Treatment of Newly Diagnosed High Risk Acute Lymphoblastic Leukemia in Children

  • STATUS
    Recruiting
  • End date
    Apr 21, 2023
  • participants needed
    110
  • sponsor
    The Korean Society of Pediatric Hematology Oncology
Updated on 21 January 2021
lymphoid leukemia
methotrexate
white blood cell count
b-cell acute lymphoblastic leukemia
childhood all
blood cell count

Summary

Treatment of pediatric acute lymphoblastic leukemia (ALL) has advanced and the overall survival exceeds 80% nowadays. However the overall survival of high risk ALL remains 75-90%, thus recent studies focus on treatment intensification according to the risk group. According to the previous reports, we designed a multicenter prospective trial for pediatric ALL.

Description

Purpose of the study

  1. For slow early responder (SER), to confirm if the augmented interim maintenance using intravenous high dose methotrexate will improve the treatment outcome.
  2. For slow early responder (SER), to confirm if removal of prophylactic radiotherapy will relieve long term complications.
  3. To predict the treatment response and prognosis high risk pediatric ALL by monitoring of minimal residual disease (MRD).

Inclusion criteria

  1. Diagnosis
  2. Newly diagnosed B-precursor ALL meeting criteria 1.2
  3. Newly diagnosed B-precursor ALL who was previously treated with steroid.
  4. Newly diagnosed T cell ALL, excluding early T-cell precursor (ETP) leukemia

1.2 Initial WBC count

  1. from 1 years old to 9 years old : WBC 50,000/L
  2. from 10 years old to 21 years old : Any WBC
  3. from 1 years old to 21 years old : Any WBC with Testicular leukemia or CNS leukemia (CNS3)

Exclusion criteria (who are classified as very high risk group) 2.1 Philadelphia chromosome (+) or bcr/abl rearrangement (+) 2.2 Chromosome <45 by cytogenetics 2.3 Induction failure (Day 28 M3 marrow (>25% blasts)) 2.4 t(4:11) (as identified by cytogenetics, FISH or molecular studies) 2.5 Early T-cell precursor leukemia 2.6 Down syndrome ALL

Methods We will classify the patients to rapid early responder (RER) and slow early responder (SER), according to the treatment response after induction remission and risk factors at diagnosis. SER includes M2 (5-25% or leukemic cells at bone marrow exam) or M3 (25% or more of leukemic cells at bone marrow exam) response at the 14th day of the start of induction remission. If a patient showed total WBC count 100,000/L, had testis or CNS (CNS 3) involvement at diagnosis and was diagnosed as T-ALL, the patients will also be included into the SER group.

Rapid early responders will undergo interim maintenance two times and reinduction for one time. Slow early responders will undergo two times of interim maintenance treatment with high dose intravenous methotrexate. For SER, adriamycin was previously administered only when absolute neutrophil count and platelet was normal, but it will be administered without restriction in this study. Both groups (RER and SER) will undergo maintenance chemotherapy thereafter, with the treatment duration of 3 years from the 1st interim maintenance for boys and 2 years for girls.

For SER group, prophylactic radiotherapy will not be done and it will be replaced by high dose intravenous methotrexate and intensification of intrathecal chemotherapy by replacing the intrathecal methotrexate to intrathecal cytarabine, methotrexate and hydrocortisone.

Details
Condition childhood ALL, Child, Lymphocytic Leukemia, Acute, acute lymphoblastic leukemia, leukemia, acute lymphoblastic, acute lymphoid leukaemia, acute lymphocytic leukemia, acute lymphoblastic leukemia (all)
Treatment high dose methotrexate, Intrathecal triple chemotherapy
Clinical Study IdentifierNCT02339350
SponsorThe Korean Society of Pediatric Hematology Oncology
Last Modified on21 January 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

Is your age between 1 yrs and 21 yrs?
Gender: Male or Female
Do you have any of these conditions: Child or childhood ALL?
Do you have any of these conditions: acute lymphoblastic leukemia or childhood ALL or Lymphocytic Leukemia, Acute or acute lymphoblastic leukemia (all) or leukemia, acute lymphoblastic or...?
Diagnosis
Newly diagnosed B-precursor ALL meeting criteria 1.2
Newly diagnosed B-precursor ALL who was previously treated with steroid
Newly diagnosed T cell ALL, excluding early T-cell precursor (ETP) leukemia
2 Initial WBC count
from 1 years old to 9 years old : WBC 50,000/L
from 10 years old to 21 years old : Any WBC
from 1 years old to 21 years old : Any WBC with Testicular leukemia or CNS leukemia (CNS3)

Exclusion Criteria

Philadelphia chromosome (+) or bcr/abl rearrangement (+)
Chromosome <45 by cytogenetics
Induction failure (Day 28 M3 marrow (>25% blasts))
t(4:11) (as identified by cytogenetics, FISH or molecular studies)
Early T-cell precursor leukemia
Down syndrome ALL
Clear my responses

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