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

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'''Use of this site is subject to you reading and agreeing with the terms set forth in the [[HemOnc.org_-_A_Hematology_Oncology_Wiki:General_disclaimer|disclaimer]]. If this is your first time visiting, we suggest you read the [[tutorial]].'''
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Is there a regimen missing from this list? Would you like to share a different dosage/schedule or an additional reference for a regimen? Have you noticed an error? Do you have an idea that will help the site grow to better meet your needs and the needs of many others? You are [[How_to_contribute|invited to contribute to the site]].
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[[#top|Back to Top]]
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</div>
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{{#lst:Editorial board transclusions|t-all}}
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<big>Note that many of the regimens used to treat this disease are generic to '''[[B-cell acute lymphoblastic leukemia]]'''; this page contains regimens that are specific to T-cell acute lymphoblastic leukemia (a.k.a. T-cell lymphoblastic lymphoma when primarily nodal-based).</big>
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<big>'''Note: certain regimens have been moved to dedicated pages:
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*'''[[T-cell acute lymphoblastic leukemia, pediatric|Pediatric T-cell ALL]]
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</big>
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*''We have moved [[How I Treat]] articles to a dedicated page.''
 
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{| class="wikitable" style="float:right; margin-right: 5px;"
 
|-
 
|-
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|<div style="background-color: #66FF66; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}" align="right"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]] |?Regimen |limit=10000|format=sum}} regimens on this page</b></font></div>
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|<div style="background-color: #fee0d1; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}" align="right"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]] |?Regimen |limit=10000|format=sum}} [[Tutorial#Regimens|regimens]] on this page</b></font></div>
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<div style="background-color: #66CCFF; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]] |?Variant |limit=10000|format=sum}} variants on this page</b></font></div>
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<div style="background-color: #deebf6; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]] |?Variant |limit=10000|format=sum}} [[Tutorial#Variants|variants]] on this page</b></font></div>
 
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|}
 
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''Note that many of the regimens used to treat this disease are generic to [[Acute_lymphocytic_leukemia|acute lymphoblastic leukemia]]; this page contains regimens that are specific to T-cell acute lymphoblastic leukemia (a.k.a. T-cell lymphoblastic lymphoma when primarily nodal-based).
 
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=Guidelines=
 
=Guidelines=
−
==[https://www.nccn.org/ NCCN]==
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'''Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.'''
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*[https://www.nccn.org/professionals/physician_gls/pdf/t-cell.pdf NCCN Guidelines - T-cell Lymphomas]
+
==NCCN==
 +
*''NCCN does not currently have guidelines at this granular level; please see [https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1410 NCCN Guidelines - Acute Lymphoblastic Leukemia].''
 +
*'''2021:''' Brown et al. [https://doi.org/10.6004/Jnccn.2021.0042 Acute Lymphoblastic Leukemia, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology.] [https://pubmed.ncbi.nlm.nih.gov/34551384/ PubMed]
  
 
=Pre-phase=
 
=Pre-phase=
 
==Prednisone monotherapy {{#subobject:30c275|Regimen=1}}==
 
==Prednisone monotherapy {{#subobject:30c275|Regimen=1}}==
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{| class="wikitable" style="float:right; margin-left: 5px;"
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<div class="toccolours" style="background-color:#eeeeee">
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|-
 
−
|[[#top|back to top]]
 
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|}
 
 
===Regimen {{#subobject:af8a3d|Variant=1}}===
 
===Regimen {{#subobject:af8a3d|Variant=1}}===
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{| class="wikitable" style="width: 100%; text-align:center;"  
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{| class="wikitable" style="width: 40%; text-align:center;"  
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!Study
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!style="width: 25%"|Study
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|[[Levels_of_Evidence#Evidence|'''Evidence''']]
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!style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]]
 
|-
 
|-
−
|[http://jco.ascopubs.org/content/34/6/572.full Lepretre et al. 2015 (GRAALL-LYSA LL03)]
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|[https://doi.org/10.1200/JCO.2015.61.5385 Lepretre et al. 2015 (GRAALL-LYSA LL03)]
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|style="background-color:#EEEE00"|Phase II
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|style="background-color:#91cf61"|Phase 2
 
|-
 
|-
 
|}
 
|}
−
====Chemotherapy====
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<div class="toccolours" style="background-color:#b3e2cd">
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*[[Prednisone (Sterapred)]] 60 mg/m<sup>2</sup>/day on days -7 to -1
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====Glucocorticoid therapy====
−
 
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*[[Prednisone (Sterapred)]] 60 mg/m<sup>2</sup>/day PO on days -7 to -1
−
====CNS treatment====
+
====CNS therapy, prophylaxis====
 
