Difference between revisions of "CNS leukemia"
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''Note: these regimens are primarily culled from literature that describes them as part of a comprehensive treatment regimen. If that is the case, the original regimens can be found on the following pages:'' | ''Note: these regimens are primarily culled from literature that describes them as part of a comprehensive treatment regimen. If that is the case, the original regimens can be found on the following pages:'' | ||
*[[Acute promyelocytic leukemia]] | *[[Acute promyelocytic leukemia]] | ||
− | *[[Adult T-cell leukemia | + | *[[Adult T-cell leukemia-lymphoma]] |
*[[B-cell acute lymphoblastic leukemia]] | *[[B-cell acute lymphoblastic leukemia]] | ||
*[[T-cell acute lymphoblastic leukemia]] | *[[T-cell acute lymphoblastic leukemia]] | ||
− | |||
=CNS prophylaxis, local therapy= | =CNS prophylaxis, local therapy= | ||
− | |||
==IT Cytarabine & Methotrexate {{#subobject:c47af4|Regimen=1}}== | ==IT Cytarabine & Methotrexate {{#subobject:c47af4|Regimen=1}}== | ||
− | {| class="wikitable" style=" | + | <div class="toccolours" style="background-color:#eeeeee"> |
+ | ===Regimen variant #1, 16 doses {{#subobject:8be879|Variant=1}}=== | ||
+ | {| class="wikitable sortable" style="width: 60%; text-align:center;" | ||
+ | !style="width: 33%"|Study | ||
+ | !style="width: 33%"|Dates of enrollment | ||
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
− | + | |[https://doi.org/10.1002/cncr.21776 Thomas et al. 2006] | |
− | + | |2000-02 to 2005-01 | |
− | + | |style="background-color:#ffffbe"|Pilot, fewer than 20 pts | |
− | |||
− | |||
− | |||
− | |||
− | |[https:// | ||
− | |style="background-color:#ffffbe"|Pilot, | ||
|- | |- | ||
|} | |} | ||
− | ====CNS therapy==== | + | <div class="toccolours" style="background-color:#b3e2cd"> |
− | *[[Methotrexate (MTX)]] 12 mg | + | ====CNS therapy, prophylaxis==== |
+ | *[[Methotrexate (MTX)]] by the following route-based criteria: | ||
+ | **LP: 12 mg IT once on day 2 | ||
+ | **Ommaya reservoir: 6 mg IT once on day 2 | ||
*[[Cytarabine (Ara-C)]] 100 mg IT once on day 7 | *[[Cytarabine (Ara-C)]] 100 mg IT once on day 7 | ||
− | |||
'''Given each cycle for a total of 16 intrathecal treatments''' | '''Given each cycle for a total of 16 intrathecal treatments''' | ||
− | + | </div></div><br> | |
− | === | + | <div class="toccolours" style="background-color:#eeeeee"> |
− | {| class="wikitable" style="width: | + | ===Regimen variant #2, 6 to 8 doses {{#subobject:f842e7|Variant=1}}=== |
− | !style="width: | + | {| class="wikitable sortable" style="width: 60%; text-align:center;" |
− | !style="width: | + | !style="width: 33%"|Study |
+ | !style="width: 33%"|Dates of enrollment | ||
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
− | |[ | + | |[https://doi.org/10.1200/jco.1999.17.8.2461 Thomas et al. 1999] |
− | |style="background-color:#91cf61"|Phase | + | |1992-09 to 1997-06 |
+ | |style="background-color:#91cf61"|Phase 2 | ||
|- | |- | ||
− | |[ | + | |[https://doi.org/10.1182/blood-2003-08-2958 Thomas et al. 2003] |
− | |style="background-color:#91cf61"|Phase | + | |2001-04 to 2003-03 |
+ | |style="background-color:#91cf61"|Phase 2 | ||
|- | |- | ||
− | |[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4081177/ Ravandi et al. 2010] | + | |[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4081177/ Ravandi et al. 2010 (MDACC 2006-0478)] |
− | |style="background-color:#91cf61"|Phase | + | |2006-09-28 to 2009-07-15 |
+ | |style="background-color:#91cf61"|Phase 2 | ||
|- | |- | ||
|} | |} | ||
− | ''Total number of doses depends on risk for CNS relapse based on serum lactate dehydrogenase (LDH) greater than 1400 IU/L and/or proliferative index percentage of S + G2M greater than or equal to 14%.'' | + | ''Note: Total number of doses depends on risk for CNS relapse based on serum lactate dehydrogenase (LDH) greater than 1400 IU/L and/or proliferative index percentage of S + G2M greater than or equal to 14%.'' |
− | ====CNS therapy==== | + | <div class="toccolours" style="background-color:#b3e2cd"> |
− | *[[Methotrexate (MTX)]] 12 mg | + | ====CNS therapy, prophylaxis==== |
− | *[[Cytarabine (Ara-C)]] 100 mg IT once on day 7 or 8 | + | *[[Methotrexate (MTX)]] by the following route-based criteria: |
− | + | **LP: 12 mg IT once on day 2 | |
+ | **Ommaya reservoir: 6 mg IT once on day 2 | ||
+ | *[[Cytarabine (Ara-C)]] 100 mg IT once on either day 7 or 8 | ||
'''Given each cycle (approximately every 3 weeks) for a total of 6 or 8 intrathecal treatments''' | '''Given each cycle (approximately every 3 weeks) for a total of 6 or 8 intrathecal treatments''' | ||
− | + | </div></div> | |
===References=== | ===References=== | ||
− | # Thomas DA, Cortes J, O'Brien S, Pierce S, Faderl S, Albitar M, Hagemeister FB, Cabanillas FF, Murphy S, Keating MJ, Kantarjian H. Hyper-CVAD program in Burkitt's-type adult acute lymphoblastic leukemia. J Clin Oncol. 1999 Aug;17(8):2461-70. [ | + | # Thomas DA, Cortes J, O'Brien S, Pierce S, Faderl S, Albitar M, Hagemeister FB, Cabanillas FF, Murphy S, Keating MJ, Kantarjian H. Hyper-CVAD program in Burkitt's-type adult acute lymphoblastic leukemia. J Clin Oncol. 1999 Aug;17(8):2461-70. [https://doi.org/10.1200/jco.1999.17.8.2461 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/10561310/ PubMed] |
− | # Thomas DA, Faderl S, Cortes J, O'Brien S, Giles FJ, Kornblau SM, Garcia-Manero G, Keating MJ, Andreeff M, Jeha S, Beran M, Verstovsek S, Pierce S, Letvak L, Salvado A, Champlin R, Talpaz M, Kantarjian H. Treatment of Philadelphia chromosome-positive acute lymphocytic leukemia with hyper-CVAD and imatinib mesylate. Blood. 2004 Jun 15;103(12):4396-407. Epub 2003 Oct 9. [ | + | # Thomas DA, Faderl S, Cortes J, O'Brien S, Giles FJ, Kornblau SM, Garcia-Manero G, Keating MJ, Andreeff M, Jeha S, Beran M, Verstovsek S, Pierce S, Letvak L, Salvado A, Champlin R, Talpaz M, Kantarjian H. Treatment of Philadelphia chromosome-positive acute lymphocytic leukemia with hyper-CVAD and imatinib mesylate. Blood. 2004 Jun 15;103(12):4396-407. Epub 2003 Oct 9. [https://doi.org/10.1182/blood-2003-08-2958 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/14551133/ PubMed] |
− | ## '''Update:''' Daver N, Thomas D, Ravandi F, Cortes J, Garris R, Jabbour E, Garcia-Manero G, Borthakur G, Kadia T, Rytting M, Konopleva M, Kantarjian H, O' Brien S. Final report of a phase II study of imatinib mesylate with hyper-CVAD for the frontline treatment of adult patients with Philadelphia chromosome positive (Ph+) acute lymphoblastic leukemia. Haematologica. 2015 May;100(5):653-61. Epub 2015 Feb 14. [ | + | ## '''Update:''' Daver N, Thomas D, Ravandi F, Cortes J, Garris R, Jabbour E, Garcia-Manero G, Borthakur G, Kadia T, Rytting M, Konopleva M, Kantarjian H, O' Brien S. Final report of a phase II study of imatinib mesylate with hyper-CVAD for the frontline treatment of adult patients with Philadelphia chromosome positive (Ph+) acute lymphoblastic leukemia. Haematologica. 2015 May;100(5):653-61. Epub 2015 Feb 14. [https://doi.org/10.3324/haematol.2014.118588 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420214/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/25682595/ PubMed] |
− | # Thomas DA, Faderl S, O'Brien S, Bueso-Ramos C, Cortes J, Garcia-Manero G, Giles FJ, Verstovsek S, Wierda WG, Pierce SA, Shan J, Brandt M, Hagemeister FB, Keating MJ, Cabanillas F, Kantarjian H. Chemoimmunotherapy with hyper-CVAD plus rituximab for the treatment of adult Burkitt and Burkitt-type lymphoma or acute lymphoblastic leukemia. Cancer. 2006 Apr 1;106(7):1569-80. [https:// | + | # Thomas DA, Faderl S, O'Brien S, Bueso-Ramos C, Cortes J, Garcia-Manero G, Giles FJ, Verstovsek S, Wierda WG, Pierce SA, Shan J, Brandt M, Hagemeister FB, Keating MJ, Cabanillas F, Kantarjian H. Chemoimmunotherapy with hyper-CVAD plus rituximab for the treatment of adult Burkitt and Burkitt-type lymphoma or acute lymphoblastic leukemia. Cancer. 2006 Apr 1;106(7):1569-80. [https://doi.org/10.1002/cncr.21776 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/16502413/ PubMed] |
− | ## '''Update:''' Fayad L, Thomas D, Romaguera J. Update of the MD Anderson Cancer Center experience with hyper-CVAD and rituximab for the treatment of mantle cell and Burkitt-type lymphomas. Clin Lymphoma Myeloma. 2007 Dec;8 Suppl 2:S57-62. [https:// | + | ## '''Update:''' Fayad L, Thomas D, Romaguera J. Update of the MD Anderson Cancer Center experience with hyper-CVAD and rituximab for the treatment of mantle cell and Burkitt-type lymphomas. Clin Lymphoma Myeloma. 2007 Dec;8 Suppl 2:S57-62. [https://doi.org/10.3816/clm.2007.s.034 link to original article] [https://pubmed.ncbi.nlm.nih.gov/18284717/ PubMed] |
− | # Ravandi F, O'Brien S, Thomas D, Faderl S, Jones D, Garris R, Dara S, Jorgensen J, Kebriaei P, Champlin R, Borthakur G, Burger J, Ferrajoli A, Garcia-Manero G, Wierda W, Cortes J, Kantarjian H. First report of phase 2 study of dasatinib with hyper-CVAD for the frontline treatment of patients with Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia. Blood. 2010 Sep 23;116(12):2070-7. Epub 2010 May 13. [ | + | # '''MDACC 2006-0478:''' Ravandi F, O'Brien S, Thomas D, Faderl S, Jones D, Garris R, Dara S, Jorgensen J, Kebriaei P, Champlin R, Borthakur G, Burger J, Ferrajoli A, Garcia-Manero G, Wierda W, Cortes J, Kantarjian H. First report of phase 2 study of dasatinib with hyper-CVAD for the frontline treatment of patients with Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia. Blood. 2010 Sep 23;116(12):2070-7. Epub 2010 May 13. [https://doi.org/10.1182/blood-2009-12-261586 link to original article] '''contains dosing details in manuscript'''--parts of the protocol were not explicitly listed in this reference, which instead referred to [[#Hyper-CVAD_.26_Imatinib_.28Gleevec.29_.28induction_.26_maintenance.29|Thomas et al. 2004]] and [[#Hyper-CVAD_.28induction.29|Kantarjian et al. 2004]] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4081177/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/20466853/ PubMed] [https://clinicaltrials.gov/study/NCT00390793 NCT00390793] |
− | ## '''Update:''' Ravandi F, O'Brien SM, Cortes JE, Thomas DM, Garris R, Faderl S, Burger JA, Rytting ME, Ferrajoli A, Wierda WG, Verstovsek S, Champlin R, Kebriaei P, McCue DA, Huang X, Jabbour E, Garcia-Manero G, Estrov Z, Kantarjian HM. Long-term follow-up of a phase 2 study of chemotherapy plus dasatinib for the initial treatment of patients with Philadelphia chromosome-positive acute lymphoblastic leukemia. Cancer. 2015 Dec 1;121(23):4158-64. Epub 2015 Aug 26. [https:// | + | ## '''Update:''' Ravandi F, O'Brien SM, Cortes JE, Thomas DM, Garris R, Faderl S, Burger JA, Rytting ME, Ferrajoli A, Wierda WG, Verstovsek S, Champlin R, Kebriaei P, McCue DA, Huang X, Jabbour E, Garcia-Manero G, Estrov Z, Kantarjian HM. Long-term follow-up of a phase 2 study of chemotherapy plus dasatinib for the initial treatment of patients with Philadelphia chromosome-positive acute lymphoblastic leukemia. Cancer. 2015 Dec 1;121(23):4158-64. Epub 2015 Aug 26. [https://doi.org/10.1002/cncr.29646 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4666803/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/26308885/ PubMed] |
− | |||
==IT Cytarabine, Methotrexate, Methylprednisolone {{#subobject:eb3e09|Regimen=1}}== | ==IT Cytarabine, Methotrexate, Methylprednisolone {{#subobject:eb3e09|Regimen=1}}== | ||
− | + | <div class="toccolours" style="background-color:#eeeeee"> | |
− | |||
− | |||
− | |||
===Regimen {{#subobject:daa284|Variant=1}}=== | ===Regimen {{#subobject:daa284|Variant=1}}=== | ||
− | {| class="wikitable" style="width: | + | {| class="wikitable sortable" style="width: 60%; text-align:center;" |
− | !style="width: | + | !style="width: 33%"|Study |
− | !style="width: | + | !style="width: 33%"|Dates of enrollment |
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
− | |[ | + | |[https://doi.org/10.1200/JCO.2008.18.6916 Huguet et al. 2009 (GRAALL-2003)] |
− | |style="background-color:#91cf61"|Phase | + | |2003-2005 |
+ | |style="background-color:#91cf61"|Phase 2 | ||
|- | |- | ||
|} | |} | ||
− | ''Intrathecal treatments are given on days 1 & 8 of induction, day 29 of each series of consolidation blocks, and day 1 of late intensification -- 6 doses total.'' | + | ''Note: Intrathecal treatments are given on days 1 & 8 of induction, day 29 of each series of consolidation blocks, and day 1 of late intensification -- 6 doses total.'' |
− | ====CNS therapy==== | + | <div class="toccolours" style="background-color:#b3e2cd"> |
+ | ====CNS therapy, prophylaxis==== | ||
*[[Cytarabine (Ara-C)]] 40 mg IT mixed with methotrexate and methylprednisolone | *[[Cytarabine (Ara-C)]] 40 mg IT mixed with methotrexate and methylprednisolone | ||
− | *[[Methotrexate (MTX)]] 15 mg IT mixed with cytarabine and methylprednisolone | + | *[[Methotrexate (MTX)]] 15 mg IT mixed with cytarabine and methylprednisolone |
*[[Methylprednisolone (Solumedrol)]] 40 mg IT mixed with cytarabine and methotrexate | *[[Methylprednisolone (Solumedrol)]] 40 mg IT mixed with cytarabine and methotrexate | ||
− | + | '''6 doses (see note)''' | |
− | '''6 doses''' | + | </div></div> |
− | |||
===References=== | ===References=== | ||
