ALinC 17, Classification ©), B-precursor Induction Treatment (I)
OBJECTIVES:
- To provide the clinical and laboratory data necessary for placing each patient with ALL
onto the proper therapeutic trial. (Classification)
- To provide an administrative base to capture classification data for correlative
studies in ALL treatment protocols and series of historical protocols. (Classification)
- To provide appropriate induction regimens for patients who may then enter risk
specific, post-induction therapeutic trials. (Induction therapy)
- To determine the correlation between event-free survival (EFS) and the following
measures of minimal-residual disease (MRD)/early response (ER): 1) the rate of
peripheral blast count disappearance and the absolute blast count on day 8 as
determined morphologically, by flow cytometry, and using molecular techniques; 2)
Marrow morphology on day 8, and; 3) MRD as determined by flow cytometry and molecular
techniques on bone marrow and peripheral blood samples on day 29. (Induction therapy)
OUTLINE: This is a multicenter study.
- Classification study: Bone marrow or peripheral blood samples are collected and may be
analyzed for B- and T-lineage antigen screening; cytochemical stains; cytogenetics
(karyotype); immunophenotype screening for MLL, E2A-PBX1, TEL-AML1; immunophenotype
detection of minimal-residual disease (MRD); FCM ploidy (DNA index); trisomies 4 and 10
(FISH); molecular testing for BCR/ABL, MLL rearrangements, E2A-PBX1, and TEL-AML1;
molecular detection of MRD - Tγ, Tδ, or IgH; acute lymphoblastic leukemia (ALL) cell
bank; special T-ALL reference laboratory studies (role of tumor suppressor genes in
T-ALL and drug sensitivity profiles in T-ALL); special study for mature B-ALL
[t(18;14)(a24;q32)] by FISH; and hematopathology consultation concerning morphology and
cytochemistry. The immunophenotype results are used to assign patients to a treatment
protocol, to assign patients to post-induction (day 28) risk group and treatment for
patients with B-precursor (non-T, non-B) ALL, and to use as reference laboratory MRD
results.
- Induction therapy study: Patients are entered on stratum 3 (three drugs) for NCI
consensus standard-risk disease (age < 10 years and WBC < 50,000/mm³) or stratum 4
(four drugs) induction therapy for NCI consensus high-risk disease (age ≥ 10 years
and/or WBC ≥ 50,000/mm³ or CNS3 disease or testicular disease).
- Stratum 3: Patients receive oral dexamethasone twice daily on days 1-28;
vincristine sulfate IV on days 1, 8, 15, and 22; pegaspargase intramuscularly (IM)
on day 4, 5, or 6; cytarabine intrathecally (IT) on day 1; and methotrexate IT on
day 8 (some patients also receive methotrexate IT on days 15 and 22).
- Stratum 4: Patients receive oral prednisone twice daily on days 1-28; vincristine
sulfate IV on days 1, 8, 15, and 22; IM SC-PEG E. coli asparaginase IM on days 2,
5, 8, 12, 15, and 19; daunorubicin hydrochloride IV over 15-20 minutes on days 8,
15, and 22; and methotrexate IT on days 1 and 8 (some patients also receive
methotrexate IT on days 15 and 22).
Based on day 29 bone marrow results, patients may start consolidation therapy, undergo
retesting in a week, or receive 2 additional weeks of therapy. Additional therapy comprises
oral prednisone thrice daily for 14 days; vincristine sulfate IV and daunorubicin
hydrochloride IV over 15-20 minutes on days 29 and 36; and IM pegaspargase on day 29, 30, or
31. After successful remission induction, patients are assigned to COG-P9904, COG-P9905, or
COG-P9906 based on the classification study.
Patients undergo bone marrow aspiration on day 8 to determine the prognostic significance of
early remission in the context of this therapy.
After completion of study treatment, patients are followed up every 6 months for 4 years and
annually thereafter.
Interventional
Primary Purpose: Treatment
Collection of the clinical and laboratory data necessary for placing patients with acute lymphoblastic leukemia (ALL) onto the proper therapeutic trial (Classification)
No
Dale J. Pullen, MD
Study Chair
University of Mississippi Cancer Clinic
United States: Federal Government
CDR0000078618
NCT01225874
December 1999
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