POMP

Say it: pomp

Mercaptopurine, vincristine, methotrexate and prednisone

POMP is a long, gentler maintenance plan of mostly pills that people with acute lymphoblastic leukemia (ALL) take for about 2 years after their intensive treatment.

Also called: POMP maintenance, ALL maintenance, 6-MP, vincristine, methotrexate and prednisone, Maintenance chemotherapy for ALL

What it is

Even after intensive chemotherapy clears the leukemia, a few cells may hide in the body. Steady, lower strength treatment over a long time helps stop them from growing back. The goal is cure. Most of the plan is pills you take at home, with a clinic visit about once a month.

Often used for

• Maintenance treatment for acute lymphoblastic leukemia (ALL) after intensive chemotherapy such as Hyper-CVAD
• Maintenance for some aggressive lymphomas treated like ALL

POMP with a targeted pill

For Philadelphia chromosome positive ALL, a daily targeted pill (such as ponatinib or dasatinib) is usually added during maintenance and often continued longer.

The medicines in this plan

Mercaptopurine (6-MP)

A chemotherapy pill taken once a day, every day, usually in the evening.

Methotrexate

A chemotherapy pill taken once a week, on the same day each week. Never daily.

Vincristine

Chemotherapy given through a vein once a month at the clinic.

Prednisone

A steroid pill taken for 5 days each month, starting on the day of vincristine.

How you get it

POMP is mostly pills taken at home, plus a short clinic visit about once a month for blood tests and vincristine. In adults it usually lasts about 2 years (longer in children). Your doses of mercaptopurine and methotrexate will be adjusted over time based on your blood counts and liver tests. Your schedule may be different.

A typical cycle

Every day

Mercaptopurine pill, at about the same time each evening.

Once a week

Methotrexate pills, on the same day each week.

Once a month, day 1

Clinic visit for blood tests and vincristine through a vein.

Once a month, days 1 to 5

Prednisone pill each morning with food.

About 2 years

Total length of maintenance, with blood tests every 2 to 4 weeks.

Common side effects and what helps

• Lower blood counts and higher infection risk. Wash hands often and avoid sick people.
• Tingling in fingers and toes, jaw pain or constipation from vincristine. Eat fiber, drink fluids, and use a stool softener if your team advises it.
• Mouth sores. Rinse often with a mild salt and baking soda rinse.
• Nausea, especially early on. Taking pills at bedtime may help.
• Tiredness. Most people can return to school, work and normal activities.
• Mood changes, big appetite and trouble sleeping during prednisone days.
• Skin that sunburns easily. Use sunscreen and a hat.

Call your care team right away if you have

• A fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher, or chills
• Yellow skin or eyes, dark urine or pain in the upper right belly
• Bleeding that will not stop, or many new bruises
• No bowel movement for 3 days, or bad belly pain
• Trouble walking, new weakness or drooping eyelids
• A cough with fever, or trouble breathing
• Contact with chickenpox or shingles, if you are not immune

Good to know

• Methotrexate pills are taken once a week, not every day. Taking it daily by mistake is dangerous.
• Blood tests every few weeks check your counts and liver so your team can adjust your doses.
• Some people have gene changes (TPMT or NUDT15) that make mercaptopurine much stronger. This testing is often done before or during treatment.
• Allopurinol and febuxostat can make mercaptopurine much stronger. Tell your team about all medicines you take.
• You may take an antibiotic to prevent a type of pneumonia (PJP). Avoid live vaccines during treatment.

At home

• Use a pill box and a calendar. Set a phone reminder for your weekly methotrexate day.
• Take mercaptopurine the same way every day (for example, at bedtime, with or without food in the same way each time).
• Avoid alcohol, which can harm the liver with methotrexate.
• Handle pills with clean hands and keep them away from children and pets.
• Wash hands often and keep up with dental care using a soft toothbrush.

Questions to ask

• How long will my maintenance last?
• Which day of the week should I take methotrexate?
• Have I had TPMT or NUDT15 testing?
• Which other medicines, vaccines or supplements should I avoid?
• When can I return to work, school and travel?

Leukemia

Last updated: 2026-10-27. Medically reviewed by Veli Bakalov, MD, medical oncologist (October 2026). General education from Step by Step, the patient portal of HemeOncBuddy.