− | # '''GRAALL-2003:''' Huguet F, Leguay T, Raffoux E, Thomas X, Beldjord K, Delabesse E, Chevallier P, Buzyn A, Delannoy A, Chalandon Y, Vernant JP, Lafage-Pochitaloff M, Chassevent A, Lhéritier V, Macintyre E, Béné MC, Ifrah N, Dombret H. Pediatric-inspired therapy in adults with Philadelphia chromosome-negative acute lymphoblastic leukemia: the GRAALL-2003 study. J Clin Oncol. 2009 Feb 20;27(6):911-8. Epub 2009 Jan 5. Erratum in: J Clin Oncol. 2009 May 20;27(15):2574. Dosage error in article text. [ | + | # '''GRAALL-2003:''' Huguet F, Leguay T, Raffoux E, Thomas X, Beldjord K, Delabesse E, Chevallier P, Buzyn A, Delannoy A, Chalandon Y, Vernant JP, Lafage-Pochitaloff M, Chassevent A, Lhéritier V, Macintyre E, Béné MC, Ifrah N, Dombret H. Pediatric-inspired therapy in adults with Philadelphia chromosome-negative acute lymphoblastic leukemia: the GRAALL-2003 study. J Clin Oncol. 2009 Feb 20;27(6):911-8. Epub 2009 Jan 5. Erratum in: J Clin Oncol. 2009 May 20;27(15):2574. Dosage error in article text. [https://doi.org/10.1200/JCO.2008.18.6916 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/19124805/ PubMed] [https://clinicaltrials.gov/study/NCT00222027 NCT00222027] |
− | |||
==IT Cytarabine, Methotrexate, Prednisone {{#subobject:d81b63|Regimen=1}}== | ==IT Cytarabine, Methotrexate, Prednisone {{#subobject:d81b63|Regimen=1}}== | ||
− | + | <div class="toccolours" style="background-color:#eeeeee"> | |
− | |||
− | |||
− | |||
===Regimen {{#subobject:6f33ca|Variant=1}}=== | ===Regimen {{#subobject:6f33ca|Variant=1}}=== | ||
− | {| class="wikitable" style="width: | + | {| class="wikitable sortable" style="width: 60%; text-align:center;" |
− | !style="width: | + | !style="width: 33%"|Study |
− | !style="width: | + | !style="width: 33%"|Dates of enrollment |
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
− | |[ | + | |[https://doi.org/10.1200/jco.2007.11.9958 Tsukasaki et al. 2007 (JCOG 9801)] |
− | |style="background-color:#91cf61"|Non-randomized | + | |1998-2003 |
+ | |style="background-color:#91cf61"|Non-randomized part of phase 3 RCT | ||
|- | |- | ||
− | |[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5024033/ Ishida et al. 2015] | + | |[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5024033/ Ishida et al. 2015 (Kyowa 0761-003)] |
− | |style="background-color:#91cf61"|Non-randomized | + | |2010-2011 |
+ | |style="background-color:#91cf61"|Non-randomized part of phase 2 RCT | ||
|- | |- | ||
|} | |} | ||
− | ''Treatments were given after cycles 1, 3, and 5 after platelets greater than 70 | + | ''Note: Treatments were given after cycles 1, 3, and 5 after platelets greater than 70 x 10<sup>9</sup>/L and within 2 days before the next cycle.'' |
− | ====CNS therapy==== | + | <div class="toccolours" style="background-color:#b3e2cd"> |
+ | ====CNS therapy, prophylaxis==== | ||
*[[Cytarabine (Ara-C)]] 40 mg IT mixed with methotrexate and prednisone | *[[Cytarabine (Ara-C)]] 40 mg IT mixed with methotrexate and prednisone | ||
*[[Methotrexate (MTX)]] 15 mg IT mixed with cytarabine and prednisone | *[[Methotrexate (MTX)]] 15 mg IT mixed with cytarabine and prednisone | ||
*[[Prednisone (Sterapred)]] 10 mg IT mixed with cytarabine and methotrexate | *[[Prednisone (Sterapred)]] 10 mg IT mixed with cytarabine and methotrexate | ||
− | + | '''3 doses (see note)''' | |
− | '''3 doses''' | + | </div></div> |
− | |||
===References=== | ===References=== | ||
<!-- Presented in part at the 47th Annual Meeting of the American Society of Hematology, December 10-13, 2005, Atlanta, GA. --> | <!-- Presented in part at the 47th Annual Meeting of the American Society of Hematology, December 10-13, 2005, Atlanta, GA. --> | ||
− | # Tsukasaki K, Utsunomiya A, Fukuda H, Shibata T, Fukushima T, Takatsuka Y, Ikeda S, Masuda M, Nagoshi H, Ueda R, Tamura K, Sano M, Momita S, Yamaguchi K, Kawano F, Hanada S, Tobinai K, Shimoyama M, Hotta T, Tomonaga M; | + | # '''JCOG 9801:''' Tsukasaki K, Utsunomiya A, Fukuda H, Shibata T, Fukushima T, Takatsuka Y, Ikeda S, Masuda M, Nagoshi H, Ueda R, Tamura K, Sano M, Momita S, Yamaguchi K, Kawano F, Hanada S, Tobinai K, Shimoyama M, Hotta T, Tomonaga M; [[Study_Groups#JCOG|JCOG]]. VCAP-AMP-VECP compared with biweekly CHOP for adult T-cell leukemia-lymphoma: Japan Clinical Oncology Group Study JCOG9801. J Clin Oncol. 2007 Dec 1;25(34):5458-64. Epub 2007 Oct 29. [https://doi.org/10.1200/jco.2007.11.9958 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/17968021/ PubMed] [https://clinicaltrials.gov/study/NCT00145002 NCT00145002] |
− | # Ishida T, Jo T, Takemoto S, Suzushima H, Uozumi K, Yamamoto K, Uike N, Saburi Y, Nosaka K, Utsunomiya A, Tobinai K, Fujiwara H, Ishitsuka K, Yoshida S, Taira N, Moriuchi Y, Imada K, Miyamoto T, Akinaga S, Tomonaga M, Ueda R. Dose-intensified chemotherapy alone or in combination with mogamulizumab in newly diagnosed aggressive adult T-cell leukaemia-lymphoma: a randomized phase II study. Br J Haematol. 2015 Jun;169(5):672-82. Epub 2015 Mar 2. [https:// | + | # '''Kyowa 0761-003:''' Ishida T, Jo T, Takemoto S, Suzushima H, Uozumi K, Yamamoto K, Uike N, Saburi Y, Nosaka K, Utsunomiya A, Tobinai K, Fujiwara H, Ishitsuka K, Yoshida S, Taira N, Moriuchi Y, Imada K, Miyamoto T, Akinaga S, Tomonaga M, Ueda R. Dose-intensified chemotherapy alone or in combination with mogamulizumab in newly diagnosed aggressive adult T-cell leukaemia-lymphoma: a randomized phase II study. Br J Haematol. 2015 Jun;169(5):672-82. Epub 2015 Mar 2. [https://doi.org/10.1111/bjh.13338 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5024033/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/25733162/ PubMed] [https://clinicaltrials.gov/study/NCT01173887 NCT01173887] |
==IT Cytarabine & WBRT {{#subobject:d62e53|Regimen=1}}== | ==IT Cytarabine & WBRT {{#subobject:d62e53|Regimen=1}}== | ||
− | |||
− | |||
− | |||
− | |||
Cytarabine & WBRT: Cytarabine & '''<u>W</u>'''hole '''<u>B</u>'''rain '''<u>R</u>'''adiation '''<u>T</u>'''herapy | Cytarabine & WBRT: Cytarabine & '''<u>W</u>'''hole '''<u>B</u>'''rain '''<u>R</u>'''adiation '''<u>T</u>'''herapy | ||
+ | <div class="toccolours" style="background-color:#eeeeee"> | ||
===Regimen {{#subobject:b3f29d|Variant=1}}=== | ===Regimen {{#subobject:b3f29d|Variant=1}}=== | ||
− | {| class="wikitable" style="width: | + | {| class="wikitable sortable" style="width: 60%; text-align:center;" |
− | !style="width: | + | !style="width: 33%"|Study |
− | !style="width: | + | !style="width: 33%"|Dates of enrollment |
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
− | |[ | + | |[https://doi.org/10.1182/blood-2005-04-1623 Rowe et al. 2005 (MRC UKALL XII/ECOG E2993)] |
− | |style="background-color:#91cf61"|Non-randomized | + | |1993-2003 |
+ | |style="background-color:#91cf61"|Non-randomized part of phase 3 RCT | ||
|- | |- | ||
|} | |} | ||
''Note: while this is not chemoradiation in the traditional sense, the delivery of chemotherapy and radiation overlap so may have synergistic effects.'' | ''Note: while this is not chemoradiation in the traditional sense, the delivery of chemotherapy and radiation overlap so may have synergistic effects.'' | ||
− | ====CNS therapy==== | + | <div class="toccolours" style="background-color:#b3e2cd"> |
+ | ====CNS therapy, prophylaxis==== | ||
*[[Cytarabine (Ara-C)]] as follows: | *[[Cytarabine (Ara-C)]] as follows: | ||
**Consolidation & Maintenance: 50 mg IT once per week for 4 weeks, then once per quarter for 4 doses (8 doses, total) | **Consolidation & Maintenance: 50 mg IT once per week for 4 weeks, then once per quarter for 4 doses (8 doses, total) | ||
====Radiotherapy==== | ====Radiotherapy==== | ||
*[[External_beam_radiotherapy|Whole-brain irradiation]] to 2400 cGy, given during consolidation | *[[External_beam_radiotherapy|Whole-brain irradiation]] to 2400 cGy, given during consolidation | ||
− | + | </div></div> | |
===References=== | ===References=== | ||
− | # Rowe JM, Buck G, Burnett AK, Chopra R, Wiernik PH, Richards SM, Lazarus HM, Franklin IM, Litzow MR, Ciobanu N, Prentice HG, Durrant J, Tallman MS, Goldstone AH; ECOG; MRC/NCRI Adult Leukemia Working Party. Induction therapy for adults with acute lymphoblastic leukemia: results of more than 1500 patients from the international ALL trial: MRC UKALL XII/ECOG E2993. Blood. 2005 Dec 1;106(12):3760-7. Epub 2005 Aug 16. [ | + | # '''MRC UKALL XII/ECOG E2993:''' Rowe JM, Buck G, Burnett AK, Chopra R, Wiernik PH, Richards SM, Lazarus HM, Franklin IM, Litzow MR, Ciobanu N, Prentice HG, Durrant J, Tallman MS, Goldstone AH; ECOG; MRC/NCRI Adult Leukemia Working Party. Induction therapy for adults with acute lymphoblastic leukemia: results of more than 1500 patients from the international ALL trial: MRC UKALL XII/ECOG E2993. Blood. 2005 Dec 1;106(12):3760-7. Epub 2005 Aug 16. [https://doi.org/10.1182/blood-2005-04-1623 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/16105981/ PubMed] [https://clinicaltrials.gov/study/NCT00002514 NCT00002514] |
− | ## '''Update:''' Goldstone AH, Richards SM, Lazarus HM, Tallman MS, Buck G, Fielding AK, Burnett AK, Chopra R, Wiernik PH, Foroni L, Paietta E, Litzow MR, Marks DI, Durrant J, McMillan A, Franklin IM, Luger S, Ciobanu N, Rowe JM. In adults with standard-risk acute lymphoblastic leukemia, the greatest benefit is achieved from a matched sibling allogeneic transplantation in first complete remission, and an autologous transplantation is less effective than conventional consolidation/maintenance chemotherapy in all patients: final results of the International ALL Trial (MRC UKALL XII/ECOG E2993). Blood. 2008 Feb 15;111(4):1827-33. Epub 2007 Nov 29. [ | + | ## '''Update:''' Goldstone AH, Richards SM, Lazarus HM, Tallman MS, Buck G, Fielding AK, Burnett AK, Chopra R, Wiernik PH, Foroni L, Paietta E, Litzow MR, Marks DI, Durrant J, McMillan A, Franklin IM, Luger S, Ciobanu N, Rowe JM. In adults with standard-risk acute lymphoblastic leukemia, the greatest benefit is achieved from a matched sibling allogeneic transplantation in first complete remission, and an autologous transplantation is less effective than conventional consolidation/maintenance chemotherapy in all patients: final results of the International ALL Trial (MRC UKALL XII/ECOG E2993). Blood. 2008 Feb 15;111(4):1827-33. Epub 2007 Nov 29. [https://doi.org/10.1182/blood-2007-10-116582 link to original article] [https://pubmed.ncbi.nlm.nih.gov/18048644/ PubMed] |
− | ## '''Update:''' Fielding AK, Rowe JM, Richards SM, Buck G, Moorman AV, Durrant IJ, Marks DI, McMillan AK, Litzow MR, Lazarus HM, Foroni L, Dewald G, Franklin IM, Luger SM, Paietta E, Wiernik PH, Tallman MS, Goldstone AH. Prospective outcome data on 267 unselected adult patients with Philadelphia chromosome-positive acute lymphoblastic leukemia confirms superiority of allogeneic transplantation over chemotherapy in the pre-imatinib era: results from the International ALL Trial MRC UKALLXII/ECOG2993. Blood. 2009 May 7;113(19):4489-96. Epub 2009 Feb 24. [ | + | ## '''Update:''' Fielding AK, Rowe JM, Richards SM, Buck G, Moorman AV, Durrant IJ, Marks DI, McMillan AK, Litzow MR, Lazarus HM, Foroni L, Dewald G, Franklin IM, Luger SM, Paietta E, Wiernik PH, Tallman MS, Goldstone AH. Prospective outcome data on 267 unselected adult patients with Philadelphia chromosome-positive acute lymphoblastic leukemia confirms superiority of allogeneic transplantation over chemotherapy in the pre-imatinib era: results from the International ALL Trial MRC UKALLXII/ECOG2993. Blood. 2009 May 7;113(19):4489-96. Epub 2009 Feb 24. [https://doi.org/10.1182/blood-2009-01-199380 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4188540/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/19244158/ PubMed] |
− | ## '''Update:''' Fielding AK, Rowe JM, Buck G, Foroni L, Gerrard G, Litzow MR, Lazarus H, Luger SM, Marks DI, McMillan AK, Moorman AV, Patel B, Paietta E, Tallman MS, Goldstone AH. UKALLXII/ECOG2993: addition of imatinib to a standard treatment regimen enhances long-term outcomes in Philadelphia positive acute lymphoblastic leukemia. Blood. 2014 Feb 6;123(6):843-50. Epub 2013 Nov 25. [ | + | ## '''Update:''' Fielding AK, Rowe JM, Buck G, Foroni L, Gerrard G, Litzow MR, Lazarus H, Luger SM, Marks DI, McMillan AK, Moorman AV, Patel B, Paietta E, Tallman MS, Goldstone AH. UKALLXII/ECOG2993: addition of imatinib to a standard treatment regimen enhances long-term outcomes in Philadelphia positive acute lymphoblastic leukemia. Blood. 2014 Feb 6;123(6):843-50. Epub 2013 Nov 25. [https://doi.org/10.1182/blood-2013-09-529008 link to original article] '''contains dosing details in manuscript''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3916877/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/24277073/ PubMed] |
− | |||
==IT Methotrexate monotherapy {{#subobject:98fb82|Regimen=1}}== | ==IT Methotrexate monotherapy {{#subobject:98fb82|Regimen=1}}== | ||
− | + | <div class="toccolours" style="background-color:#eeeeee"> | |
− | |||
− | |||
− | |||
===Regimen {{#subobject:0f3d6e|Variant=1}}=== | ===Regimen {{#subobject:0f3d6e|Variant=1}}=== | ||
− | {| class="wikitable" style="width: | + | {| class="wikitable sortable" style="width: 60%; text-align:center;" |
− | !style="width: | + | !style="width: 33%"|Study |
− | !style="width: | + | !style="width: 33%"|Dates of enrollment |
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
− | |[ | + | |[https://doi.org/10.1182/blood-2005-04-1623 Rowe et al. 2005 (MRC UKALL XII/ECOG E2993)] |
− | |style="background-color:#91cf61"|Non-randomized | + | |1993-2003 |
+ | |style="background-color:#91cf61"|Non-randomized part of phase 3 RCT | ||
|- | |- | ||
|} | |} | ||
− | ====CNS therapy==== | + | <div class="toccolours" style="background-color:#b3e2cd"> |
+ | ====CNS therapy, prophylaxis==== | ||
*[[Methotrexate (MTX)]] as follows: | *[[Methotrexate (MTX)]] as follows: | ||
**Phase 1: 12 mg IT once on day 15 | **Phase 1: 12 mg IT once on day 15 | ||
**Phase 2: 12 mg IT once per day on days 1, 8, 15, 22 | **Phase 2: 12 mg IT once per day on days 1, 8, 15, 22 | ||
− | + | </div></div> | |
