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A phase IV study with the primary goal to optimize therapy of adult patients with acute lymphoblastic leukemia or lymphoblastic lymphoma (LBL) by dose and time intensive, pediatric based chemotherapy, risk adapted stem cell transplantation (SCT) and minimal residual disease (MRD) based individualised and intensified therapy. Study will further evaluate the role of asparaginase intensification, the extended use of rituximab and the use of nelarabine as consolidation therapy in T-ALL in a phase III-part of the study. Furthermore two randomisations will focus on the role of central nervous system (CNS) irradiation in combination with intrathecal therapy versus intrathecal therapy only in B-precursor ALL/LBL and the role of SCT in high-risk patients with molecular complete remission. Finally a new, dose reduced induction therapy in combination with Imatinib will be evaluated in Ph/BCR-ABL positive ALL.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Stratification I - Standard Risk (SR)/ High Risk (HR) | Other | Induction and consolidation I therapy for standard and high risk patients, PH/BCR-ABL-negative Chemotherapy, immunotherapy, intrathecal prophylaxis, CNS irradiation according to randomisation I Drugs: Rituximab, Vincristine, Daunorubicin, Dexamethasone, Cyclophosphamide, Cytarabine, Mercaptopurine, PEG-Asparaginase, Methotrexate, Vindesine, VP16 |
|
| Stratification I - Philadelphia (PH)+ | Other | Induction and consolidation I therapy for PH+ patients Chemotherapy, immunotherapy, intrathecal prophylaxis Drugs: Rituximab, Vincristine, Imatinib, Dexamethasone, PEG-Asparaginase, Cytarabine, Methotrexate, Vindesine, VP16 |
|
| Rand I - B-Lin + CNS Rad + i.th. MTX | Active Comparator | Chemotherapy according to Stratification I SR/HR CNS prophylaxis: CNS irradiation 24 Gy, intrathecal Methotrexate |
|
| Rand I - B-Lin + i.th. MTX | Experimental |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Rituximab | Drug |
|
| Measure | Description | Time Frame |
|---|---|---|
| Event free survival | 3.5 years |
| Measure | Description | Time Frame |
|---|---|---|
| Time until consolidation treatment I | approximately 70 days | |
| Disease free survival | 1 year |
| Measure | Description | Time Frame |
|---|---|---|
| Hematological remission rate | after induction, approximately 6-8 weeks from diagnosis | |
| Molecular remission rate | after induction and consolidation, approximately 6-8 weeks from diagnosis | |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Nicola Gökbuget, Dr. med. | University Hospital of Frankfurt (Main) | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University Hospital of Frankfurt (Main) | Frankfurt am Main | 60590 | Germany |
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Chemotherapy according to Stratification I SR/HR CNS prophylaxis: intrathecal Methotrexate |
|
| Stratification II - SR + MRD-neg | Other | Chemotherapy, immunotherapy, intrathecal prophylaxis, consolidation II, reinduction, consolidation III - VI, maintenance Drugs: Rituximab, PEG-Asparaginase, Cytarabine, Methotrexate, Vindesine, Adriamycin, Prednisolone, Cyclophosphamide, Nelarabine, Dexamethasone |
|
| Stratification II - HR + MRD-neg | Other | Chemotherapy or stem cell transplantation according to randomisation II |
|
| Stratification II - SR/HR/PH+ + MRD-pos | Other | Chemotherapy or targeted therapy, followed by stem cell transplantation Drugs: Fludarabine, Idarubicin, Cytarabine, Nelarabine |
|
| Randomisation II - HR + MRD-neg-SCT | Active Comparator | Stem cell transplantation |
|
| Randomisation II - HR + MRD-neg-SR-chemo | Experimental | Chemotherapy, immunotherapy, intrathecal prophylaxis, consolidation II, reinduction, consolidation III - VI, maintenance Drugs: Rituximab, Dexamethasone, PEG-Asparaginase, Cytarabine, Methotrexate, Vindesine, Adriamycin, Prednisolone, Cyclophosphamide, Nelarabine |
|
| Nelarabine | Drug |
|
| PEG-Asparaginase | Drug |
|
| Cranial irradiation | Procedure |
|
| Imatinib | Drug |
|
| Idarubicin | Drug |
|
| Dexamethasone | Drug |
|
| Cyclophosphamide | Drug |
|
| Fludarabine | Drug |
|
| Vincristine | Drug |
|
| Mercaptopurine | Drug |
|
| VP16 | Drug |
|
| Daunorubicin (DNR) | Drug |
|
| Methotrexate | Drug |
|
| Stem cell transplantation | Procedure |
|
| Cytarabine | Drug |