*[[Methotrexate (MTX)]] 15 mg IT once at some point between days -7 and -4
 
*[[Methotrexate (MTX)]] 15 mg IT once at some point between days -7 and -4
−
 
+
'''7-day course'''
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''Patients then proceed to [[#Cyclophosphamide.2C_Daunorubicin.2C_L-Asparaginase.2C_Vincristine.2C_Prednisone|cyclophosphamide, daunorubicin, L-asparaginase, vincristine, prednisone reinforced induction]].''
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</div>
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<div class="toccolours" style="background-color:#cbd5e7">
 +
====Subsequent treatment====
 +
*[[#Cyclophosphamide.2C_Daunorubicin.2C_L-Asparaginase.2C_Vincristine.2C_Prednisone|Cyclophosphamide, daunorubicin, L-asparaginase, vincristine, prednisone]] re-induction
 +
</div></div>
 
===References===
 
===References===
 
<!-- Presented at the 56th Annual Meeting of the American Society of Hematology, San Francisco, CA, December 6-9, 2014. -->
 
<!-- Presented at the 56th Annual Meeting of the American Society of Hematology, San Francisco, CA, December 6-9, 2014. -->
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# Lepretre S, Touzart A, Vermeulin T, Picquenot JM, Tanguy-Schmidt A, Salles G, Lamy T, Béné MC, Raffoux E, Huguet F, Chevallier P, Bologna S, Bouabdallah R, Benichou J, Brière J, Moreau A, Tallon-Simon V, Seris S, Graux C, Asnafi V, Ifrah N, Macintyre E, Dombret H. Pediatric-Like Acute Lymphoblastic Leukemia Therapy in Adults With Lymphoblastic Lymphoma: The GRAALL-LYSA LL03 Study. J Clin Oncol. 2016 Feb 20;34(6):572-80. Epub 2015 Dec 7. [http://jco.ascopubs.org/content/34/6/572.full link to original article] [http://jco.ascopubs.org/content/suppl/2015/12/07/JCO.2015.61.5385.DC1/DS_2015.615385.pdf link to data supplement] '''contains protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/26644537 PubMed]
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#'''GRAALL-LYSA LL03:''' Lepretre S, Touzart A, Vermeulin T, Picquenot JM, Tanguy-Schmidt A, Salles G, Lamy T, Béné MC, Raffoux E, Huguet F, Chevallier P, Bologna S, Bouabdallah R, Benichou J, Brière J, Moreau A, Tallon-Simon V, Seris S, Graux C, Asnafi V, Ifrah N, Macintyre E, Dombret H. Pediatric-Like Acute Lymphoblastic Leukemia Therapy in Adults With Lymphoblastic Lymphoma: The GRAALL-LYSA LL03 Study. J Clin Oncol. 2016 Feb 20;34(6):572-80. Epub 2015 Dec 7. [https://doi.org/10.1200/JCO.2015.61.5385 link to original article] [https://ascopubs.org/doi/suppl/10.1200/JCO.2015.61.5385 link to data supplement] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/26644537/ PubMed] [https://clinicaltrials.gov/study/NCT00195871 NCT00195871]
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=Upfront induction therapy=
 
=Upfront induction therapy=
−
 
−
==Daunorubicin, Pegaspargase, Vincristine, Dexamethasone {{#subobject:516f7b|Regimen=1}}==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#top|back to top]]
 
−
|}
 
−
===Regimen, modified ABFM {{#subobject:88f520|Variant=1}}===
 
−
{| class="wikitable" style="width: 100%; text-align:center;"
 
−
!Study
 
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 
−
!Comparator
 
−
![[Levels_of_Evidence#Efficacy|Efficacy]]
 
−
|-
 
−
|See note (COG AALL1231)
 
−
|style="background-color:#1a9851"|Phase III
 
−
|Daunorubicin, L-Asparaginase, Vincristine, Dexamethasone, Bortezomib
 
−
|TBD
 
−
|-
 
−
|}
 
−
''Note: this regimen is available as a COG protocol but no manuscript has been published yet, to our knowledge. Per the protocol, it is intended only for patients greater than 1 and less than 31 years of age. It is based on the UKALL 2003 backbone, although there are some differences.''
 
−
====Chemotherapy====
 
−
*[[Daunorubicin (Cerubidine)]] 25 mg/m<sup>2</sup> IV push over 1 to 15 minutes once per day on days 1, 8, 15, 22
 
−
*[[Pegaspargase (Oncaspar)]] 2500 units/m<sup>2</sup> IV over 1 to 2 hours once per day on days 4 & 18
 
−
*[[Vincristine (Oncovin)]] 1.5 mg/m<sup>2</sup> (maximum dose of 2 mg) IV once per day on days 1, 8, 15, 22
 
−
*[[Dexamethasone (Decadron)]] 3 mg/m<sup>2</sup> PO or IV BID on days 1 to 28
 
−
 
−
====CNS prophylaxis====
 
−
*[[Cytarabine (Cytosar)]] as follows:
 
−
**Ages 1 to 1.99: 30 mg IT once on day 1
 
−
**Ages 2 to 2.99: 50 mg IT once on day 1
 
−
**Age 3 and older: 70 mg IT once on day 1
 
−
*[[Methotrexate (MTX)]] as follows:
 
−
**Ages 1 to 1.99: 8 mg IT once per day on days 8 & 29
 
−
**Ages 2 to 2.99: 10 mg IT once per day on days 8 & 29
 
−
**Ages 3 to 8.99: 12 mg IT once per day on days 8 & 29
 
−
**Age 9 and older: 15 mg IT once per day on days 8 & 29
 
−
 
−
'''4-week course'''
 
−
 
−
''Treatment followed by [[#Cyclophosphamide.2C_Cytarabine.2C_Mercaptopurine.2C_Pegaspargase.2C_Vincristine|cyclophosphamide, cytarabine, mercaptopurine, pegaspargase, vincristine consolidation]]. Bone marrow biopsy is required after induction, to determine post-consolidation risk stratification and therapy.''
 