===References=== | ===References=== | ||
− | # Rowe JM, Buck G, Burnett AK, Chopra R, Wiernik PH, Richards SM, Lazarus HM, Franklin IM, Litzow MR, Ciobanu N, Prentice HG, Durrant J, Tallman MS, Goldstone AH; ECOG; MRC/NCRI Adult Leukemia Working Party. Induction therapy for adults with acute lymphoblastic leukemia: results of more than 1500 patients from the international ALL trial: MRC UKALL XII/ECOG E2993. Blood. 2005 Dec 1;106(12):3760-7. Epub 2005 Aug 16. [ | + | # '''MRC UKALL XII/ECOG E2993:''' Rowe JM, Buck G, Burnett AK, Chopra R, Wiernik PH, Richards SM, Lazarus HM, Franklin IM, Litzow MR, Ciobanu N, Prentice HG, Durrant J, Tallman MS, Goldstone AH; ECOG; MRC/NCRI Adult Leukemia Working Party. Induction therapy for adults with acute lymphoblastic leukemia: results of more than 1500 patients from the international ALL trial: MRC UKALL XII/ECOG E2993. Blood. 2005 Dec 1;106(12):3760-7. Epub 2005 Aug 16. [https://doi.org/10.1182/blood-2005-04-1623 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/16105981/ PubMed] [https://clinicaltrials.gov/study/NCT00002514 NCT00002514] |
− | ## '''Update:''' Goldstone AH, Richards SM, Lazarus HM, Tallman MS, Buck G, Fielding AK, Burnett AK, Chopra R, Wiernik PH, Foroni L, Paietta E, Litzow MR, Marks DI, Durrant J, McMillan A, Franklin IM, Luger S, Ciobanu N, Rowe JM. In adults with standard-risk acute lymphoblastic leukemia, the greatest benefit is achieved from a matched sibling allogeneic transplantation in first complete remission, and an autologous transplantation is less effective than conventional consolidation/maintenance chemotherapy in all patients: final results of the International ALL Trial (MRC UKALL XII/ECOG E2993). Blood. 2008 Feb 15;111(4):1827-33. Epub 2007 Nov 29. [ | + | ## '''Update:''' Goldstone AH, Richards SM, Lazarus HM, Tallman MS, Buck G, Fielding AK, Burnett AK, Chopra R, Wiernik PH, Foroni L, Paietta E, Litzow MR, Marks DI, Durrant J, McMillan A, Franklin IM, Luger S, Ciobanu N, Rowe JM. In adults with standard-risk acute lymphoblastic leukemia, the greatest benefit is achieved from a matched sibling allogeneic transplantation in first complete remission, and an autologous transplantation is less effective than conventional consolidation/maintenance chemotherapy in all patients: final results of the International ALL Trial (MRC UKALL XII/ECOG E2993). Blood. 2008 Feb 15;111(4):1827-33. Epub 2007 Nov 29. [https://doi.org/10.1182/blood-2007-10-116582 link to original article] [https://pubmed.ncbi.nlm.nih.gov/18048644/ PubMed] |
− | ## '''Update:''' Fielding AK, Rowe JM, Richards SM, Buck G, Moorman AV, Durrant IJ, Marks DI, McMillan AK, Litzow MR, Lazarus HM, Foroni L, Dewald G, Franklin IM, Luger SM, Paietta E, Wiernik PH, Tallman MS, Goldstone AH. Prospective outcome data on 267 unselected adult patients with Philadelphia chromosome-positive acute lymphoblastic leukemia confirms superiority of allogeneic transplantation over chemotherapy in the pre-imatinib era: results from the International ALL Trial MRC UKALLXII/ECOG2993. Blood. 2009 May 7;113(19):4489-96. Epub 2009 Feb 24. [ | + | ## '''Update:''' Fielding AK, Rowe JM, Richards SM, Buck G, Moorman AV, Durrant IJ, Marks DI, McMillan AK, Litzow MR, Lazarus HM, Foroni L, Dewald G, Franklin IM, Luger SM, Paietta E, Wiernik PH, Tallman MS, Goldstone AH. Prospective outcome data on 267 unselected adult patients with Philadelphia chromosome-positive acute lymphoblastic leukemia confirms superiority of allogeneic transplantation over chemotherapy in the pre-imatinib era: results from the International ALL Trial MRC UKALLXII/ECOG2993. Blood. 2009 May 7;113(19):4489-96. Epub 2009 Feb 24. [https://doi.org/10.1182/blood-2009-01-199380 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4188540/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/19244158/ PubMed] |
− | ## '''Update:''' Fielding AK, Rowe JM, Buck G, Foroni L, Gerrard G, Litzow MR, Lazarus H, Luger SM, Marks DI, McMillan AK, Moorman AV, Patel B, Paietta E, Tallman MS, Goldstone AH. UKALLXII/ECOG2993: addition of imatinib to a standard treatment regimen enhances long-term outcomes in Philadelphia positive acute lymphoblastic leukemia. Blood. 2014 Feb 6;123(6):843-50. Epub 2013 Nov 25. [ | + | ## '''Update:''' Fielding AK, Rowe JM, Buck G, Foroni L, Gerrard G, Litzow MR, Lazarus H, Luger SM, Marks DI, McMillan AK, Moorman AV, Patel B, Paietta E, Tallman MS, Goldstone AH. UKALLXII/ECOG2993: addition of imatinib to a standard treatment regimen enhances long-term outcomes in Philadelphia positive acute lymphoblastic leukemia. Blood. 2014 Feb 6;123(6):843-50. Epub 2013 Nov 25. [https://doi.org/10.1182/blood-2013-09-529008 link to original article] '''contains dosing details in manuscript''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3916877/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/24277073/ PubMed] |
− | |||
==IT Methotrexate & Hydrocortisone {{#subobject:d0d04e|Regimen=1}}== | ==IT Methotrexate & Hydrocortisone {{#subobject:d0d04e|Regimen=1}}== | ||
− | + | <div class="toccolours" style="background-color:#eeeeee"> | |
− | |||
− | |||
− | |||
===Regimen {{#subobject:edc35f|Variant=1}}=== | ===Regimen {{#subobject:edc35f|Variant=1}}=== | ||
− | {| class="wikitable" style="width: 100%; text-align:center;" | + | {| class="wikitable sortable" style="width: 100%; text-align:center;" |
− | !style="width: | + | !style="width: 20%"|Study |
− | !style="width: | + | !style="width: 20%"|Dates of enrollment |
− | !style="width: | + | !style="width: 20%"|[[Levels_of_Evidence#Evidence|Evidence]] |
− | !style="width: | + | !style="width: 20%"|Comparator |
+ | !style="width: 20%"|[[Levels_of_Evidence#Comparative_efficacy|Comparative Efficacy]] | ||
|- | |- | ||
− | |[ | + | |[https://doi.org/10.1182/blood.V50.3.471.471 Sullivan et al. 1977] |
− | | style="background-color:#1a9851" |Phase | + | |1971-1973 |
+ | | style="background-color:#1a9851" |Phase 3 (C) | ||
|IT MTX, Ara-C, HC | |IT MTX, Ara-C, HC | ||
− | | style="background-color:#ffffbf" | | + | | style="background-color:#ffffbf" |Did not meet primary endpoint of DOR |
|- | |- | ||
− | |[ | + | |[https://doi.org/10.1182/blood-2015-03-636548 Kim et al. 2015 (AMC-UUCM-2008-0310)] |
− | |style="background-color:#91cf61"|Phase | + | |2009-2012 |
+ | |style="background-color:#91cf61"|Phase 2 | ||
| style="background-color:#d3d3d3" | | | style="background-color:#d3d3d3" | | ||
| style="background-color:#d3d3d3" | | | style="background-color:#d3d3d3" | | ||
|- | |- | ||
|} | |} | ||
− | ''Treatment can be started during or after induction.'' | + | ''Note: Treatment can be started during or after induction.'' |
− | ====CNS therapy==== | + | <div class="toccolours" style="background-color:#b3e2cd"> |
+ | ====CNS therapy, prophylaxis==== | ||
*[[Methotrexate (MTX)]] 15 mg IT (schedule not specified), admixed with hydrocortisone | *[[Methotrexate (MTX)]] 15 mg IT (schedule not specified), admixed with hydrocortisone | ||
*[[Hydrocortisone (Cortef)]] 50 mg IT (schedule not specified), admixed with methotrexate | *[[Hydrocortisone (Cortef)]] 50 mg IT (schedule not specified), admixed with methotrexate | ||
− | |||
'''Up to 10 doses''' | '''Up to 10 doses''' | ||
− | + | </div></div> | |
===References=== | ===References=== | ||
− | # Sullivan MP, Moon TE, Trueworthy R, Vietti TJ, Humphrey GB, Komp D. Combination intrathecal therapy for meningeal leukemia: two versus three drugs. Blood. 1977 Sep;50(3):471-9. [ | + | # Sullivan MP, Moon TE, Trueworthy R, Vietti TJ, Humphrey GB, Komp D. Combination intrathecal therapy for meningeal leukemia: two versus three drugs. Blood. 1977 Sep;50(3):471-9. [https://doi.org/10.1182/blood.V50.3.471.471 link to original article] [https://pubmed.ncbi.nlm.nih.gov/577889/ PubMed] |
− | # '''AMC-UUCM-2008-0310:''' Kim DY, Joo YD, Lim SN, Kim SD, Lee JH, Lee JH, Kim DH, Kim K, Jung CW, Kim I, Yoon SS, Park S, Ahn JS, Yang DH, Lee JJ, Lee HS, Kim YS, Mun YC, Kim H, Park JH, Moon JH, Sohn SK, Lee SM, Lee WS, Kim KH, Won JH, Hyun MS, Park J, Lee JH, Shin HJ, Chung JS, Lee H, Eom HS, Lee GW, Cho YU, Jang S, Park CJ, Chi HS, Lee KH; Adult Acute Lymphoblastic Leukemia Working Party of the Korean Society of Hematology. Nilotinib combined with multiagent chemotherapy for newly diagnosed Philadelphia-positive acute lymphoblastic leukemia. Blood. 2015 Aug 6;126(6):746-56. Epub 2015 Jun 11. [ | + | # '''AMC-UUCM-2008-0310:''' Kim DY, Joo YD, Lim SN, Kim SD, Lee JH, Lee JH, Kim DH, Kim K, Jung CW, Kim I, Yoon SS, Park S, Ahn JS, Yang DH, Lee JJ, Lee HS, Kim YS, Mun YC, Kim H, Park JH, Moon JH, Sohn SK, Lee SM, Lee WS, Kim KH, Won JH, Hyun MS, Park J, Lee JH, Shin HJ, Chung JS, Lee H, Eom HS, Lee GW, Cho YU, Jang S, Park CJ, Chi HS, Lee KH; Adult Acute Lymphoblastic Leukemia Working Party of the Korean Society of Hematology. Nilotinib combined with multiagent chemotherapy for newly diagnosed Philadelphia-positive acute lymphoblastic leukemia. Blood. 2015 Aug 6;126(6):746-56. Epub 2015 Jun 11. [https://doi.org/10.1182/blood-2015-03-636548 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/26065651/ PubMed] [https://clinicaltrials.gov/study/NCT00844298 NCT00844298] |
− | |||
==IT Methotrexate & Methylprednisolone {{#subobject:6a4bad|Regimen=1}}== | ==IT Methotrexate & Methylprednisolone {{#subobject:6a4bad|Regimen=1}}== | ||
− | + | <div class="toccolours" style="background-color:#eeeeee"> | |
− | |||
− | |||
− | |||
===Regimen {{#subobject:358389|Variant=1}}=== | ===Regimen {{#subobject:358389|Variant=1}}=== | ||
− | {| class="wikitable" style="width: | + | {| class="wikitable sortable" style="width: 60%; text-align:center;" |
− | !style="width: | + | !style="width: 33%"|Study |
− | !style="width: | + | !style="width: 33%"|Dates of enrollment |
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
− | |[ | + | |[https://doi.org/10.1182/blood-2010-03-276196 Lo-Coco et al. 2010 (GIMEMA AIDA-2000)] |
+ | |2000-2006 | ||
|style="background-color:#91cf61"|Non-randomized | |style="background-color:#91cf61"|Non-randomized | ||
|- | |- | ||
|} | |} | ||
− | ''It is not explicitly stated but presumably these are admixed and given together.'' | + | ''Note: It is not explicitly stated but presumably these are admixed and given together.'' |
− | ====CNS therapy==== | + | <div class="toccolours" style="background-color:#b3e2cd"> |
− | *[[Methotrexate (MTX)]] 12 mg IT once | + | ====CNS therapy, prophylaxis==== |
− | *[[Methylprednisolone (Solumedrol)]] 40 mg IT once | + | *[[Methotrexate (MTX)]] 12 mg IT once prior to each consolidation cycle |
− | + | *[[Methylprednisolone (Solumedrol)]] 40 mg IT once prior to each consolidation cycle | |
'''Total of 3 doses''' | '''Total of 3 doses''' | ||
− | + | </div></div> | |
===References=== | ===References=== | ||
− | # '''GIMEMA AIDA-2000:''' Lo-Coco F, Avvisati G, Vignetti M, Breccia M, Gallo E, Rambaldi A, Paoloni F, Fioritoni G, Ferrara F, Specchia G, Cimino G, Diverio D, Borlenghi E, Martinelli G, Di Raimondo F, Di Bona E, Fazi P, Peta A, Bosi A, Carella AM, Fabbiano F, Pogliani EM, Petti MC, Amadori S, Mandelli F; | + | # '''GIMEMA AIDA-2000:''' Lo-Coco F, Avvisati G, Vignetti M, Breccia M, Gallo E, Rambaldi A, Paoloni F, Fioritoni G, Ferrara F, Specchia G, Cimino G, Diverio D, Borlenghi E, Martinelli G, Di Raimondo F, Di Bona E, Fazi P, Peta A, Bosi A, Carella AM, Fabbiano F, Pogliani EM, Petti MC, Amadori S, Mandelli F; GIMEMA. Front-line treatment of acute promyelocytic leukemia with AIDA induction followed by risk-adapted consolidation for adults younger than 61 years: results of the AIDA-2000 trial of the GIMEMA Group. Blood. 2010 Oct 8;116(17):3171-9. Epub 2010 Jul 19. [https://doi.org/10.1182/blood-2010-03-276196 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/20644121/ PubMed] [https://clinicaltrials.gov/study/NCT01064570 NCT01064570] |
==IT Methotrexate & WBRT {{#subobject:4b9a67|Regimen=1}}== | ==IT Methotrexate & WBRT {{#subobject:4b9a67|Regimen=1}}== | ||
− | |||
− | |||
− | |||
− | |||
IT Methotrexate & WBRT: '''<u>I</u>'''ntra'''<u>T</u>'''hecal Methotrexate & '''<u>W</u>'''hole '''<u>B</u>'''rain '''<u>R</u>'''adiation '''<u>T</u>'''herapy | IT Methotrexate & WBRT: '''<u>I</u>'''ntra'''<u>T</u>'''hecal Methotrexate & '''<u>W</u>'''hole '''<u>B</u>'''rain '''<u>R</u>'''adiation '''<u>T</u>'''herapy | ||
+ | <div class="toccolours" style="background-color:#eeeeee"> | ||
===Regimen {{#subobject:b1f086|Variant=1}}=== | ===Regimen {{#subobject:b1f086|Variant=1}}=== | ||
− | {| class="wikitable" style="width: 100%; text-align:center;" | + | {| class="wikitable sortable" style="width: 100%; text-align:center;" |
− | !style="width: | + | !style="width: 20%"|Study |
− | !style="width: | + | !style="width: 20%"|Dates of enrollment |
− | !style="width: | + | !style="width: 20%"|[[Levels_of_Evidence#Evidence|Evidence]] |
− | !style="width: | + | !style="width: 20%"|Comparator |
+ | !style="width: 20%"|[[Levels_of_Evidence#Comparative_efficacy|Comparative Efficacy]] | ||
|- | |- | ||
− | |[ | + | |[https://doi.org/10.1182/blood.V69.4.1242.1242 Linker et al. 1987] |
− | |style="background-color:#91cf61"|Phase | + | |1980-1986 |
+ | |style="background-color:#91cf61"|Phase 2 | ||
| style="background-color:#d3d3d3" | | | style="background-color:#d3d3d3" | | ||
| style="background-color:#d3d3d3" | | | style="background-color:#d3d3d3" | | ||
|- | |- | ||
− | |[ | + | |[https://doi.org/10.1200/JCO.1998.16.3.920 Nachman et al. 1998 (CCG 1882)] |
− | | style="background-color:#1a9851" |Phase | + | |1989-1995 |
