Een studie om blinatumomab te onderzoeken in combinatie met chemotherapie bij patiënten met nieuw gediagnosticeerde B-lymfoblastische leukemie
Een fase 3-onderzoek naar blinatumomab (NSC# 765986) in combinatie met chemotherapie bij patiënten met nieuw gediagnosticeerd standaardrisico of het syndroom van Down B-lymfoblastische leukemie (B-ALL) en de behandeling van patiënten met gelokaliseerd B-lymfoblastisch lymfoom (B-LLy)
This phase III trial studies how well blinatumomab works in combination with chemotherapy in treating patients with newly diagnosed, standard risk B-lymphoblastic leukemia or B-lymphoblastic lymphoma with or without Down syndrome. Monoclonal antibodies, such as blinatumomab, may induce changes in the body's immune system and may interfere with the ability of cancer cells to grow and spread. Chemotherapy drugs, such as vincristine, dexamethasone, prednisone, prednisolone, pegaspargase, methotrexate, cytarabine, mercaptopurine, doxorubicin, cyclophosphamide, and thioguanine, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Leucovorin decreases the toxic effects of methotrexate. Giving monoclonal antibody therapy with chemotherapy may kill more cancer cells. Giving blinatumomab and combination chemotherapy may work better than combination chemotherapy alone in treating patients with B-ALL. This trial also assigns patients into different chemotherapy treatment regimens based on risk (the chance of cancer returning after treatment). Treating patients with chemotherapy based on risk may help doctors decide which patients can best benefit from which chemotherapy treatment regimens.
Studie Overzicht
Toestand
Interventie / Behandeling
- Geneesmiddel: Cyclophosphamide
- Geneesmiddel: Doxorubicin Hydrochloride
- Geneesmiddel: Vincristine Sulfate
- Biologisch: Blinatumomab
- Geneesmiddel: Mercaptopurine
- Geneesmiddel: Leucovorin Calcium
- Geneesmiddel: Pegaspargase
- Geneesmiddel: Dexamethasone
- Geneesmiddel: Thioguanine
- Geneesmiddel: Cytarabine
- Geneesmiddel: Asparaginase Erwinia chrysanthemi
- Geneesmiddel: Mercaptopurine Oral Suspension
- Geneesmiddel: Methotrexate
- Geneesmiddel: Prednisone
- Geneesmiddel: Prednisolone
- Straling: Radiation Therapy
- Straling: Radiation Therapy
Gedetailleerde beschrijving
PRIMARY OBJECTIVES:
I. To determine in a randomized manner if the addition of 2 cycles of blinatumomab to standard therapy improves disease-free survival (DFS) in patients with standard risk (SR) B-ALL and higher risk features (SR-High), and patients with standard-risk average (SR-Avg) B-ALL who are negative for minimal residual disease (MRD) by flow cytometry but have detectable or indeterminate MRD as measured by high-throughput sequencing (HTS) at end of induction (EOI).
II. To confirm that boys in the standard-risk favorable (SR-Fav) subset of B-ALL, with or without Down syndrome (DS), will maintain a 5-year DFS of greater than 93% when treated with a standard chemotherapy regimen with a treatment duration of 2 years from the start of interim maintenance I (IM1).
SECONDARY OBJECTIVES:
I. To describe the DFS for patients with SR-Avg B-ALL who are negative for MRD measured by flow cytometry and HTS at EOI when treated with standard chemotherapy with a treatment duration of 2 years from the start of IM1, regardless of sex.
II. To describe the DFS for patients with standard-risk favorable (SR-Fav) B-ALL when treated with a standard chemotherapy regimen.
III. To determine if patients with DS-High achieve a reduction of treatment-related mortality (TRM) after replacement of intensive elements of standard chemotherapy (omission of anthracyclines in induction, omission of the second month of delayed intensification [DI]) with 3 cycles of blinatumomab.
IV. To describe the DFS characterized by the replacement of intensive elements of standard chemotherapy with 3 cycles of blinatumomab in patients with DS-High B ALL.
V. To describe the DFS for patients with localized (Murphy stage I and II) B lymphoblastic lymphoma (B-LLy) receiving standard risk B-ALL therapy.
VI. To compare the change in neurocognitive functioning, as measured by the CogState Cognitive Composite, from baseline to end-of-therapy among patients with ALL ages 4- < 10 years at the time of diagnosis between children from poor families (defined as presence of household material hardship [HMH], including either food, housing or energy insecurity) and non-poor families (absence of HMH).
VII. To describe the impact of blinatumomab on caregiver burden and patient/proxy-reported symptoms among a subset of children enrolled in the HMH and neurocognitive outcome study.
VII. To evaluate available peripheral blood (PB) samples at EOI using HTS MRD and compare the results against bone marrow (BM) results.
IX. To evaluate available end of Consolidation (EOC) BM samples using HTS in patients who were Day 29 MRD positive by flow cytometry and who have submitted EOC BM flow cytometry results.
EXPLORATORY OBJECTIVES:
I. To explore adaptive and innate immune functions and host genetic factors associated with severe infectious complications in children with DS B-ALL.
II. To explore the impact of acute lymphoblastic leukemia (ALL) and its therapy on neurocognitive, functional, and quality of life outcomes in patients with DS and ALL, as measured by caregiver (parent/legal guardian) questionnaires.
III. To define the prevalence of minimal marrow disease (MMD) in B-LLy and to correlate MMD at diagnosis with outcome in patients with B-LLy.
IV. To explore the significance of and genomic landscape of Ig clonal composition in pediatric B-ALL.
V. To explore the incidence of HTS MRD ≥ 0.01% versus (vs.) HTS MRD < 0.01% in patients with multiparameter flow cytometry defined MRD < 0.01% at end of Induction and genetically characterize those with discordance defined by the 0.01% threshold.
VI. To test whether differences in cerebrospinal fluid (CSF) metabolites clustered in glycerophospholipid metabolic pathways will distinguish patients with vs. without neurocognitive decline.
VII. To determine the ability of next-generation sequencing assays to detect and track leukemic cell-free deoxyribonucleic acid (DNA) in CSF.
VIII. Using single-cell genomic profiling, describe intra-tumoral clonal heterogeneity and cell developmental state in National Cancer Institute (NCI) SR B-ALL patients and determine its relationship to immunoglobulin clonality and response to therapy.
OUTLINE: All patients are assigned to, and complete an INDUCTION treatment regimen. Patients are then assigned to a CONSOLIDATION treatment regimen. Finally, following CONSOLIDATION, patients are either assigned or randomized to 1 of 7 arms.
NON-DS SR B-ALL INDUCTION: Patients receive cytarabine intrathecally (IT) on day 1, vincristine intravenous (IV) push over 1 minute on days 1, 8, 15, and 22, dexamethasone orally (PO) or IV twice daily (BID) on days 1-28, pegaspargase IV over 1-2 hours or intramuscularly (IM) on day 4, and methotrexate IT on days 8 and 29. CNS2 patients also receive cytarabine IT twice weekly except during weeks when days 8 and 29 methotrexate is administered. Treatment continues for 35 days in the absence of disease progression or unacceptable toxicity.
* After Non-DS SR B-ALL INDUCTION, SR-Fav and SR-Avg patients complete SR CONSOLIDATION, while patients with SR-High complete high-risk (HR) CONSOLIDATION.
DS B-ALL INDUCTION: Patients receive cytarabine IT on day 1, vincristine IV push over 1 minute on days 1, 8, 15, and 22, pegaspargase IV over 1-2 hours or IM on day 4, methotrexate IT on days 8 and 29, and leucovorin PO or IV every 6 hours for 2 doses on days 9 and 30. Additionally, patients under 10 years of age receive dexamethasone PO or IV BID on days 1-28, and patients 10 years of age or older receive prednisone or prednisolone PO or IV BID on days 1-28. CNS2 patients also receive cytarabine IT twice weekly except during weeks when days 8 and 29 IT methotrexate is administered. CNS3 patients also receive methotrexate IT on days 15 and 22, and leucovorin PO or IV every 6 hours for 2 doses on days 16 and 23. Treatment continues for 35 days in the absence of disease progression or unacceptable toxicity.
* After DS B-ALL INDUCTION, patients without high risk features and MRD < 0.01 % complete SR CONSOLIDATION. Patients without high risk features and MRD >= 0.01%, OR with high risk features and any MRD complete HR CONSOLIDATION.
NON-DS B-LLy INDUCTION: Patients receive cytarabine IT on day 1 and twice weekly if CNS2, vincristine IV push over 1 minute on days 1, 8, 15, and 22, dexamethasone PO or IV BID on days 1-28, pegaspargase IV over 1-2 hours or IM on day 4, and methotrexate IT on days 8 and 29. Treatment continues for 35 days in the absence of disease progression or unacceptable toxicity.
* After NON-DS B-LLy INDUCTION, all B-LLy patients then complete SR CONSOLIDATION.
DS B-LLY INDUCTION: Patients receive cytarabine IT on day 1, vincristine IV push over 1 minute on days 1, 8, 15, and 22, pegaspargase IV over 1-2 hours or IM on day 4, methotrexate IT on days 8 and 29, and leucovorin PO or IV every 6 hours for 2 doses on days 9 and 30. Additionally, patients under 10 years of age receive dexamethasone PO or IV BID on days 1-28, and patients 10 years of age or older receive PO or IV prednisone or methylprednisolone on days 1-28. Treatment continues for 35 days in the absence of disease progression or unacceptable toxicity.
