Combination Chemotherapy in Treating Young Patients With Newly Diagnosed T-Cell Acute Lymphoblastic Leukemia or T-cell Lymphoblastic Lymphoma
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The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. |
| ClinicalTrials.gov Identifier: NCT00408005 |
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Recruitment Status :
Active, not recruiting
First Posted : December 5, 2006
Results First Posted : June 20, 2019
Last Update Posted : April 5, 2024
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Sponsor:
National Cancer Institute (NCI)
Information provided by (Responsible Party):
National Cancer Institute (NCI)
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Brief Summary:
This randomized phase III trial is studying different combination chemotherapy regimens and their side effects and comparing how well they work in treating young patients with newly diagnosed T-cell acute lymphoblastic leukemia or T-cell lymphoblastic lymphoma. Drugs used in chemotherapy work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Giving more than one drug (combination chemotherapy) may kill more cancer cells. It is not yet known which combination chemotherapy regimen is more effective in treating T-cell acute lymphoblastic leukemia or T-cell lymphoblastic lymphoma. After a common induction therapy, patients were risk assigned and eligible for one or both post-induction randomizations: Escalating dose Methotrexate versus High Dose Methotrexate in Interim Maintenance therapy, No Nelarabine versus Nelarabine in Consolidation therapy. T-ALL patients are risk assigned as Low Risk, Intermediate Risk or High Risk. Low Risk patients are not eligible for the Nelarabine randomization, Patients with CNS disease at diagnosis were assgined to receive High Dose Methotrexate, patients who failed induction therapy were assigned to receive Nelarabine and High Dose Methotrexate. T-LLy patients were all assigned to escalating dose Methotrexate and were risk assigned as Standard Risk, High Risk and induction failures. Standard risk patients did not receive nelarabine, High risk T-LLy patients were randomized to No Nelarabine versus Nelarabine, and Induction failures were assigned to receive Nelarabine.
| Condition or disease | Intervention/treatment | Phase |
|---|---|---|
| T Acute Lymphoblastic Leukemia T Lymphoblastic Lymphoma | Drug: Asparaginase Drug: Cyclophosphamide Drug: Cytarabine Drug: Daunorubicin Hydrochloride Drug: Dexamethasone Drug: Doxorubicin Hydrochloride Other: Laboratory Biomarker Analysis Drug: Leucovorin Calcium Drug: Mercaptopurine Drug: Methotrexate Drug: Nelarabine Drug: Pegaspargase Drug: Prednisone Radiation: Radiation Therapy Drug: Thioguanine Drug: Vincristine Sulfate | Phase 3 |
Show detailed description
| Study Type : | Interventional (Clinical Trial) |
| Actual Enrollment : | 1895 participants |
| Allocation: | Randomized |
| Intervention Model: | Parallel Assignment |
| Masking: | None (Open Label) |
| Primary Purpose: | Treatment |
| Official Title: | Intensified Methotrexate, Nelarabine (Compound 506U78) and Augmented BFM Therapy for Children and Young Adults With Newly Diagnosed T-cell Acute Lymphoblastic Leukemia (ALL) or T-cell Lymphoblastic Lymphoma |
| Actual Study Start Date : | January 22, 2007 |
| Actual Primary Completion Date : | September 30, 2017 |
| Estimated Study Completion Date : | March 7, 2025 |
Resource links provided by the National Library of Medicine
| Arm | Intervention/treatment |
|---|---|
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Experimental: Group 0 Induction Therapy
All patients (T-ALL and T-LLy) receive cytarabine intrathecally (IT) on day 1; vincristine sulfate IV on days 1, 8, 15, and 22; prednisone IV or PO twice daily BID on days 1-28; pegaspargase IM (may give IV over 1 to 2 hours) on day 4, 5, or 6; daunorubicin hydrochloride IV on days 1, 8, 15 and 22; and methotrexate IT on days 8 and 29 (and days 15 and 22 for patients with CNS3 disease).