−
 
−
===References===
 
−
# Vora A, Goulden N, Wade R, Mitchell C, Hancock J, Hough R, Rowntree C, Richards S. Treatment reduction for children and young adults with low-risk acute lymphoblastic leukaemia defined by minimal residual disease (UKALL 2003): a randomised controlled trial. Lancet Oncol. 2013 Mar;14(3):199-209. [http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(12)70600-9/fulltext link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/23395119 PubMed]
 
−
# COG AALL1231: TBD, see note
 
−
 
−
==Daunorubicin, Pegaspargase, Vincristine, Prednisone {{#subobject:a39331|Regimen=1}}==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#top|back to top]]
 
−
|}
 
−
===Regimen {{#subobject:1511c2|Variant=1}}===
 
−
{| class="wikitable" style="width: 100%; text-align:center;"
 
−
!Study
 
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 
−
|-
 
−
|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4433576/ Winter et al. 2015 (COG AALL0434)]
 
−
|style="background-color:#EEEE00"|Phase II
 
−
|-
 
−
|}
 
−
====Chemotherapy====
 
−
*[[Daunorubicin (Cerubidine)]] 25 mg/m<sup>2</sup> IV once per day on days 1, 8, 15, 22
 
−
*[[Pegaspargase (Oncaspar)]] 2500 units/m<sup>2</sup> IV once on day 4, 5, OR 6 (1 dose)
 
−
*[[Vincristine (Oncovin)]] 1.5 mg/m<sup>2</sup> (maximum dose of 2 mg) IV once per day on days 1, 8, 15, 22
 
−
*[[Prednisone (Sterapred)]] 30 mg/m<sup>2</sup> PO BID on days 1 to 28
 
−
 
−
'''One course'''
 
−
 
−
''See paper for details of post-induction therapy.''
 
−
 
−
===References===
 
−
# Winter SS, Dunsmore KP, Devidas M, Eisenberg N, Asselin BL, Wood BL, Leonard Rn MS, Murphy J, Gastier-Foster JM, Carroll AJ, Heerema NA, Loh ML, Raetz EA, Winick NJ, Carroll WL, Hunger SP. Safe integration of nelarabine into intensive chemotherapy in newly diagnosed T-cell acute lymphoblastic leukemia: Children's Oncology Group Study AALL0434. Pediatr Blood Cancer. 2015 Jul;62(7):1176-83. Epub 2015 Mar 8. [http://onlinelibrary.wiley.com/doi/10.1002/pbc.25470/abstract link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4433576/ link to PMC article] [https://www.ncbi.nlm.nih.gov/pubmed/25755211 PubMed]
 
−
 
 
==Cyclophosphamide, Daunorubicin, L-Asparaginase, Vincristine, Prednisone {{#subobject:b90dc3|Regimen=1}}==
 
==Cyclophosphamide, Daunorubicin, L-Asparaginase, Vincristine, Prednisone {{#subobject:b90dc3|Regimen=1}}==
−
{| class="wikitable" style="float:right; margin-left: 5px;"
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<div class="toccolours" style="background-color:#eeeeee">
−
|-
 
−
|[[#top|back to top]]
 
−
|}
 
−
'''[[Asparaginase (Elspar)]] was discontinued by the manufacturer in December 2012, and is now essentially out of stock. Alternatives include [[Pegaspargase (Oncaspar)]] or [[Asparaginase Erwinia chrysanthemi (Erwinaze)]].'''
 
 
===Regimen, "Pediatric-like GRAALL reinforced induction" {{#subobject:56ea06|Variant=1}}===
 
===Regimen, "Pediatric-like GRAALL reinforced induction" {{#subobject:56ea06|Variant=1}}===
−
{| class="wikitable" style="width: 100%; text-align:center;"  
+
{| class="wikitable" style="width: 40%; text-align:center;"  
−
!Study
+
!style="width: 25%"|Study
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+
!style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]]
 
|-
 
|-
−
|[http://jco.ascopubs.org/content/34/6/572.full Lepretre et al. 2015 (GRAALL-LYSA LL03)]
+
|[https://doi.org/10.1200/JCO.2015.61.5385 Lepretre et al. 2015 (GRAALL-LYSA LL03)]
−
|style="background-color:#EEEE00"|Phase II
+
|style="background-color:#91cf61"|Phase 2
 
|-
 
|-
 
|}
 
|}
 
''Note: This regimen was meant for patients less than 60 years old (up to age 59). Regimen is as per the [[Acute_lymphocytic_leukemia#Pediatric-like_GRAALL_induction|GRAALL-2003 Study]] with some minor differences. High-risk patients with an HLA sibling-matched donor or a fully matched (10/10) unrelated donor who achieved CR1 were offered allogeneic stem cell transplant.''
 
