Treatment Protocol for Children and Adolescents With Acute Lymphoblastic Leukemia - AIEOP-BFM ALL 2017
Acute Lymphoblastic Leukemia, Pediatric
About this trial
This is an interventional treatment trial for Acute Lymphoblastic Leukemia, Pediatric focused on measuring Acute Lymphoblastic Leukemia, Childhood, Pediatric, Immunotherapy, Blinatumomab, Proteasome Inhibitor, Bispecific antibody, Bortezomib, Chemotherapy, Randomized trial
Eligibility Criteria
Inclusion Criteria:
- newly diagnosed acute lymphoblastic leukemia or
- newly diagnosed mixed phenotype acute leukemia (MPAL) meeting one of the following criteria:
- biphenotypic with a dominant T or B lineage assignment
- bilineal either with a dominant lymphoblastic population or if another reasonable rationale exists to treat the patient with an ALL-based therapy regimen
- newly diagnosed acute undifferentiated leukemia
- age < 18 years (up to 17 years and 365 days) at the day of diagnosis
- patient enrolled in a participating center
- written informed consent to trial participation and transfer and processing of data A subsequent removal from the study is only allowed if the inclusion criteria turn out not to be fulfilled or in the case of pregnancy of the patient.
Exclusion Criteria:
- Ph+ (BCR-ABL1 or t(9;22)-positive) ALL
- bilineal leukemia with a lymphoblastic and a separate non-lymphoblastic (≥ 10% of total cells) blast subset
- pre-treatment with cytostatic drugs
- glucocorticoid pre-treatment with ≥ 1 mg/kg/d for more than two weeks during the last month before diagnosis
- treatment started according to another protocol
- underlying disease that does not allow treatment according to the protocol (e.g. severe congenital heart disease, Charcot-Marie Syndrome, Ataxia-teleangiectasia…)
- ALL diagnosed as second malignancy and preceding chemotherapy and/or radiotherapy
- evidence of pregnancy or lactation period
- Sexually active adolescents not willing to use highly effective contraceptive method (pearl index <1) until 12 months after end of anti-leukemic therapy
- participation in another clinical trial except for add-on trials within the scope of supportive care approved by the sponsor
- live vaccine immunization within 2 weeks before start of protocol treatment
Sites / Locations
- Sydney Children's HospitalRecruiting
- The Children's Hospital at WestmeadRecruiting
- Univ.Klinik für Kinder- und Jugendheilkunde GrazRecruiting
- Univ.Klinik für Kinder- und Jugendheilkunde InnsbruckRecruiting
- Kepler UniversitätsklinikumRecruiting
- LKH SalzburgRecruiting
- St. Anna KinderspitalRecruiting
- University Hospital BrnoRecruiting
- University Hospital Hradec KrálovéRecruiting
- University Hospital OlomoucRecruiting
- University Hospital Ostrava-PorubaRecruiting
- University Hospital PlzeňRecruiting
- University Hospital MotolRecruiting
- Masaryk´s Hospital Ústí nad LabemRecruiting
- Regional Hospital České BudějoviceRecruiting
- Kinderklinik der med. Fakultät der RWTH, Bereich Hämatologie/OnkologieRecruiting
- I. Klinik für Kinder u. Jugendliche, Klinikum Augsburg, Hämatologie/ OnkologieRecruiting
- Klinikum Berlin-Buch II. Kinderklinik, Bereich Onkologie/Allg. PädiatrieRecruiting
- Kinderklinik der Charité, Campus Virchow Klinikum (CVK), Abt.: KinderhämatologieRecruiting
- Städtisches Krankenhaus, KinderklinikRecruiting
- Klinikum Chemnitz gGmbH, Klinik für Kinder- und Jugendmedizin, Hämatologie / OnkologieRecruiting
- Carl-Thiem-Klinikum, Kinderklinik, Abt. Hämatologie/OnkologieRecruiting
- Vestische Kinder- u. Jugendklinik, Universitätsklinik Witten/HerdeckeRecruiting
- Klinikum Dortmund, Klinik f. Kinder- und JugendmedizinRecruiting