|
Drug: Cytarabine
Given IT, IV, or SC
Other Names:
Drug: Daunorubicin Hydrochloride Given IV
Other Names:
Drug: Methotrexate Given IT or PO
Other Names:
Drug: Pegaspargase Given IM or IV
Other Names:
Drug: Prednisone Given IV or PO
Other Names:
Drug: Vincristine Sulfate Given IV
Other Names:
|
|
Active Comparator: Group 1 Arm IV (Consolidation chemotherapy)
Patients receive nelarabine IV over 60 minutes on days 1-5 and 43-47; methotrexate IT on days 15, 22, 57, and 64; cyclophosphamide IV over 30 minutes on days 8 and 50; cytarabine IV over 15-30 minutes or SC on days 8-11, 15-18, 50-53 and 57-60; mercaptopurine PO on days 8-21 and 50-63; vincristine sulfate IV on days 22, 29, 64, and 71; and pegaspargase IM or IV over 1-2 hours on days 22 and 64. Patients with persistent testicular disease or with DS and testicular disease undergo testicular radiotherapy on days 15, 22-26, and 29-33 (DS patients excluded as of 09/29/10). (Patients with intermediate-risk or high-risk disease (CNS1 or CNS2) undergo prophylactic CRT QD on days 22-28 and 29-35.
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Drug: Cyclophosphamide
Given IV
Other Names:
Drug: Cytarabine Given IT, IV, or SC
Other Names:
Drug: Mercaptopurine Given PO
Other Names:
Drug: Methotrexate Given IT or PO
Other Names:
Drug: Nelarabine Given IV
Other Names:
Drug: Pegaspargase Given IM or IV
Other Names:
Radiation: Radiation Therapy Some patients undergo testicular and/or prophylactic cranial RT
Other Names:
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|
Active Comparator: Group I Arm I (Consolidation chemotherapy)
Patients receive methotrexate IT on days 1, 8, 15, and 22; cyclophosphamide IV over 30 minutes on days 1 and 29; cytarabine IV over 15-30 minutes or SC on days 1-4, 8-11, 29-32, and 36-39; mercaptopurine PO on days 1-14 and 29-42; vincristine sulfate IV on days 15, 22, 43 and 50; and pegaspargase IM or IV over 1-2 hours on days 15 and 43. Patients with DS also receive leucovorin calcium PO at 48 and 60 hours after each methotrexate dose. Patients with persistent testicular disease or with DS and testicular disease undergo testicular radiotherapy on days 11-12, 15-19, and 22-26. (DS patients excluded as of 09/29/10.) Patients with intermediate-risk or high-risk disease (CNS1 or CNS2) undergo prophylactic CRT (1,200 cGy/dose) QD on days 15-21 and 22-28. Patients with low-risk disease do not undergo CRT. Patients with standard risk T-LLy received Arm I, and those with high risk T-LLy were randomized between Arm I and Arm II combination chemotherapy.
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Drug: Cyclophosphamide
Given IV
Other Names:
Drug: Cytarabine Given IT, IV, or SC
Other Names:
Drug: Leucovorin Calcium Given PO
Other Names:
Drug: Mercaptopurine Given PO
Other Names:
Drug: Methotrexate Given IT or PO
Other Names:
Drug: Pegaspargase Given IM or IV
Other Names:
Radiation: Radiation Therapy Some patients undergo testicular and/or prophylactic cranial RT
Other Names:
Drug: Vincristine Sulfate Given IV
Other Names:
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Active Comparator: Group I Arm I (Delayed intensification chemotherapy
Patients receive vincristine sulfate IV on days 1, 8, 15, 43, and 50; dexamethasone IV or PO BID on days 1-21 (for patients < 10 years of age) OR on days 1-7 and 15-21 (for patients >= 10 years of age and for patients with DS); doxorubicin hydrochloride IV on days 1, 8, and 15; pegaspargase IM or IV over 1-2 hours on day 4, 5, OR 6, AND day 43; methotrexate IT on days 1, 29, and 36; cyclophosphamide IV over 30 minutes on day 29; cytarabine IV over 15-30 minutes or SC on days 29-32 and 36-39; and thioguanine PO on days 29-42. Patients with DS also receive leucovorin calcium PO at 48 and 60 hours after each methotrexate dose (DS patients excluded as of 09/29/10). Standard risk T-LLy patients were assigned to Arm I and those with high risk were randomized between Arm I and Arm II.