|
| Vindesine | Drug |
|
| Adriamycin | Drug |
|
| Prednisolone | Drug |
|
| Results of the positron emission tomography (PET) based remission evaluation |
| after consolidation, approximately 8-10 weeks |
| Remission duration | up to 10 years |
| Relapse rate | up to 10 years |
| Overall survival | up to 10 years |
| Relapse location | at timepoint of relapse (up to 10 years) |
| Early death | during induction, approximately 6-8 weeks from diagnosis |
| Death in clinical remission (CR) | during treatment, up to approximately 2.5 years from diagnosis |
| Comorbidities according to Charlson Score | up to 2.5 years |
| Quality of life assessed by QLQ-C30 | up to 2.5 years |
| Eastern Cooperative Oncology Group (ECOG) under therapy | up to 2.5 years |
| Toxicity assessed by CTCAE v4.03 | up to 2.5 years |
| Results of the Dementia Detection (DemTect) test | up to 2.5 years |
| ID | Term |
|---|---|
| D054198 | Precursor Cell Lymphoblastic Leukemia-Lymphoma |
| ID | Term |
|---|---|
| D007945 | Leukemia, Lymphoid |
| D007938 | Leukemia |
| D009370 | Neoplasms by Histologic Type |
| D009369 | Neoplasms |
| D006402 | Hematologic Diseases |
| D006425 | Hemic and Lymphatic Diseases |
| D008232 | Lymphoproliferative Disorders |
| D008206 | Lymphatic Diseases |
| D007160 | Immunoproliferative Disorders |
| D007154 | Immune System Diseases |
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| ID | Term |
|---|---|
| D000069283 | Rituximab |
| C104457 | nelarabine |
| C042705 | pegaspargase |
| D016371 | Cranial Irradiation |
| D000068877 | Imatinib Mesylate |
| D015255 | Idarubicin |
| D003907 | Dexamethasone |
| D003520 | Cyclophosphamide |
| C024352 | fludarabine |
| D014750 | Vincristine |
| D015122 | Mercaptopurine |
| D005047 | Etoposide |
| D003630 | Daunorubicin |
| D008727 | Methotrexate |
| D033581 | Stem Cell Transplantation |
| D003561 | Cytarabine |
| D014751 | Vindesine |
| D004317 | Doxorubicin |
| D011239 | Prednisolone |
| ID | Term |
|---|---|
| D058846 | Antibodies, Monoclonal, Murine-Derived |
| D000911 | Antibodies, Monoclonal |
| D000906 | Antibodies |
| D007136 | Immunoglobulins |
| D007162 | Immunoproteins |
| D001798 | Blood Proteins |
| D011506 | Proteins |
| D000602 | Amino Acids, Peptides, and Proteins |
| D012712 | Serum Globulins |
| D005916 | Globulins |
| D011878 | Radiotherapy |
| D013812 | Therapeutics |
| D001549 | Benzamides |
| D000577 | Amides |
| D009930 | Organic Chemicals |
| D001565 | Benzoates |
| D000146 | Acids, Carbocyclic |
| D002264 | Carboxylic Acids |
| D001555 | Benzene Derivatives |
| D006841 | Hydrocarbons, Aromatic |
| D006844 | Hydrocarbons, Cyclic |
| D006838 | Hydrocarbons |
| D010879 | Piperazines |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
| D011743 | Pyrimidines |
| D018943 | Anthracyclines |
| D009279 | Naphthacenes |
| D011084 | Polycyclic Aromatic Hydrocarbons |
| D011083 | Polycyclic Compounds |
| D000617 | Aminoglycosides |
| D006027 | Glycosides |
| D002241 | Carbohydrates |
| D011246 | Pregnadienetriols |
| D011245 | Pregnadienes |
| D011278 | Pregnanes |
| D013256 | Steroids |
| D000072473 | Fused-Ring Compounds |
| D013259 | Steroids, Fluorinated |
| D010752 | Phosphoramide Mustards |
| D009588 | Nitrogen Mustard Compounds |
| D009150 | Mustard Compounds |
| D006846 | Hydrocarbons, Halogenated |
| D063088 | Phosphoramides |
| D009943 | Organophosphorus Compounds |
| D014748 | Vinca Alkaloids |
| D046948 | Secologanin Tryptamine Alkaloids |
| D026121 | Indole Alkaloids |
| D000470 | Alkaloids |
| D007211 | Indoles |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D054836 | Indolizidines |
| D007212 | Indolizines |
| D013438 | Sulfhydryl Compounds |
| D013457 | Sulfur Compounds |
| D011687 | Purines |
| D011034 | Podophyllotoxin |
| D013764 | Tetrahydronaphthalenes |
| D009281 | Naphthalenes |
| D005960 | Glucosides |
| D000630 | Aminopterin |
| D011622 | Pterins |
| D011621 | Pteridines |
| D017690 | Cell Transplantation |
| D064987 | Cell- and Tissue-Based Therapy |
| D001691 | Biological Therapy |
| D014180 | Transplantation |
| D013514 | Surgical Procedures, Operative |
| D003562 | Cytidine |
| D011741 | Pyrimidine Nucleosides |
| D001087 | Arabinonucleosides |
| D009705 | Nucleosides |
| D009706 | Nucleic Acids, Nucleotides, and Nucleosides |
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