''Note: This regimen was meant for patients less than 60 years old (up to age 59). Regimen is as per the [[Acute_lymphocytic_leukemia#Pediatric-like_GRAALL_induction|GRAALL-2003 Study]] with some minor differences. High-risk patients with an HLA sibling-matched donor or a fully matched (10/10) unrelated donor who achieved CR1 were offered allogeneic stem cell transplant.''
 +
<div class="toccolours" style="background-color:#cbd5e8">
 
====Preceding treatment====
 
====Preceding treatment====
−
*[[#Prednisone_monotherapy|Prednisone pre-phase]]
+
*[[#Prednisone_monotherapy|Prednisone]] pre-phase
 +
</div>
 +
<div class="toccolours" style="background-color:#b3e2cd">
 
====Chemotherapy====
 
====Chemotherapy====
−
*[[Cyclophosphamide (Cytoxan)]] 750 mg/m<sup>2</sup> IV over 3 hours once on day 1, then 500 mg/m<sup>2</sup> IV q12h on days 15 & 16
+
*[[Cyclophosphamide (Cytoxan)]] 750 mg/m<sup>2</sup> IV over 3 hours once on day 1, then 500 mg/m<sup>2</sup> IV every 12 hours on days 15 & 16
 
*[[Daunorubicin (Cerubidine)]] 50 mg/m<sup>2</sup> IV once per day on days 1 to 3, then 30 mg/m<sup>2</sup> IV once per day on days 15 & 16
 
*[[Daunorubicin (Cerubidine)]] 50 mg/m<sup>2</sup> IV once per day on days 1 to 3, then 30 mg/m<sup>2</sup> IV once per day on days 15 & 16
 
*[[Asparaginase (Elspar)]] 6000 units/m<sup>2</sup>/day (route not specified) on days 8, 10, 12, 20, 22, 24, 26, 28
 
*[[Asparaginase (Elspar)]] 6000 units/m<sup>2</sup>/day (route not specified) on days 8, 10, 12, 20, 22, 24, 26, 28
 
*[[Vincristine (Oncovin)]] 2 mg IV once per day on days 1, 8, 15, 22
 
*[[Vincristine (Oncovin)]] 2 mg IV once per day on days 1, 8, 15, 22
 +
====Glucocorticoid therapy====
 
*[[Prednisone (Sterapred)]] 60 mg/m<sup>2</sup>/day PO on days 1 to 14
 
*[[Prednisone (Sterapred)]] 60 mg/m<sup>2</sup>/day PO on days 1 to 14
−
 
+
====Supportive therapy====
−
====Supportive medications====
 
 
*[[Lenograstim (Granocyte)]] 150 mcg/m<sup>2</sup> SC once per day from day 17 until myeloid recovery
 
*[[Lenograstim (Granocyte)]] 150 mcg/m<sup>2</sup> SC once per day from day 17 until myeloid recovery
−
 
+
====CNS therapy, prophylaxis====
−
====CNS prophylaxis====
 
 
*[[Methotrexate (MTX)]] 15 mg IT once per day on days 1 & 8
 
*[[Methotrexate (MTX)]] 15 mg IT once per day on days 1 & 8
−
*[[Cytarabine (Cytosar)]] 40 mg IT once per day on days 1 & 8
+
*[[Cytarabine (Ara-C)]] 40 mg IT once per day on days 1 & 8
 
*[[Methylprednisolone (Solumedrol)|Methylprednisolone (Depo-Medrol)]] 40 mg IT once per day on days 1 & 8
 
*[[Methylprednisolone (Solumedrol)|Methylprednisolone (Depo-Medrol)]] 40 mg IT once per day on days 1 & 8
−
 
+
'''28-day course'''
−
'''One course'''
+
</div>
−
 
+
<div class="toccolours" style="background-color:#cbd5e7">
−
''See paper for details beyond induction.''
+
====Subsequent treatment====
−
 
+
*See paper for details beyond induction
 +
</div></div>
 
===References===
 
===References===
 
<!-- Presented at the 56th Annual Meeting of the American Society of Hematology, San Francisco, CA, December 6-9, 2014. -->
 