- Universitatsklinikum Carl Gustav CarusRecruiting
- UniversitätsklinikRecruiting
- Helios Klinikum Erfurt GmbH, Klinik für KinderheilkundeRecruiting
- Universitaets - KinderklinikRecruiting
- Universitaetsklinikum EssenRecruiting
- Klinikum der J.W. Goethe UniversitaetRecruiting
- Universitaetskinderklinik - Universitaetsklinikum FreiburgRecruiting
- Klinikum der Justus-Liebig-Universität, Zentrum für Kinderheilkunde, Abt. Hämatologie/OnkologieRecruiting
- Klinik und Poliklinik für Kinder und Jugendmedizin, Allgemeine Pädiatrie mit Poliklinik/Pädiatrische Onkologie und HämatologieRecruiting
- Universitäts-Kinderklinik Päd. I, Hämatologie/OnkologieRecruiting
- Medizinische Hochschule Hannover, Zentrum Kinderheilkunde u. JugendmedizinRecruiting
- Universitäts-Kinderklinik, Päd. Onkologie, Hämatologie, und ImmunologieRecruiting
- Klinikum Heilbronn GmbH, Klinik für Kinderheilkunde und Jugendmedizin/PerinatalzentrumRecruiting
- Gemeinschaftskrankenhaus Herdecke, KinderabteilungRecruiting
- Universitaetsklinikum des SaarlandesRecruiting
- Klinikum, der Friedrich-Schiller-Universität, Klinik für Kinder- und JugendmedizinRecruiting
- Staedtisches Klinikum Karlsruhe gGmbHRecruiting
- Klinikum KasselRecruiting
- Klinik für Allgemeine Paediatrie, Univ.-Klinikum Schleswig-Holstein, Campus KielRecruiting
- Kliniken der Stadt Köln GmbH, Kinderkrankenhaus RiehlRecruiting
- Med. Einrichtungen der Universität zu Köln, Klinik für Allg. Kinderheilkunde, Onkologisch-hämatologische StationRecruiting
- Department für Frauen- und Kindermedizin, Abteilung für Pädiatrische Onkologie, Hämatologie und HämostaseologieRecruiting
- Universität zu Lübeck, Klinik für Kinder- u. Jugendmedizin, Abt. Hämatologie/ Onkologie/ImmunologieRecruiting
- Universitätsklinikum Magdeburg, Klinik für Päd. Hämatologie/OnkologieRecruiting
- Klinikum Mannheim gGmbH, Kinderklinik, Abt. Hämatologie/OnkologieRecruiting
- UniversitätsklinikumRecruiting
- Johannes Wesling Klinikum MindenRecruiting
- Städt. Krankenhaus München GmbH, Krankenhaus München-Schwabingen, Kinderklinik d. TURecruiting
- Ludwig-Maximilian-Universität, Dr. von Haunersches KinderspitalRecruiting
- Universitäts-Kinderklinik, Päd. Hämatologie und OnkologieRecruiting
- Cnopf'sche Kinderklinik, OnkologieRecruiting
- Klinikum Oldenburg gGmbH, Zentrum für Kinder- u. Jugendmedizin, (Elisabeth Kinderkrankenhaus)Recruiting
- UniversitätsklinikumRecruiting
- Universitäts-KinderklinikRecruiting
- Asklepios-Klinik, Sankt Augustin GmbHRecruiting
- HELIOS Kliniken Schwerin, Klinik f. Kinder-u. JugendmedizinRecruiting
- Olga-Hospital, Kinderklinik, Pädiatrisches Zentrum, Abt. Hämatologie/OnkologieRecruiting
- Krankenanstalt Trier, Mutterhaus der Borromaeerinnen, Pädiatrische AbteilungRecruiting
- Universitaetsklinikum TuebingenRecruiting
- Comprehensive Cancer Center Ulm at Universitaetsklinikum UlmRecruiting
- Stadtkrankenhaus, KinderklinikRecruiting
- Universitaets - Kinderklinik WuerzburgRecruiting
- Soroka University Medical CenterRecruiting
- Rambam Health Care CampusRecruiting
- Hadassah Medical centerRecruiting
- Schneider Children Medical Center of IsraelRecruiting
- Sheba Medical Center Tel-HashomerRecruiting
- Dana children hospitalRecruiting
- Azienda ospedali riunitiRecruiting
- AOUC Policlinico BariRecruiting
- A.O. Papa Giovanni XXIIIRecruiting
- Università di BolognaRecruiting
- ASST Spedali Civili di BresciaRecruiting
- Ospedale BusincoRecruiting
- Azienda ospedaliero universitariaRecruiting
- AO Pugliese CiaccioRecruiting
- S.O. Annunziata - A. O. CosenzaRecruiting
- Ospedale MeyerRecruiting
- Istituto Giannina GasliniRecruiting
