Version June 2023
| Cycle 1¶ |
| Cyclophosphamide: 200 mg/m2 IV per day on days 1 through 5 |
| Prednisone: 60 mg/m2 PO per day on days 1 through 7 |
| Cycles 2, 4, and 6¶ |
| Ifosfamide: 800 mg/m2 over one hour IV per day on days 1 through 5 |
| Mesna: 200 mg/m2 IV per day on days 1 through 5 at 0, 4, and 8 hours after ifosfamide |
| Methotrexate: 150 mg/m2 IV over 30 minutes on day 1, then 1.35 g/m2 IV over the next 23.5 hours, for a total dose of 1.5 g/m2 |
| Leucovorin: 50 mg/m2 IV 36 hours after initiation of methotrexate, then 15 mg/m2 every 6 hours until serum methotrexate concentration <0.05 micromolar |
| Vincristine: 2 mg IV push on day 1 |
| Cytarabine: 150 mg/m2 per day by continuous IV infusion on days 4 and 5 |
| Etoposide: 80 mg/m2 per day IV over one hour on days 4 and 5 |
| Dexamethasone: 10 mg/m2 PO per day on days 1 through 5 |
| Cycles 3, 5, and 7 |
| Cyclophosphamide: 200 mg/m2 per day IV on days 1 through 5 |
| Methotrexate: 150 mg/m2 IV over 30 minutes on day 1, then 1.35 g/m2 IV over the next 23.5 hours, for a total dose of 1.5 g/m2 |
| Leucovorin: 50 mg/m2 IV 36 hours after initiation of methotrexate, then 15 mg/m2 every 6 hours until serum methotrexate concentration <0.05 micromolar |
| Vincristine: 2 mg IV push on day 1 |
| Doxorubicin: 25 mg/m2 per day by IV bolus on days 4 and 5 |
| Dexamethasone: 10 mg/m2 PO per day on days 1 through 5 |
| Intrathecal chemotherapy with cycles 2 through 7 (amended) |
| Methotrexate: 15 mg IT on day 1 |
| Cytarabine: 40 mg IT on day 1 |
| Hydrocortisone: 50 mg IT on day 1 |
| Cranial irradiation (amended) |
| 2400 cGy administered in 12 fractions after chemotherapy for cycle 7 completed, only for patients who had prior bone marrow involvement at the time of presentation |
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