1\. Intervention Measures 1.1 Induction Therapy Regimen
VICP+VEN regimen:
* Vindesine: 3 mg/m²/day (max 4 mg), administered on days 1, 8, 15, 22.
* Idarubicin (IDA): 8 mg/m², days 1, 8, 15, 22.
* Cyclophosphamide (CTX): 500 mg/m², days 7, 21.
* Prednisone: 1 mg/kg/day, days 1-14; 0.5 mg/kg/day, days 15-28
* Venetoclax (VEN) 8-day ramp-up: Day 1: 100 mg, Day 2: 200 mg, Days 3-8: 400 mg/day 1.2 Pre-Treatment Regimen
Indications for pre-treatment:
* WBC ≥30×10⁹/L, or significant hepatosplenomegaly/lymphadenopathy.
* Laboratory signs of tumor lysis syndrome (e.g., electrolyte abnormalities).
Pre-treatment protocol:
* Glucocorticoids (e.g., prednisone or dexamethasone): Prednisone 1 mg/kg/day (PO/IV) for 3-5 days.
* Optional addition of CTX: 200 mg/m²/day IV for 3-5 days. 1.3 Post-CR Treatment
Principles:
1. MRD-positive or rising: Administer blinatumomab (CD19/CD3 bispecific antibody) for residual disease clearance, followed by allogeneic hematopoietic stem cell transplantation (allo-HSCT).
2. MRD-negative/unknown: Continue multi-agent chemotherapy ± blinatumomab consolidation. Allo-HSCT for patients with high-risk clinical/genetic features.
1.4 Post-CR Consolidation Regimens
① Hyper-CVAD-B (Methotrexate/Cytarabine-based):
* Methotrexate (MTX): 1 g/m² IV over 24h (Day 1) with urine alkalinization (pH \>7.0) and leucovorin rescue.
* Cytarabine (Ara-C): 1 g/m² IV q12h (Days 2-3; total 4 doses).
* Dexamethasone: 40 mg/day (PO/IV, Days 1-4).
* Cycle interval: 21-28 days (alternating with other regimens).
* CAM Regimen:
* CTX: 750 mg/m² IV (split over 2 days).
* Ara-C: 75 mg/m²/dose (8 days; 1-2 doses/day IV; if once daily, administer 5 days/week × 2 weeks).
* 6-MP: 50-75 mg/m²/day fasting (7-14 days PO). 1.5 Transplant-Eligible Subsequent Therapy
* Allo-HSCT for eligible patients after induction.
* Conditioning regimen: TBI-VP16-CY.
* Donor priority: HLA-matched sibling donor (MSD), Matched unrelated donor (MUD), Haploidentical donor (Haplo). (Consider age/donor health status).
1.6 Allo-HSCT Protocol 1.6.1 Conditioning Regimen (TBI-VP16-Cy/ATG):
• TBI: 5 Gy (Days -7 to -6).
* VP16: 10 mg/kg/day (Days -5 to -4).
* CTX: 30 mg/kg/day (Days -3 to -2).
* ATG: 7.5 mg/kg/day (Days -5 to -2). 1.6.2 GVHD Prophylaxis:
* Basiliximab (anti-CD25 mAb): 50 mg (Days +1, +4).
* Standard regimen: Cyclosporine (CsA): IV: 2 mg/kg/day (start Day -9; target level 150-250 μg/L). PO: 3-5 mg/kg/day BID (switch delayed until Day +10 if no aGVHD); Mycophenolate mofetil (MMF) + short-course methotrexate.
1.7 Non-Transplant Maintenance Therapy
Options:
* Hyper-CVAD-B (Methotrexate/Cytarabine-based):
• Methotrexate (MTX): 1 g/m² IV over 24h (Day 1) with urine alkalinization (pH \>7.0) and leucovorin rescue.
• Cytarabine (Ara-C): 1 g/m² IV q12h (Days 2-3; total 4 doses).
• Dexamethasone: 40 mg/day (PO/IV, Days 1-4).
* Cycle interval: 21-28 days (alternating with other regimens).
* CAM Regimen:
* CTX: 750 mg/m² IV (split over 2 days).
* Ara-C: 75 mg/m²/dose (8 days; 1-2 doses/day IV; if once daily, administer 5 days/week × 2 weeks).
* 6-MP: 50-75 mg/m²/day fasting (7-14 days PO).
* Maintenance (6-MP/MTX alternating with V-Dex): 6-MP: 75 mg/m²/day at bedtime (Days 1-21); MTX: 20 mg/m² IM weekly × 3 weeks.\*Adjust doses to maintain WBC \~3×10⁹/L, ANC 1.0-1.5×10⁹/L.\*