* After DS B-LLy INDUCTION, patients then complete SR CONSOLIDATION.
SR CONSOLIDATION: Patients receive vincristine IV push over 1 minute on day 1, mercaptopurine PO on days 1-28, and methotrexate IT on days 1, 8, and 15. DS patients also receive leucovorin PO or IV every 6 hours for 2 doses on days 2, 9, and 16. Treatment continues for 28 days in the absence of disease progression or unacceptable toxicity.
* After SR CONSOLIDATION, patients with MRD undetectable are assigned to ARM A, and patients with MRD detectable/indeterminate/unavailable are randomized to ARM A or B. Patients with SR-Fav and all B-LLy patients are assigned to treatments identical to that in ARM A.
HR CONSOLIDATION: Patients receive cyclophosphamide IV over 30-60 minutes on days 1 and 29, cytarabine IV over 1-30 minutes or SC on days 1-4, 8-11, 29-32, and 36-39, vincristine IV push over 1 minute on days 15, 22, 43, and 50, mercaptopurine PO on days 1-14 and 29-42, methotrexate IT on days 1, 8, 15, and 22 , and pegaspargase IV over 1-2 hours or IM on days 15 and 43. DS patients also receive leucovorin PO or IV every 6 hours for 2 doses on days 2, 9, 16, and 23 (on days 2 and 9 only for DS CNS3 patients). Treatment continues for 56 days in the absence of disease progression or unacceptable toxicity. Patients with continued clinical evidence of DS or testicular leukemia (from diagnosis through the end of Induction) undergo testicular radiation therapy over 12 fractions once daily (QD).
* After HR CONSOLIDATION, patients are randomized to ARM C or D. DS B-ALL patients with MRD < 1% are assigned to an arm including three blocks of blinatumomab.
ARM A:
- INTERIM MAINTENANCE I: Patients receive vincristine IV push over 1 minute on days 1, 11, 21, 31, and 41, methotrexate IV over 2-5 minutes (undiluted) or 10-15 minutes (diluted) on days 1, 11, 21, 31, and 41, and methotrexate IT on day 31. DS patients also receive leucovorin PO or IV every 6 hours for 2 doses on day 32. Treatment continues for 56 days in the absence of disease progression or unacceptable toxicity.
- DELAYED INTENSIFICATION: Patients receive methotrexate IT on day 1 and 29, dexamethasone PO BID or IV on days 1-7 and 15-21, vincristine IV push over 1 minute on days 1, 8, and 15, doxorubicin IV push/infusion over 1-15 minutes on days 1, 8, and 15, pegaspargase IV over 1-2 hours or IM on day 4, cyclophosphamide IV over 30-60 minutes on day 29, thioguanine PO on days 29-42, and cytarabine IV over 1-30 minutes or subcutaneously (SC) on days 29-32 and 36-39. DS patients receive leucovorin PO or IV every 6 hours for 2 doses on days 2 and 30. Treatment continues for 56 days in the absence of disease progression or unacceptable toxicity.
- INTERIM MAINTENANCE II: Patients receive vincristine IV push over 1 minute on days 1, 11, 21, 31, and 41, methotrexate IV over 2-5 minutes undiluted or 10-15 minutes diluted on days 1, 11, 21, 31, and 41, and methotrexate IT on days 1 and 31. DS patients receive leucovorin PO or IV every 6 hours for 2 doses on days 2 and 32. Treatment continues for 56 days in the absence of disease progression or unacceptable toxicity.
- MAINTENANCE: Non-DS patients receive methotrexate IT on day 1, vincristine IV push over 1 minute on day 1, dexamethasone PO on days 1-5, mercaptopurine PO on days 1-84, and methotrexate PO on days 8, 15, 22, 29, 36, 43, 50, 57, 64, 71, and 78. DS patients receive vincristine IV push over 1 minute on day 1, methotrexate IT on day 1, dexamethasone PO on days 1-5, mercaptopurine PO on days 1-84, and methotrexate PO on days 8, 15, 22, 29, 36, 43, 50, 57, 64, 71, and 78, and leucovorin IV or PO on day 2 if DS. Treatment repeats every 84 days until a total duration of therapy of 2 years from start of INTERIM MAINTENANCE I is reached in the absence of disease progression or unacceptable toxicity.
ARM B:
- BLINATUMOMAB BLOCK I: Patients receive dexamethasone IV or PO on day 1, methotrexate IT on day 1, and blinatumomab IV continuously on days 1-28. DS patients also receive leucovorin IV or PO every 6 hours for 2 doses on day 2. Treatment continues for 35 days in the absence of disease progression or unacceptable toxicity.
- INTERIM MAINTENANCE I: Patients receive vincristine IV push over 1 minute on days 1, 11, 21, 31, and 41, methotrexate IV over 2-5 minutes (undiluted) or 10-15 minutes (diluted) on days 1, 11, 21, 31, and 41, and methotrexate IT on day 31. DS patients also receive leucovorin PO or IV every 6 hours for 2 doses on day 32. Treatment continues for 56 days in the absence of disease progression or unacceptable toxicity.
- BLINATUMOMAB BLOCK II: Patients receive methotrexate IT on day 1, and blinatumomab IV continuously on days 1-28. DS patients also receive leucovorin PO or IV every 6 hours for 2 doses on day 2. Treatment continues for 35 days in the absence of disease progression or unacceptable toxicity.
- DELAYED INTENSIFICATION: Patients receive methotrexate IT on day 1 and 29, dexamethasone PO or IV on days 1-7 and 15-21, vincristine IV push over 1 minute on days 1, 8, and 15, doxorubicin IV push/infusion over 1-15 minutes on days 1, 8, and 15, pegaspargase IV over 1-2 hours or IM on day 4, cyclophosphamide IV over 30-60 minutes on day 29, thioguanine PO on days 29-42, and cytarabine IV over 1-30 minutes or SC on days 29-32 and 36-39. DS patients receive leucovorin PO or IV every 6 hours for 2 doses on days 2 and 30. Treatment continues for 56 days in the absence of disease progression or unacceptable toxicity.
- INTERIM MAINTENANCE II: Patients receive vincristine IV push over 1 minute on days 1, 11, 21, 31, and 41, methotrexate IV over 2-5 minutes (undiluted) or 10-15 minutes (diluted) on days 1, 11, 21, 31, and 41, and methotrexate IT on days 1 and 31. DS patients also receive leucovorin PO or IV every 6 hours for 2 doses on days 2 and 32. Treatment continues for 56 days in the absence of disease progression or unacceptable toxicity.
- MAINTENANCE: Non-DS patients receive methotrexate IT on day 1 (omit cycles 5-6), vincristine IV push over 1 minute on day 1, dexamethasone PO on days 1-5, mercaptopurine PO on days 1-84, and methotrexate PO on days 1, 8, 15, 22, 29, 36, 43, 50, 57, 64, 71, and 78 (omit day 1 when coinciding with IT methotrexate). DS patients receive methotrexate IT on day 1 (omit cycles 5-6), dexamethasone PO on days 1-5, mercaptopurine PO on days 1-84, and methotrexate PO on days 1, 8, 15, 22, 29, 36, 43, 50, 57, 64, 71, and 78 (omit day 1 when coinciding with IT methotrexate), for DS patients and leucovorin IV or PO every 6 hours for 2 doses on day 2 (omit on final 2 cycles). Treatment repeats every 84 days until a total duration of therapy of 2 years from start of INTERIM MAINTENANCE I is reached in the absence of disease progression or unacceptable toxicity.
ARM C:
- INTERIM MAINTENANCE I: Patients receive vincristine IV push over 1 minute on days 1, 15, 29, and 43, high dose methotrexate IV on days 1, 15, 29, and 43, mercaptopurine PO on days 1-14, 15-28, 29-42, and 43-56, methotrexate IT on day 1 and 29, and leucovorin PO or IV on days 3-4, 17-18, 31-32, and 45-46. Treatment continues for 56 days in the absence of disease progression or unacceptable toxicity.
- DELAYED INTENSIFICATION: Patients receive methotrexate IT on day 1, dexamethasone PO BID or IV on days 1-7 and 15-21, vincristine IV over 1 minute on days 1, 8, 15, 43, and 50, doxorubicin IV over 1-15 minutes on days 1, 8, and 15, pegaspargase IV over 1-2 hours or IM on days 4 and 43, cyclophosphamide IV over 30-60 minutes on day 29, thioguanine PO on days 29-42, and cytarabine IV over 1-30 minutes or SC on days 29-32 and 36-39. Treatment continues for 56 days in the absence of disease progression or unacceptable toxicity.
- INTERIM MAINTENANCE II: Patients receive vincristine IV over 1 minute on days 1, 11, 21, 31, and 41, Capizzi style methotrexate IV over 2-5 minutes (undiluted) or over 10-15 minutes (diluted) on days 1, 11, 21, 31, and 41, methotrexate IT on days 1 and 31, and pegaspargase IV over 1-2 hours or IM on days 2 and 22. Treatment continues for 56 days in the absence of disease progression or unacceptable toxicity.