- Policlinico di Modena Azienda Ospedaliero-UniversitariaRecruiting
- Clinica pediatrica Fondazione MBBMRecruiting
- A.O.U. VanvitelliRecruiting
- AORN Santobono PausiliponRecruiting
- Azienda ospedaliera di PadovaRecruiting
- Ospedale Civico ARNAS Civico e Di CristinaRecruiting
- Azienda ospedaliero-universitaria di ParmaRecruiting
- Fondazione IRCCS Policlinico San MatteoRecruiting
- Ospedale S. Maria della misericordiaRecruiting
- Ospedale Civile di PescaraRecruiting
- Ospedale Santa Chiara PisaRecruiting
- Grande ospedale metropolitano B-M-MRecruiting
- Ospedale infermiRecruiting
- Fondazione Policlinico GemelliRecruiting
- Ospedale Bambino GesùRecruiting
- Policlinico Umberto I Università Sapienza di RomaRecruiting
- Ospedale "Casa sollievo della sofferenza"Recruiting
- A.O.U. Città della salute e della scienza di TorinoRecruiting
- IRCCS Burlo GarofoloRecruiting
- AOU VeronaRecruiting
- Klinika pediatrickej hematológie a onkológie SZU a DFNsPRecruiting
- Comenius University Children's HospitalRecruiting
- Detská fakultná nemocnica KošiceRecruiting
- Kantonsspital AarauRecruiting
- Universitäts-Kinderspital beider BaselRecruiting
- Ospedale San Giovanni BellinzonaRecruiting
- Inselspital BernRecruiting
- HUG Hôpitaux Universitaires de GèneveRecruiting
- CHUV Centre Hospitalier Universitaire VaudoisRecruiting
- Luzerner Kantonsspital-Kinderspital LuzernRecruiting
- Ostschweizer KinderspitalRecruiting
- Universitäts-Kinderspital ZürichRecruiting
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Arm 5
Arm 6
Arm 7
Arm 8
Arm 9
Arm 10
Arm 11
Arm 12
Active Comparator
Experimental
Experimental
Experimental
Active Comparator
Experimental
Experimental
Experimental
Other
Active Comparator
Experimental
Other
pB: early (non-)HR-standard/MR-standard
pB: early HR-exp./MR-standard
pB: early (non)HR-standard/MR-exp.
pB: early HR-exp./MR-exp.
pB: early (non-)HR-standard/HR-standard
pB: early HR-exp./HR-standard
pB: early (non-)HR-standard/HR-exp.
pB: early HR-exp./HR-exp.
pB: early non-HR/SR
T: early non-SR-standard/(non-)HR
T: early non-SR-exp/(non-)HR
T: early SR/non-HR
Induction (5 wks): "Protocol IA" with prednisolone, vincristine, daunorubicin, pegaspargase, IT methotrexate (MTX) Consolidation (6 w/4 w): "Consolidation extended" (control arm of randomization R-eHR) with cyclophosphamide, cytarabine, 6-mercaptopurine (6-MP), IT MTX, dexamethasone, vincristine, pegaspargase or "Consolidation short" (standard arm of early non-HR group) with cyclophosphamide, cytarabine, 6-mercaptopurine, IT MTX Extra-compartment phase (8 wks): "Protocol M" with 6-MP, HD-MTX, IT MTX Reinduction (6 wks): "Protocol II" with dexamethasone, vincristine, doxorubicin, pegaspargase, IT MTX, cyclophosphamide, tioguanine, cytarabine Maintenance (until 2 years after initial diagnosis): 6-MP, MTX [without preceding blinatumomab (control arm of randomization R-MR)] Erwinase is given in case of allergy to pegaspargase.
Induction (5 w): "Protocol IA" with prednisolone, vincristine, daunorubicin, pegaspargase, IT MTX Consolidation (6 w): "Consolidation extended+BZM" (experimental arm of randomization R-eHR) with cyclophosphamide, cytarabine, 6-MP, IT MTX, dexamethasone, vincristine, pegaspargase, bortezomib (given at 1.3 mg/m²/dose on days 50, 53, 56 and 59) Extra-compartment phase (8 wks): "Protocol M" with 6-MP, HD-MTX, IT MTX Reinduction (6 wks): "Protocol II" with dexamethasone, vincristine, doxorubicin, pegaspargase, IT MTX, cyclophosphamide, tioguanine, cytarabine Maintenance (until 2 yrs after initial diagnosis): 6-MP, MTX [without preceding blinatumomab (control arm of randomization R-MR)] Erwinase is given in case of allergy to pegaspargase.