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Drug: Cyclophosphamide
Given IV
Other Names:
Drug: Cytarabine Given IT, IV, or SC
Other Names:
Drug: Dexamethasone Given IV or PO
Other Names:
Drug: Doxorubicin Hydrochloride Given IV
Other Names:
Drug: Leucovorin Calcium Given PO
Other Names:
Drug: Methotrexate Given IT or PO
Other Names:
Drug: Pegaspargase Given IM or IV
Other Names:
Drug: Thioguanine Given PO
Other Names:
Drug: Vincristine Sulfate Given IV
Other Names:
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Active Comparator: Group I Arm I (Maintenance chemotherapy)
Patients receive vincristine sulfate IV on days 1, 29, and 57; prednisone PO BID on days 1-5, 29-33, and 57-61; mercaptopurine PO QD on days 1-84; methotrexate PO on days 8, 15, 22, 29, 36, 43, 50, 57, 64, 71, and 78; and methotrexate IT on day 1. Treatment repeats every 84 days until the total duration of study treatment is 2 years from the start of interim maintenance therapy (approximately week 119) (for girls with T-ALL), all patients with T-LLy, and 3 years from the start of interim maintenance therapy (approximately week 171) (for boys with T-ALL).
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Other: Laboratory Biomarker Analysis
Correlative studies Drug: Mercaptopurine Given PO
Other Names:
Drug: Methotrexate Given IT or PO
Other Names:
Drug: Prednisone Given IV or PO
Other Names:
Drug: Vincristine Sulfate Given IV
Other Names:
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Active Comparator: Group I Arm I (Interim maintenance chemotherapy)
Patients receive vincristine sulfate IV and escalating doses of methotrexate IV on days 1, 11, 21, 31, and 41; pegaspargase* IM or IV over 1-2 hours on days 2 and 22; and methotrexate IT on days 1 and 31. Patients with DS also receive leucovorin calcium PO 48 and 60 hours after each methotrexate IT dose (DS patients excluded as of 09/29/10). Note: *Patients with an allergy to pegaspargase receive Erwinia asparaginase on days 2, 4, 6, 8, 10, 12, 22, 24, 26, 28, 30, and 32. |
Drug: Leucovorin Calcium
Given PO
Other Names:
Drug: Methotrexate Given IT or PO
Other Names:
Drug: Pegaspargase Given IM or IV
Other Names:
Drug: Vincristine Sulfate Given IV
Other Names:
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|
Active Comparator: Group I Arm II (Consolidation chemotherapy)
Patients receive nelarabine IV over 60 minutes on days 1-5 and 43-47; methotrexate IT on days 15, 22, 57, and 64; cyclophosphamide IV over 30 minutes on days 8 and 50; cytarabine IV over 15-30 minutes or SC on days 8-11, 15-18, 50-53 and 57-60; mercaptopurine PO on days 8-21 and 50-63; vincristine sulfate IV on days 22, 29, 64, and 71; and pegaspargase IM or IV over 1-2 hours on days 22 and 64. Patients with persistent testicular disease or with DS and testicular disease undergo testicular radiotherapy on days 15, 22-26, and 29-33 (DS patients excluded as of 09/29/10). (Patients with intermediate-risk or high-risk disease (CNS1 or CNS2) undergo prophylactic CRT QD on days 22-28 and 29-35. Patients with high risk T-LLy were either randomized to Arm I or Arm II. Patients with T-LLy who failed induction therapy were assigned to Arm II.
|
Drug: Cyclophosphamide
Given IV
Other Names:
Drug: Cytarabine Given IT, IV, or SC
Other Names:
Drug: Mercaptopurine Given PO
Other Names:
Drug: Methotrexate Given IT or PO
Other Names:
Drug: Nelarabine Given IV
Other Names:
Drug: Pegaspargase Given IM or IV
Other Names:
Radiation: Radiation Therapy Some patients undergo testicular and/or prophylactic cranial RT
Other Names:
Drug: Vincristine Sulfate Given IV
Other Names:
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|
Active Comparator: Group I Arm II (Delayed intensification chemotherapy)
Patients receive vincristine sulfate IV on days 1, 8, 15, and 50; dexamethasone IV or PO BID on days 1-21 (for patients < 10 years of age) OR on days 1-7 and 15-21 (for patients >= 10 years of age); doxorubicin hydrochloride IV on days 1, 8, and 15; pegaspargase IM or IV over 1-2 hours on day 4, 5, OR 6 AND day 50; methotrexate IT on days 1, 36, and 43; nelarabine IV over 60 minutes on days 29-33; cyclophosphamide IV over 30 minutes on day 36; cytarabine IV over 15-30 minutes or SC on days 36-39 and 43-46; and thioguanine PO on days 36-49.