- MAINTENANCE: Patients receive vincristine IV over 1 minute on day 1, prednisone or prednisolone or methylprednisolone PO or IV on days 1-5, mercaptopurine PO on days 1-84, methotrexate IT on days 1 and 29 of cycles 1-2 and on day 1 of subsequent cycles, methotrexate PO on days 8, 15, 22, 29 (for cycle 3 and later only), 36, 43, 50, 57, 64, 71, and 78. Treatment repeats every 84 days until a total duration of therapy of 2 years from start of interim maintenance I is reached in the absence of disease progression or unacceptable toxicity.
ARM D:
- BLINATUMOMAB BLOCK I: Patients receive dexamethasone PO or IV on day 1, methotrexate IT on day 1, and blinatumomab IV continuously on days 1-28. Treatment continues for 35 days in the absence of disease progression or unacceptable toxicity.
- INTERIM MAINTENANCE I: Patients receive vincristine IV over 1 minute on days 1, 15, 29, and 43, high dose methotrexate IV on days 1, 15, 29, and 43, mercaptopurine PO on days 1-14, 15-28, 29-42, and 43-56, methotrexate IT on days 1 and 29, and leucovorin PO or IV on days 3-4, 17-18, 31-32, and 45-46. Treatment continues for 56 days in the absence of disease progression or unacceptable toxicity.
- BLINATUMOMAB BLOCK II: Patients receive blinatumomab IV on days 1-28 and methotrexate IT on day 1. Treatment continues for 35 days in the absence of disease progression or unacceptable toxicity.
- DELAYED INTENSIFICATION: Patients receive methotrexate IT on day 1, dexamethasone PO or IV on days 1-7 and 15-21, vincristine IV over 1 minute on days 1, 8, 15, 43, and 50, doxorubicin IV over 1-15 minutes on days 1, 8, and 15, pegaspargase IV over 1-2 hours or IM on days 4 and 43, cyclophosphamide IV over 30-60 minutes on day 29, thioguanine PO on days 29-42, and cytarabine IV over 1-30 minutes or SC on days 29-32 and 36-39. Treatment continues for 56 days in the absence of disease progression or unacceptable toxicity.
- INTERIM MAINTENANCE II: Patients receive vincristine IV over 1 minute on days 1, 11, 21, 31, and 41, Capizzi style methotrexate IV over 2-5 minutes (undiluted) or over 10-15 minutes (diluted) on days 1, 11, 21, 31, and 41, methotrexate IT on days 1 and 31, and pegaspargase IV over 1-2 hours or IM on days 2 and 22. Treatment continues for 56 days in the absence of disease progression or unacceptable toxicity.
- MAINTENANCE: Patients receive methotrexate IT on day 1, vincristine IV over 1 minute on day 1, prednisone, prednisolone or methylprednisolone PO or IV on days 1-5, mercaptopurine PO on days 1-84, and methotrexate PO on days 8, 15, 22, 29, 36, 43, 50, 57, 64, 71, and 78. Treatment repeats every 84 days until a total duration of therapy of 2 years from start of interim maintenance I is reached in the absence of disease progression or unacceptable toxicity.
DS-HIGH B-ALL:
- BLINATUMOMAB BLOCK I: Patients receive dexamethasone PO or IV on day 1, blinatumomab IV continuously on days 1-28, methotrexate IT on day 1 (or on day 56 of Consolidation), and leucovorin PO or IV every 6 hours for 2 doses on day 2. Treatment continues for 35 days in the absence of disease progression or unacceptable toxicity.
- INTERIM MAINTENANCE: Patients receive vincristine IV push over 1 minute on days 1, 15, 29, and 43, intermediate dose methotrexate IV over 24 hours on days 1, 15, 29, and 43, mercaptopurine PO on days 1-14, 15-28, 29-42, and 43-46, methotrexate IT on days 1 and 29, and leucovorin PO or IV every 6 hours for 2 doses on days 2-4, 16-18, 30-32, and 44-46. Treatment continues for 63 days in the absence of disease progression or unacceptable toxicity.
- BLINATUMOMAB BLOCK II: Patients receive blinatumomab IV on days 1-28, methotrexate IT on day 1, and leucovorin PO or IV every 6 hours for 2 doses on day 2. Treatment continues for 35 days in the absence of disease progression or unacceptable toxicity.
- DELAYED INTENSIFICATION: Patients receive vincristine IV over 1 minute on days 1, 8, and 15, doxorubicin IV over 1-15 minutes on days 1, 8, and 15, dexamethasone PO or IV on days 1-7 and 15-21, methotrexate IT on day 1, leucovorin PO or IV every 6 hours for 2 doses on day 2, and pegaspargase IV over 1-2 hours or IM on day 4. Treatment continues for 28 days in the absence of disease progression or unacceptable toxicity.
- BLINATUMOMAB BLOCK III: Patients receive blinatumomab IV on days 1-28, methotrexate IT on day 1, and leucovorin PO or IV every 6 hours for 2 doses on day 2. Treatment continues for 35 days in the absence of disease progression or unacceptable toxicity.
- MAINTENANCE: Patients receive vincristine IV push over 1 minute on day 1, prednisone, prednisolone or methylprednisolone PO or IV BID on days 1-5, mercaptopurine PO on days 1-84, methotrexate IT on day 1, methotrexate PO on days 8, 15, 22, 29 (omit day 29 for first 3 cycles for patients who do not receive cranial radiotherapy), 36, 43, 50, 57, 64, 71, and 78, and leucovorin PO on days 2 and 30 (day 30 dose is for cycles 1-3 and for patients who do not receive cranial radiotherapy). CNS3 patients receive cranial radiotherapy during first 4 weeks of cycle 1. Treatment repeats every 84 days until a total duration of therapy of 2 years from start of interim maintenance I is reached in the absence of disease progression or unacceptable toxicity.
All B-LLy patients:
- INTERIM MAINTENANCE I: Patients receive vincristine IV push over 1 minute on days 1, 11, 21, 31, and 41, methotrexate IV over 2-5 minutes (undiluted) or 10-15 (diluted) on days 1, 11, 21, 31, and 41, and methotrexate IT on day 31. DS patients also receive leucovorin PO or IV every 6 hours for 2 doses on day 32. Treatment continues for 56 days in the absence of disease progression or unacceptable toxicity.
- DELAYED INTENSIFICATION: Patients receive vincristine IV push over 1 minute on days 1, 8 and 15, doxorubicin IV over 1-15 minutes on days 1, 8, and 15, dexamethasone PO or IV on days 1-7 and 15-21, methotrexate IT on days 1 and 29, pegaspargase IV over 1-2 hours or IM on day 4, cyclophosphamide IV over 30-60 minutes on day 29, thioguanine PO on days 29-42, and cytarabine IV over 1-30 minutes or SC on days 29-32 and 36-39. DS patients additionally receive leucovorin PO or IV every 6 hours for 2 doses on days 2 and 30. Treatment continues for 56 days in the absence of disease progression or unacceptable toxicity.
- INTERIM MAINTENANCE II: Patients receive vincristine IV push over 1 minute on days 1, 11, 21, 31, and 41, methotrexate IV over 2-5 minutes (undiluted) or 10-15 minutes (diluted) on days 1, 11, 21, 31, and 41, and methotrexate IT on days 1 and 31. DS patients also receive leucovorin PO or IV every 6 hours for 2 doses on days 2 and 32. Treatment continues for 56 days in the absence of disease progression or unacceptable toxicity.
- MAINTENANCE: Patients receive vincristine IV push over 1 minute on day 1, dexamethasone PO on days 1-5, mercaptopurine PO on days 1-84, methotrexate IT on day 1, and methotrexate PO on days 8, 15, 22, 29, 36, 43, 50, 57, 64, 71, and 78. DS patients also receive leucovorin PO or IV every 6 hours for 2 doses on day 2. Treatment repeats every 84 days until a total duration of therapy of 2 years from start of interim maintenance I is reached in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up every 4 weeks until complete blood count(CBC)/differential/platelet count recovery, then every 3 months for the first 2 years, then every 4-6 months for the 3rd year, and every 6-12 months for the 4th and 5th years.