− | |[[#IT_Methotrexate_monotherapy| | + | | style="background-color:#1a9851" |Phase 3 (C) |
− | | style="background-color:#ffffbf" | | + | |[[#IT_Methotrexate_monotherapy|IT MTX]]; intensified |
+ | | style="background-color:#ffffbf" |Did not meet primary endpoint of EFS | ||
|- | |- | ||
|} | |} | ||
− | ''Treatment is started within 1 week of achieving complete remission. Details are from Linker et al. 1987'' | + | ''Note: Treatment is started within 1 week of achieving complete remission. Details are from Linker et al. 1987'' |
− | ====CNS therapy==== | + | <div class="toccolours" style="background-color:#b3e2cd"> |
+ | ====CNS therapy, prophylaxis==== | ||
*[[Methotrexate (MTX)]] 12 mg IT once per week x 6 doses concurrent with radiation | *[[Methotrexate (MTX)]] 12 mg IT once per week x 6 doses concurrent with radiation | ||
====Radiotherapy==== | ====Radiotherapy==== | ||
− | *[[External_beam_radiotherapy|Whole-brain irradiation]], | + | *[[External_beam_radiotherapy|Whole-brain irradiation]], 1800 cGy total given in 10 fractions over 12 to 14 days |
− | + | </div></div> | |
===References=== | ===References=== | ||
− | # Linker CA, Levitt LJ, O'Donnell M, Ries CA, Link MP, Forman SJ, Farbstein MJ. Improved results of treatment of adult acute lymphoblastic leukemia. Blood. 1987 Apr;69(4):1242-8. [ | + | # Linker CA, Levitt LJ, O'Donnell M, Ries CA, Link MP, Forman SJ, Farbstein MJ. Improved results of treatment of adult acute lymphoblastic leukemia. Blood. 1987 Apr;69(4):1242-8. [https://doi.org/10.1182/blood.V69.4.1242.1242 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/3470055/ PubMed] |
− | ## '''Update:''' Linker CA, Levitt LJ, O'Donnell M, Forman SJ, Ries CA. Treatment of adult acute lymphoblastic leukemia with intensive cyclical chemotherapy: a follow-up report. Blood. 1991 Dec 1;78(11):2814-22. [ | + | ## '''Update:''' Linker CA, Levitt LJ, O'Donnell M, Forman SJ, Ries CA. Treatment of adult acute lymphoblastic leukemia with intensive cyclical chemotherapy: a follow-up report. Blood. 1991 Dec 1;78(11):2814-22. [https://doi.org/10.1182/blood.V78.11.2814.2814 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/1835410/ PubMed] |
− | # '''CCG 1882:''' Nachman J, Sather HN, Cherlow JM, Sensel MG, Gaynon PS, Lukens JN, Wolff L, Trigg ME. Response of children with high-risk acute lymphoblastic leukemia treated with and without cranial irradiation: a report from the Children's Cancer Group. J Clin Oncol. 1998 Mar;16(3):920-30. [ | + | # '''CCG 1882:''' Nachman J, Sather HN, Cherlow JM, Sensel MG, Gaynon PS, Lukens JN, Wolff L, Trigg ME. Response of children with high-risk acute lymphoblastic leukemia treated with and without cranial irradiation: a report from the Children's Cancer Group. J Clin Oncol. 1998 Mar;16(3):920-30. [https://doi.org/10.1200/JCO.1998.16.3.920 link to original article] [https://pubmed.ncbi.nlm.nih.gov/9508174/ PubMed] |
− | |||
==WBRT {{#subobject:4c3d39|Regimen=1}}== | ==WBRT {{#subobject:4c3d39|Regimen=1}}== | ||
− | |||
− | |||
− | |||
− | |||
WBRT: '''<u>W</u>'''hole '''<u>B</u>'''rain '''<u>R</u>'''adiation '''<u>T</u>'''herapy | WBRT: '''<u>W</u>'''hole '''<u>B</u>'''rain '''<u>R</u>'''adiation '''<u>T</u>'''herapy | ||
+ | <div class="toccolours" style="background-color:#eeeeee"> | ||
===Regimen {{#subobject:bcb463|Variant=1}}=== | ===Regimen {{#subobject:bcb463|Variant=1}}=== | ||
− | {| class="wikitable" style="width: 100%; text-align:center;" | + | {| class="wikitable sortable" style="width: 100%; text-align:center;" |
− | !style="width: | + | !style="width: 20%"|Study |
− | !style="width: | + | !style="width: 20%"|Dates of enrollment |
− | !style="width: | + | !style="width: 20%"|[[Levels_of_Evidence#Evidence|Evidence]] |
− | !style="width: | + | !style="width: 20%"|Comparator |
+ | !style="width: 20%"|[[Levels_of_Evidence#Comparative_efficacy|Comparative Efficacy]] | ||
|- | |- | ||
− | |[https:// | + | |[https://doi.org/10.1016/s0140-6736(81)91849-3 Nesbit et al. 1981] |
− | | style="background-color:#1a9851" |Phase | + | |1972-1975 |
− | | | + | | style="background-color:#1a9851" |Phase 3 (C) |
− | | style="background-color:#ffffbf" | | + | |[[#WBRT|WBRT]]; lower-dose |
+ | | style="background-color:#ffffbf" |Did not meet endpoint of OS | ||
|- | |- | ||
− | |[https:// | + | |[https://doi.org/10.1056/NEJM198303033080902 Freeman et al. 1983 (CALGB 7611)] |
− | | style="background-color:#1a9851" |Phase | + | |1976-1979 |
+ | | style="background-color:#1a9851" |Phase 3 (C) | ||
|Intermediate-dose MTX | |Intermediate-dose MTX | ||
| style="background-color:#ffffbf" |Mixed results | | style="background-color:#ffffbf" |Mixed results | ||
|- | |- | ||
|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2754320/ Pui et al. 2009 (Total Therapy XV)] | |[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2754320/ Pui et al. 2009 (Total Therapy XV)] | ||
− | | style="background-color:#1a9851" |Phase | + | |2000-2007 |
+ | | style="background-color:#1a9851" |Phase 3 (C) | ||
|Observation | |Observation | ||
− | | style="background-color:#ffffbf" | | + | | style="background-color:#ffffbf" |Did not meet co-primary endpoints of EFS/OS |
|- | |- | ||
|} | |} | ||
''Note: in Total Therapy XV, this is the control arm of a de-escalation study.'' | ''Note: in Total Therapy XV, this is the control arm of a de-escalation study.'' | ||
+ | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Radiotherapy==== | ====Radiotherapy==== | ||
*[[External_beam_radiotherapy|Whole-brain irradiation]] | *[[External_beam_radiotherapy|Whole-brain irradiation]] | ||
− | |||
'''One course''' | '''One course''' | ||
− | + | </div></div> | |
===References=== | ===References=== | ||
− | # Nesbit ME Jr, Sather HN, Robison LL, Ortega J, Littman PS, D'Angio GJ, Hammond GD. Presymptomatic central nervous system therapy in previously untreated childhood acute lymphoblastic leukaemia: comparison of 1800 rad and 2400 rad: a report for Children's Cancer Study Group. Lancet. 1981 Feb 28;1(8218):461-6. [https:// | + | # Nesbit ME Jr, Sather HN, Robison LL, Ortega J, Littman PS, D'Angio GJ, Hammond GD; Children's Cancer Group. Presymptomatic central nervous system therapy in previously untreated childhood acute lymphoblastic leukaemia: comparison of 1800 rad and 2400 rad: a report for Children's Cancer Study Group. Lancet. 1981 Feb 28;1(8218):461-6. [https://doi.org/10.1016/s0140-6736(81)91849-3 link to original article] [https://pubmed.ncbi.nlm.nih.gov/6110090/ PubMed] |
− | # '''CALGB 7611:''' Freeman AI, Weinberg V, Brecher ML, Jones B, Glicksman AS, Sinks LF, Weil M, Pleuss H, Hananian J, Burgert EO Jr, Gilchrist GS, Necheles T, Harris M, Kung F, Patterson RB, Maurer H, Leventhal B, Chevalier L, Forman E, Holland JF. Comparison of intermediate-dose methotrexate with cranial irradiation for the post-induction treatment of acute lymphocytic leukemia in children. N Engl J Med. 1983 Mar 3;308(9):477-84. [https:// | + | # '''CALGB 7611:''' Freeman AI, Weinberg V, Brecher ML, Jones B, Glicksman AS, Sinks LF, Weil M, Pleuss H, Hananian J, Burgert EO Jr, Gilchrist GS, Necheles T, Harris M, Kung F, Patterson RB, Maurer H, Leventhal B, Chevalier L, Forman E, Holland JF. Comparison of intermediate-dose methotrexate with cranial irradiation for the post-induction treatment of acute lymphocytic leukemia in children. N Engl J Med. 1983 Mar 3;308(9):477-84. [https://doi.org/10.1056/NEJM198303033080902 link to original article] [https://pubmed.ncbi.nlm.nih.gov/6571946/ PubMed] |
− | ## '''Update:''' Freeman AI, Boyett JM, Glicksman AS, Brecher ML, Leventhal BG, Sinks LF, Holland JF. Intermediate-dose methotrexate versus cranial irradiation in childhood acute lymphoblastic leukemia: a ten-year follow-up. Med Pediatr Oncol. 1997 Feb;28(2):98-107. [https:// | + | ## '''Update:''' Freeman AI, Boyett JM, Glicksman AS, Brecher ML, Leventhal BG, Sinks LF, Holland JF. Intermediate-dose methotrexate versus cranial irradiation in childhood acute lymphoblastic leukemia: a ten-year follow-up. Med Pediatr Oncol. 1997 Feb;28(2):98-107. [https://doi.org/10.1002/(SICI)1096-911X(199702)28:2%3C98::AID-MPO3%3E3.0.CO;2-N link to original article] [https://pubmed.ncbi.nlm.nih.gov/8986145/ PubMed] |
− | # '''Total Therapy XV:''' Pui CH, Campana D, Pei D, Bowman WP, Sandlund JT, Kaste SC, Ribeiro RC, Rubnitz JE, Raimondi SC, Onciu M, Coustan-Smith E, Kun LE, Jeha S, Cheng C, Howard SC, Simmons V, Bayles A, Metzger ML, Boyett JM, Leung W, Handgretinger R, Downing JR, Evans WE, Relling MV. Treating childhood acute lymphoblastic leukemia without cranial irradiation. N Engl J Med. 2009 Jun 25;360(26):2730-41. [https:// | + | # '''Total Therapy XV:''' Pui CH, Campana D, Pei D, Bowman WP, Sandlund JT, Kaste SC, Ribeiro RC, Rubnitz JE, Raimondi SC, Onciu M, Coustan-Smith E, Kun LE, Jeha S, Cheng C, Howard SC, Simmons V, Bayles A, Metzger ML, Boyett JM, Leung W, Handgretinger R, Downing JR, Evans WE, Relling MV. Treating childhood acute lymphoblastic leukemia without cranial irradiation. N Engl J Med. 2009 Jun 25;360(26):2730-41. [https://doi.org/10.1056/NEJMoa0900386 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2754320/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/19553647/ PubMed] [https://clinicaltrials.gov/study/NCT00137111 NCT00137111] |
− | |||
=CNS prophylaxis, systemic therapy= | =CNS prophylaxis, systemic therapy= | ||
==Mercaptopurine & WBRT {{#subobject:fab960|Regimen=1}}== | ==Mercaptopurine & WBRT {{#subobject:fab960|Regimen=1}}== | ||
− | |||
− | |||
− | |||
− | |||
Mercaptopurine & WBRT: Mercaptopurine & '''<u>W</u>'''hole '''<u>B</u>'''rain '''<u>R</u>'''adiation '''<u>T</u>'''herapy | Mercaptopurine & WBRT: Mercaptopurine & '''<u>W</u>'''hole '''<u>B</u>'''rain '''<u>R</u>'''adiation '''<u>T</u>'''herapy | ||
+ | <div class="toccolours" style="background-color:#eeeeee"> | ||
===Regimen {{#subobject:846b99|Variant=1}}=== | ===Regimen {{#subobject:846b99|Variant=1}}=== | ||
− | {| class="wikitable" style="width: | + | {| class="wikitable sortable" style="width: 60%; text-align:center;" |
− | !style="width: | + | !style="width: 33%"|Study |
− | !style="width: | + | !style="width: 33%"|Dates of enrollment |
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
− | |[ | + | |[https://doi.org/10.1200/JCO.2008.18.6916 Huguet et al. 2009 (GRAALL-2003)] |
− | |style="background-color:#91cf61"|Phase | + | |2003-2005 |
+ | |style="background-color:#91cf61"|Phase 2 | ||
|- | |- | ||
|} | |} | ||
− | ''Chemoradiation is given before maintenance therapy.'' | + | ''Note: Chemoradiation is given before maintenance therapy.'' |
+ | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Chemotherapy==== | ====Chemotherapy==== | ||
*[[Mercaptopurine (6-MP)]] 60 mg/m<sup>2</sup>/day PO during irradiation | *[[Mercaptopurine (6-MP)]] 60 mg/m<sup>2</sup>/day PO during irradiation | ||
====Radiotherapy==== | ====Radiotherapy==== | ||
− | *[[External_beam_radiotherapy|Whole-brain irradiation]] to | + | *[[External_beam_radiotherapy|Whole-brain irradiation]] to 1800 cGy (details not provided) |
− | |||
'''One course''' | '''One course''' | ||
− | + | </div></div> | |
===References=== | ===References=== | ||
− | # '''GRAALL-2003:''' Huguet F, Leguay T, Raffoux E, Thomas X, Beldjord K, Delabesse E, Chevallier P, Buzyn A, Delannoy A, Chalandon Y, Vernant JP, Lafage-Pochitaloff M, Chassevent A, Lhéritier V, Macintyre E, Béné MC, Ifrah N, Dombret H. Pediatric-inspired therapy in adults with Philadelphia chromosome-negative acute lymphoblastic leukemia: the GRAALL-2003 study. J Clin Oncol. 2009 Feb 20;27(6):911-8. Epub 2009 Jan 5. Erratum in: J Clin Oncol. 2009 May 20;27(15):2574. Dosage error in article text. [ | + | # '''GRAALL-2003:''' Huguet F, Leguay T, Raffoux E, Thomas X, Beldjord K, Delabesse E, Chevallier P, Buzyn A, Delannoy A, Chalandon Y, Vernant JP, Lafage-Pochitaloff M, Chassevent A, Lhéritier V, Macintyre E, Béné MC, Ifrah N, Dombret H. Pediatric-inspired therapy in adults with Philadelphia chromosome-negative acute lymphoblastic leukemia: the GRAALL-2003 study. J Clin Oncol. 2009 Feb 20;27(6):911-8. Epub 2009 Jan 5. Erratum in: J Clin Oncol. 2009 May 20;27(15):2574. Dosage error in article text. [https://doi.org/10.1200/JCO.2008.18.6916 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/19124805/ PubMed] [https://clinicaltrials.gov/study/NCT00222027 NCT00222027] |
=CNS treatment, local therapy= | =CNS treatment, local therapy= | ||
− | |||
==IT Cytarabine & Methotrexate {{#subobject:7536ce|Regimen=1}}== | ==IT Cytarabine & Methotrexate {{#subobject:7536ce|Regimen=1}}== | ||
− | {| class="wikitable" style=" | + | <div class="toccolours" style="background-color:#eeeeee"> |
+ | ===Regimen variant #1, LP {{#subobject:c0aa53|Variant=1}}=== | ||
+ | {| class="wikitable sortable" style="width: 60%; text-align:center;" | ||
+ | !style="width: 33%"|Study | ||
+ | !style="width: 33%"|Dates of enrollment | ||
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
+ | |- | ||
+ | |[https://doi.org/10.1200/jco.1999.17.8.2461 Thomas et al. 1999] | ||
+ | |1992-09 to 1997-06 | ||
+ | |style="background-color:#91cf61"|Phase 2 | ||
|- | |- | ||
− | |||
|} | |} | ||
− | ===Regimen {{#subobject:c0aa53|Variant=1}}=== | + | ''Note: while there is measurable CNS disease, both drugs are given every week, alternating, usually separated by at least 48 hours (e.g., on Mondays & Thursdays).'' |
− | {| class="wikitable" style="width: | + | <div class="toccolours" style="background-color:#b3e2cd"> |
− | !style="width: | + | ====CNS therapy, treatment==== |
− | !style="width: | + | *[[Methotrexate (MTX)]] as follows: |
+ | **Measurable CNS disease: 12 mg IT once per week | ||