|
Drug: Cyclophosphamide
Given IV
Other Names:
Drug: Cytarabine Given IT, IV, or SC
Other Names:
Drug: Dexamethasone Given IV or PO
Other Names:
Drug: Doxorubicin Hydrochloride Given IV
Other Names:
Drug: Nelarabine Given IV
Other Names:
Drug: Pegaspargase Given IM or IV
Other Names:
Drug: Thioguanine Given PO
Other Names:
Drug: Vincristine Sulfate Given IV
Other Names:
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Active Comparator: Group I Arm II (Interim maintenance chemotherapy)
Patients receive vincristine sulfate IV and escalating doses of methotrexate IV on days 1, 11, 21, 31, and 41; pegaspargase* IM or IV over 1-2 hours on days 2 and 22; and methotrexate IT on days 1 and 31. Note: *Patients with an allergy to pegaspargase receive Erwinia asparaginase on Monday, Wednesday and Friday for two consecutive weeks starting the day of asparaginase substitution. |
Drug: Asparaginase
Given IM or IV
Other Names:
Drug: Methotrexate Given IT or PO
Other Names:
Drug: Pegaspargase Given IM or IV
Other Names:
Drug: Vincristine Sulfate Given IV
Other Names:
|
|
Active Comparator: Group I Arm II (Maintenance chemotherapy)
Patients receive vincristine sulfate, prednisone, mercaptopurine, methotrexate PO, methotrexate IT, and nelarabine in Cycles 1, 2 and 3. Patients then receive treatment (without nelarabine) as follows: vincristine sulfate, prednisone, mercaptopurine, methotrexate PO, and methotrexate IT as in arm II. Treatment (without nelarabine) repeats every 84 days until the total duration of study treatment is 2 years from the start of interim maintenance therapy (approximately week 121) (for girls with T-ALL), and for those with T-LLY, and 3 years from the start of interim maintenance therapy (approximately week 173) (for boys with T-ALL).
|
Drug: Mercaptopurine
Given PO
Other Names:
Drug: Methotrexate Given IT or PO
Other Names:
Drug: Nelarabine Given IV
Other Names:
Drug: Prednisone Given IV or PO
Other Names:
Drug: Vincristine Sulfate Given IV
Other Names:
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Active Comparator: Group I Arm III (Consolidation chemotherapy)
Patients receive methotrexate IT on days 1, 8, 15, and 22; cyclophosphamide IV over 30 minutes on days 1 and 29; cytarabine IV over 15-30 minutes or SC on days 1-4, 8-11, 29-32, and 36-39; mercaptopurine PO on days 1-14 and 29-42; vincristine sulfate IV on days 15, 22, 43 and 50; and pegaspargase IM or IV over 1-2 hours on days 15 and 43. Patients with DS also receive leucovorin calcium PO at 48 and 60 hours after each methotrexate dose. Patients with persistent testicular disease or with DS and testicular disease undergo testicular radiotherapy on days 11-12, 15-19, and 22-26. (DS patients excluded as of 09/29/10.) Patients with intermediate-risk or high-risk disease (CNS1 or CNS2) undergo prophylactic CRT (1,200 cGy/dose) QD on days 15-21 and 22-28. Patients with low-risk disease do not undergo CRT.
|
Drug: Cyclophosphamide
Given IV
Other Names:
Drug: Cytarabine Given IT, IV, or SC
Other Names:
Drug: Leucovorin Calcium Given PO
Other Names:
Drug: Mercaptopurine Given PO
Other Names:
Drug: Methotrexate Given IT or PO
Other Names:
Drug: Pegaspargase Given IM or IV
Other Names:
Radiation: Radiation Therapy Some patients undergo testicular and/or prophylactic cranial RT
Other Names:
Drug: Vincristine Sulfate Given IV
Other Names:
|
|
Active Comparator: Group I Arm III (Delayed intensification chemotherapy)
Patients receive vincristine sulfate IV on days 1, 8, 15, 43, and 50; dexamethasone IV or PO BID on days 1-21 (for patients < 10 years of age) OR on days 1-7 and 15-21 (for patients >= 10 years of age and for patients with DS); doxorubicin hydrochloride IV on days 1, 8, and 15; pegaspargase IM or IV over 1-2 hours on day 4, 5, OR 6, AND day 43; methotrexate IT on days 1, 29, and 36; cyclophosphamide IV over 30 minutes on day 29; cytarabine IV over 15-30 minutes or SC on days 29-32 and 36-39; and thioguanine PO on days 29-42. Patients with DS also receive leucovorin calcium PO at 48 and 60 hours after each methotrexate dose (DS patients excluded as of 09/29/10).