Studietype
Inschrijving (Geschat)
Fase
- Fase 3
Contacten en locaties
Studie Locaties
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New South Wales
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Hunter Regional Mail Centre, New South Wales, Australië, 2310
- John Hunter Children's Hospital
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Westmead, New South Wales, Australië, 2145
- The Children's Hospital at Westmead
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Queensland
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South Brisbane, Queensland, Australië, 4101
- Queensland Children's Hospital
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South Australia
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North Adelaide, South Australia, Australië, 5006
- Women's and Children's Hospital-Adelaide
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Victoria
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Clayton, Victoria, Australië, 3168
- Monash Medical Center-Clayton Campus
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Parkville, Victoria, Australië, 3052
- Royal Children's Hospital
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Western Australia
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Perth, Western Australia, Australië, 6009
- Perth Children's Hospital
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Québec, Canada, G1V 4G2
- CHU de Quebec-Centre Hospitalier de l'Universite Laval (CHUL)
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Alberta
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Calgary, Alberta, Canada, T3B 6A8
- Alberta Children's Hospital
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Edmonton, Alberta, Canada, T6G 2B7
- University of Alberta Hospital
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British Columbia
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Vancouver, British Columbia, Canada, V6H 3V4
- British Columbia Children's Hospital
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Manitoba
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Winnipeg, Manitoba, Canada, R3E 0V9
- CancerCare Manitoba
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Newfoundland and Labrador
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St. John's, Newfoundland and Labrador, Canada, A1B 3V6
- Janeway Child Health Centre
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Nova Scotia
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Halifax, Nova Scotia, Canada, B3K 6R8
- IWK Health Centre
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Ontario
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Hamilton, Ontario, Canada, L8N 3Z5
- McMaster Children's Hospital at Hamilton Health Sciences
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Kingston, Ontario, Canada, K7L 2V7
- Kingston Health Sciences Centre
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London, Ontario, Canada, N6A 5W9
- Children's Hospital
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Ottawa, Ontario, Canada, K1H 8L1
- Children's Hospital of Eastern Ontario
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Toronto, Ontario, Canada, M5G 1X8
- Hospital for Sick Children
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Quebec
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Montreal, Quebec, Canada, H3H 1P3
- The Montreal Children's Hospital of the MUHC
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Sherbrooke, Quebec, Canada, J1H 5N4
- Centre Hospitalier Universitaire de Sherbrooke-Fleurimont
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Saskatchewan
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Saskatoon, Saskatchewan, Canada, S7N 4H4
- Saskatoon Cancer Centre
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Saskatoon, Saskatchewan, Canada, S7N 0W8
- Jim Pattison Children's Hospital
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Christchurch, Nieuw-Zeeland, 8011
- Christchurch Hospital
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Auckland
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Grafton, Auckland, Nieuw-Zeeland, 1145
- Starship Children's Hospital
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Caguas, Puerto Rico, 00726
- HIMA San Pablo Oncologic Hospital
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San Juan, Puerto Rico, 00926
- University Pediatric Hospital
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Alabama
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Birmingham, Alabama, Verenigde Staten, 35233
- Children's Hospital of Alabama
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Mobile, Alabama, Verenigde Staten, 36604
- USA Health Strada Patient Care Center
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Alaska
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Anchorage, Alaska, Verenigde Staten, 99508
- Providence Alaska Medical Center
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Arizona
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Mesa, Arizona, Verenigde Staten, 85202
- Banner Children's at Desert
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Phoenix, Arizona, Verenigde Staten, 85016
- Phoenix Childrens Hospital
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Tucson, Arizona, Verenigde Staten, 85719
- Banner University Medical Center - Tucson
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Arkansas
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Little Rock, Arkansas, Verenigde Staten, 72202-3591
- Arkansas Children's Hospital
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California
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Downey, California, Verenigde Staten, 90242
- Kaiser Permanente Downey Medical Center
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Duarte, California, Verenigde Staten, 91010
- City of Hope Comprehensive Cancer Center
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Loma Linda, California, Verenigde Staten, 92354
- Loma Linda University Medical Center
-
Long Beach, California, Verenigde Staten, 90806
- Miller Children's and Women's Hospital Long Beach
-
Los Angeles, California, Verenigde Staten, 90048
- Cedars-Sinai Medical Center
-
Los Angeles, California, Verenigde Staten, 90027
- Children's Hospital Los Angeles
-
Los Angeles, California, Verenigde Staten, 90095
- Mattel Children's Hospital UCLA
-
Madera, California, Verenigde Staten, 93636
- Valley Children's Hospital
-
Oakland, California, Verenigde Staten, 94609
- UCSF Benioff Children's Hospital Oakland
-
Oakland, California, Verenigde Staten, 94611
- Kaiser Permanente-Oakland
-
Orange, California, Verenigde Staten, 92868
- Children's Hospital of Orange County
-
Palo Alto, California, Verenigde Staten, 94304
- Lucile Packard Children's Hospital Stanford University
-
Sacramento, California, Verenigde Staten, 95816
- Sutter Medical Center Sacramento
-
Sacramento, California, Verenigde Staten, 95817
- University of California Davis Comprehensive Cancer Center
-
San Diego, California, Verenigde Staten, 92123
- Rady Children's Hospital - San Diego
-
San Diego, California, Verenigde Staten, 92134
- Naval Medical Center -San Diego
-
San Francisco, California, Verenigde Staten, 94158
- UCSF Medical Center-Mission Bay
-
Santa Barbara, California, Verenigde Staten, 93102
- Santa Barbara Cottage Hospital
-
Torrance, California, Verenigde Staten, 90502
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center
-
-
Colorado
-
Aurora, Colorado, Verenigde Staten, 80045
- Children's Hospital Colorado
-
Denver, Colorado, Verenigde Staten, 80218
- Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center
-
-
Connecticut
-
Hartford, Connecticut, Verenigde Staten, 06106
- Connecticut Children's Medical Center
-
New Haven, Connecticut, Verenigde Staten, 06520
- Yale University
-
-
Delaware
-
Wilmington, Delaware, Verenigde Staten, 19803
- Alfred I duPont Hospital for Children
-
-
District of Columbia
-
Washington D.C., District of Columbia, Verenigde Staten, 20010
- Children's National Medical Center
-
Washington D.C., District of Columbia, Verenigde Staten, 20007
- MedStar Georgetown University Hospital
-
-
Florida
-
Fort Lauderdale, Florida, Verenigde Staten, 33316
- Broward Health Medical Center
-
Fort Myers, Florida, Verenigde Staten, 33908
- Golisano Children's Hospital of Southwest Florida
-
Gainesville, Florida, Verenigde Staten, 32610
- UF Health Cancer Institute - Gainesville
-
Hollywood, Florida, Verenigde Staten, 33021
- Memorial Regional Hospital/Joe DiMaggio Children's Hospital
-
Jacksonville, Florida, Verenigde Staten, 32207
- Nemours Children's Clinic-Jacksonville
-
Loxahatchee Groves, Florida, Verenigde Staten, 33470
- Palms West Radiation Therapy
-
Miami, Florida, Verenigde Staten, 33155
- Nicklaus Children's Hospital
-
Miami, Florida, Verenigde Staten, 33136
- University of Miami Miller School of Medicine-Sylvester Cancer Center
-
Miami, Florida, Verenigde Staten, 33176
- Miami Cancer Institute
-
Orlando, Florida, Verenigde Staten, 32827
- Nemours Children's Hospital
-
Orlando, Florida, Verenigde Staten, 32803
- AdventHealth Orlando
-
Orlando, Florida, Verenigde Staten, 32806
- Arnold Palmer Hospital for Children
-
Pensacola, Florida, Verenigde Staten, 32504
- Sacred Heart Hospital
-
St. Petersburg, Florida, Verenigde Staten, 33701
- Johns Hopkins All Children's Hospital
-
Tampa, Florida, Verenigde Staten, 33606
- Tampa General Hospital
-
