available change to Doxo 20 mg / m 2 / dose

PRED / DEXA DOSAGE ( mg / m2 ) PRED / DEXA DOSAGE ( mg / m2 ) Age Dosages Mtx.it Dexa it
Days Days < 1 year 6 mg / x 0,6 mg
LEUCOCYTE LEUCOCYTE
1 2 3 4 5 1 2 3 4 5 1 year 8 mg / x 0,8 mg
< 20.000 60 / 6 60 / 6 60 / 6 60 / 6 60 / 6 > 50.000 - < 100.000 10 / 1 20 / 2 30 / 3 40 / 4 60 / 6 2 years 10 mg / x 1 mg
> 20.000 - < 50.000 20 / 2 30 / 3 40 / 4 50 / 5 60 / 6 > 100.000 5 / 0.5 10 / 1 20 / 2 40 / 4 60 / 6 ≥ 3 years 12 mg / x 1 mg

Mengetahui
Supervisor Divisi Hemato-Onkologi

Prof. Dr. dr. H. Dasril Daud, SpA (K)

Dr. dr. Nadirah R. Ridha, M.Kes, SpA