<!-- Presented at the 56th Annual Meeting of the American Society of Hematology, San Francisco, CA, December 6-9, 2014. -->
−
# Lepretre S, Touzart A, Vermeulin T, Picquenot JM, Tanguy-Schmidt A, Salles G, Lamy T, Béné MC, Raffoux E, Huguet F, Chevallier P, Bologna S, Bouabdallah R, Benichou J, Brière J, Moreau A, Tallon-Simon V, Seris S, Graux C, Asnafi V, Ifrah N, Macintyre E, Dombret H. Pediatric-Like Acute Lymphoblastic Leukemia Therapy in Adults With Lymphoblastic Lymphoma: The GRAALL-LYSA LL03 Study. J Clin Oncol. 2016 Feb 20;34(6):572-80. Epub 2015 Dec 7. [http://jco.ascopubs.org/content/34/6/572.full link to original article] [http://jco.ascopubs.org/content/suppl/2015/12/07/JCO.2015.61.5385.DC1/DS_2015.615385.pdf link to data supplement] '''contains protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/26644537 PubMed]
+
#'''GRAALL-LYSA LL03:''' Lepretre S, Touzart A, Vermeulin T, Picquenot JM, Tanguy-Schmidt A, Salles G, Lamy T, Béné MC, Raffoux E, Huguet F, Chevallier P, Bologna S, Bouabdallah R, Benichou J, Brière J, Moreau A, Tallon-Simon V, Seris S, Graux C, Asnafi V, Ifrah N, Macintyre E, Dombret H. Pediatric-Like Acute Lymphoblastic Leukemia Therapy in Adults With Lymphoblastic Lymphoma: The GRAALL-LYSA LL03 Study. J Clin Oncol. 2016 Feb 20;34(6):572-80. Epub 2015 Dec 7. [https://doi.org/10.1200/JCO.2015.61.5385 link to original article] [https://ascopubs.org/doi/suppl/10.1200/JCO.2015.61.5385 link to data supplement] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/26644537/ PubMed] [https://clinicaltrials.gov/study/NCT00195871 NCT00195871]
 +
==Daunorubicin, Pegaspargase, Vincristine, Dexamethasone {{#subobject:516f7b|Regimen=1}}==
 +
<div class="toccolours" style="background-color:#eeeeee">
 +
===Regimen, modified ABFM {{#subobject:88f520|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/10.1016/S1470-2045(12)70600-9 Vora et al. 2013 (UKALL 2003)]
 +
|2003-2011
 +
| style="background-color:#91cf61" |Non-randomized part of phase 2 RCT
 +
|-
 +
|}
 +
<div class="toccolours" style="background-color:#b3e2cd">
 +
====Chemotherapy====
 +
*[[Daunorubicin (Cerubidine)]] 25 mg/m<sup>2</sup> IV over 1 to 15 minutes once per day on days 1, 8, 15, 22
 +
*[[Pegaspargase (Oncaspar)]] 2500 units/m<sup>2</sup> IV over 1 to 2 hours once per day on days 4 & 18
 +
*[[Vincristine (Oncovin)]] 1.5 mg/m<sup>2</sup> (maximum dose of 2 mg) IV once per day on days 1, 8, 15, 22
 +
====Glucocorticoid therapy====
 +
*[[Dexamethasone (Decadron)]] 3 mg/m<sup>2</sup> IV or PO twice per day on days 1 to 28
 +
====CNS therapy, prophylaxis====
 +
*[[Cytarabine (Ara-C)]] by the following age-based criteria:
 +
**1 to 1.99 years old: 30 mg IT once on day 1
 +
**2 to 2.99 years old: 50 mg IT once on day 1
 +
**3 years old or older: 70 mg IT once on day 1
 +
*[[Methotrexate (MTX)]] by the following age-based criteria:
 +
**1 to 1.99 years old: 8 mg IT once per day on days 8 & 29
 +
**2 to 2.99 years old: 10 mg IT once per day on days 8 & 29
 +
**3 to 8.99 years old: 12 mg IT once per day on days 8 & 29
 +
**9 years old or older: 15 mg IT once per day on days 8 & 29
 +
'''4-week course'''
 +
</div>
 +
<div class="toccolours" style="background-color:#cbd5e7">
 +
====Subsequent treatment====
 +
*[[#Cyclophosphamide.2C_Cytarabine.2C_Mercaptopurine.2C_Pegaspargase.2C_Vincristine|Cyclophosphamide, cytarabine, mercaptopurine, pegaspargase, vincristine]] consolidation
 +
</div></div>
  
−
=Consolidation after upfront therapy=
 
−
 
−
==Allogeneic HSCT==
 
−
To be completed
 
 
===References===
 
===References===
−
# Schrauder A, Reiter A, Gadner H, Niethammer D, Klingebiel T, Kremens B, Peters C, Ebell W, Zimmermann M, Niggli F, Ludwig WD, Riehm H, Welte K, Schrappe M. Superiority of allogeneic hematopoietic stem-cell transplantation compared with chemotherapy alone in high-risk childhood T-cell acute lymphoblastic leukemia: results from ALL-BFM 90 and 95. J Clin Oncol. 2006 Dec 20;24(36):5742-9. [http://ascopubs.org/doi/full/10.1200/JCO.2006.06.2679 link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/17179108 PubMed]
+
# '''UKALL 2003:''' Vora A, Goulden N, Wade R, Mitchell C, Hancock J, Hough R, Rowntree C, Richards S. Treatment reduction for children and young adults with low-risk acute lymphoblastic leukaemia defined by minimal residual disease (UKALL 2003): a randomised controlled trial. Lancet Oncol. 2013 Mar;14(3):199-209. Epub 2013 Feb 7. [https://doi.org/10.1016/S1470-2045(12)70600-9 link to original article] [https://pubmed.ncbi.nlm.nih.gov/23395119/ PubMed] ISRCTN07355119
  