Tampa, Florida, Verenigde Staten, 33607
- Saint Joseph's Hospital/Children's Hospital-Tampa
-
West Palm Beach, Florida, Verenigde Staten, 33407
- Saint Mary's Medical Center
-
-
Georgia
-
Atlanta, Georgia, Verenigde Staten, 30329
- Children's Healthcare of Atlanta - Arthur M Blank Hospital
-
Augusta, Georgia, Verenigde Staten, 30912
- Augusta University Medical Center
-
Macon, Georgia, Verenigde Staten, 31201
- Atrium Health Navicent
-
Savannah, Georgia, Verenigde Staten, 31404
- Memorial Health University Medical Center
-
-
Hawaii
-
Honolulu, Hawaii, Verenigde Staten, 96826
- Kapiolani Medical Center for Women and Children
-
Honolulu, Hawaii, Verenigde Staten, 96859
- Tripler Army Medical Center
-
-
Idaho
-
Boise, Idaho, Verenigde Staten, 83712
- Saint Luke's Cancer Institute - Boise
-
-
Illinois
-
Chicago, Illinois, Verenigde Staten, 60637
- University of Chicago Comprehensive Cancer Center
-
Chicago, Illinois, Verenigde Staten, 60612
- University of Illinois
-
Chicago, Illinois, Verenigde Staten, 60611
- Lurie Children's Hospital-Chicago
-
Maywood, Illinois, Verenigde Staten, 60153
- Loyola University Medical Center
-
Oak Lawn, Illinois, Verenigde Staten, 60453
- Advocate Children's Hospital-Oak Lawn
-
Park Ridge, Illinois, Verenigde Staten, 60068
- Advocate Children's Hospital-Park Ridge
-
Peoria, Illinois, Verenigde Staten, 61637
- OSF Children's Hospital of Illinois
-
Springfield, Illinois, Verenigde Staten, 62702
- Southern Illinois University School of Medicine
-
Winfield, Illinois, Verenigde Staten, 60190
- Northwestern Medicine Central DuPage Hospital
-
-
Indiana
-
Indianapolis, Indiana, Verenigde Staten, 46202
- Riley Hospital for Children
-
Indianapolis, Indiana, Verenigde Staten, 46260
- Ascension Saint Vincent Indianapolis Hospital
-
-
Iowa
-
Des Moines, Iowa, Verenigde Staten, 50309
- Blank Children's Hospital
-
Iowa City, Iowa, Verenigde Staten, 52242
- University of Iowa/Holden Comprehensive Cancer Center
-
-
Kentucky
-
Lexington, Kentucky, Verenigde Staten, 40536
- University of Kentucky/Markey Cancer Center
-
Louisville, Kentucky, Verenigde Staten, 40202
- Norton Children's Hospital
-
-
Louisiana
-
New Orleans, Louisiana, Verenigde Staten, 70121
- Ochsner Medical Center Jefferson
-
New Orleans, Louisiana, Verenigde Staten, 70118
- Children's Hospital New Orleans
-
-
Maine
-
Bangor, Maine, Verenigde Staten, 04401
- Eastern Maine Medical Center
-
Scarborough, Maine, Verenigde Staten, 04074
- Maine Children's Cancer Program
-
-
Maryland
-
Baltimore, Maryland, Verenigde Staten, 21287
- Johns Hopkins University/Sidney Kimmel Cancer Center
-
Baltimore, Maryland, Verenigde Staten, 21215
- Sinai Hospital of Baltimore
-
Baltimore, Maryland, Verenigde Staten, 21201
- University of Maryland/Greenebaum Cancer Center
-
Bethesda, Maryland, Verenigde Staten, 20889-5600
- Walter Reed National Military Medical Center
-
-
Massachusetts
-
Boston, Massachusetts, Verenigde Staten, 02215
- Dana-Farber Cancer Institute
-
Boston, Massachusetts, Verenigde Staten, 02114
- Massachusetts General Hospital Cancer Center
-
Boston, Massachusetts, Verenigde Staten, 02111
- Tufts Children's Hospital
-
Springfield, Massachusetts, Verenigde Staten, 01199
- Baystate Medical Center
-
Worcester, Massachusetts, Verenigde Staten, 01655
- UMass Memorial Medical Center - University Campus
-
-
Michigan
-
Ann Arbor, Michigan, Verenigde Staten, 48109
- C S Mott Children's Hospital
-
Detroit, Michigan, Verenigde Staten, 48201
- Children's Hospital of Michigan
-
Detroit, Michigan, Verenigde Staten, 48236
- Henry Ford Health Saint John Hospital
-
East Lansing, Michigan, Verenigde Staten, 48823
- Michigan State University
-
Grand Rapids, Michigan, Verenigde Staten, 49503
- Corewell Health Grand Rapids Hospitals - Helen DeVos Children's Hospital
-
Kalamazoo, Michigan, Verenigde Staten, 49007
- Bronson Methodist Hospital
-
Royal Oak, Michigan, Verenigde Staten, 48073
- Corewell Health Children's
-
-
Minnesota
-
Minneapolis, Minnesota, Verenigde Staten, 55404
- Children's Hospitals and Clinics of Minnesota - Minneapolis
-
Minneapolis, Minnesota, Verenigde Staten, 55455
- University of Minnesota/Masonic Cancer Center
-
Rochester, Minnesota, Verenigde Staten, 55905
- Mayo Clinic in Rochester
-
-
Mississippi
-
Jackson, Mississippi, Verenigde Staten, 39216
- University of Mississippi Medical Center
-
-
Missouri
-
Columbia, Missouri, Verenigde Staten, 65212
- University of Missouri Children's Hospital
-
Kansas City, Missouri, Verenigde Staten, 64108
- Children's Mercy Hospitals and Clinics
-
St Louis, Missouri, Verenigde Staten, 63110
- Washington University School of Medicine
-
St Louis, Missouri, Verenigde Staten, 63141
- Mercy Hospital Saint Louis
-
St Louis, Missouri, Verenigde Staten, 63104
- Cardinal Glennon Children's Medical Center
-
-
Nebraska
-
Omaha, Nebraska, Verenigde Staten, 68198
- University of Nebraska Medical Center
-
Omaha, Nebraska, Verenigde Staten, 68114
- Children's Hospital and Medical Center of Omaha
-
-
Nevada
-
Las Vegas, Nevada, Verenigde Staten, 89144
- Summerlin Hospital Medical Center
-
Las Vegas, Nevada, Verenigde Staten, 89109
- Sunrise Hospital and Medical Center
-
Las Vegas, Nevada, Verenigde Staten, 89135
- Alliance for Childhood Diseases/Cure 4 the Kids Foundation
-
Las Vegas, Nevada, Verenigde Staten, 89102
- University Medical Center of Southern Nevada
-
Reno, Nevada, Verenigde Staten, 89502
- Renown Regional Medical Center
-
-
New Hampshire
-
Lebanon, New Hampshire, Verenigde Staten, 03756
- Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center
-
-
New Jersey
-
Hackensack, New Jersey, Verenigde Staten, 07601
- Hackensack University Medical Center
-
Morristown, New Jersey, Verenigde Staten, 07960
- Morristown Medical Center
-
Neptune City, New Jersey, Verenigde Staten, 07753
- Jersey Shore Medical Center
-
New Brunswick, New Jersey, Verenigde Staten, 08901
- Saint Peter's University Hospital
-
New Brunswick, New Jersey, Verenigde Staten, 08903
- Rutgers Cancer Institute of New Jersey-Robert Wood Johnson University Hospital
-
Newark, New Jersey, Verenigde Staten, 07112
- Newark Beth Israel Medical Center
-
Paterson, New Jersey, Verenigde Staten, 07503
- Saint Joseph's Regional Medical Center
-
-
New Mexico
-
Albuquerque, New Mexico, Verenigde Staten, 87106
- Presbyterian Hospital
-
Albuquerque, New Mexico, Verenigde Staten, 87106
- University of New Mexico Cancer Center
-
-
New York
-
Albany, New York, Verenigde Staten, 12208
- Albany Medical Center
-
Brooklyn, New York, Verenigde Staten, 11219
- Maimonides Medical Center
-
Mineola, New York, Verenigde Staten, 11501
- NYU Langone Hospital - Long Island
-
New Hyde Park, New York, Verenigde Staten, 11040
- The Steven and Alexandra Cohen Children's Medical Center of New York
-
New York, New York, Verenigde Staten, 10065
- Memorial Sloan Kettering Cancer Center
-
New York, New York, Verenigde Staten, 10029
- Mount Sinai Hospital
-
New York, New York, Verenigde Staten, 10032
- NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
-
New York, New York, Verenigde Staten, 10065
- NYP/Weill Cornell Medical Center
-
New York, New York, Verenigde Staten, 10016
- Laura and Isaac Perlmutter Cancer Center at NYU Langone
-
Rochester, New York, Verenigde Staten, 14642
- University of Rochester
-
Stony Brook, New York, Verenigde Staten, 11794
- Stony Brook University Medical Center
-
Syracuse, New York, Verenigde Staten, 13210
- State University of New York Upstate Medical University
-
The Bronx, New York, Verenigde Staten, 10467
- Montefiore Medical Center - Moses Campus
-
Valhalla, New York, Verenigde Staten, 10595
- New York Medical College
-
-
North Carolina
-
Asheville, North Carolina, Verenigde Staten, 28801
- Mission Hospital
-
Chapel Hill, North Carolina, Verenigde Staten, 27599
- UNC Lineberger Comprehensive Cancer Center
-
Charlotte, North Carolina, Verenigde Staten, 28203
- Carolinas Medical Center/Levine Cancer Institute
-
Charlotte, North Carolina, Verenigde Staten, 28204
- Novant Health Presbyterian Medical Center
-
Durham, North Carolina, Verenigde Staten, 27710
- Duke University Medical Center
-
Greenville, North Carolina, Verenigde Staten, 27834
- East Carolina University
-
Winston-Salem, North Carolina, Verenigde Staten, 27157
- Wake Forest University Health Sciences
-
-
North Dakota
-
Fargo, North Dakota, Verenigde Staten, 58122
- Sanford Broadway Medical Center
-
-
Ohio
-
Akron, Ohio, Verenigde Staten, 44308
- Children's Hospital Medical Center of Akron
-
Cincinnati, Ohio, Verenigde Staten, 45229
- Cincinnati Children's Hospital Medical Center
-
Cleveland, Ohio, Verenigde Staten, 44195
- Cleveland Clinic Foundation
-
Cleveland, Ohio, Verenigde Staten, 44106
- Rainbow Babies and Childrens Hospital
-
Columbus, Ohio, Verenigde Staten, 43205
- Nationwide Children's Hospital
-
Dayton, Ohio, Verenigde Staten, 45404
- Dayton Children's Hospital
-
Toledo, Ohio, Verenigde Staten, 43606
- ProMedica Toledo Hospital/Russell J Ebeid Children's Hospital
-
-
Oklahoma
-
Oklahoma City, Oklahoma, Verenigde Staten, 73104
- University of Oklahoma Health Sciences Center
-
Tulsa, Oklahoma, Verenigde Staten, 74136
- Saint Francis Children's Hospital
-
-
Oregon
-
Portland, Oregon, Verenigde Staten, 97239
- Oregon Health and Science University
-
Portland, Oregon, Verenigde Staten, 97227
- Legacy Emanuel Children's Hospital
-
-
Pennsylvania
-
Allentown, Pennsylvania, Verenigde Staten, 18103
- Lehigh Valley Hospital-Cedar Crest
-
Danville, Pennsylvania, Verenigde Staten, 17822
- Geisinger Medical Center