+ | **First 4 weeks after cell count & cytology are negative: 12 mg IT once per week on weeks 1 & 3 | ||
+ | **Remainder of induction: 12 mg IT once on day 2 | ||
+ | *[[Cytarabine (Ara-C)]] as follows: | ||
+ | **Measurable CNS disease: 100 mg IT once per week | ||
+ | **First 4 weeks after cell count & cytology are negative: 100 mg IT once per week on weeks 2 & 4 | ||
+ | **Remainder of induction: 100 mg IT once on day 7 or 8 | ||
+ | </div></div><br> | ||
+ | <div class="toccolours" style="background-color:#eeeeee"> | ||
+ | ===Regimen variant #2, Ommaya reservoir {{#subobject:c0aa53|Variant=1}}=== | ||
+ | {| class="wikitable sortable" style="width: 60%; text-align:center;" | ||
+ | !style="width: 33%"|Study | ||
+ | !style="width: 33%"|Dates of enrollment | ||
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
− | |[ | + | |[https://doi.org/10.1200/jco.1999.17.8.2461 Thomas et al. 1999] |
− | |style="background-color:#91cf61"|Phase | + | |1992-09 to 1997-06 |
+ | |style="background-color:#91cf61"|Phase 2 | ||
|- | |- | ||
|} | |} | ||
''Note: while there is measurable CNS disease, both drugs are given every week, alternating, usually separated by at least 48 hours (e.g., on Mondays & Thursdays).'' | ''Note: while there is measurable CNS disease, both drugs are given every week, alternating, usually separated by at least 48 hours (e.g., on Mondays & Thursdays).'' | ||
− | ====CNS therapy==== | + | <div class="toccolours" style="background-color:#b3e2cd"> |
+ | ====CNS therapy, treatment==== | ||
*[[Methotrexate (MTX)]] as follows: | *[[Methotrexate (MTX)]] as follows: | ||
− | **Measurable CNS disease: | + | **Measurable CNS disease: 6 mg IT once per week |
− | **First 4 weeks after cell count & cytology are negative: | + | **First 4 weeks after cell count & cytology are negative: 6 mg IT once per week on weeks 1 & 3 |
− | **Remainder of induction: | + | **Remainder of induction: 6 mg IT once on day 2 |
*[[Cytarabine (Ara-C)]] as follows: | *[[Cytarabine (Ara-C)]] as follows: | ||
**Measurable CNS disease: 100 mg IT once per week | **Measurable CNS disease: 100 mg IT once per week | ||
**First 4 weeks after cell count & cytology are negative: 100 mg IT once per week on weeks 2 & 4 | **First 4 weeks after cell count & cytology are negative: 100 mg IT once per week on weeks 2 & 4 | ||
**Remainder of induction: 100 mg IT once on day 7 or 8 | **Remainder of induction: 100 mg IT once on day 7 or 8 | ||
− | + | </div></div> | |
===References=== | ===References=== | ||
− | # Thomas DA, Cortes J, O'Brien S, Pierce S, Faderl S, Albitar M, Hagemeister FB, Cabanillas FF, Murphy S, Keating MJ, Kantarjian H. Hyper-CVAD program in Burkitt's-type adult acute lymphoblastic leukemia. J Clin Oncol. 1999 Aug;17(8):2461-70. [ | + | # Thomas DA, Cortes J, O'Brien S, Pierce S, Faderl S, Albitar M, Hagemeister FB, Cabanillas FF, Murphy S, Keating MJ, Kantarjian H. Hyper-CVAD program in Burkitt's-type adult acute lymphoblastic leukemia. J Clin Oncol. 1999 Aug;17(8):2461-70. [https://doi.org/10.1200/jco.1999.17.8.2461 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/10561310/ PubMed] |
==IT Cytarabine, Methotrexate, Methylprednisolone {{#subobject:833d98|Regimen=1}}== | ==IT Cytarabine, Methotrexate, Methylprednisolone {{#subobject:833d98|Regimen=1}}== | ||
− | + | <div class="toccolours" style="background-color:#eeeeee"> | |
− | |||
− | |||
− | |||
===Regimen {{#subobject:0ded48|Variant=1}}=== | ===Regimen {{#subobject:0ded48|Variant=1}}=== | ||
− | {| class="wikitable" style="width: | + | {| class="wikitable sortable" style="width: 60%; text-align:center;" |
− | !style="width: | + | !style="width: 33%"|Study |
− | !style="width: | + | !style="width: 33%"|Dates of enrollment |
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
− | |[ | + | |[https://doi.org/10.1200/JCO.2008.18.6916 Huguet et al. 2009 (GRAALL-2003)] |
− | |style="background-color:#91cf61"|Phase | + | |2003-2005 |
+ | |style="background-color:#91cf61"|Phase 2 | ||
|- | |- | ||
|} | |} | ||
− | ''Intrathecal treatments are given as follows: eight between days -7 and 21 of induction, four during the first two consolidation blocks, and one at day 29 of consolidation blocks 3 and 6 -- 14 total doses.'' | + | ''Note: Intrathecal treatments are given as follows: eight between days -7 and 21 of induction, four during the first two consolidation blocks, and one at day 29 of consolidation blocks 3 and 6 -- 14 total doses.'' |
− | ====CNS therapy==== | + | <div class="toccolours" style="background-color:#b3e2cd"> |
+ | ====CNS therapy, treatment==== | ||
*[[Cytarabine (Ara-C)]] 40 mg IT mixed with methotrexate and methylprednisolone | *[[Cytarabine (Ara-C)]] 40 mg IT mixed with methotrexate and methylprednisolone | ||
− | *[[Methotrexate (MTX)]] 15 mg IT mixed with cytarabine and methylprednisolone | + | *[[Methotrexate (MTX)]] 15 mg IT mixed with cytarabine and methylprednisolone |
*[[Methylprednisolone (Solumedrol)]] 40 mg IT mixed with cytarabine and methotrexate | *[[Methylprednisolone (Solumedrol)]] 40 mg IT mixed with cytarabine and methotrexate | ||
− | + | '''14 doses (see note)''' | |
− | '''14 doses''' | + | </div></div> |
− | |||
===References=== | ===References=== | ||
− | # '''GRAALL-2003:''' Huguet F, Leguay T, Raffoux E, Thomas X, Beldjord K, Delabesse E, Chevallier P, Buzyn A, Delannoy A, Chalandon Y, Vernant JP, Lafage-Pochitaloff M, Chassevent A, Lhéritier V, Macintyre E, Béné MC, Ifrah N, Dombret H. Pediatric-inspired therapy in adults with Philadelphia chromosome-negative acute lymphoblastic leukemia: the GRAALL-2003 study. J Clin Oncol. 2009 Feb 20;27(6):911-8. Epub 2009 Jan 5. Erratum in: J Clin Oncol. 2009 May 20;27(15):2574. Dosage error in article text. [ | + | # '''GRAALL-2003:''' Huguet F, Leguay T, Raffoux E, Thomas X, Beldjord K, Delabesse E, Chevallier P, Buzyn A, Delannoy A, Chalandon Y, Vernant JP, Lafage-Pochitaloff M, Chassevent A, Lhéritier V, Macintyre E, Béné MC, Ifrah N, Dombret H. Pediatric-inspired therapy in adults with Philadelphia chromosome-negative acute lymphoblastic leukemia: the GRAALL-2003 study. J Clin Oncol. 2009 Feb 20;27(6):911-8. Epub 2009 Jan 5. Erratum in: J Clin Oncol. 2009 May 20;27(15):2574. Dosage error in article text. [https://doi.org/10.1200/JCO.2008.18.6916 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/19124805/ PubMed] [https://clinicaltrials.gov/study/NCT00222027 NCT00222027] |
− | |||
==IT Cytarabine, Methotrexate, WBRT {{#subobject:2457a6|Regimen=1}}== | ==IT Cytarabine, Methotrexate, WBRT {{#subobject:2457a6|Regimen=1}}== | ||
− | {| class="wikitable" style=" | + | Cytarabine, Methotrexate, WBRT: Cytarabine, Methotrexate, '''<u>W</u>'''hole '''<u>B</u>'''rain '''<u>R</u>'''adiation '''<u>T</u>'''herapy |
+ | <div class="toccolours" style="background-color:#eeeeee"> | ||
+ | ===Regimen variant #1, LP {{#subobject:b3fdae|Variant=1}}=== | ||
+ | {| class="wikitable sortable" style="width: 60%; text-align:center;" | ||
+ | !style="width: 33%"|Study | ||
+ | !style="width: 33%"|Dates of enrollment | ||
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
+ | |- | ||
+ | |[https://doi.org/10.1182/blood-2003-08-2958 Thomas et al. 2003] | ||
+ | |2001-04 to 2003-03 | ||
+ | |style="background-color:#91cf61"|Phase 2 | ||
+ | |- | ||
+ | |[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4081177/ Ravandi et al. 2010 (MDACC 2006-0478)] | ||
+ | |2006-09-28 to 2009-07-15 | ||
+ | |style="background-color:#91cf61"|Phase 2 | ||
|- | |- | ||
− | |||
|} | |} | ||
− | + | ''Note: while there is measurable CNS disease, both drugs are given every week, alternating, usually separated by at least 48 hours (e.g., on Mondays & Thursdays).'' | |
− | ===Regimen {{#subobject: | + | <div class="toccolours" style="background-color:#b3e2cd"> |
− | {| class="wikitable" style="width: | + | ====CNS therapy, treatment==== |
− | !style="width: | + | *[[Methotrexate (MTX)]] as follows: |
− | !style="width: | + | **Measurable CNS disease: 12 mg IT once per week |
+ | **First 4 weeks after cell count & cytology are negative: 12 mg IT once per week on weeks 1 & 3 | ||
+ | **Remainder of induction: 12 mg IT once on day 2 | ||
+ | *[[Cytarabine (Ara-C)]] as follows: | ||
+ | **Measurable CNS disease: 100 mg IT once per week | ||
+ | **First 4 weeks after cell count & cytology are negative: 100 mg IT once per week on weeks 2 & 4 | ||
+ | **Remainder of induction: 100 mg IT once on day 7 or 8 | ||
+ | ====Radiotherapy==== | ||
+ | *Therapeutic [[External_beam_radiotherapy|whole-brain irradiation]] is given to patients with CNS disease at presentation | ||
+ | </div></div><br> | ||
+ | <div class="toccolours" style="background-color:#eeeeee"> | ||
+ | ===Regimen variant #2, Ommaya reservoir {{#subobject:b3fadu|Variant=1}}=== | ||
+ | {| class="wikitable sortable" style="width: 60%; text-align:center;" | ||
+ | !style="width: 33%"|Study | ||
+ | !style="width: 33%"|Dates of enrollment | ||
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
− | |[ | + | |[https://doi.org/10.1182/blood-2003-08-2958 Thomas et al. 2003] |
− | |style="background-color:#91cf61"|Phase | + | |2001-04 to 2003-03 |
+ | |style="background-color:#91cf61"|Phase 2 | ||
|- | |- | ||
− | |[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4081177/ Ravandi et al. 2010] | + | |[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4081177/ Ravandi et al. 2010 (MDACC 2006-0478)] |
− | |style="background-color:#91cf61"|Phase | + | |2006-09-28 to 2009-07-15 |
+ | |style="background-color:#91cf61"|Phase 2 | ||
|- | |- | ||
|} | |} | ||
''Note: while there is measurable CNS disease, both drugs are given every week, alternating, usually separated by at least 48 hours (e.g., on Mondays & Thursdays).'' | ''Note: while there is measurable CNS disease, both drugs are given every week, alternating, usually separated by at least 48 hours (e.g., on Mondays & Thursdays).'' | ||
− | ====CNS therapy==== | + | <div class="toccolours" style="background-color:#b3e2cd"> |
+ | ====CNS therapy, treatment==== | ||
*[[Methotrexate (MTX)]] as follows: | *[[Methotrexate (MTX)]] as follows: | ||
− | **Measurable CNS disease: | + | **Measurable CNS disease: 6 mg IT once per week |
− | **First 4 weeks after cell count & cytology are negative: | + | **First 4 weeks after cell count & cytology are negative: 6 mg IT once per week on weeks 1 & 3 |
− | **Remainder of induction: | + | **Remainder of induction: 6 mg IT once on day 2 |
*[[Cytarabine (Ara-C)]] as follows: | *[[Cytarabine (Ara-C)]] as follows: | ||
**Measurable CNS disease: 100 mg IT once per week | **Measurable CNS disease: 100 mg IT once per week | ||
Line 426: | Line 473: | ||
====Radiotherapy==== | ====Radiotherapy==== | ||
*Therapeutic [[External_beam_radiotherapy|whole-brain irradiation]] is given to patients with CNS disease at presentation | *Therapeutic [[External_beam_radiotherapy|whole-brain irradiation]] is given to patients with CNS disease at presentation | ||
− | + | </div></div> | |
===References=== | ===References=== | ||
− | # Thomas DA, Faderl S, Cortes J, O'Brien S, Giles FJ, Kornblau SM, Garcia-Manero G, Keating MJ, Andreeff M, Jeha S, Beran M, Verstovsek S, Pierce S, Letvak L, Salvado A, Champlin R, Talpaz M, Kantarjian H. Treatment of Philadelphia chromosome-positive acute lymphocytic leukemia with hyper-CVAD and imatinib mesylate. Blood. 2004 Jun 15;103(12):4396-407. Epub 2003 Oct 9. [ | + | # Thomas DA, Faderl S, Cortes J, O'Brien S, Giles FJ, Kornblau SM, Garcia-Manero G, Keating MJ, Andreeff M, Jeha S, Beran M, Verstovsek S, Pierce S, Letvak L, Salvado A, Champlin R, Talpaz M, Kantarjian H. Treatment of Philadelphia chromosome-positive acute lymphocytic leukemia with hyper-CVAD and imatinib mesylate. Blood. 2004 Jun 15;103(12):4396-407. Epub 2003 Oct 9. [https://doi.org/10.1182/blood-2003-08-2958 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/14551133/ PubMed] |
− | ## '''Update:''' Daver N, Thomas D, Ravandi F, Cortes J, Garris R, Jabbour E, Garcia-Manero G, Borthakur G, Kadia T, Rytting M, Konopleva M, Kantarjian H, O' Brien S. Final report of a phase II study of imatinib mesylate with hyper-CVAD for the frontline treatment of adult patients with Philadelphia chromosome positive (Ph+) acute lymphoblastic leukemia. Haematologica. 2015 May;100(5):653-61. Epub 2015 Feb 14. [ | + | ## '''Update:''' Daver N, Thomas D, Ravandi F, Cortes J, Garris R, Jabbour E, Garcia-Manero G, Borthakur G, Kadia T, Rytting M, Konopleva M, Kantarjian H, O' Brien S. Final report of a phase II study of imatinib mesylate with hyper-CVAD for the frontline treatment of adult patients with Philadelphia chromosome positive (Ph+) acute lymphoblastic leukemia. Haematologica. 2015 May;100(5):653-61. Epub 2015 Feb 14. [https://doi.org/10.3324/haematol.2014.118588 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420214/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/25682595/ PubMed] |
− | # Ravandi F, O'Brien S, Thomas D, Faderl S, Jones D, Garris R, Dara S, Jorgensen J, Kebriaei P, Champlin R, Borthakur G, Burger J, Ferrajoli A, Garcia-Manero G, Wierda W, Cortes J, Kantarjian H. First report of phase 2 study of dasatinib with hyper-CVAD for the frontline treatment of patients with Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia. Blood. 2010 Sep 23;116(12):2070-7. Epub 2010 May 13. [ | + | # '''MDACC 2006-0478:''' Ravandi F, O'Brien S, Thomas D, Faderl S, Jones D, Garris R, Dara S, Jorgensen J, Kebriaei P, Champlin R, Borthakur G, Burger J, Ferrajoli A, Garcia-Manero G, Wierda W, Cortes J, Kantarjian H. First report of phase 2 study of dasatinib with hyper-CVAD for the frontline treatment of patients with Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia. Blood. 2010 Sep 23;116(12):2070-7. Epub 2010 May 13. [https://doi.org/10.1182/blood-2009-12-261586 link to original article] '''contains dosing details in manuscript'''--parts of the protocol were not explicitly listed in this reference, which instead referred to [[#Hyper-CVAD_.26_Imatinib_.28Gleevec.29_.28induction_.26_maintenance.29|Thomas et al. 2004]] and [[#Hyper-CVAD_.28induction.29|Kantarjian et al. 2004]] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4081177/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/20466853/ PubMed] [https://clinicaltrials.gov/study/NCT00390793 NCT00390793] |