−
==Cyclophosphamide, Cytarabine, Mercaptopurine, Pegaspargase, Vincristine {{#subobject:980f97|Regimen=1}}==
+
=Consolidation after upfront therapy=
−
{| class="wikitable" style="float:right; margin-left: 5px;"
+
==Etoposide & TBI, then allo HSCT {{#subobject:b389e1|Regimen=1}}==
−
|-
+
<div class="toccolours" style="background-color:#eeeeee">
−
|[[#top|back to top]]
+
===Regimen {{#subobject:e4216b|Variant=1}}===
−
|}
+
{| class="wikitable" style="width: 40%; text-align:center;"  
−
===Regimen {{#subobject:61171f|Variant=1}}===
+
!style="width: 25%"|Study
−
{| class="wikitable" style="width: 100%; text-align:center;"  
+
!style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]]
−
!Study
 
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 
 
|-
 
|-
−
|See note (COG AALL1231)
+
|[https://doi.org/10.1182/blood-2005-04-1623 Rowe et al. 2005 (MRC UKALL XII/ECOG E2993)]
−
|style="background-color:#eeee00"|Non-randomized portion of RCT
+
| style="background-color:#91cf61" |Non-randomized part of phase 3 RCT
 
|-
 
|-
 
|}
 
|}
−
''Note: this regimen is available as a COG protocol but no manuscript has been published yet, to our knowledge. Per the protocol, it is intended only for patients greater than 1 and less than 31 years of age.''
+
{{#lst:Allogeneic HSCT|e4216b}}
−
====Preceding treatment====
+
</div></div>
−
*[[#Daunorubicin.2C_Pegaspargase.2C_Vincristine.2C_Dexamethasone|Daunorubicin, pegaspargase, vincristine, dexamethasone induction]]
 
−
====Chemotherapy====
 
−
*[[Cyclophosphamide (Cytoxan)]] 1000 mg/m<sup>2</sup> IV over 30 to 60 minutes once per day on days 1 & 29
 
−
*[[Cytarabine (Cytosar)]] 75 mg/m<sup>2</sup> IV or SC once per day on days 1 to 4, 8 to 11, 29 to 32, 36 to 39
 
−
*[[Mercaptopurine (Purinethol)]] 60 mg/m<sup>2</sup> PO once per day on days 1 to 14, 29 to 42
 
−
**Dose may be modified based on TPMT status
 
−
*[[Pegaspargase (Oncaspar)]] 2500 units/m<sup>2</sup> IV over 1 to 2 hours once per day on days 15 & 43
 
−
*[[Vincristine (Oncovin)]] 1.5 mg/m<sup>2</sup> (maximum dose of 2 mg) IV once per day on days 15, 22, 43, 50
 
−
 
 
−
====Supportive medications====
 
−
*[[Mesna (Mesnex)]] "is not required for this dose of cyclophosphamide, but may be administered at institutional discretion."
 
−
 
 
−
====CNS prophylaxis====
 
−
*[[Methotrexate (MTX)]] as follows, for CNS3:
 
−
**Ages 1 to 1.99: 8 mg IT once per day on days 1 & 8
 
−
**Ages 2 to 2.99: 10 mg IT once per day on days 1 & 8
 
−
**Ages 3 to 8.99: 12 mg IT once per day on days 1 & 8
 
−
**Age 9 and older: 15 mg IT once per day on days 1 & 8
 
−
 
 
−
'''One course'''
 
−
 
 
−
''See protocol for details of treatment beyond consolidation, which is guided by MRD status obtained at the end of induction.''
 
−
 
 
 
===References===
 
===References===
−
# COG AALL1231: TBD, see note
+
# '''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. [https://doi.org/10.1182/blood-2007-10-116582 link to original article] [https://pubmed.ncbi.nlm.nih.gov/18048644/ PubMed]
−
=Consolidation after salvage therapy=
+
## '''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. [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]
−
==Allogeneic HSCT==
 
−
To be completed
 
  
 