-
Hershey, Pennsylvania, Verenigde Staten, 17033
- Penn State Children's Hospital
-
Philadelphia, Pennsylvania, Verenigde Staten, 19104
- Children's Hospital of Philadelphia
-
Philadelphia, Pennsylvania, Verenigde Staten, 19134
- Saint Christopher's Hospital for Children
-
Pittsburgh, Pennsylvania, Verenigde Staten, 15224
- Children's Hospital of Pittsburgh of UPMC
-
-
Rhode Island
-
Providence, Rhode Island, Verenigde Staten, 02903
- Rhode Island Hospital
-
-
South Carolina
-
Charleston, South Carolina, Verenigde Staten, 29425
- Medical University of South Carolina
-
Columbia, South Carolina, Verenigde Staten, 29203
- Prisma Health Richland Hospital
-
Greenville, South Carolina, Verenigde Staten, 29605
- BI-LO Charities Children's Cancer Center
-
-
South Dakota
-
Sioux Falls, South Dakota, Verenigde Staten, 57117-5134
- Sanford USD Medical Center - Sioux Falls
-
-
Tennessee
-
Chattanooga, Tennessee, Verenigde Staten, 37403
- T C Thompson Children's Hospital
-
Knoxville, Tennessee, Verenigde Staten, 37916
- East Tennessee Childrens Hospital
-
Nashville, Tennessee, Verenigde Staten, 37232
- Vanderbilt University/Ingram Cancer Center
-
Nashville, Tennessee, Verenigde Staten, 37203
- The Children's Hospital at TriStar Centennial
-
-
Texas
-
Amarillo, Texas, Verenigde Staten, 79106
- Texas Tech University Health Sciences Center-Amarillo
-
Austin, Texas, Verenigde Staten, 78723
- Dell Children's Medical Center of Central Texas
-
Corpus Christi, Texas, Verenigde Staten, 78411
- Driscoll Children's Hospital
-
Dallas, Texas, Verenigde Staten, 75390
- UT Southwestern/Simmons Cancer Center-Dallas
-
Dallas, Texas, Verenigde Staten, 75230
- Medical City Dallas Hospital
-
El Paso, Texas, Verenigde Staten, 79905
- El Paso Children's Hospital
-
Fort Worth, Texas, Verenigde Staten, 76104
- Cook Children's Medical Center
-
Houston, Texas, Verenigde Staten, 77030
- UT MD Anderson Cancer Center
-
Houston, Texas, Verenigde Staten, 77030
- Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center
-
Lubbock, Texas, Verenigde Staten, 79410
- Covenant Children's Hospital
-
Lubbock, Texas, Verenigde Staten, 79415
- UMC Cancer Center / UMC Health System
-
McAllen, Texas, Verenigde Staten, 78503
- Vannie Cook Children's Clinic
-
San Antonio, Texas, Verenigde Staten, 78229
- University of Texas Health Science Center at San Antonio
-
San Antonio, Texas, Verenigde Staten, 78207
- Children's Hospital of San Antonio
-
San Antonio, Texas, Verenigde Staten, 78229
- Methodist Children's Hospital of South Texas
-
Temple, Texas, Verenigde Staten, 76508
- Scott and White Memorial Hospital
-
-
Utah
-
Salt Lake City, Utah, Verenigde Staten, 84113
- Primary Children's Hospital
-
-
Vermont
-
Burlington, Vermont, Verenigde Staten, 05405
- University of Vermont and State Agricultural College
-
-
Virginia
-
Charlottesville, Virginia, Verenigde Staten, 22908
- University of Virginia Cancer Center
-
Falls Church, Virginia, Verenigde Staten, 22042
- Inova Fairfax Hospital
-
Norfolk, Virginia, Verenigde Staten, 23507
- Children's Hospital of The King's Daughters
-
Portsmouth, Virginia, Verenigde Staten, 23708-2197
- Naval Medical Center - Portsmouth
-
Richmond, Virginia, Verenigde Staten, 23298
- VCU Massey Comprehensive Cancer Center
-
Roanoke, Virginia, Verenigde Staten, 24014
- Carilion Children's
-
-
Washington
-
Seattle, Washington, Verenigde Staten, 98105
- Seattle Children's Hospital
-
Spokane, Washington, Verenigde Staten, 99204
- Providence Sacred Heart Medical Center and Children's Hospital
-
Tacoma, Washington, Verenigde Staten, 98405
- Mary Bridge Children's Hospital and Health Center
-
Tacoma, Washington, Verenigde Staten, 98431
- Madigan Army Medical Center
-
-
West Virginia
-
Charleston, West Virginia, Verenigde Staten, 25304
- Vandalia Health/CAMC Institute for Academic Medicine
-
Huntington, West Virginia, Verenigde Staten, 25701
- Edwards Comprehensive Cancer Center
-
Morgantown, West Virginia, Verenigde Staten, 26506
- West Virginia University Healthcare
-
-
Wisconsin
-
Green Bay, Wisconsin, Verenigde Staten, 54301
- Saint Vincent Hospital Cancer Center Green Bay
-
Madison, Wisconsin, Verenigde Staten, 53792
- University of Wisconsin Carbone Cancer Center - University Hospital
-
Marshfield, Wisconsin, Verenigde Staten, 54449
- Marshfield Medical Center-Marshfield
-
Milwaukee, Wisconsin, Verenigde Staten, 53226
- Children's Hospital of Wisconsin
-
-
Deelname Criteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
Accepteert gezonde vrijwilligers
Geslachten die in aanmerking komen voor studie
Beschrijving
Inclusion Criteria:
-
All B-ALL patients must be enrolled on APEC14B1 and consented to Eligibility Screening (Part A) prior to treatment and enrollment on AALL1731. APEC 14B1 is not a requirement for B-LLy patients. B-LLy patients may directly enroll on AALL1731.
-
Age at diagnosis:
- Patients must be >= 365 days and < 10 years of age (B-ALL patients without DS).
- Patients must be >= 365 days and =< 31 years of age (B-ALL patients with DS).
- Patients must be >= 365 days and =< 31 years of age (B-LLy patients with or without DS).
-
B-ALL patients without DS must have an initial white blood cell count < 50,000/uL (performed within 7 days prior to enrollment).
-
B-ALL patients with DS are eligible regardless of the presenting white blood cell count (WBC) (performed within 7 days prior to enrollment).
-
Patient has newly diagnosed B-cell ALL, with or without Down syndrome: > 25% blasts on a bone marrow (BM) aspirate;
- OR if a BM aspirate is not obtained or is not diagnostic of B-ALL, the diagnosis can be established by a pathologic diagnosis of B-ALL on a BM biopsy;
- OR a complete blood count (CBC) documenting the presence of at least 1,000/uL circulating leukemic cells;
- OR patient has newly diagnosed B-cell LLy Murphy stages I or II, with or without Down syndrome.
- Note: For B-LLy patients with tissue available for flow cytometry, the criterion for diagnosis should be analogous to B-ALL. For tissue processed by other means (i.e., paraffin blocks), the methodology and criteria for immunophenotypic analysis to establish the diagnosis of B-LLy defined by the submitting institution will be accepted (diagnostic biopsy for B-LLy must be performed within 14 days prior to enrollment).
-
All patients and/or their parents or legal guardians must sign a written informed consent.
-
All institutional, Food and Drug Administration (FDA), and National Cancer Institute (NCI) requirements for human studies must be met.
Exclusion Criteria:
-
Patient must not have secondary ALL that developed after treatment of a prior malignancy with cytotoxic chemotherapy. Note: patients with Down syndrome with a prior history of transient myeloproliferative disease (TMD) are not considered to have had a prior malignancy. They would therefore be eligible whether or not the TMD was treated with cytarabine.
-
With the exception of steroid pretreatment or the administration of intrathecal cytarabine, patients must not have received any prior cytotoxic chemotherapy for either the current diagnosis of B ALL or B LLy or for any cancer diagnosed prior to initiation of protocol therapy on AALL1731.
-
For patients receiving steroid pretreatment, the following additional exclusion criteria apply:
- Non-DS B-ALL patients must not have received steroids for more than 24 hours in the 2 weeks prior to diagnosis without a CBC obtained within 3 days prior to initiation of the steroids.
- DS and non-DS B-LLy patients must not have received > 48 hours of oral or IV steroids within 4 weeks of diagnosis.
-
Patients who have received > 72 hours of hydroxyurea within 1 week (7 days) prior to the start of systemic protocol therapy.
-
B-ALL patients who do not have sufficient diagnostic bone marrow submitted for APEC14B1 diagnostic testing and who do not have a peripheral blood sample submitted containing > 1,000/uL circulating leukemia cells.
-
Patient must not have acute undifferentiated leukemia (AUL).
-
Non-DS B-ALL patients with central nervous system [CNS]3 leukemia (CNS status must be known prior to enrollment).
- Note: DS patients with CNS3 disease are eligible but will be assigned to the DS-High B-ALL arm. CNS status must be determined based on a sample obtained prior to administration of any systemic or intrathecal chemotherapy, except for steroid pretreatment.
-
Non-DS B-ALL patients with testicular leukemia. (Note: DS patients with testicular disease are eligible but will be assigned to the DS-High B-ALL arm).
-
For LLy patients, the following additional exclusion criteria apply:
- T-Lymphoblastic Lymphoma.
- Morphologically unclassifiable lymphoma.
- Absence of both B-cell and T-cell phenotype markers in a case submitted as lymphoblastic lymphoma.
- CNS positive disease or testicular involvement.
- M2 (5% - 25% blasts) or M3 (> 25% blasts) marrow.
-
Patients with known Charcot-Marie-Tooth disease.
-
Patients with known MYC translocation associated with mature (Burkitt) B-cell ALL, regardless of blast immunophenotype.
-
Patients requiring radiation at diagnosis.
-
Female patients who are pregnant since fetal toxicities and teratogenic effects have been noted for several of the study drugs. A pregnancy test is required for female patients of childbearing potential.
-
Lactating females who plan to breastfeed their infants.
-
Sexually active patients of reproductive potential who have not agreed to use an effective contraceptive method for the duration of their study participation.