Induction (5 w): "Protocol IA" with prednisolone, vincristine, daunorubicin, pegaspargase, IT MTX Consolidation (6 w/4 w): "Consolidation extended" (control arm in randomization R-eHR) with cyclophosphamide, cytarabine, 6-MP, IT MTX, dexamethasone, vincristine, pegaspargase or "Consolidation short" (standard arm of early non-HR group) with cyclophosphamide, cytarabine, 6-mercaptopurine, IT MTX Extra-compartment phase (8 w): "Protocol M" with 6-MP, HD-MTX, IT MTX Reinduction (6 w): "Protocol II" with dexamethasone, vincristine, doxorubicin, pegaspargase, IT MTX, cyclophosphamide, tioguanine, cytarabine Blinatumomab (4 w): 1 cycle blinatumomab given at 15 µg/m²/day for 28 days (experimental arm of randomization R-MR) Maintenance (until 2 yrs after initial diagnosis): 6-MP, MTX Erwinase is given in case of allergy to pegaspargase.
Induction (5 w): "Protocol IA" with prednisolone, vincristine, daunorubicin, pegaspargase, IT MTX Consolidation (6 w): "Consolidation extended+BZM" (experimental arm of randomization R-eHR) with cyclophosphamide, cytarabine, 6-MP, IT MTX, dexamethasone, vincristine, pegaspargase, bortezomib (given at 1.3 mg/m²/dose on days 50, 53, 56 and 59) Extra-compartment phase (8 w): "Protocol M" with 6-MP, HD-MTX,IT MTX Reinduction (6 weeks): "Protocol II" with dexamethasone, vincristine, doxorubicin, PEG-L-asparaginase, IT MTX, cyclophosphamide, tioguanine, cytarabine Blinatumomab (4 w): 1 cycle blinatumomab given at 15 µg/m²/day for 28 days (experimental arm of randomization R-MR) Maintenance phase (until 2 yrs after initial diagnosis): 6-MP, MTX Erwinase is given in case of allergy to pegaspargase.
Induction (5 w): as in other pB arms Consolidation (6 w/4 w): "Consolidation extended" (control arm in randomization R-eHR) with cyclophosphamide, cytarabine, 6-MP, IT methotrexate, dexamethasone, vincristine, pegaspargase or "Consolidation short" (standard arm of early non-HR group) with cyclophosphamide, cytarabine, 6-MP, IT MTX Intensified consolidation (3x5 d): Block HR-1' followed by HR-2' and HR-3' (control arm in randomization R-HR) with dexamethasone, vincristine, vindesine, daunorubicin, HD-MTX, IT MTX, HD-cytarabine, cyclophosphamide, ifosfamide, pegaspargase, etoposide Reinduction (3x4 w): "Protocol III" given 3 times with dexamethasone, vincristine, doxorubicin, pegaspargase, IT MTX, cyclophosphamide, tioguanine, cytarabine Maintenance (until 2 yrs after init. diagnosis): 6-MP, MTX Erwinase is given in case pegaspargase allergy. Pts with poor response to intensified consolidation receive Myocet-FLA (Myocet, fludarabine, HD-cytarabine, IT-MTX).
Induction (5 w): as in other pB arms Consolidation (6 w): "Consolidation extended+BZM" (experimental arm of randomization R-eHR) with cyclophosphamide, cytarabine, 6-MP, IT MTX, dexamethasone, vincristine, pegaspargase, bortezomib (1.3 mg/m²/dose on days 50, 53, 56 and 59) Intensified consolidation (3x5 d): Block HR-1' followed by HR-2' and HR-3' (control arm in randomization R-HR) with dexamethasone, vincristine, vindesine, daunorubicin, HD-MTX, IT MTX, HD-cytarabine, cyclophosphamide, ifosfamide, pegaspargase, etoposide Reinduction (3x4 w): as in arm "pB: early (non-)HR-standard/HR-standard" Maintenance (until 2 yrs after initial diagnosis): 6-MP, MTX Erwinase is given in case of allergy to pegaspargase. Pts with poor response to intensified consolidation receive Myocet-FLA (Myocet, fludarabine, HD-cytarabine, IT-MTX)
