Supportive treatment

• Provide explanation and offer counselling—the word 'leukaemia' and prospect of prolonged chemotherapy are often distressing.

• RBC and platelet transfusion support will continue through treatment.

• Start neutropenic regimen (fflp550) as prophylaxis against infections.

• Start hydration aiming for urine output >100mL/h throughout induction therapy (fflp560 Tumour lysis syndrome—a special problem in B-cell or T-cell ALL).

• Start allopurinol to prevent hyperuricaemia (Note: interaction with 6-mercaptopurine: discontinue allopurinol or reduce dose of 6-MP) or Rasburicase (especially with high counts).

• Insert tunnelled central venous catheter (fflp568).

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