|
Drug: Cyclophosphamide
Given IV
Other Names:
Drug: Cytarabine Given IT, IV, or SC
Other Names:
Drug: Dexamethasone Given IV or PO
Other Names:
Drug: Doxorubicin Hydrochloride Given IV
Other Names:
Drug: Leucovorin Calcium Given PO
Other Names:
Drug: Methotrexate Given IT or PO
Other Names:
Drug: Pegaspargase Given IM or IV
Other Names:
Drug: Thioguanine Given PO
Other Names:
Drug: Vincristine Sulfate Given IV
Other Names:
|
|
Active Comparator: Group I Arm III (Interim maintenance chemotherapy)
Patients receive HDMTX IV over 24 hours and vincristine sulfate IV on days 1, 15, 29, and 43; mercaptopurine PO on days 1-56; and methotrexate IT on days 1 and 29. Beginning 42 hours after the start of HDMTX, patients also receive leucovorin calcium IV or PO once every 6 hours for 3 doses.
|
Other: Laboratory Biomarker Analysis
Correlative studies Drug: Leucovorin Calcium Given PO
Other Names:
Drug: Mercaptopurine Given PO
Other Names:
Drug: Methotrexate Given IT or PO
Other Names:
Drug: Vincristine Sulfate Given IV
Other Names:
|
|
Active Comparator: Group I Arm III (Maintenance chemotherapy)
Patients receive vincristine sulfate IV on days 1, 29, and 57; prednisone PO BID on days 1-5, 29-33, and 57-61; mercaptopurine PO QD on days 1-84; methotrexate PO on days 8, 15, 22, 29, 36, 43, 50, 57, 64, 71, and 78; and methotrexate IT on day 1. Treatment repeats every 84 days until the total duration of study treatment is 2 years from the start of interim maintenance therapy (approximately week 119) (for girls with T-ALL) and all patients with T-LLy, and 3 years from the start of interim maintenance therapy (approximately week 171) (for boys with T-ALL).
|
Drug: Methotrexate
Given IT or PO
Other Names:
Drug: Prednisone Given IV or PO
Other Names:
Drug: Vincristine Sulfate Given IV
Other Names:
|
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Active Comparator: Group I Arm IV (Delayed intensification chemotherapy)
Patients receive vincristine sulfate IV on days 1, 8, 15, and 50; dexamethasone IV or PO BID on days 1-21 (for patients < 10 years of age) OR on days 1-7 and 15-21 (for patients >= 10 years of age); doxorubicin IV on days 1, 8, and 15; pegaspargase IM or IV over 1-2 hours on day 4, 5, OR 6 AND day 50; methotrexate IT on days 1, 36, and 43; nelarabine IV over 60 minutes on days 29-33; cyclophosphamide IV over 30 minutes on day 36; cytarabine IV over 15-30 minutes or SC on days 36-39 and 43-46; and thioguanine PO on days 36-49.
|
Drug: Cyclophosphamide
Given IV
Other Names:
Drug: Cytarabine Given IT, IV, or SC
Other Names:
Drug: Dexamethasone Given IV or PO
Other Names:
Drug: Doxorubicin Hydrochloride Given IV
Other Names:
Drug: Methotrexate Given IT or PO
Other Names:
Drug: Nelarabine Given IV
Other Names:
Drug: Pegaspargase Given IM or IV
Other Names:
Drug: Thioguanine Given PO
Other Names:
Drug: Vincristine Sulfate Given IV
Other Names:
|
|
Active Comparator: Group I Arm IV (Interim maintenance chemotherapy)
Patients receive HDMTX IV over 24 hours and vincristine IV on days 1, 15, 29, and 43; mercaptopurine PO on days 1-56; and methotrexate IT on days 1 and 29. Beginning 42 hours after the start of HDMTX, patients also receive leucovorin calcium IV or PO once every 6 hours for 3 doses.
