How do you treat patients with T-cell ALL/T-cell lymphoblastic lymphoma who have pre-existing CKD with CrCl 30 mL/min or less?  

Many of the agents in either BFM protocols or hyperCVAD (eg methotrexate, cytarabine, 6-mercaptopurine) are renally cleared.  How do you deliver the chemotherapy to ensure enough dose intensity but not significant cytopenias/toxicity?