− | ## '''Update:''' Ravandi F, O'Brien SM, Cortes JE, Thomas DM, Garris R, Faderl S, Burger JA, Rytting ME, Ferrajoli A, Wierda WG, Verstovsek S, Champlin R, Kebriaei P, McCue DA, Huang X, Jabbour E, Garcia-Manero G, Estrov Z, Kantarjian HM. Long-term follow-up of a phase 2 study of chemotherapy plus dasatinib for the initial treatment of patients with Philadelphia chromosome-positive acute lymphoblastic leukemia. Cancer. 2015 Dec 1;121(23):4158-64. Epub 2015 Aug 26. [https:// | + | ## '''Update:''' Ravandi F, O'Brien SM, Cortes JE, Thomas DM, Garris R, Faderl S, Burger JA, Rytting ME, Ferrajoli A, Wierda WG, Verstovsek S, Champlin R, Kebriaei P, McCue DA, Huang X, Jabbour E, Garcia-Manero G, Estrov Z, Kantarjian HM. Long-term follow-up of a phase 2 study of chemotherapy plus dasatinib for the initial treatment of patients with Philadelphia chromosome-positive acute lymphoblastic leukemia. Cancer. 2015 Dec 1;121(23):4158-64. Epub 2015 Aug 26. [https://doi.org/10.1002/cncr.29646 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4666803/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/26308885/ PubMed] |
− | |||
==IT Methotrexate monotherapy {{#subobject:d4a3c5|Regimen=1}}== | ==IT Methotrexate monotherapy {{#subobject:d4a3c5|Regimen=1}}== | ||
− | + | <div class="toccolours" style="background-color:#eeeeee"> | |
− | |||
− | |||
− | |||
===Regimen {{#subobject:183c87|Variant=1}}=== | ===Regimen {{#subobject:183c87|Variant=1}}=== | ||
− | {| class="wikitable" style="width: | + | {| class="wikitable sortable" style="width: 60%; text-align:center;" |
− | !style="width: | + | !style="width: 33%"|Study |
− | !style="width: | + | !style="width: 33%"|Dates of enrollment |
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
− | |[https:// | + | |[https://doi.org/10.1056/NEJM196107272650404 Shanbrom et al. 1961] |
+ | |1957-1960 | ||
| style="background-color:#ffffbe" |Pilot | | style="background-color:#ffffbe" |Pilot | ||
|- | |- | ||
− | |[ | + | |[https://doi.org/10.1200/JCO.2008.18.6916 Huguet et al. 2009 (GRAALL-2003)] |
− | |style="background-color:#91cf61"|Phase | + | |2003-2005 |
+ | |style="background-color:#91cf61"|Phase 2 | ||
|- | |- | ||
|} | |} | ||
− | ====CNS therapy==== | + | <div class="toccolours" style="background-color:#b3e2cd"> |
+ | ====CNS therapy, treatment==== | ||
*[[Methotrexate (MTX)]] as follows: | *[[Methotrexate (MTX)]] as follows: | ||
− | ** | + | **Pre-phase: 15 mg IT once at some point between days -7 and -4 |
+ | </div></div> | ||
===References=== | ===References=== | ||
− | # Shanbrom E, Miller S, Fairbanks VF. Intrathecal administration of amethopterin in leukemic encephalopathy of young adults. N Engl J Med. 1961 Jul 27;265:169-71. [https:// | + | # Shanbrom E, Miller S, Fairbanks VF. Intrathecal administration of amethopterin in leukemic encephalopathy of young adults. N Engl J Med. 1961 Jul 27;265:169-71. [https://doi.org/10.1056/NEJM196107272650404 link to original article] [https://pubmed.ncbi.nlm.nih.gov/13750662/ PubMed] |
− | # '''GRAALL-2003:''' Huguet F, Leguay T, Raffoux E, Thomas X, Beldjord K, Delabesse E, Chevallier P, Buzyn A, Delannoy A, Chalandon Y, Vernant JP, Lafage-Pochitaloff M, Chassevent A, Lhéritier V, Macintyre E, Béné MC, Ifrah N, Dombret H. Pediatric-inspired therapy in adults with Philadelphia chromosome-negative acute lymphoblastic leukemia: the GRAALL-2003 study. J Clin Oncol. 2009 Feb 20;27(6):911-8. Epub 2009 Jan 5. Erratum in: J Clin Oncol. 2009 May 20;27(15):2574. Dosage error in article text. [ | + | # '''GRAALL-2003:''' Huguet F, Leguay T, Raffoux E, Thomas X, Beldjord K, Delabesse E, Chevallier P, Buzyn A, Delannoy A, Chalandon Y, Vernant JP, Lafage-Pochitaloff M, Chassevent A, Lhéritier V, Macintyre E, Béné MC, Ifrah N, Dombret H. Pediatric-inspired therapy in adults with Philadelphia chromosome-negative acute lymphoblastic leukemia: the GRAALL-2003 study. J Clin Oncol. 2009 Feb 20;27(6):911-8. Epub 2009 Jan 5. Erratum in: J Clin Oncol. 2009 May 20;27(15):2574. Dosage error in article text. [https://doi.org/10.1200/JCO.2008.18.6916 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/19124805/ PubMed] [https://clinicaltrials.gov/study/NCT00222027 NCT00222027] |
− | |||
==IT Methotrexate & WBRT {{#subobject:d129ea|Regimen=1}}== | ==IT Methotrexate & WBRT {{#subobject:d129ea|Regimen=1}}== | ||
− | |||
− | |||
− | |||
− | |||
IT Methotrexate & WBRT: '''<u>I</u>'''ntra'''<u>T</u>'''hecal Methotrexate & '''<u>W</u>'''hole '''<u>B</u>'''rain '''<u>R</u>'''adiation '''<u>T</u>'''herapy | IT Methotrexate & WBRT: '''<u>I</u>'''ntra'''<u>T</u>'''hecal Methotrexate & '''<u>W</u>'''hole '''<u>B</u>'''rain '''<u>R</u>'''adiation '''<u>T</u>'''herapy | ||
+ | <div class="toccolours" style="background-color:#eeeeee"> | ||
===Regimen {{#subobject:f7b824|Variant=1}}=== | ===Regimen {{#subobject:f7b824|Variant=1}}=== | ||
− | {| class="wikitable" style="width: | + | {| class="wikitable sortable" style="width: 60%; text-align:center;" |
− | !style="width: | + | !style="width: 33%"|Study |
− | !style="width: | + | !style="width: 33%"|Dates of enrollment |
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
− | |[ | + | |[https://doi.org/10.1182/blood.V69.4.1242.1242 Linker et al. 1987] |
− | |style="background-color:#91cf61"|Phase | + | |1980-1986 |
+ | |style="background-color:#91cf61"|Phase 2 | ||
|- | |- | ||
|} | |} | ||
− | ''Treatment starts while patient is receiving induction therapy.'' | + | ''Note: Treatment starts while patient is receiving induction therapy.'' |
− | ====CNS therapy==== | + | <div class="toccolours" style="background-color:#b3e2cd"> |
+ | ====CNS therapy, treatment==== | ||
*[[Methotrexate (MTX)]] as follows: | *[[Methotrexate (MTX)]] as follows: | ||
**Induction: 12 mg IT once per week x 10 doses | **Induction: 12 mg IT once per week x 10 doses | ||
**Remainder of first year of therapy: 12 mg IT once per month | **Remainder of first year of therapy: 12 mg IT once per month | ||
====Radiotherapy==== | ====Radiotherapy==== | ||
− | *[[External_beam_radiotherapy|Whole-brain irradiation]], | + | *[[External_beam_radiotherapy|Whole-brain irradiation]], 2800 cGy total given (no details provided) |
− | + | </div></div> | |
===References=== | ===References=== | ||
− | # Linker CA, Levitt LJ, O'Donnell M, Ries CA, Link MP, Forman SJ, Farbstein MJ. Improved results of treatment of adult acute lymphoblastic leukemia. Blood. 1987 Apr;69(4):1242-8. [ | + | # Linker CA, Levitt LJ, O'Donnell M, Ries CA, Link MP, Forman SJ, Farbstein MJ. Improved results of treatment of adult acute lymphoblastic leukemia. Blood. 1987 Apr;69(4):1242-8. [https://doi.org/10.1182/blood.V69.4.1242.1242 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/3470055/ PubMed] |
− | ## '''Update:''' Linker CA, Levitt LJ, O'Donnell M, Forman SJ, Ries CA. Treatment of adult acute lymphoblastic leukemia with intensive cyclical chemotherapy: a follow-up report. Blood. 1991 Dec 1;78(11):2814-22. [ | + | ## '''Update:''' Linker CA, Levitt LJ, O'Donnell M, Forman SJ, Ries CA. Treatment of adult acute lymphoblastic leukemia with intensive cyclical chemotherapy: a follow-up report. Blood. 1991 Dec 1;78(11):2814-22. [https://doi.org/10.1182/blood.V78.11.2814.2814 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/1835410/ PubMed] |
− | |||
=CNS treatment, systemic therapy= | =CNS treatment, systemic therapy= | ||
==Mercaptopurine & WBRT {{#subobject:d6ba9e|Regimen=1}}== | ==Mercaptopurine & WBRT {{#subobject:d6ba9e|Regimen=1}}== | ||
− | {| class="wikitable" style=" | + | Mercaptopurine & WBRT: Mercaptopurine & '''<u>W</u>'''hole '''<u>B</u>'''rain '''<u>R</u>'''adiation '''<u>T</u>'''herapy |
+ | <div class="toccolours" style="background-color:#eeeeee"> | ||
+ | ===Regimen variant #1 {{#subobject:cd21c7|Variant=1}}=== | ||
+ | {| class="wikitable sortable" style="width: 60%; text-align:center;" | ||
+ | !style="width: 33%"|Study | ||
+ | !style="width: 33%"|Dates of enrollment | ||
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
+ | |- | ||
+ | |[https://doi.org/10.1200/JCO.2008.18.6916 Huguet et al. 2009 (GRAALL-2003)] | ||
+ | |2003-2005 | ||
+ | |style="background-color:#91cf61"|Phase 2 | ||
|- | |- | ||
− | |||
|} | |} | ||
− | + | ''Note: Treatment administered before HSCT or maintenence initiation.'' | |
− | ===Regimen {{#subobject: | + | <div class="toccolours" style="background-color:#b3e2cd"> |
− | {| class="wikitable" style="width: | + | ====Chemotherapy==== |
− | !style="width: | + | *[[Mercaptopurine (6-MP)]] 60 mg/m<sup>2</sup>/day PO during irradiation |
− | !style="width: | + | ====Radiotherapy==== |
+ | *[[External_beam_radiotherapy|Whole-brain irradiation]] 1500 cGy before HCT (details not provided) | ||
+ | '''One course''' | ||
+ | </div></div><br> | ||
+ | <div class="toccolours" style="background-color:#eeeeee"> | ||
+ | ===Regimen variant #2 {{#subobject:cd75g7|Variant=1}}=== | ||
+ | {| class="wikitable sortable" style="width: 60%; text-align:center;" | ||
+ | !style="width: 33%"|Study | ||
+ | !style="width: 33%"|Dates of enrollment | ||
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
− | |[ | + | |[https://doi.org/10.1200/JCO.2008.18.6916 Huguet et al. 2009 (GRAALL-2003)] |
− | |style="background-color:#91cf61"|Phase | + | |2003-2005 |
+ | |style="background-color:#91cf61"|Phase 2 | ||
|- | |- | ||
|} | |} | ||
− | ''Treatment administered before HSCT or | + | ''Note: Treatment was administered before HSCT or maintenance initiation.'' |
+ | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Chemotherapy==== | ====Chemotherapy==== | ||
*[[Mercaptopurine (6-MP)]] 60 mg/m<sup>2</sup>/day PO during irradiation | *[[Mercaptopurine (6-MP)]] 60 mg/m<sup>2</sup>/day PO during irradiation | ||
====Radiotherapy==== | ====Radiotherapy==== | ||
− | *[[External_beam_radiotherapy|Whole-brain irradiation]] | + | *[[External_beam_radiotherapy|Whole-brain irradiation]] 2400 cGy before maintenance therapy initiation (details not provided) |
− | |||
− | |||
− | |||
'''One course''' | '''One course''' | ||
− | + | </div></div> | |
===References=== | ===References=== | ||
− | # '''GRAALL-2003:''' Huguet F, Leguay T, Raffoux E, Thomas X, Beldjord K, Delabesse E, Chevallier P, Buzyn A, Delannoy A, Chalandon Y, Vernant JP, Lafage-Pochitaloff M, Chassevent A, Lhéritier V, Macintyre E, Béné MC, Ifrah N, Dombret H. Pediatric-inspired therapy in adults with Philadelphia chromosome-negative acute lymphoblastic leukemia: the GRAALL-2003 study. J Clin Oncol. 2009 Feb 20;27(6):911-8. Epub 2009 Jan 5. Erratum in: J Clin Oncol. 2009 May 20;27(15):2574. Dosage error in article text. [ | + | # '''GRAALL-2003:''' Huguet F, Leguay T, Raffoux E, Thomas X, Beldjord K, Delabesse E, Chevallier P, Buzyn A, Delannoy A, Chalandon Y, Vernant JP, Lafage-Pochitaloff M, Chassevent A, Lhéritier V, Macintyre E, Béné MC, Ifrah N, Dombret H. Pediatric-inspired therapy in adults with Philadelphia chromosome-negative acute lymphoblastic leukemia: the GRAALL-2003 study. J Clin Oncol. 2009 Feb 20;27(6):911-8. Epub 2009 Jan 5. Erratum in: J Clin Oncol. 2009 May 20;27(15):2574. Dosage error in article text. [https://doi.org/10.1200/JCO.2008.18.6916 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/19124805/ PubMed] [https://clinicaltrials.gov/study/NCT00222027 NCT00222027] |
− | |||
[[Category:CNS leukemia regimens]] | [[Category:CNS leukemia regimens]] | ||
[[Category:Disease-specific pages]] | [[Category:Disease-specific pages]] | ||
− | [[Category: | + | [[Category:Acute leukemias]] |
Latest revision as of 21:10, 25 June 2024
Section editor | |
---|---|
Ashwin Kishtagari, MD Vanderbilt University Nashville, TN, USA |
16 regimens on this page
19 variants on this page
|
Note: these regimens are primarily culled from literature that describes them as part of a comprehensive treatment regimen. If that is the case, the original regimens can be found on the following pages:
- Acute promyelocytic leukemia
- Adult T-cell leukemia-lymphoma
- B-cell acute lymphoblastic leukemia
- T-cell acute lymphoblastic leukemia
CNS prophylaxis, local therapy
IT Cytarabine & Methotrexate
Regimen variant #1, 16 doses
Study | Dates of enrollment | Evidence |
---|---|---|
Thomas et al. 2006 | 2000-02 to 2005-01 | Pilot, fewer than 20 pts |
CNS therapy, prophylaxis
- Methotrexate (MTX) by the following route-based criteria:
- LP: 12 mg IT once on day 2
- Ommaya reservoir: 6 mg IT once on day 2
- Cytarabine (Ara-C) 100 mg IT once on day 7
Given each cycle for a total of 16 intrathecal treatments
Regimen variant #2, 6 to 8 doses
Study | Dates of enrollment | Evidence |
---|---|---|
Thomas et al. 1999 | 1992-09 to 1997-06 | Phase 2 |
Thomas et al. 2003 | 2001-04 to 2003-03 | Phase 2 |
Ravandi et al. 2010 (MDACC 2006-0478) | 2006-09-28 to 2009-07-15 | Phase 2 |
Note: Total number of doses depends on risk for CNS relapse based on serum lactate dehydrogenase (LDH) greater than 1400 IU/L and/or proliferative index percentage of S + G2M greater than or equal to 14%.