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Behandeling
- Toewijzing: Gerandomiseerd
- Interventioneel model: Parallelle opdracht
- Masker: Geen (open label)
Wapens en interventies
Deelnemersgroep / Arm |
Interventie / Behandeling |
|---|---|
|
Actieve vergelijker: Arm A (SR-Avg control)
Arm A: See detailed description. |
Given IV
Andere namen:
Given IV
Andere namen:
Given IV
Andere namen:
Given PO
Andere namen:
Given PO or IV
Andere namen:
Given IV or IM
Andere namen:
Given PO or IV
Andere namen:
Given PO
Andere namen:
Given IT or IV
Andere namen:
Given IV or IM
Andere namen:
Given PO
Andere namen:
Given IT or IV
Andere namen:
Given PO or IV
Andere namen:
|
|
Experimenteel: Arm B (SR-Avg experimental)
Arm B: See detailed description. |
Given IV
Andere namen:
Given IV
Andere namen:
Given IV
Andere namen:
Given IV
Andere namen:
Given PO
Andere namen:
Given PO or IV
Andere namen:
Given IV or IM
Andere namen:
Given PO or IV
Andere namen:
Given PO
Andere namen:
Given IT or IV
Andere namen:
Given IV or IM
Andere namen:
Given PO
Andere namen:
Given IT or IV
Andere namen:
|
|
Actieve vergelijker: Arm C (SR-High Control)
Arm C: See detailed description. |
Given IV
Andere namen:
Given IV
Andere namen:
Given IV
Andere namen:
Given PO
Andere namen:
Given PO or IV
Andere namen:
Given IV or IM
Andere namen:
Given PO or IV
Andere namen:
Given PO
Andere namen:
Given IT or IV
Andere namen:
Given IV or IM
Andere namen:
Given PO
Andere namen:
Given IT or IV
Andere namen:
Given PO or IV
Andere namen:
Given PO or IV
Andere namen:
|
|
Experimenteel: Arm D (SR-High experimental)
Arm D See detailed description. |
Given IV
Andere namen:
Given IV
Andere namen:
Given IV
Andere namen:
Given IV
Andere namen:
Given PO
Andere namen:
Given PO or IV
Andere namen:
Given IV or IM
Andere namen:
Given PO or IV
Andere namen:
Given PO
Andere namen:
Given IT or IV
Andere namen:
Given IV or IM
Andere namen:
Given PO
Andere namen:
Given IT or IV
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Given PO or IV
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Given PO or IV
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|
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Experimenteel: B-LLy
See detailed description. |
Given IV
Andere namen:
Given IV
Andere namen:
Given IV
Andere namen:
Given PO
Andere namen:
Given PO or IV
Andere namen:
Given IV or IM
Andere namen:
Given PO or IV
Andere namen:
Given PO
Andere namen:
Given IT or IV
Andere namen:
Given IV or IM
Andere namen:
Given PO
Andere namen:
Given IT or IV
Andere namen:
Given PO or IV
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Given PO or IV
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Experimenteel: DS B-ALL
See detailed description. |
Given IV
Andere namen:
Given IV
Andere namen:
Given IV
Andere namen:
Given PO
Andere namen:
Given PO or IV
Andere namen:
Given IV or IM
Andere namen:
Given PO or IV
Andere namen:
Given PO
Andere namen:
Given IT or IV
Andere namen:
Given IV or IM
Andere namen:
Given PO
Andere namen:
Given IT or IV
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Undergo cranial radiation therapy
Andere namen:
Undergo testicular radiation therapy
Andere namen:
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Experimenteel: NCI SR or HR DS B-ALL
See detailed description. |
Given IV
Andere namen:
Given IV
Andere namen:
Given IV
Andere namen:
Given PO
Andere namen:
Given PO or IV
Andere namen:
Given IV or IM
Andere namen:
Given PO or IV
Andere namen:
Given IV or IM
Andere namen:
Given PO
Andere namen:
Given IT or IV
Andere namen:
Given PO or IV
Andere namen:
Given PO or IV
Andere namen:
|
Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
|
Disease free survival (DFS) in randomization eligible patients with higher risk features (SR-High) or standard risk average (SR-Avg) B-ALL patients based on randomization with addition of blinatumomab
Tijdsspanne: 5.3 years
|
Will be assessed in SR-High patients and SR-Avg B-ALL patients who are negative for MRD by flow cytometry but have detectable or indeterminate MRD as measured by high throughput sequencing (HTS) at end of induction (EOI), and patients with double trisomy of chromosomes 4 and 10 (DT) with MRD (flow) 0.01% - < 0.1%. DFS is calculated as the time from randomization at the end of consolidation to first event (relapse, second malignancy, remission death) or censored at date of last contact. Five year DFS estimates will be calculated from the point of randomization for both groups. Two-sided 95% confidence intervals will be calculated. |
5.3 years
|
|
DFS in boys in the SR-favorable subset of SR B-ALL with or without Down syndrome (DS)
Tijdsspanne: 5.1 years
|
DFS is calculated as the time from end of induction to first event (relapse, second malignancy, remission death) or censored at date of last contact. A five year DFS estimate and two-sided 80% confidence interval will be calculated. |
5.1 years
|
Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
|
DFS for patients with SR-Avg B-ALL who are negative for MRD measured by flow cytometry and HTS at EOI when treated with standard chemotherapy with a treatment duration of 2 years from the start of interim maintenance (IM)1, regardless of sex
Tijdsspanne: 5.1 years
|
DFS is calculated as the time from end of induction to first event (relapse, second malignancy, remission death) or censored at date of last contact. A five year DFS estimate and a two-sided 95% confidence interval will be calculated. |
5.1 years
|
|
DFS for patients with standard-risk favorable (SR-Fav) B-ALL when treated with a standard chemotherapy regimen
Tijdsspanne: 5.1 years
|
DFS is calculated as the time from end of induction to first event (relapse, second malignancy, remission death) or censored at date of last contact. A five year DFS estimate and a two-sided 95% confidence interval will be calculated. |
5.1 years
|
|
Treatment-related mortality in Down syndrome high risk (DS-high) patients after replacement of intensive elements of standard chemotherapy (omission of anthracyclines in induction, omission of the second month of DI) with 3 cycles of blinatumomab
Tijdsspanne: 2.3 years
|
Percent of DS-high patients with treatment related mortalities will be reported with 95% confidence interval. |
2.3 years
|
|
DFS of DS-High B-ALL patients when intensive elements of chemotherapy are replaced with 3 cycles of blinatumomab
Tijdsspanne: 5.3 years
|
DFS is calculated as the time from the end of consolidation to first event (relapse, second malignancy, remission death) or censored at date of last contact. A five year DFS estimate and a two-sided 80% confidence interval will be calculated. |
5.3 years
|
|
DFS of patients with localized B-lymphoblastic lymphoma (B-LLy) receiving standard risk acute lymphoblastic leukemia therapy
Tijdsspanne: 5 years
|
DFS is calculated as the time from study enrollment to first event (disease progression, relapse, second malignancy, remission death) or censored at date of last contact. A five year DFS estimate and a two-sided 95% confidence interval will be calculated. |
5 years
|
|
Change in neurocognitive functioning from baseline to end-of-therapy between children from poor (defined as presence of household material hardship [HMH], including either food, housing or energy insecurity) and non-poor families (absence of HMH)
Tijdsspanne: 3.3 years
|
Neurocognitive functioning will be measured by the CogState Cognitive Composite at end of induction therapy and at follow-up one year off-therapy among patients with ALL ages 4-< 10 years at the time of diagnosis. Mean and 95% confidence interval for change scores will be reported by HMH group. |
3.3 years
|
|
Caregiver burden as measured by the Mean Total score from the Care of My Child with Cancer questionnaire among a subset of children enrolled in the HMH and neurocognitive outcome study
Tijdsspanne: 1 year
|
The Mean Total score from the Care of My Child with Cancer questionnaire from end of Maintenance Cycle 1. Mean scores and 95% confidence intervals will be reported by randomization group. |
1 year
|
|
Caregiver burden as measured by the At-Work Productivity Loss summary score from the Caregiver Work Limitations questionnaire among a subset of children enrolled in the HMH and neurocognitive outcome study
Tijdsspanne: 1 year
|
The Mean Total score from the Care of My Child with Cancer questionnaire from end of Maintenance Cycle 1. Mean scores and 95% confidence intervals will be reported by randomization group. |
1 year
|
|
Peripheral blood (PB) samples using HTS MRD vs. bone marrow (BM) results at EOI
Tijdsspanne: 1 year
|
Will use the Kendall's Tau-b rank correlation coefficient accounting for the left censoring inherent to sensitivity of the method. A high positive value would be strong evidence that the PB retains the relative information contained in the BM readings. An estimate and two-sided 95% Confidence interval will be calculated using banked SR-Average and SR-High samples at EOI. |