|
Other: Laboratory Biomarker Analysis
Correlative studies Drug: Leucovorin Calcium Given PO
Other Names:
Drug: Mercaptopurine Given PO
Other Names:
Drug: Methotrexate Given IT or PO
Other Names:
Drug: Vincristine Sulfate Given IV
Other Names:
|
|
Active Comparator: Group I Arm IV (Maintenance chemotherapy)
Patients receive vincristine sulfate, prednisone, mercaptopurine, methotrexate PO, methotrexate IT, and nelarabine in Cycles 1, 2 and 3. Patients then receive treatment (without nelarabine) as follows: vincristine, prednisone, mercaptopurine, methotrexate PO, and methotrexate IT as in arm II. Treatment (without nelarabine) repeats every 84 days until the total duration of study treatment is 2 years from the start of interim maintenance therapy (approximately week 121) (for girls with T-ALL), and for those with T-LLY, and 3 years from the start of interim maintenance therapy (approximately week 173) (for boys with T-ALL).
|
Drug: Mercaptopurine
Given PO
Other Names:
Drug: Methotrexate Given IT or PO
Other Names:
Drug: Nelarabine Given IV
Other Names:
Drug: Prednisone Given IV or PO
Other Names:
Drug: Vincristine Sulfate Given IV
Other Names:
|
Primary Outcome Measures :
- Disease-free Survival (DFS) for Randomized Nelarabine T-ALL Cohort (Arm I vs. Arm II vs. Arm III vs. Arm IV) [ Time Frame: 4 years from randomization at the end of induction ]Disease Free Probability where DFS time is defined as time from randomization end of induction to first event (relapse, second malignant neoplasm, death) or date of last contact for patients who are event-free.
- Disease-free Survival (DFS) for Randomized Nelarabine T-ALL Cohort (Arm I + Arm III vs. Arm II + Arm IV) [ Time Frame: 4 years from randomization at the end of induction ]Disease Free Probability where DFS time is defined as time from randomization end of induction to first event (relapse, second malignant neoplasm, death) or date of last contact for patients who are event
- Disease-free Survival (DFS) for Randomized Methotrexate T-ALL Cohort (Arm I vs. Arm II vs. Arm III vs. Arm IV) [ Time Frame: 4 years from randomization at the end of induction ]Disease-free survival defined as time from randomization end of induction to first event (relapse, second malignant neoplasm, remission death) or date of last contact for those who are event-free.
- Disease-free Survival (DFS) for Randomized Methotrexate T-ALL Cohort (Arm I + Arm II vs. Arm III + Arm IV) [ Time Frame: 4 years from randomization at the end of induction ]Disease Free Probability where DFS time is defined as time from randomization end of induction to first event (relapse, second malignant neoplasm, death) or date of last contact for patients who are event-free.
- Disease-free Survival (DFS) for T-cell Lymphoblastic Lymphoma (T-LLy) Cohort [ Time Frame: 4 years from end of induction ]Disease Free Probability where DFS time is defined as time from randomization end of induction to first event (relapse, second malignant neoplasm, death) or date of last contact for patients who are event-free.
Secondary Outcome Measures :
- Cumulative Incidence of CNS Relapse for T-ALL by Risk Group [ Time Frame: 4 years from randomization at the end of induction ]Cumulative incidence of CNS relapse adjusting for DFS events, was calculated using the method Gray et. al. High risk patients receive cranial radiation and low risk patients receive no cranial radiation.