CNS therapy, prophylaxis
- Methotrexate (MTX) by the following route-based criteria:
- LP: 12 mg IT once on day 2
- Ommaya reservoir: 6 mg IT once on day 2
- Cytarabine (Ara-C) 100 mg IT once on either day 7 or 8
Given each cycle (approximately every 3 weeks) for a total of 6 or 8 intrathecal treatments
References
- Thomas DA, Cortes J, O'Brien S, Pierce S, Faderl S, Albitar M, Hagemeister FB, Cabanillas FF, Murphy S, Keating MJ, Kantarjian H. Hyper-CVAD program in Burkitt's-type adult acute lymphoblastic leukemia. J Clin Oncol. 1999 Aug;17(8):2461-70. link to original article contains dosing details in manuscript PubMed
- Thomas DA, Faderl S, Cortes J, O'Brien S, Giles FJ, Kornblau SM, Garcia-Manero G, Keating MJ, Andreeff M, Jeha S, Beran M, Verstovsek S, Pierce S, Letvak L, Salvado A, Champlin R, Talpaz M, Kantarjian H. Treatment of Philadelphia chromosome-positive acute lymphocytic leukemia with hyper-CVAD and imatinib mesylate. Blood. 2004 Jun 15;103(12):4396-407. Epub 2003 Oct 9. link to original article contains dosing details in manuscript PubMed
- Update: Daver N, Thomas D, Ravandi F, Cortes J, Garris R, Jabbour E, Garcia-Manero G, Borthakur G, Kadia T, Rytting M, Konopleva M, Kantarjian H, O' Brien S. Final report of a phase II study of imatinib mesylate with hyper-CVAD for the frontline treatment of adult patients with Philadelphia chromosome positive (Ph+) acute lymphoblastic leukemia. Haematologica. 2015 May;100(5):653-61. Epub 2015 Feb 14. link to original article link to PMC article PubMed
- Thomas DA, Faderl S, O'Brien S, Bueso-Ramos C, Cortes J, Garcia-Manero G, Giles FJ, Verstovsek S, Wierda WG, Pierce SA, Shan J, Brandt M, Hagemeister FB, Keating MJ, Cabanillas F, Kantarjian H. Chemoimmunotherapy with hyper-CVAD plus rituximab for the treatment of adult Burkitt and Burkitt-type lymphoma or acute lymphoblastic leukemia. Cancer. 2006 Apr 1;106(7):1569-80. link to original article contains dosing details in manuscript PubMed
- Update: Fayad L, Thomas D, Romaguera J. Update of the MD Anderson Cancer Center experience with hyper-CVAD and rituximab for the treatment of mantle cell and Burkitt-type lymphomas. Clin Lymphoma Myeloma. 2007 Dec;8 Suppl 2:S57-62. link to original article PubMed
- MDACC 2006-0478: Ravandi F, O'Brien S, Thomas D, Faderl S, Jones D, Garris R, Dara S, Jorgensen J, Kebriaei P, Champlin R, Borthakur G, Burger J, Ferrajoli A, Garcia-Manero G, Wierda W, Cortes J, Kantarjian H. First report of phase 2 study of dasatinib with hyper-CVAD for the frontline treatment of patients with Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia. Blood. 2010 Sep 23;116(12):2070-7. Epub 2010 May 13. link to original article contains dosing details in manuscript--parts of the protocol were not explicitly listed in this reference, which instead referred to Thomas et al. 2004 and Kantarjian et al. 2004 link to PMC article PubMed NCT00390793
- Update: Ravandi F, O'Brien SM, Cortes JE, Thomas DM, Garris R, Faderl S, Burger JA, Rytting ME, Ferrajoli A, Wierda WG, Verstovsek S, Champlin R, Kebriaei P, McCue DA, Huang X, Jabbour E, Garcia-Manero G, Estrov Z, Kantarjian HM. Long-term follow-up of a phase 2 study of chemotherapy plus dasatinib for the initial treatment of patients with Philadelphia chromosome-positive acute lymphoblastic leukemia. Cancer. 2015 Dec 1;121(23):4158-64. Epub 2015 Aug 26. link to original article link to PMC article PubMed
IT Cytarabine, Methotrexate, Methylprednisolone
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Huguet et al. 2009 (GRAALL-2003) | 2003-2005 | Phase 2 |
Note: Intrathecal treatments are given on days 1 & 8 of induction, day 29 of each series of consolidation blocks, and day 1 of late intensification -- 6 doses total.
CNS therapy, prophylaxis
- Cytarabine (Ara-C) 40 mg IT mixed with methotrexate and methylprednisolone
- Methotrexate (MTX) 15 mg IT mixed with cytarabine and methylprednisolone
- Methylprednisolone (Solumedrol) 40 mg IT mixed with cytarabine and methotrexate
6 doses (see note)
References
- GRAALL-2003: Huguet F, Leguay T, Raffoux E, Thomas X, Beldjord K, Delabesse E, Chevallier P, Buzyn A, Delannoy A, Chalandon Y, Vernant JP, Lafage-Pochitaloff M, Chassevent A, Lhéritier V, Macintyre E, Béné MC, Ifrah N, Dombret H. Pediatric-inspired therapy in adults with Philadelphia chromosome-negative acute lymphoblastic leukemia: the GRAALL-2003 study. J Clin Oncol. 2009 Feb 20;27(6):911-8. Epub 2009 Jan 5. Erratum in: J Clin Oncol. 2009 May 20;27(15):2574. Dosage error in article text. link to original article contains dosing details in manuscript PubMed NCT00222027
IT Cytarabine, Methotrexate, Prednisone
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Tsukasaki et al. 2007 (JCOG 9801) | 1998-2003 | Non-randomized part of phase 3 RCT |
Ishida et al. 2015 (Kyowa 0761-003) | 2010-2011 | Non-randomized part of phase 2 RCT |
Note: Treatments were given after cycles 1, 3, and 5 after platelets greater than 70 x 109/L and within 2 days before the next cycle.
CNS therapy, prophylaxis
- Cytarabine (Ara-C) 40 mg IT mixed with methotrexate and prednisone
- Methotrexate (MTX) 15 mg IT mixed with cytarabine and prednisone
- Prednisone (Sterapred) 10 mg IT mixed with cytarabine and methotrexate
3 doses (see note)
References
- JCOG 9801: Tsukasaki K, Utsunomiya A, Fukuda H, Shibata T, Fukushima T, Takatsuka Y, Ikeda S, Masuda M, Nagoshi H, Ueda R, Tamura K, Sano M, Momita S, Yamaguchi K, Kawano F, Hanada S, Tobinai K, Shimoyama M, Hotta T, Tomonaga M; JCOG. VCAP-AMP-VECP compared with biweekly CHOP for adult T-cell leukemia-lymphoma: Japan Clinical Oncology Group Study JCOG9801. J Clin Oncol. 2007 Dec 1;25(34):5458-64. Epub 2007 Oct 29. link to original article contains dosing details in manuscript PubMed NCT00145002
- Kyowa 0761-003: Ishida T, Jo T, Takemoto S, Suzushima H, Uozumi K, Yamamoto K, Uike N, Saburi Y, Nosaka K, Utsunomiya A, Tobinai K, Fujiwara H, Ishitsuka K, Yoshida S, Taira N, Moriuchi Y, Imada K, Miyamoto T, Akinaga S, Tomonaga M, Ueda R. Dose-intensified chemotherapy alone or in combination with mogamulizumab in newly diagnosed aggressive adult T-cell leukaemia-lymphoma: a randomized phase II study. Br J Haematol. 2015 Jun;169(5):672-82. Epub 2015 Mar 2. link to original article link to PMC article PubMed NCT01173887
IT Cytarabine & WBRT
Cytarabine & WBRT: Cytarabine & Whole Brain Radiation Therapy
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Rowe et al. 2005 (MRC UKALL XII/ECOG E2993) | 1993-2003 | Non-randomized part of phase 3 RCT |
Note: while this is not chemoradiation in the traditional sense, the delivery of chemotherapy and radiation overlap so may have synergistic effects.
CNS therapy, prophylaxis
- Cytarabine (Ara-C) as follows:
- Consolidation & Maintenance: 50 mg IT once per week for 4 weeks, then once per quarter for 4 doses (8 doses, total)
Radiotherapy
- Whole-brain irradiation to 2400 cGy, given during consolidation
References
- MRC UKALL XII/ECOG E2993: Rowe JM, Buck G, Burnett AK, Chopra R, Wiernik PH, Richards SM, Lazarus HM, Franklin IM, Litzow MR, Ciobanu N, Prentice HG, Durrant J, Tallman MS, Goldstone AH; ECOG; MRC/NCRI Adult Leukemia Working Party. Induction therapy for adults with acute lymphoblastic leukemia: results of more than 1500 patients from the international ALL trial: MRC UKALL XII/ECOG E2993. Blood. 2005 Dec 1;106(12):3760-7. Epub 2005 Aug 16. link to original article contains dosing details in manuscript PubMed NCT00002514
- Update: Goldstone AH, Richards SM, Lazarus HM, Tallman MS, Buck G, Fielding AK, Burnett AK, Chopra R, Wiernik PH, Foroni L, Paietta E, Litzow MR, Marks DI, Durrant J, McMillan A, Franklin IM, Luger S, Ciobanu N, Rowe JM. In adults with standard-risk acute lymphoblastic leukemia, the greatest benefit is achieved from a matched sibling allogeneic transplantation in first complete remission, and an autologous transplantation is less effective than conventional consolidation/maintenance chemotherapy in all patients: final results of the International ALL Trial (MRC UKALL XII/ECOG E2993). Blood. 2008 Feb 15;111(4):1827-33. Epub 2007 Nov 29. link to original article PubMed
- Update: Fielding AK, Rowe JM, Richards SM, Buck G, Moorman AV, Durrant IJ, Marks DI, McMillan AK, Litzow MR, Lazarus HM, Foroni L, Dewald G, Franklin IM, Luger SM, Paietta E, Wiernik PH, Tallman MS, Goldstone AH. Prospective outcome data on 267 unselected adult patients with Philadelphia chromosome-positive acute lymphoblastic leukemia confirms superiority of allogeneic transplantation over chemotherapy in the pre-imatinib era: results from the International ALL Trial MRC UKALLXII/ECOG2993. Blood. 2009 May 7;113(19):4489-96. Epub 2009 Feb 24. link to original article link to PMC article PubMed
- Update: Fielding AK, Rowe JM, Buck G, Foroni L, Gerrard G, Litzow MR, Lazarus H, Luger SM, Marks DI, McMillan AK, Moorman AV, Patel B, Paietta E, Tallman MS, Goldstone AH. UKALLXII/ECOG2993: addition of imatinib to a standard treatment regimen enhances long-term outcomes in Philadelphia positive acute lymphoblastic leukemia. Blood. 2014 Feb 6;123(6):843-50. Epub 2013 Nov 25. link to original article contains dosing details in manuscript link to PMC article PubMed
IT Methotrexate monotherapy
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Rowe et al. 2005 (MRC UKALL XII/ECOG E2993) | 1993-2003 | Non-randomized part of phase 3 RCT |
CNS therapy, prophylaxis
- Methotrexate (MTX) as follows:
- Phase 1: 12 mg IT once on day 15
- Phase 2: 12 mg IT once per day on days 1, 8, 15, 22
References
- MRC UKALL XII/ECOG E2993: Rowe JM, Buck G, Burnett AK, Chopra R, Wiernik PH, Richards SM, Lazarus HM, Franklin IM, Litzow MR, Ciobanu N, Prentice HG, Durrant J, Tallman MS, Goldstone AH; ECOG; MRC/NCRI Adult Leukemia Working Party. Induction therapy for adults with acute lymphoblastic leukemia: results of more than 1500 patients from the international ALL trial: MRC UKALL XII/ECOG E2993. Blood. 2005 Dec 1;106(12):3760-7. Epub 2005 Aug 16. link to original article contains dosing details in manuscript PubMed NCT00002514
- Update: Goldstone AH, Richards SM, Lazarus HM, Tallman MS, Buck G, Fielding AK, Burnett AK, Chopra R, Wiernik PH, Foroni L, Paietta E, Litzow MR, Marks DI, Durrant J, McMillan A, Franklin IM, Luger S, Ciobanu N, Rowe JM. In adults with standard-risk acute lymphoblastic leukemia, the greatest benefit is achieved from a matched sibling allogeneic transplantation in first complete remission, and an autologous transplantation is less effective than conventional consolidation/maintenance chemotherapy in all patients: final results of the International ALL Trial (MRC UKALL XII/ECOG E2993). Blood. 2008 Feb 15;111(4):1827-33. Epub 2007 Nov 29. link to original article PubMed
- Update: Fielding AK, Rowe JM, Richards SM, Buck G, Moorman AV, Durrant IJ, Marks DI, McMillan AK, Litzow MR, Lazarus HM, Foroni L, Dewald G, Franklin IM, Luger SM, Paietta E, Wiernik PH, Tallman MS, Goldstone AH. Prospective outcome data on 267 unselected adult patients with Philadelphia chromosome-positive acute lymphoblastic leukemia confirms superiority of allogeneic transplantation over chemotherapy in the pre-imatinib era: results from the International ALL Trial MRC UKALLXII/ECOG2993. Blood. 2009 May 7;113(19):4489-96. Epub 2009 Feb 24. link to original article link to PMC article PubMed
- Update: Fielding AK, Rowe JM, Buck G, Foroni L, Gerrard G, Litzow MR, Lazarus H, Luger SM, Marks DI, McMillan AK, Moorman AV, Patel B, Paietta E, Tallman MS, Goldstone AH. UKALLXII/ECOG2993: addition of imatinib to a standard treatment regimen enhances long-term outcomes in Philadelphia positive acute lymphoblastic leukemia. Blood. 2014 Feb 6;123(6):843-50. Epub 2013 Nov 25. link to original article contains dosing details in manuscript link to PMC article PubMed
IT Methotrexate & Hydrocortisone
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Sullivan et al. 1977 | 1971-1973 | Phase 3 (C) | IT MTX, Ara-C, HC | Did not meet primary endpoint of DOR |
Kim et al. 2015 (AMC-UUCM-2008-0310) | 2009-2012 | Phase 2 |
Note: Treatment can be started during or after induction.
CNS therapy, prophylaxis
- Methotrexate (MTX) 15 mg IT (schedule not specified), admixed with hydrocortisone
- Hydrocortisone (Cortef) 50 mg IT (schedule not specified), admixed with methotrexate
Up to 10 doses
References
- Sullivan MP, Moon TE, Trueworthy R, Vietti TJ, Humphrey GB, Komp D. Combination intrathecal therapy for meningeal leukemia: two versus three drugs. Blood. 1977 Sep;50(3):471-9. link to original article PubMed
- AMC-UUCM-2008-0310: Kim DY, Joo YD, Lim SN, Kim SD, Lee JH, Lee JH, Kim DH, Kim K, Jung CW, Kim I, Yoon SS, Park S, Ahn JS, Yang DH, Lee JJ, Lee HS, Kim YS, Mun YC, Kim H, Park JH, Moon JH, Sohn SK, Lee SM, Lee WS, Kim KH, Won JH, Hyun MS, Park J, Lee JH, Shin HJ, Chung JS, Lee H, Eom HS, Lee GW, Cho YU, Jang S, Park CJ, Chi HS, Lee KH; Adult Acute Lymphoblastic Leukemia Working Party of the Korean Society of Hematology. Nilotinib combined with multiagent chemotherapy for newly diagnosed Philadelphia-positive acute lymphoblastic leukemia. Blood. 2015 Aug 6;126(6):746-56. Epub 2015 Jun 11. link to original article contains dosing details in manuscript PubMed NCT00844298
IT Methotrexate & Methylprednisolone
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Lo-Coco et al. 2010 (GIMEMA AIDA-2000) | 2000-2006 | Non-randomized |
Note: It is not explicitly stated but presumably these are admixed and given together.
CNS therapy, prophylaxis
- Methotrexate (MTX) 12 mg IT once prior to each consolidation cycle
- Methylprednisolone (Solumedrol) 40 mg IT once prior to each consolidation cycle
Total of 3 doses
References
- GIMEMA AIDA-2000: Lo-Coco F, Avvisati G, Vignetti M, Breccia M, Gallo E, Rambaldi A, Paoloni F, Fioritoni G, Ferrara F, Specchia G, Cimino G, Diverio D, Borlenghi E, Martinelli G, Di Raimondo F, Di Bona E, Fazi P, Peta A, Bosi A, Carella AM, Fabbiano F, Pogliani EM, Petti MC, Amadori S, Mandelli F; GIMEMA. Front-line treatment of acute promyelocytic leukemia with AIDA induction followed by risk-adapted consolidation for adults younger than 61 years: results of the AIDA-2000 trial of the GIMEMA Group. Blood. 2010 Oct 8;116(17):3171-9. Epub 2010 Jul 19. link to original article contains dosing details in manuscript PubMed NCT01064570
IT Methotrexate & WBRT
IT Methotrexate & WBRT: IntraThecal Methotrexate & Whole Brain Radiation Therapy
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Linker et al. 1987 | 1980-1986 | Phase 2 | ||
Nachman et al. 1998 (CCG 1882) | 1989-1995 | Phase 3 (C) | IT MTX; intensified | Did not meet primary endpoint of EFS |
Note: Treatment is started within 1 week of achieving complete remission. Details are from Linker et al. 1987
CNS therapy, prophylaxis
- Methotrexate (MTX) 12 mg IT once per week x 6 doses concurrent with radiation
Radiotherapy
- Whole-brain irradiation, 1800 cGy total given in 10 fractions over 12 to 14 days
References
- Linker CA, Levitt LJ, O'Donnell M, Ries CA, Link MP, Forman SJ, Farbstein MJ. Improved results of treatment of adult acute lymphoblastic leukemia. Blood. 1987 Apr;69(4):1242-8. link to original article contains dosing details in manuscript PubMed
- Update: Linker CA, Levitt LJ, O'Donnell M, Forman SJ, Ries CA. Treatment of adult acute lymphoblastic leukemia with intensive cyclical chemotherapy: a follow-up report. Blood. 1991 Dec 1;78(11):2814-22. link to original article contains dosing details in manuscript PubMed
- CCG 1882: Nachman J, Sather HN, Cherlow JM, Sensel MG, Gaynon PS, Lukens JN, Wolff L, Trigg ME. Response of children with high-risk acute lymphoblastic leukemia treated with and without cranial irradiation: a report from the Children's Cancer Group. J Clin Oncol. 1998 Mar;16(3):920-30. link to original article PubMed
WBRT
WBRT: Whole Brain Radiation Therapy
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Nesbit et al. 1981 | 1972-1975 | Phase 3 (C) | WBRT; lower-dose | Did not meet endpoint of OS |
Freeman et al. 1983 (CALGB 7611) | 1976-1979 | Phase 3 (C) | Intermediate-dose MTX | Mixed results |
Pui et al. 2009 (Total Therapy XV) | 2000-2007 | Phase 3 (C) | Observation | Did not meet co-primary endpoints of EFS/OS |
Note: in Total Therapy XV, this is the control arm of a de-escalation study.