=Relapsed or refractory=
 
=Relapsed or refractory=
−
 
 
==Nelarabine monotherapy {{#subobject:bb7a38|Regimen=1}}==
 
==Nelarabine monotherapy {{#subobject:bb7a38|Regimen=1}}==
−
{| class="wikitable" style="float:right; margin-left: 5px;"
+
<div class="toccolours" style="background-color:#eeeeee">
 +
===Regimen variant #1, 5-day dosing {{#subobject:44a025|Variant=1}}===
 +
{| class="wikitable sortable" style="width: 80%; text-align:center;"
 +
!style="width: 25%"|Study
 +
!style="width: 25%"|Dates of enrollment
 +
!style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]]
 +
!style="width: 25%"|[[Levels_of_Evidence#Efficacy|Efficacy]]
 +
|-
 +
|[https://doi.org/10.1200/JCO.2005.03.426 Berg et al. 2005]
 +
|1997-2002
 +
|style="background-color:#91cf61"|Phase 2 (RT)
 +
|ORR: 14-55%
 +
|-
 +
|[https://doi.org/10.1111/bjh.14874 Zwaan et al. 2017 (GSK 111081)]
 +
|2009-2014
 +
|style="background-color:#91cf61"|Phase 4
 +
|style="background-color:#666666; color:white"|ORR: 39%
 
|-
 
|-
−
|[[#top|back to top]]
 
 
|}
 
|}
−
 
+
<div class="toccolours" style="background-color:#b3e2cd">
−
===Regimen {{#subobject:b5ce00|Variant=1}}===
+
====Chemotherapy====
−
{| class="wikitable" style="width: 100%; text-align:center;"  
+
*[[Nelarabine (Arranon)]] 650 mg/m<sup>2</sup> IV over 60 minutes once per day on days 1 to 5
−
!Study
+
'''21-day cycles'''
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+
</div></div><br>
 +
<div class="toccolours" style="background-color:#eeeeee">
 +
===Regimen variant #2, intermittent dosing {{#subobject:b5ce00|Variant=1}}===
 +
{| class="wikitable sortable" style="width: 80%; text-align:center;"  
 +
!style="width: 25%"|Study
 +
!style="width: 25%"|Dates of enrollment
 +
!style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]]
 +
!style="width: 25%"|[[Levels_of_Evidence#Efficacy|Efficacy]]
 
|-
 
|-
−
|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1941786/ DeAngelo et al. 2007 (CALGB 19801)]  
+
|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1941786/ DeAngelo et al. 2007 (CALGB 19801)]
−
|style="background-color:#EEEE00"|Phase II
+
|1998-2001
 +
|style="background-color:#91cf61"|Phase 2 (RT)
 +
|style="background-color:#666666; color:white"|ORR: 41% (95% CI, 15-43)
 
|-
 
|-
 
|}
 
|}
−
 
+
''Note: See paper for details about the schedule.''
−
''See paper for details about the schedule.''
+
<div class="toccolours" style="background-color:#b3e2cd">
 
====Chemotherapy====
 
====Chemotherapy====
−
*[[Nelarabine (Arranon)]] 1.5 g/m<sup>2</sup> IV over 2 hours once per day on days 1, 3, 5
+
*[[Nelarabine (Arranon)]] 1500 mg/m<sup>2</sup> IV over 2 hours once per day on days 1, 3, 5
−
 
 
 
'''21-day cycle for 3 to 4 cycles (or delayed for count recovery)'''
 
'''21-day cycle for 3 to 4 cycles (or delayed for count recovery)'''
−
 
+
</div></div>
 
===References===
 
===References===
−
# DeAngelo DJ, Yu D, Johnson JL, Coutre SE, Stone RM, Stopeck AT, Gockerman JP, Mitchell BS, Appelbaum FR, Larson RA. Nelarabine induces complete remissions in adults with relapsed or refractory T-lineage acute lymphoblastic leukemia or lymphoblastic lymphoma: Cancer and Leukemia Group B study 19801. Blood. 2007 Jun 15;109(12):5136-42. Epub 2007 Mar 7. [http://www.bloodjournal.org/content/109/12/5136.long link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1941786/ link to PMC article] [https://www.ncbi.nlm.nih.gov/pubmed/17344466 PubMed]
+
# Berg SL, Blaney SM, Devidas M, Lampkin TA, Murgo A, Bernstein M, Billett A, Kurtzberg J, Reaman G, Gaynon P, Whitlock J, Krailo M, Harris MB; Children's Oncology Group. Phase II study of nelarabine (compound 506U78) in children and young adults with refractory T-cell malignancies: a report from the Children's Oncology Group. J Clin Oncol. 2005 May 20;23(15):3376-82. [https://doi.org/10.1200/JCO.2005.03.426 link to original article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/15908649/ PubMed]
−
 
+
# '''CALGB 19801:''' DeAngelo DJ, Yu D, Johnson JL, Coutre SE, Stone RM, Stopeck AT, Gockerman JP, Mitchell BS, Appelbaum FR, Larson RA. Nelarabine induces complete remissions in adults with relapsed or refractory T-lineage acute lymphoblastic leukemia or lymphoblastic lymphoma: Cancer and Leukemia Group B study 19801. Blood. 2007 Jun 15;109(12):5136-42. Epub 2007 Mar 7. [https://doi.org/10.1182/blood-2006-11-056754 link to original article] '''contains dosing details in manuscript''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1941786/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/17344466/ PubMed]
 +
# '''GSK 111081:''' Zwaan CM, Kowalczyk J, Schmitt C, Bielorai B, Russo MW, Woessner M, Ranganathan S, Leverger G. Safety and efficacy of nelarabine in children and young adults with relapsed or refractory T-lineage acute lymphoblastic leukaemia or T-lineage lymphoblastic lymphoma: results of a phase 4 study. Br J Haematol. 2017 Oct;179(2):284-293. Epub 2017 Aug 2. [https://doi.org/10.1111/bjh.14874 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/28771663/ PubMed] [https://clinicaltrials.gov/study/NCT00866671 NCT00866671]
 
