MA Spore Protocol for Pediatric Leukemia
I cannot identify a specific "MA Spore" or "Massachusetts Spore" protocol in the available evidence. This terminology does not appear in current pediatric leukemia treatment guidelines or literature from major cooperative groups.
What You May Be Referring To
The most likely possibilities are:
1. BFM (Berlin-Frankfurt-Münster) Protocol
This is the most widely used pediatric ALL treatment framework globally and may be what you're seeking 1, 2.
Core structure includes:
- Induction: 4-drug regimen with vincristine, anthracycline (daunorubicin/doxorubicin), corticosteroid (prednisone/dexamethasone), and L-asparaginase 1
- Consolidation: High-dose methotrexate for high-risk and T-cell ALL 3
- Delayed intensification: Dexamethasone, vincristine, and asparaginase 3
- Maintenance: Mercaptopurine and methotrexate for 2-2.5 years 3, 4
2. Children's Oncology Group (COG) Protocols
These are the standard protocols used across North America 3, 1.
Key features:
- Standard-risk B-ALL: 3-drug induction (dexamethasone, asparaginase, vincristine) without anthracyclines 3, 1
- High-risk patients: 4-drug induction including anthracyclines 3, 4
- Dexamethasone 6 mg/m² per day for 28 days during induction 3
3. MRD-Guided Modified BFM 95 Protocol
Recent data from India shows excellent outcomes with this approach 2.
Treatment outcomes:
CNS Prophylaxis Requirements
All pediatric ALL patients require CNS-directed therapy 3:
- CNS-1 status: Standard intrathecal prophylaxis 3
- CNS-2 status: Enhanced intrathecal therapy 3
- CNS-3 status: Intensive intrathecal chemotherapy ± cranial radiation (18 Gy at 1.5-1.8 Gy/fraction) 3
Triple intrathecal therapy is recommended for T-cell ALL and patients with CSF blasts 3.
Risk Stratification Factors
Poor prognostic indicators requiring intensified therapy 1, 5:
- WBC ≥30×10⁹/L (B-cell) or ≥100×10⁹/L (T-cell) 1
- Hypodiploidy (<44 chromosomes) 5
- KMT2A (MLL) rearrangements 1, 5
- End-induction MRD positivity 3
Critical Recommendation
If you are looking for a specific institutional protocol named "MA Spore," you should contact the treating institution directly, as this may be a local protocol name not published in the medical literature. The standard of care for pediatric ALL in the United States follows COG protocols, which are BFM-based regimens with MRD-guided risk stratification 3, 1.