Difference between revisions of "T-cell acute lymphoblastic leukemia"

From HemOnc.org - A Hematology Oncology Wiki
Jump to navigation Jump to search
(guidelines)
Line 27: Line 27:
 
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 
|-
 
|-
−
|[http://onlinelibrary.wiley.com/doi/10.1002/pbc.25470/abstract Winter et al. 2015]
+
|[http://onlinelibrary.wiley.com/doi/10.1002/pbc.25470/abstract Winter et al. 2015 (COG AALL0434)]
 
|style="background-color:#EEEE00"|Phase II
 
|style="background-color:#EEEE00"|Phase II
 
|-
 
|-
Line 35: Line 35:
 
===References===
 
===References===
 
# Winter SS, Dunsmore KP, Devidas M, Eisenberg N, Asselin BL, Wood BL, Leonard Rn MS, Murphy J, Gastier-Foster JM, Carroll AJ, Heerema NA, Loh ML, Raetz EA, Winick NJ, Carroll WL, Hunger SP. Safe integration of nelarabine into intensive chemotherapy in newly diagnosed T-cell acute lymphoblastic leukemia: Children's Oncology Group Study AALL0434. Pediatr Blood Cancer. 2015 Jul;62(7):1176-83. Epub 2015 Mar 8. [http://onlinelibrary.wiley.com/doi/10.1002/pbc.25470/abstract link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/25755211 PubMed]
 
# Winter SS, Dunsmore KP, Devidas M, Eisenberg N, Asselin BL, Wood BL, Leonard Rn MS, Murphy J, Gastier-Foster JM, Carroll AJ, Heerema NA, Loh ML, Raetz EA, Winick NJ, Carroll WL, Hunger SP. Safe integration of nelarabine into intensive chemotherapy in newly diagnosed T-cell acute lymphoblastic leukemia: Children's Oncology Group Study AALL0434. Pediatr Blood Cancer. 2015 Jul;62(7):1176-83. Epub 2015 Mar 8. [http://onlinelibrary.wiley.com/doi/10.1002/pbc.25470/abstract link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/25755211 PubMed]
 +
 +
==Daunorubicin, L-Asparaginase, Vincristine, Dexamethasone {{#subobject:516f7b|Regimen=1}}==
 +
{| class="wikitable" style="float:right; margin-left: 5px;"
 +
|-
 +
|[[#top|back to top]]
 +
|}
 +
===Regimen {{#subobject:88f520|Variant=1}}===
 +
{| border="1" style="text-align:center;" !align="left"
 +
|'''Study'''
 +
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 +
|'''Comparator'''
 +
|[[Levels_of_Evidence#Efficacy|'''Efficacy''']]
 +
|-
 +
|See note (COG AALL1231)
 +
|style="background-color:#00cd00"|Phase III
 +
|Daunorubicin, L-Asparaginase, Vincristine, Dexamethasone, Bortezomib
 +
|TBD
 +
|-
 +
|}
 +
''Note: this regimen is available as a COG protocol but no manuscript has been published yet, to our knowledge. Per the protocol, it is intended only for patients > 1 and < 31 years of age. It is based on the UKALL 2003 backbone, although there are some differences.''
 +
====Chemotherapy====
 +
*[[Daunorubicin (Cerubidine)]] 25 mg/m<sup>2</sup> IV push over 1 to 15 minutes once per day on days 1, 8, 15, 22
 +
*[[Pegaspargase (Oncaspar)]] 2500 units/m<sup>2</sup> IV over 1 to 2 hours once per day on days 4 & 18
 +
*[[Vincristine (Oncovin)]] 1.5 mg/m<sup>2</sup> (maximum dose of 2 mg) IV once per day on days 1, 8, 15, 22
 +
*[[Dexamethasone (Decadron)]] 3 mg/m<sup>2</sup> PO or IV BID on days 1 to 28
 +
 +
====CNS prophylaxis====
 +
*[[Cytarabine (Cytosar)]] as follows:
 +
**Ages 1 to 1.99: 30 mg IT once on day 1
 +
**Ages 2 to 2.99: 50 mg IT once on day 1
 +
**Age 3 and older: 70 mg IT once on day 1
 +
*[[Methotrexate (MTX)]] as follows:
 +
**Ages 1 to 1.99: 8 mg IT once per day on days 8 & 29
 +
**Ages 2 to 2.99: 10 mg IT once per day on days 8 & 29
 +
**Ages 3 to 8.99: 12 mg IT once per day on days 8 & 29
 +
**Age 9 and older: 15 mg IT once per day on days 8 & 29
 +
 +
'''4-week course'''
 +
 +
''See protocol for details of treatment beyond induction, which is guided by MRD status.''
 +
 +
===References===
 +
# Vora A, Goulden N, Wade R, Mitchell C, Hancock J, Hough R, Rowntree C, Richards S. Treatment reduction for children and young adults with low-risk acute lymphoblastic leukaemia defined by minimal residual disease (UKALL 2003): a randomised controlled trial. Lancet Oncol. 2013 Mar;14(3):199-209. [http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(12)70600-9/fulltext link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/23395119 PubMed]
 +
# COG AALL1231: TBD, see note
  
 
==Pediatric-like GRAALL induction {{#subobject:b90dc3|Regimen=1}}==
 
==Pediatric-like GRAALL induction {{#subobject:b90dc3|Regimen=1}}==

Revision as of 03:11, 21 January 2017

Use of this site is subject to you reading and agreeing with the terms set forth in the disclaimer.

