Anaplastic large cell lymphoma, pediatric

Back to Top
This page contains studies that were specific to pediatric populations. For the more general ALCL page, follow this link.
Are you looking for a regimen but can't find it here? It is possible that we've moved it to the historical regimens page.
Last updated on 2024-12-02:2 regimens on this page
2 variants on this page
=Untreated=
==COG ANHL12P1 protocol==
Study 	Dates of enrollment	Evidence 	Comparator 	Comparative Efficacy
Lowe et al. 2021 (COG ANHL12P1)	2013-2017 	Randomized Phase 2	Chemotherapy + Brentuximab vedotin (Adcetris) vs Chemotherapy + Crizotinib (Xalkori)	Chemotherapy + Brentuximab vedotin (Adcetris) 2-year Overall Survival 97% (95%CI 88-99%), Event Free Survival 79% (95% CI 67-87%) (Ref 1) Crizotinib (Xalkori) arm with similar OS/EFS, but increased risk of thromboembolic events (Ref 2)
Note: there appear to be several dosing errors in Table 2; the authors have been contacted for clarification.
===Pre-phase===
====Chemotherapy====
*Cyclophosphamide (Cytoxan) 200 mg/m2/dose IV once per day over 15 to 30 minutes on days 1 & 2
====Glucocorticoid therapy====
*Dexamethasone (Decadron) 5 mg/m2/dose PO/IV once daily on days 1 & 2, then 5 mg/m2/dose PO twice daily on days 3 to 5
====CNS therapy, prophylaxis====
*Methotrexate (MTX) age-based IT once on day 1
*Cytarabine (Ara-C) age-based IT once on day 1
*Hydrocortisone (Cortef) age-based IT once on day 1
5-day course
===Induction===
====Antibody-drug conjugate therapy====
*Brentuximab vedotin (Adcetris) 1.8 mg/kg/dose (maximum dose of 180 mg) IV over 30 minutes once on day 1
====Chemotherapy====
*Methotrexate (MTX) 3000 mg/m2/dose IV over 3 hours once on day 1
*Ifosfamide (Ifex) as follows:
**Cycles 1, 3, 5: 800 mg/m2/dose IV over 1 hour once per day on days 1 to 5
*Etoposide (Vepesid) as follows:
**Cycles 1, 3, 5: 100 mg/m2/dose IV over 2 hours once per day on days 4 & 5
*Cytarabine (Ara-C) as follows:
**Cycles 1, 3, 5: 150 mg/m2/dose IV over 1 to 30 minutes every 12 hours on days 4 & 5 for a total of 4 doses (total dose per cycle: 600 mg/m2)
*Cyclophosphamide (Cytoxan) as follows:
**Cycles 2, 4, 6: 200 mg/m2/dose IV over 15 to 30 minutes once per day on days 1 to 5
*Doxorubicin (Adriamycin) as follows:
**Cycles 2, 4, 6: 25 mg/m2/dose IV over 1 to 15 minutes once per day on days 4 & 5
====Glucocorticoid therapy====
*Dexamethasone (Decadron) 5 mg/m2/dose PO/IV twice daily on days 1 to 5
====Supportive therapy====
*Leucovorin (Folinic acid) 15 mg/m2/dose IV or PO every 6 hours beginning 24 hours after the start of IV Methotrexate (MTX) until Methotrexate (MTX) level falls below 0.1μM/L
*Mesna (Mesnex) 160 mg/m2/dose (480 mg/m2/day) IV at hours 0, 4, and 8 following each dose of Ifosfamide (Ifex)
21-day cycle for 6 cycles
===References===
#COG ANHL12P1: Lowe EJ, Reilly AF, Lim MS, Gross TG, Saguilig L, Barkauskas DA, Wu R, Alexander S, Bollard CM. Brentuximab vedotin in combination with chemotherapy for pediatric patients with ALK+ ALCL: results of COG trial ANHL12P1. Blood. 2021 Jul 1;137(26):3595-3603. link to original article dosing details in manuscript have been reviewed by our editors link to PMC article EuroPMC NCT01979536
#COG ANHL12P1: Lowe EJ, Reilly AF, Lim MS, Gross TG, Saguilig L, Barkauskas DA, Wu R, Alexander S, Bollard CM. Crizotinib in Combination With Chemotherapy for Pediatric Patients With ALK+ Anaplastic Large-Cell Lymphoma: The Results of Children's Oncology Group Trial ANHL12P1. J Clin Oncol. 2023 Apr 10;41(11):2043-2053. link to original article dosing details in manuscript have been reviewed by our editors link to PMC article EuroPMC NCT01979536
=Relapsed or refractory, subsequent lines of therapy=
==Crizotinib monotherapy==
===Regimen===
FDA-recommended dose
Study 	Dates of enrollment	Evidence
Mossé et al. 2013 (COG ADVL0912)	2009-2012 	Phase 1/2 (RT)
Note: this was an expansion cohort of a phase 1/2 study.
====Biomarker eligibility criteria====
*ALK rearrangement
====Targeted therapy====
*Crizotinib (Xalkori) 280 mg/m2/dose PO twice daily on days 1 to 28
28-day cycles
===References===
# COG ADVL0912: Mossé YP, Lim MS, Voss SD, Wilner K, Ruffner K, Laliberte J, Rolland D, Balis FM, Maris JM, Weigel BJ, Ingle AM, Ahern C, Adamson PC, Blaney SM. Safety and activity of crizotinib for paediatric patients with refractory solid tumours or anaplastic large-cell lymphoma: a Children's Oncology Group phase 1 consortium study. Lancet Oncol. 2013 May;14(6):472-80. Epub 2013 Apr 16. link to original article link to PMC article dosing details in manuscript have been reviewed by our editors EuroPMC NCT00939770
Category:Anaplastic large cell lymphoma regimens
Category:Disease-specific pages
Category:T-cell lymphomas
Category:Pediatric hematologic neoplasms