Information from the National Library of Medicine
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| Ages Eligible for Study: | 1 Year to 30 Years (Child, Adult) |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | No |
Criteria
Inclusion Criteria:
- T-ALL patients must be enrolled on AALL08B1 prior to treatment and enrollment on AALL0434
- Patients must have newly diagnosed T-ALL or T-lineage lymphoblastic lymphoma (T-NHL) stage II-IV; B-lineage lymphoblastic lymphoma will not be eligible for this study; a diagnosis of T-ALL is established when leukemic blasts lack myeloperoxidase or evidence of B-lineage derivation (cluster of differentiation [CD]19/CD22/CD20), and express either surface or cytoplasmic CD3 or two or more of the antigens CD8, CD7, CD5, CD4, CD2 or CD1a; if surface CD3 is expressed on all leukemic cells, additional markers of immaturity, including transmission disequilibrium test (TdT), CD34 or CD99 will be assessed for expression; cases with uncertain expression will receive additional review within the appropriate Children's Oncology Group (COG) reference laboratory
-
T-NHL PATIENTS:
- For T-NHL patients with tissue available for flow cytometry, the criterion for diagnosis should be analogous to T-ALL; for tissue processed by other means (i.e. paraffin blocks), the methodology and criteria for immunophenotypic analysis to establish the diagnosis of T-NHL defined by the submitting institution will be accepted
-
Prior therapy restrictions
- Patients shall have had no prior cytotoxic chemotherapy with the exception of steroids and/or IT cytarabine
- IT chemotherapy with cytarabine is allowed prior to registration for patient convenience; this is usually done at the time of the diagnostic bone marrow or venous line placement to avoid a second lumbar puncture; (Note: the CNS status must be determined based on a sample obtained prior to administration of any systemic or intrathecal chemotherapy, except for steroid pretreatment); systemic chemotherapy must begin within 72 hours of this IT therapy
- Patients diagnosed as having T-NHL or T-ALL with respiratory distress or hyperleukocytosis may require steroids prior to the initiation of additional systemic therapy; they are eligible for AALL0434 and will be stratified, based on the initial complete blood count (CBC); steroid pretreatment may alter the risk group assessment; if the T-ALL patient's clinical status precludes a lumbar puncture within 48 hours of the initiation of steroid therapy, T-ALL patients CANNOT be classified as low risk and will be Intermediate or high risk based on the results of the day 29 marrow as above; patients with T-NHL who receive steroid pre-treatment will be classified as high risk; the dose and duration of previous steroid therapy should be carefully documented
- For the management of airway compromise, patients who have received emergent chest irradiation up to 600 cGy will be eligible for this study
- Patients with a prior seizure disorder requiring anti-convulsant therapy are not eligible to receive nelarabine; in addition, patients with pre-existing grade 2 (or greater) peripheral neurotoxicity, as determined prior to Induction treatment by the treating physician or a neurologist, are not eligible to receive nelarabine; these restrictions in eligibility are designed to prevent excessive nelarabine-induced central and peripheral neurotoxicity in at-risk patients; for the purposes of this study, this includes any patient that has received anticonvulsant therapy to prevent/treat seizures in the prior two years
Exclusion Criteria:
- Pregnant or lactating females are ineligible
- Patients with Down syndrome are ineligible to enroll onto this study
-
For T-NHL patients the following additional exclusion criteria apply:
- B-precursor lymphoblastic lymphoma
- Morphologically unclassifiable lymphoma
- Absence of both B-cell and T-cell phenotype markers in a case submitted as lymphoblastic lymphoma
- CNS3-positive or testicular involvement
Information from the National Library of Medicine
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00408005
Locations
Show 215 study locations
Sponsors and Collaborators
National Cancer Institute (NCI)
Investigators
| Principal Investigator: | Stuart S Winter | Children's Oncology Group |
Study Documents (Full-Text)
Documents provided by National Cancer Institute (NCI):
Documents provided by National Cancer Institute (NCI):
Study Protocol and Statistical Analysis Plan [PDF] March 24, 2016
Additional Information:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
| Responsible Party: | National Cancer Institute (NCI) |
| ClinicalTrials.gov Identifier: | NCT00408005 |
| Other Study ID Numbers: |
NCI-2009-00307 NCI-2009-00307 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) ) COG-AALL0434 07-169 CDR0000514500 AALL0434 ( Other Identifier: Children's Oncology Group ) AALL0434 ( Other Identifier: CTEP ) U10CA098543 ( U.S. NIH Grant/Contract ) U10CA180886 ( U.S. NIH Grant/Contract ) |
| First Posted: | December 5, 2006 Key Record Dates |
| Results First Posted: | June 20, 2019 |
| Last Update Posted: | April 5, 2024 |
| Last Verified: | January 2024 |
Additional relevant MeSH terms:
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Lymphoma Leukemia Precursor Cell Lymphoblastic Leukemia-Lymphoma Leukemia, Lymphoid Lymphoma, Non-Hodgkin Precursor T-Cell Lymphoblastic Leukemia-Lymphoma Neoplasms by Histologic Type Neoplasms Lymphoproliferative Disorders Lymphatic Diseases Immunoproliferative Disorders Immune System Diseases Hematologic Diseases Calcium, Dietary Leucovorin |
Folic Acid Cytarabine 6-methoxypurine arabinoside Dexamethasone Dexamethasone acetate Prednisone Cortisone Cyclophosphamide Doxorubicin Liposomal doxorubicin Methotrexate Vincristine Daunorubicin Asparaginase Mercaptopurine |