References
- Nesbit ME Jr, Sather HN, Robison LL, Ortega J, Littman PS, D'Angio GJ, Hammond GD; Children's Cancer Group. Presymptomatic central nervous system therapy in previously untreated childhood acute lymphoblastic leukaemia: comparison of 1800 rad and 2400 rad: a report for Children's Cancer Study Group. Lancet. 1981 Feb 28;1(8218):461-6. link to original article PubMed
- CALGB 7611: Freeman AI, Weinberg V, Brecher ML, Jones B, Glicksman AS, Sinks LF, Weil M, Pleuss H, Hananian J, Burgert EO Jr, Gilchrist GS, Necheles T, Harris M, Kung F, Patterson RB, Maurer H, Leventhal B, Chevalier L, Forman E, Holland JF. Comparison of intermediate-dose methotrexate with cranial irradiation for the post-induction treatment of acute lymphocytic leukemia in children. N Engl J Med. 1983 Mar 3;308(9):477-84. link to original article PubMed
- Update: Freeman AI, Boyett JM, Glicksman AS, Brecher ML, Leventhal BG, Sinks LF, Holland JF. Intermediate-dose methotrexate versus cranial irradiation in childhood acute lymphoblastic leukemia: a ten-year follow-up. Med Pediatr Oncol. 1997 Feb;28(2):98-107. link to original article PubMed
- Total Therapy XV: Pui CH, Campana D, Pei D, Bowman WP, Sandlund JT, Kaste SC, Ribeiro RC, Rubnitz JE, Raimondi SC, Onciu M, Coustan-Smith E, Kun LE, Jeha S, Cheng C, Howard SC, Simmons V, Bayles A, Metzger ML, Boyett JM, Leung W, Handgretinger R, Downing JR, Evans WE, Relling MV. Treating childhood acute lymphoblastic leukemia without cranial irradiation. N Engl J Med. 2009 Jun 25;360(26):2730-41. link to original article link to PMC article PubMed NCT00137111
CNS prophylaxis, systemic therapy
Mercaptopurine & WBRT
Mercaptopurine & WBRT: Mercaptopurine & Whole Brain Radiation Therapy
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Huguet et al. 2009 (GRAALL-2003) | 2003-2005 | Phase 2 |
Note: Chemoradiation is given before maintenance therapy.
Chemotherapy
- Mercaptopurine (6-MP) 60 mg/m2/day PO during irradiation
Radiotherapy
- Whole-brain irradiation to 1800 cGy (details not provided)
One course
References
- GRAALL-2003: Huguet F, Leguay T, Raffoux E, Thomas X, Beldjord K, Delabesse E, Chevallier P, Buzyn A, Delannoy A, Chalandon Y, Vernant JP, Lafage-Pochitaloff M, Chassevent A, Lhéritier V, Macintyre E, Béné MC, Ifrah N, Dombret H. Pediatric-inspired therapy in adults with Philadelphia chromosome-negative acute lymphoblastic leukemia: the GRAALL-2003 study. J Clin Oncol. 2009 Feb 20;27(6):911-8. Epub 2009 Jan 5. Erratum in: J Clin Oncol. 2009 May 20;27(15):2574. Dosage error in article text. link to original article contains dosing details in manuscript PubMed NCT00222027
CNS treatment, local therapy
IT Cytarabine & Methotrexate
Regimen variant #1, LP
Study | Dates of enrollment | Evidence |
---|---|---|
Thomas et al. 1999 | 1992-09 to 1997-06 | Phase 2 |
Note: while there is measurable CNS disease, both drugs are given every week, alternating, usually separated by at least 48 hours (e.g., on Mondays & Thursdays).
CNS therapy, treatment
- Methotrexate (MTX) as follows:
- Measurable CNS disease: 12 mg IT once per week
- First 4 weeks after cell count & cytology are negative: 12 mg IT once per week on weeks 1 & 3
- Remainder of induction: 12 mg IT once on day 2
- Cytarabine (Ara-C) as follows:
- Measurable CNS disease: 100 mg IT once per week
- First 4 weeks after cell count & cytology are negative: 100 mg IT once per week on weeks 2 & 4
- Remainder of induction: 100 mg IT once on day 7 or 8
Regimen variant #2, Ommaya reservoir
Study | Dates of enrollment | Evidence |
---|---|---|
Thomas et al. 1999 | 1992-09 to 1997-06 | Phase 2 |
Note: while there is measurable CNS disease, both drugs are given every week, alternating, usually separated by at least 48 hours (e.g., on Mondays & Thursdays).
CNS therapy, treatment
- Methotrexate (MTX) as follows:
- Measurable CNS disease: 6 mg IT once per week
- First 4 weeks after cell count & cytology are negative: 6 mg IT once per week on weeks 1 & 3
- Remainder of induction: 6 mg IT once on day 2
- Cytarabine (Ara-C) as follows:
- Measurable CNS disease: 100 mg IT once per week
- First 4 weeks after cell count & cytology are negative: 100 mg IT once per week on weeks 2 & 4
- Remainder of induction: 100 mg IT once on day 7 or 8
References
- Thomas DA, Cortes J, O'Brien S, Pierce S, Faderl S, Albitar M, Hagemeister FB, Cabanillas FF, Murphy S, Keating MJ, Kantarjian H. Hyper-CVAD program in Burkitt's-type adult acute lymphoblastic leukemia. J Clin Oncol. 1999 Aug;17(8):2461-70. link to original article contains dosing details in manuscript PubMed
IT Cytarabine, Methotrexate, Methylprednisolone
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Huguet et al. 2009 (GRAALL-2003) | 2003-2005 | Phase 2 |
Note: Intrathecal treatments are given as follows: eight between days -7 and 21 of induction, four during the first two consolidation blocks, and one at day 29 of consolidation blocks 3 and 6 -- 14 total doses.
CNS therapy, treatment
- Cytarabine (Ara-C) 40 mg IT mixed with methotrexate and methylprednisolone
- Methotrexate (MTX) 15 mg IT mixed with cytarabine and methylprednisolone
- Methylprednisolone (Solumedrol) 40 mg IT mixed with cytarabine and methotrexate
14 doses (see note)
References
- GRAALL-2003: Huguet F, Leguay T, Raffoux E, Thomas X, Beldjord K, Delabesse E, Chevallier P, Buzyn A, Delannoy A, Chalandon Y, Vernant JP, Lafage-Pochitaloff M, Chassevent A, Lhéritier V, Macintyre E, Béné MC, Ifrah N, Dombret H. Pediatric-inspired therapy in adults with Philadelphia chromosome-negative acute lymphoblastic leukemia: the GRAALL-2003 study. J Clin Oncol. 2009 Feb 20;27(6):911-8. Epub 2009 Jan 5. Erratum in: J Clin Oncol. 2009 May 20;27(15):2574. Dosage error in article text. link to original article contains dosing details in manuscript PubMed NCT00222027
IT Cytarabine, Methotrexate, WBRT
Cytarabine, Methotrexate, WBRT: Cytarabine, Methotrexate, Whole Brain Radiation Therapy
Regimen variant #1, LP
Study | Dates of enrollment | Evidence |
---|---|---|
Thomas et al. 2003 | 2001-04 to 2003-03 | Phase 2 |
Ravandi et al. 2010 (MDACC 2006-0478) | 2006-09-28 to 2009-07-15 | Phase 2 |
Note: while there is measurable CNS disease, both drugs are given every week, alternating, usually separated by at least 48 hours (e.g., on Mondays & Thursdays).
CNS therapy, treatment
- Methotrexate (MTX) as follows:
- Measurable CNS disease: 12 mg IT once per week
- First 4 weeks after cell count & cytology are negative: 12 mg IT once per week on weeks 1 & 3
- Remainder of induction: 12 mg IT once on day 2
- Cytarabine (Ara-C) as follows:
- Measurable CNS disease: 100 mg IT once per week
- First 4 weeks after cell count & cytology are negative: 100 mg IT once per week on weeks 2 & 4
- Remainder of induction: 100 mg IT once on day 7 or 8
Radiotherapy
- Therapeutic whole-brain irradiation is given to patients with CNS disease at presentation
Regimen variant #2, Ommaya reservoir
Study | Dates of enrollment | Evidence |
---|---|---|
Thomas et al. 2003 | 2001-04 to 2003-03 | Phase 2 |
Ravandi et al. 2010 (MDACC 2006-0478) | 2006-09-28 to 2009-07-15 | Phase 2 |
Note: while there is measurable CNS disease, both drugs are given every week, alternating, usually separated by at least 48 hours (e.g., on Mondays & Thursdays).
CNS therapy, treatment
- Methotrexate (MTX) as follows:
- Measurable CNS disease: 6 mg IT once per week
- First 4 weeks after cell count & cytology are negative: 6 mg IT once per week on weeks 1 & 3
- Remainder of induction: 6 mg IT once on day 2
- Cytarabine (Ara-C) as follows:
- Measurable CNS disease: 100 mg IT once per week
- First 4 weeks after cell count & cytology are negative: 100 mg IT once per week on weeks 2 & 4
- Remainder of induction: 100 mg IT once on day 7 or 8
Radiotherapy
- Therapeutic whole-brain irradiation is given to patients with CNS disease at presentation
References
- Thomas DA, Faderl S, Cortes J, O'Brien S, Giles FJ, Kornblau SM, Garcia-Manero G, Keating MJ, Andreeff M, Jeha S, Beran M, Verstovsek S, Pierce S, Letvak L, Salvado A, Champlin R, Talpaz M, Kantarjian H. Treatment of Philadelphia chromosome-positive acute lymphocytic leukemia with hyper-CVAD and imatinib mesylate. Blood. 2004 Jun 15;103(12):4396-407. Epub 2003 Oct 9. link to original article contains dosing details in manuscript PubMed
- Update: Daver N, Thomas D, Ravandi F, Cortes J, Garris R, Jabbour E, Garcia-Manero G, Borthakur G, Kadia T, Rytting M, Konopleva M, Kantarjian H, O' Brien S. Final report of a phase II study of imatinib mesylate with hyper-CVAD for the frontline treatment of adult patients with Philadelphia chromosome positive (Ph+) acute lymphoblastic leukemia. Haematologica. 2015 May;100(5):653-61. Epub 2015 Feb 14. link to original article link to PMC article PubMed
- MDACC 2006-0478: Ravandi F, O'Brien S, Thomas D, Faderl S, Jones D, Garris R, Dara S, Jorgensen J, Kebriaei P, Champlin R, Borthakur G, Burger J, Ferrajoli A, Garcia-Manero G, Wierda W, Cortes J, Kantarjian H. First report of phase 2 study of dasatinib with hyper-CVAD for the frontline treatment of patients with Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia. Blood. 2010 Sep 23;116(12):2070-7. Epub 2010 May 13. link to original article contains dosing details in manuscript--parts of the protocol were not explicitly listed in this reference, which instead referred to Thomas et al. 2004 and Kantarjian et al. 2004 link to PMC article PubMed NCT00390793
- Update: Ravandi F, O'Brien SM, Cortes JE, Thomas DM, Garris R, Faderl S, Burger JA, Rytting ME, Ferrajoli A, Wierda WG, Verstovsek S, Champlin R, Kebriaei P, McCue DA, Huang X, Jabbour E, Garcia-Manero G, Estrov Z, Kantarjian HM. Long-term follow-up of a phase 2 study of chemotherapy plus dasatinib for the initial treatment of patients with Philadelphia chromosome-positive acute lymphoblastic leukemia. Cancer. 2015 Dec 1;121(23):4158-64. Epub 2015 Aug 26. link to original article link to PMC article PubMed
IT Methotrexate monotherapy
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Shanbrom et al. 1961 | 1957-1960 | Pilot |
Huguet et al. 2009 (GRAALL-2003) | 2003-2005 | Phase 2 |
CNS therapy, treatment
- Methotrexate (MTX) as follows:
- Pre-phase: 15 mg IT once at some point between days -7 and -4
References
- Shanbrom E, Miller S, Fairbanks VF. Intrathecal administration of amethopterin in leukemic encephalopathy of young adults. N Engl J Med. 1961 Jul 27;265:169-71. link to original article PubMed
- GRAALL-2003: Huguet F, Leguay T, Raffoux E, Thomas X, Beldjord K, Delabesse E, Chevallier P, Buzyn A, Delannoy A, Chalandon Y, Vernant JP, Lafage-Pochitaloff M, Chassevent A, Lhéritier V, Macintyre E, Béné MC, Ifrah N, Dombret H. Pediatric-inspired therapy in adults with Philadelphia chromosome-negative acute lymphoblastic leukemia: the GRAALL-2003 study. J Clin Oncol. 2009 Feb 20;27(6):911-8. Epub 2009 Jan 5. Erratum in: J Clin Oncol. 2009 May 20;27(15):2574. Dosage error in article text. link to original article contains dosing details in manuscript PubMed NCT00222027
IT Methotrexate & WBRT
IT Methotrexate & WBRT: IntraThecal Methotrexate & Whole Brain Radiation Therapy
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Linker et al. 1987 | 1980-1986 | Phase 2 |
Note: Treatment starts while patient is receiving induction therapy.
CNS therapy, treatment
- Methotrexate (MTX) as follows:
- Induction: 12 mg IT once per week x 10 doses
- Remainder of first year of therapy: 12 mg IT once per month
Radiotherapy
- Whole-brain irradiation, 2800 cGy total given (no details provided)
References
- Linker CA, Levitt LJ, O'Donnell M, Ries CA, Link MP, Forman SJ, Farbstein MJ. Improved results of treatment of adult acute lymphoblastic leukemia. Blood. 1987 Apr;69(4):1242-8. link to original article contains dosing details in manuscript PubMed
- Update: Linker CA, Levitt LJ, O'Donnell M, Forman SJ, Ries CA. Treatment of adult acute lymphoblastic leukemia with intensive cyclical chemotherapy: a follow-up report. Blood. 1991 Dec 1;78(11):2814-22. link to original article contains dosing details in manuscript PubMed
CNS treatment, systemic therapy
Mercaptopurine & WBRT
Mercaptopurine & WBRT: Mercaptopurine & Whole Brain Radiation Therapy
Regimen variant #1
Study | Dates of enrollment | Evidence |
---|---|---|
Huguet et al. 2009 (GRAALL-2003) | 2003-2005 | Phase 2 |
Note: Treatment administered before HSCT or maintenence initiation.
Chemotherapy
- Mercaptopurine (6-MP) 60 mg/m2/day PO during irradiation
Radiotherapy
- Whole-brain irradiation 1500 cGy before HCT (details not provided)
One course
Regimen variant #2
Study | Dates of enrollment | Evidence |
---|---|---|
Huguet et al. 2009 (GRAALL-2003) | 2003-2005 | Phase 2 |
Note: Treatment was administered before HSCT or maintenance initiation.
Chemotherapy
- Mercaptopurine (6-MP) 60 mg/m2/day PO during irradiation
Radiotherapy
- Whole-brain irradiation 2400 cGy before maintenance therapy initiation (details not provided)
One course
References
- GRAALL-2003: Huguet F, Leguay T, Raffoux E, Thomas X, Beldjord K, Delabesse E, Chevallier P, Buzyn A, Delannoy A, Chalandon Y, Vernant JP, Lafage-Pochitaloff M, Chassevent A, Lhéritier V, Macintyre E, Béné MC, Ifrah N, Dombret H. Pediatric-inspired therapy in adults with Philadelphia chromosome-negative acute lymphoblastic leukemia: the GRAALL-2003 study. J Clin Oncol. 2009 Feb 20;27(6):911-8. Epub 2009 Jan 5. Erratum in: J Clin Oncol. 2009 May 20;27(15):2574. Dosage error in article text. link to original article contains dosing details in manuscript PubMed NCT00222027