Induction (5 w): as in other pB arms Consolidation (6 w/4 w): "Consolidation extended" (control arm in randomization R-eHR) with cyclophosphamide, cytarabine, 6-MP, IT MTX, dexamethasone, vincristine, pegaspargase or "Consolidation short" (standard arm of early non-HR group) with cyclophosphamide, cytarabine, 6-MP, IT MTX Intensified consolidation (1x5 d + 2x28 d): Block HR-1' with dexamethasone, vincristine, HD-MTX, IT MTX, HD-cytarabine, cyclophosphamide, pegaspargase followed by 2 cycles blinatumomab at 15 µg/m²/day for 28 days per cycle plus 2x2 doses IT MTX (experimental arm of randomization R-HR) Reinduction (3x4 weeks): as in arm "pB: early (non-)HR-standard/HR-standard" Maintenance (until 2 yrs after init. diagnosis): 6-MP, MTX Erwinase is given in case of pegaspargase allergy. Pts with poor response to intensified consolidation receive Myocet-FLA (Myocet, fludarabine, HD-cytarabine, IT-MTX)
Induction (5 w): as in other pB arms Consolidation (6 w): "Consolidation extended+BZM" (experimental arm of randomization R-eHR) with cyclophosphamide, cytarabine, 6-MP, IT MTX, dexamethasone, vincristine, pegaspargase, bortezomib (1.3 mg/m²/dose on days 50, 53, 56 and 59) Intensified consolidation (1x5 d + 2x28 d): Block HR-1' with dexamethasone, vincristine, HD-MTX, IT MTX, HD-cytarabine, cyclophosphamide, pegaspargase followed by 2 cycles blinatumomab at 15 µg/m²/day for 28 days per cycle plus 2x2 doses IT MTX (experimental arm of randomization R-HR) Reinduction (3x4 weeks): as in arm "pB: early (non-)HR-standard/HR-standard" Maintenance (until 2 yrs after initial diagnosis): 6-MP, MTX Erwinase is given in case of allergy to pegaspargase. Pts with poor response to intensified consolidation receive Myocet-FLA (Myocet, fludarabine, HD-cytarabine, IT-MTX)
Induction (5 w): "Protocol IA" with prednisolone, vincristine, daunorubicin, pegaspargase, IT MTX Consolidation (4 w): "Consolidation short" with cyclophosphamide, cytarabine, 6-mercaptopurine, IT MTX Extra-compartment phase (8 w): "Protocol M" with 6-MP, HD-MTX, IT MTX Reinduction (6 w): "Protocol II" with dexamethasone, vincristine, doxorubicin, pegaspargase, IT MTX, cyclophosphamide, tioguanine, cytarabine Maintenance (until 2 yrs after initial diagnosis): 6-MP, MTX Erwinase is given in case of allergy to pegaspargase.
Induction (5 w): "Protocol IA-Dexa" with prednisolone/dexamethasone, vincristine, daunorubicin, pegaspargase, IT MTX or "Protocol IA-CPM" with prednisolone instead of dexamethasone and additional CPM Consolidation (4 w): "Protocol IB regular" (control arm in randomization. R-T) with cyclophosphamide, cytarabine, 6-mercaptopurine, IT MTX non-HR extra-compartment phase and reinduction: as in arm "pB: early non-HR/SR" HR intensified consolidation and reinduction: as in arm "pB: early (non-)HR-standard/HR-standard" Maintenance (until 2 yrs after initial diagnosis): 6-MP, MTX Erwinase is given in case of allergy to pegaspargase. Pts with poor response to intensified consolidation receive Myocet-FLA (Myocet, fludarabine, HD-cytarabine, IT-MTX)
Induction (5 w): "Protocol IA-Dexa" with prednisolone/dexamethasone, vincristine, daunorubicin, pegaspargase, IT MTX or "Protocol IA-CPM" with prednisolone instead of dexamethasone and additional CPM Consolidation (6 w): "Protocol IB long" (experimental arm in randomization R-T) with cyclophosphamide, cytarabine, 6-mercaptopurine, IT MTX non-HR extra-compartment phase and reinduction: as in arm "pB: early non-HR/SR" HR intensified consolidation and reinduction: as in arm "pB: early (non-)HR-standard/HR-standard" Maintenance (until 2 yrs after initial diagnosis): 6-MP, MTX Erwinase is given in case of allergy to pegaspargase. Pts with poor response to intensified consolidation receive Myocet-FLA (Myocet, fludarabine, HD-cytarabine, IT-MTX)
Induction (5 w): "Protocol IA-Dexa" with prednisolone/dexamethasone, vincristine, daunorubicin, pegaspargase, IT MTX Consolidation (4 w): "Protocol IB regular" with cyclophosphamide, cytarabine, 6-mercaptopurine, IT MTX Extra-compartment phase (8 w): "Protocol M" with 6-MP, HD-MTX, IT MTX Reinduction (6 w): "Protocol II" with dexamethasone, vincristine, doxorubicin, pegaspargase, IT MTX, cyclophosphamide, tioguanine, cytarabine Maintenance (until 2 yrs after initial diagnosis): 6-MP, MTX Erwinase is given in case of allergy to pegaspargase.