Combination Chemotherapy in Treating Children With Acute Lymphoblastic Leukemia
Condition: Leukemia
MeSH terms: Leukemia; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Leukemia, Lymphoid
Study type: Interventional
Phase: Phase 3

Summary: 
      RATIONALE: Drugs used in chemotherapy work in different ways to stop cancer cells from
      dividing so they stop growing or die. Combining more than one chemotherapy drug may kill more
      cancer cells. It is not yet known which combination chemotherapy regimen is more effective
      for acute lymphoblastic leukemia.

      PURPOSE: Phase III trial to determine the effectiveness of combination chemotherapy in
      treating children who have newly diagnosed acute lymphoblastic leukemia.
    

Detailed description: 
      OBJECTIVES:

        -  Determine whether augmented BFM therapy is superior to ALinc 14/15 therapy in patients
           with newly diagnosed high-risk acute lymphoblastic leukemia.

        -  Determine whether minimal residual disease after induction therapy is predictive of an
           inferior prognosis in this patient population.

        -  Determine the correlation between event-free survival, minimal residual disease, and
           early response in this patient population treated with this multiple drug regimen.

      OUTLINE: Patients are stratified by CNS or testicular disease (yes vs no).

        -  Induction therapy (weeks 1-5): Patients receive oral prednisone 3 times daily on days
           1-29; vincristine IV on days 1, 8, 15, and 22; daunorubicin IV on days 8, 15, 22; and
           asparaginase intramuscularly (IM) on days 2, 5, 8, 12, 15, and 19. Patients also receive
           methotrexate intrathecally (IT) on days 1 and 8. Patients with CNS 2 or 3 disease also
           receive methotrexate IT on days 15 and 22.

      Patients with M1 bone marrow proceed to consolidation therapy. Patients achieving M2 bone
      marrow on day 29 receive oral prednisone 3 times daily on days 29-42; vincristine IV and
      daunorubicin IV over 15 minutes on days 29 and 36; and asparaginase IM on days 29, 32, 36,
      and 39. If bone marrow is M3 on day 29 or M2 on day 43, then patient is off study.

        -  Consolidation therapy (weeks 6-14): Patients receive cyclophosphamide IV over 30 minutes
           on days 1 and 29; cytarabine subcutaneously (SC) or IV on days 2-5, 9-12, 30-33, and
           37-40; oral mercaptopurine daily on days 1-14 and 29-42; vincristine IV on days 15, 22,
           43, and 50; asparaginase IM on days 15, 17, 19, 22, 24, 26, 43, 45, 47, 50, 52, and 54;
           and methotrexate IT on days 1, 15, 29, and 43.

      Patients then proceed to interim maintenance and delayed intensification on weeks 15-46.
      Courses repeat every 16 weeks.

        -  Maintenance I and II (weeks 15-22 and 31-38): Patients receive vincristine IV and
           methotrexate IV on days 1, 11, 21, 31, and 41; asparaginase IM on days 2, 12, 22, 32,
           and 42; and methotrexate IT on days 1 and 31.

        -  Delayed Intensification (weeks 23-36 and 39-42): Patients receive vincristine IV on days
           57, 64, and 71; methotrexate IT on day 57; oral dexamethasone 2-3 times daily on days
           57-63 and 71-77; doxorubicin IV over 15 minutes 3 times weekly on days 57, 64, and 71;
           and asparaginase IM on days 60, 62, 64, 67, 69, and 71.

        -  Delayed Intensification-Reconsolidation (weeks 27-30 and 43-46): Patients receive oral
           thioguanine on days 85-98; methotrexate IT on day 85; cyclophosphamide IV over 30
           minutes on day 85; cytarabine IV or SC on days 86-89 and 93-96; asparaginase IM on days
           99, 101, 103, 106, 108, and 110; and vincristine IV on days 99 and 106.

        -  Continuation therapy (weeks 47-130): Patients receive vincristine IV on days 1, 29, and
           57; oral dexamethasone twice daily for 5 consecutive days on days 1-5, 29-33, and 57-61;
           oral mercaptopurine on days 1-84; oral methotrexate on days 8, 15, 22, 29, 36, 43, 50,
           57, 64, 71, and 78; and methotrexate IT on day 1.

      Patients with CNS 3 disease or who are within 24 months of diagnosis with an initial WBC ≥
      100,000/mm^3 undergo whole brain radiotherapy (omit or discontinue mercaptopurine and IT
      methotrexate) on day 1. Testicular radiotherapy also begins on day 1.

      Patients may receive oral methotrexate on day 1 of each course (if IT methotrexate is not
      administered).

      Patients are followed every 2 months for 2 years, every 3 months for 1 year, every 6 months
      for 2 years, and then annually thereafter.

      PROJECTED ACCRUAL: A total of 260 patients will be accrued for this study within 3.1 years.
    

Intervention name(s): asparaginase; cyclophosphamide; cytarabine; daunorubicin hydrochloride; dexamethasone; doxorubicin hydrochloride; mercaptopurine; methotrexate; prednisone; thioguanine; vincristine sulfate
Intervention type(s): Drug; Drug; Drug; Drug; Drug; Drug; Drug; Drug; Drug; Drug; Drug
Intervention MeSH terms: Cytarabine; Dexamethasone; Prednisone; Cyclophosphamide; Doxorubicin; Liposomal doxorubicin; Methotrexate; Vincristine; Daunorubicin; Asparaginase; Mercaptopurine; Thioguanine
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: childhood acute lymphoblastic leukemia in remission; B-cell childhood acute lymphoblastic leukemia