CODOX-M (cycle 1 & 3)

Cyclophosphamide: 800 mg/m² IV on day 1.

Doxorubicin: 40 mg/m² IV on day 1.

Vincristine: 1.5 mg/m² IV on days 1 and 8 (cycle 1). Days 1, 8 and 15 (cycle 3).

Methotrexate: 1200 mg/m² IV over one hour on day 10, then 240 mg/m² per hour for the next 23 h.

Leucovorin rescue: begins 36 h from the start of the methotrexate infusion.

CNS prophylaxis

Intrathecal cytarabine 70 mg on days 1 and 3.

Intrathecal methotrexate 12 mg on day 15.

IVAC (cycles two and four)

Ifosfamide: 1500 mg/m² IV on days 1 through 5 with mesnauroprotection.

Etoposide: 60 mg/m² IV on days 1 through 5.

Cytarabine: 2.0 gm/m² IV every 12 h on days 1 and 2 (four doses).