Is there a regimen missing from this list? Would you like to share a different dosage/schedule or an additional reference for a regimen? Have you noticed an error? Do you have an idea that will help the site grow to better meet your needs and the needs of many others? You are invited to contribute to the site.

5 regimens on this page
6 variants on this page


Note that many of the regimens used to treat this disease are generic to acute lymphoblastic leukemia; this page contains regimens that are specific to T-cell acute lymphoblastic leukemia (a.k.a. T-cell lymphoblastic lymphoma when primarily nodal-based).

Guidelines

NCCN

Induction therapy

AALL0434 Induction

back to top

Regimen

Study Evidence
Winter et al. 2015 (COG AALL0434) Phase II

To be completed

References

  1. Winter SS, Dunsmore KP, Devidas M, Eisenberg N, Asselin BL, Wood BL, Leonard Rn MS, Murphy J, Gastier-Foster JM, Carroll AJ, Heerema NA, Loh ML, Raetz EA, Winick NJ, Carroll WL, Hunger SP. Safe integration of nelarabine into intensive chemotherapy in newly diagnosed T-cell acute lymphoblastic leukemia: Children's Oncology Group Study AALL0434. Pediatr Blood Cancer. 2015 Jul;62(7):1176-83. Epub 2015 Mar 8. link to original article PubMed

Daunorubicin, L-Asparaginase, Vincristine, Dexamethasone

back to top

Regimen

Study Evidence Comparator Efficacy
See note (COG AALL1231) Phase III Daunorubicin, L-Asparaginase, Vincristine, Dexamethasone, Bortezomib TBD

Note: this regimen is available as a COG protocol but no manuscript has been published yet, to our knowledge. Per the protocol, it is intended only for patients > 1 and < 31 years of age. It is based on the UKALL 2003 backbone, although there are some differences.

Chemotherapy

CNS prophylaxis

  • Cytarabine (Cytosar) as follows:
    • Ages 1 to 1.99: 30 mg IT once on day 1
    • Ages 2 to 2.99: 50 mg IT once on day 1
    • Age 3 and older: 70 mg IT once on day 1
  • Methotrexate (MTX) as follows:
    • Ages 1 to 1.99: 8 mg IT once per day on days 8 & 29
    • Ages 2 to 2.99: 10 mg IT once per day on days 8 & 29
    • Ages 3 to 8.99: 12 mg IT once per day on days 8 & 29
    • Age 9 and older: 15 mg IT once per day on days 8 & 29

4-week course

See protocol for details of treatment beyond induction, which is guided by MRD status.

References

  1. Vora A, Goulden N, Wade R, Mitchell C, Hancock J, Hough R, Rowntree C, Richards S. Treatment reduction for children and young adults with low-risk acute lymphoblastic leukaemia defined by minimal residual disease (UKALL 2003): a randomised controlled trial. Lancet Oncol. 2013 Mar;14(3):199-209. link to original article PubMed
  2. COG AALL1231: TBD, see note

Pediatric-like GRAALL induction

back to top

Regimen

Study Evidence
Lepretre et al. 2015 (GRAALL-LYSA LL03) Phase II

This regimen was meant for patients less than 60 years old (up to age 59). Regimen is as per the GRAALL-2003 Study with some minor differences, to be completed. High-risk patients with an HLA sibling-matched donor or a fully matched (10/10) unrelated donor who achieved CR1 were offered allogeneic stem cell transplant.

References

  1. Lepretre S, Touzart A, Vermeulin T, Picquenot JM, Tanguy-Schmidt A, Salles G, Lamy T, Béné MC, Raffoux E, Huguet F, Chevallier P, Bologna S, Bouabdallah R, Benichou J, Brière J, Moreau A, Tallon-Simon V, Seris S, Graux C, Asnafi V, Ifrah N, Macintyre E, Dombret H. Pediatric-Like Acute Lymphoblastic Leukemia Therapy in Adults With Lymphoblastic Lymphoma: The GRAALL-LYSA LL03 Study. J Clin Oncol. 2016 Feb 20;34(6):572-80. Epub 2015 Dec 7. link to original article link to data supplement contains protocol PubMed

Relapsed/Refractory

Nelarabine (Arranon)

back to top

Regimen

Study Evidence
DeAngelo et al. 2007 (CALGB 19801) Phase II

See paper for details about the schedule.

Chemotherapy

21-day cycle for 3 to 4 cycles (or delayed for count recovery)

References

  1. DeAngelo DJ, Yu D, Johnson JL, Coutre SE, Stone RM, Stopeck AT, Gockerman JP, Mitchell BS, Appelbaum FR, Larson RA. Nelarabine induces complete remissions in adults with relapsed or refractory T-lineage acute lymphoblastic leukemia or lymphoblastic lymphoma: Cancer and Leukemia Group B study 19801. Blood. 2007 Jun 15;109(12):5136-42. Epub 2007 Mar 7. link to original article contains verified protocol PubMed
Retrieved from "https://hemonc.org/w/index.php?title=T-cell_acute_lymphoblastic_leukemia&oldid=12992"