Alemtuzumab With or Without Methotrexate and Mercaptopurine in Treating Young Patients With Relapsed Acute Lymphoblastic Leukemia

Inclusion Criteria: Diagnosis of acute lymphoblastic leukemia (ALL) Meets 1 of the following criteria: Second or subsequent bone marrow relapse Failed ≥ 2 regimens for remission induction Patients who relapse while receiving standard ALL maintenance chemotherapy do not require a waiting period prior to study entry More than 25% blasts in bone marrow aspirate (M3 marrow) CD52 expression on ≥ 25% of malignant cells at relapse Philadelphia chromosome-positive patients must have failed prior imatinib mesylate Performance status - Karnofsky 50-100% (for patients > 10 years of age) Performance status - Lansky 50-100% (for patients ≤ 10 years of age) At least 8 weeks ALT ≤ 5 times upper limit of normal (ULN) Bilirubin ≤ 1.5 times ULN Creatinine clearance or radioisotope glomerular filtration rate ≥ 70 mL/min Creatinine normal for age Pulse oximetry > 94% No evidence of dyspnea at rest No exercise intolerance No serious uncontrolled infection No autoimmune hemolytic anemia No autoimmune thrombocytopenia Not pregnant or nursing No nursing for 3 months after study participation Negative pregnancy test Fertile patients must use effective contraception during and for 6 months after study participation Seizure disorder allowed provided patients are on anticonvulsants and symptoms are well controlled CNS toxicity ≤ grade 2 No other serious uncontrolled medical condition (e.g., diabetes) Recovered from prior immunotherapy At least 8 weeks since prior biologic agents (e.g., monoclonal antibodies) More than 1 week since prior growth factor(s) At least 4 months since prior stem cell transplantation No evidence of active acute or chronic graft-versus-host disease post allogeneic stem cell transplantation No prior alemtuzumab or its components No other concurrent anticancer immunomodulating agents Recovered from prior chemotherapy One dose of prior intrathecal (IT) methotrexate, cytarabine, and hydrocortisone; IT cytarabine alone; or IT methotrexate alone allowed as part of initial diagnostic spinal tap Prior hydroxyurea therapy allowed No other concurrent anticancer chemotherapy agents Prior steroid therapy allowed More than 2 weeks since prior radiotherapy and recovered