1 year
|
|
BM using HTS MRD vs. BM by flow cytometry at EOC in patients who were Day 29 MRD positive by flow cytometry
Tijdsspanne: 1 year
|
Will use the Kendall's Tau-b rank correlation coefficient accounting for the left censoring inherent to sensitivity of the methods30. A high positive value would be strong evidence that HTS of IgH loci determined-MRD from the BM at EOC retains the relative information contained in the flow-cytometry-determined readings. An estimate and 95% Confidence interval will be calculated using pairs of banked samples at EOC. |
1 year
|
Andere uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
|
To explore adaptive and innate immune functions and host genetic factors associated with severe infectious complications in children with DS B-ALL
Tijdsspanne: 5 years
|
FlowSom high resolution clustering approach to identify cellular subsets and/or activation states (endophenotypes) that distinguish cases from controls. Perform secondary analysis using the "diffCyt" framework to identify those cell clusters that differ significantly between groups. |
5 years
|
|
Neurocognitive, functional, and quality of life outcomes in patients with DS and ALL
Tijdsspanne: 5 years
|
Measured by caregiver (parent/legal guardian) using questionnaires that rate executive function, behavior, adaptive skills, and quality of life. |
5 years
|
|
Prevalence of minimal marrow disease (MMD) in B-LLy
Tijdsspanne: 5 years
|
Correlate MMD at diagnosis with outcome in patients with B-LLy. |
5 years
|
|
Genetic landscape of B-ALL lacking a clonal Ig sequence
Tijdsspanne: 5 years
|
Will be measured by performing targeted sequencing (hemoglobin [heme] deoxyribonucleic acid [DNA] mutation and ribonucleic acid [RNA] fusion panels) on samples from all identified patients without a clonal Ig sequence with banked material and compare to matched subjects with clonal Ig sequences. Will determine associations between having or lacking a clonal Ig sequence and discrete mutations/fusions using Fisher's exact test. Will also be assessed with a 1-sided alpha of 0.05, a log-rank test. |
5 years
|
|
Association between flow cytometry
Tijdsspanne: At the end of induction
|
Will be determined by MRD and HTS of IgH loci from the BM in NCI SR B-ALL patients who are MRD positive by flow cytometry. Will use the Kendall's Tau-b rank correlation coefficient accounting for the left censoring inherent to sensitivity of the methods. A high positive value would be strong evidence that the PB retains the relative information contained in the BM readings. An estimate and two-sided 95% Confidence interval will be calculated using banked SR-Average and SR-High samples. |
At the end of induction
|
|
Differences in cerebrospinal fluid (CSF) metabolites clustered in glycerophospholipid metabolic pathways will distinguish patients with versus without neurocognitive decline
Tijdsspanne: Up to 5 years
|
The metabolic composition of CSF will be analyzed using liquid chromatography/multiple-stage mass spectrometry. Pathway analysis will be used to test whether the set of metabolites that best discriminate between groups are enriched within glycerophospholipid metabolic pathways. Discriminant analysis and dimensionality reduction will be used to cluster samples. Receiver operating curve analysis will be used to characterize the performance of the clustering algorithm. |
Up to 5 years
|
|
Ability of next-generation sequencing assays to detect and track leukemic cell-free deoxyribonucleic acid (cfDNA) in cerebrospinal fluid
Tijdsspanne: Up to 5 years
|
Will describe the frequency of detectable leukemic cfDNA in end of induction and consolidation CSF samples and compare the levels detected by each method. We will also compare patterns of detectable leukemic cfDNA between patients who did and did not experience a subsequent relapse involving the CNS. |
Up to 5 years
|
|
Intra-tumoral clonal heterogeneity and cell developmental state in NCI SR B-ALL patients and determine its relationship to immunoglobulin clonality and response to therapy
Tijdsspanne: Up to 5 years
|
Will compare the cell developmental state of samples obtained from patients at diagnosis without a dominant recombined immunoglobulin (Ig) sequence to a matched cohort of those with one or more dominant Ig sequence(s) as determined by Ig high-throughput sequencing already performed on these samples. |
Up to 5 years
|
Medewerkers en onderzoekers
Sponsor
Onderzoekers
- Hoofdonderzoeker: Sumit Gupta, Children's Oncology Group
Publicaties en nuttige links
Algemene publicaties
- Sora F, Annunziata M, Laurenti L, Giammarco S, Chiusolo P, Innocenti I, Autore F, Metafuni E, Galli E, Bacigalupo A, Ferrara F, Sica S. Blinatumomab as a successful and safe therapy in Down syndrome patients with relapsed/refractory b-precursor acute lymphoblastic leukaemia: Case reports and literature review. Pediatr Blood Cancer. 2021 Jul;68(7):e29044. doi: 10.1002/pbc.29044. Epub 2021 Apr 12. No abstract available.
- Gupta S, Rau RE, Kairalla JA, Rabin KR, Wang C, Angiolillo AL, Alexander S, Carroll AJ, Conway S, Gore L, Kirsch I, Kubaney HR, Li AM, McNeer JL, Militano O, Miller TP, Moyer Y, O'Brien MM, Okada M, Reshmi SC, Shago M, Wagner E, Winick N, Wood BL, Haworth-Wright T, Zaman F, Zugmaier G, Zupanec S, Devidas M, Hunger SP, Teachey DT, Raetz EA, Loh ML. Blinatumomab in Standard-Risk B-Cell Acute Lymphoblastic Leukemia in Children. N Engl J Med. 2025 Feb 27;392(9):875-891. doi: 10.1056/NEJMoa2411680. Epub 2024 Dec 7.
Studie record data
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Primaire voltooiing (Geschat)
Studie voltooiing (Geschat)
Studieregistratiedata
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Eerst ingediend dat voldeed aan de QC-criteria
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Laatst geverifieerd
Meer informatie
Termen gerelateerd aan deze studie
Aanvullende relevante MeSH-voorwaarden
- Neurologische manifestaties
- Ziekten van het zenuwstelsel
- Neoplasmata
- Genetische ziekten, aangeboren
- Ziekten van het immuunsysteem
- Infecties
- Virusziekten
- Neoplasmata per histologisch type
- Neurologische gedragsmanifestaties
- Hematologische ziekten
- DNA-virusinfecties
- Lymfatische ziekten
- Lymfoproliferatieve aandoeningen
- Immunoproliferatieve aandoeningen
- Lymfoom, non-Hodgkin
- Aangeboren afwijkingen
- Lymfoom, B-cel
- Lymfoom
- Afwijkingen, meerdere
- Verstandelijk gehandicapt
- Leukemie, Lymfoïde
- Leukemie
- Epstein-Barr-virusinfecties
- Herpesviridae-infecties
- Tumorvirusinfecties
- Chromosoomaandoeningen
- Voorlopercel lymfoblastische leukemie-lymfoom
- Aangeboren, erfelijke en neonatale ziekten en afwijkingen
- Hemische en lymfatische ziekten
- Burkitt lymfoom
- Syndroom van Down
- Precursor B-cel lymfoblastische leukemie-lymfoom
- Zwavelverbindingen
- Organische chemicaliën
- Heterocyclische verbindingen, 1-ring
- Heterocyclische verbindingen
- Heterocyclische verbindingen, 2-ring
- Heterocyclische verbindingen, gefuseerd ring
- Therapeutica
- Nucleïnezuren, nucleotiden en nucleosiden
- Koolwaterstoffen
- Koolwaterstoffen, cyclisch
- Koolhydraten
- Fysieke fenomeen
- Alkaloïden
- Polycyclische aromatische koolwaterstoffen
- Koolwaterstoffen, aromatisch
- Polycyclische verbindingen
- Glycosiden
- Hydrolasen
- Enzymen
- Enzymen en co -enzymen
- Indolen
- Purines
- Cytidine
- Pyrimidine -nucleosiden
- Pyrimidines
- Zwangerschap
- Zwangere
- Steroïden
- Verbindingen met gefuseerde ring
- Steroïden, gefluoreerd
- Benzeenderivaten
- Sulfonzuren
- Zwavelzuren
- Fosforamide mosterd
- Stikstofmosterdverbindingen
- Mosterdverbindingen
- Koolwaterstoffen, gehalogeneerd
- Fosforamides
- Organofosforverbindingen
- Nucleosiden
- Formyltetrahydrofolates
- Tetrahydrofolaten
- Foliumzuur
- Pterins
- Pteridines
- Zwangerschap
- Zwangerschap
- Amidohydrolasen
- Vinca -alkaloïden
- Secologanin tryptamine alkaloïden
- Indol alkaloïden
- Indolizidines
- Indolizines
- Arabinonucleosides
- Aminopterine
- Antracyclines
- Naftacenes
- Aminoglycosides
- Co -enzymen
- Daunorubicine
- Benzenesulfonaten
- Arylsulfonaten
- Arylsulfonzuren
- Sulfhydrylverbindingen
- Dexamethason
- Methotrexaat
- Prednison
- Prednisolon
- Cyclofosfamide
- Cytarabine
- Leucovorin
- Doxorubicine
- Vincristine
- Methylprednisolon
- Asparaginase
- Mercaptopurine
- Thioguanine
- Calciumdobesilaat
- Radiotherapie
- Bestraling
- blinatumomab
- Dexamethason 21-fosfaat
- deltacorteen
- prednylidene
- N, N-dicyclohexyl-isoborneol-10-sulfonamide
- azathiopurine
- Merphos
- pegaspargase
- auricularum
- Dexamethason acetaat
- Asparaginase Erwinia chrysanthemi recombinant
Andere studie-ID-nummers
- NCI-2019-02187
- U10CA180886 (Subsidie/contract van de Amerikaanse NIH)
- NCI-2019-02187 (Register-ID: CTRP (Clinical Trial Reporting Program))
- AALL1731 (Andere identificatie: CTEP)
- AALL1731 (Andere identificatie: Children's Oncology Group)
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