[[Category:T-cell acute lymphoblastic leukemia regimens]]
 
[[Category:T-cell acute lymphoblastic leukemia regimens]]
 
[[Category:Disease-specific pages]]
 
[[Category:Disease-specific pages]]
−
[[Category:Acute leukemias]]
+
[[Category:Acute lymphoblastic leukemias]]
−
[[Category:Pediatric cancers]]
+
[[Category:T-cell leukemias]]

Latest revision as of 01:37, 26 June 2024

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Section editor Section editor
Bdholaria.jpg
 Bhagirathbhai Dholaria, MBBS
Vanderbilt University
Nashville, TN, USA
LinkedIn
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 Ashwin Kishtagari, MD
Vanderbilt University
Nashville, TN, USA
LinkedIn

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

  • We have moved How I Treat articles to a dedicated page.
5 regimens on this page
6 variants on this page


Guidelines

Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.

NCCN

Pre-phase

Prednisone monotherapy

Regimen

Study Evidence
Lepretre et al. 2015 (GRAALL-LYSA LL03) Phase 2

Glucocorticoid therapy

CNS therapy, prophylaxis

7-day course

Subsequent treatment

References

  1. GRAALL-LYSA LL03: Lepretre S, Touzart A, Vermeulin T, Picquenot JM, Tanguy-Schmidt A, Salles G, Lamy T, Béné MC, Raffoux E, Huguet F, Chevallier P, Bologna S, Bouabdallah R, Benichou J, Brière J, Moreau A, Tallon-Simon V, Seris S, Graux C, Asnafi V, Ifrah N, Macintyre E, Dombret H. Pediatric-Like Acute Lymphoblastic Leukemia Therapy in Adults With Lymphoblastic Lymphoma: The GRAALL-LYSA LL03 Study. J Clin Oncol. 2016 Feb 20;34(6):572-80. Epub 2015 Dec 7. link to original article link to data supplement contains dosing details in abstract PubMed NCT00195871

Upfront induction therapy

Cyclophosphamide, Daunorubicin, L-Asparaginase, Vincristine, Prednisone

Regimen, "Pediatric-like GRAALL reinforced induction"

Study Evidence
Lepretre et al. 2015 (GRAALL-LYSA LL03) Phase 2

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

Preceding treatment

Chemotherapy

Glucocorticoid therapy

Supportive therapy

CNS therapy, prophylaxis

28-day course

Subsequent treatment

  • See paper for details beyond induction

References

  1. GRAALL-LYSA LL03: Lepretre S, Touzart A, Vermeulin T, Picquenot JM, Tanguy-Schmidt A, Salles G, Lamy T, Béné MC, Raffoux E, Huguet F, Chevallier P, Bologna S, Bouabdallah R, Benichou J, Brière J, Moreau A, Tallon-Simon V, Seris S, Graux C, Asnafi V, Ifrah N, Macintyre E, Dombret H. Pediatric-Like Acute Lymphoblastic Leukemia Therapy in Adults With Lymphoblastic Lymphoma: The GRAALL-LYSA LL03 Study. J Clin Oncol. 2016 Feb 20;34(6):572-80. Epub 2015 Dec 7. link to original article link to data supplement contains dosing details in abstract PubMed NCT00195871

Daunorubicin, Pegaspargase, Vincristine, Dexamethasone

Regimen, modified ABFM

Study Dates of enrollment Evidence
Vora et al. 2013 (UKALL 2003) 2003-2011 Non-randomized part of phase 2 RCT

Chemotherapy

Glucocorticoid therapy

CNS therapy, prophylaxis

  • Cytarabine (Ara-C) by the following age-based criteria:
    • 1 to 1.99 years old: 30 mg IT once on day 1
    • 2 to 2.99 years old: 50 mg IT once on day 1
    • 3 years old or older: 70 mg IT once on day 1
  • Methotrexate (MTX) by the following age-based criteria:
    • 1 to 1.99 years old: 8 mg IT once per day on days 8 & 29
    • 2 to 2.99 years old: 10 mg IT once per day on days 8 & 29
    • 3 to 8.99 years old: 12 mg IT once per day on days 8 & 29
    • 9 years old or older: 15 mg IT once per day on days 8 & 29

4-week course

Subsequent treatment

References

  1. UKALL 2003: Vora A, Goulden N, Wade R, Mitchell C, Hancock J, Hough R, Rowntree C, Richards S. Treatment reduction for children and young adults with low-risk acute lymphoblastic leukaemia defined by minimal residual disease (UKALL 2003): a randomised controlled trial. Lancet Oncol. 2013 Mar;14(3):199-209. Epub 2013 Feb 7. link to original article PubMed ISRCTN07355119

Consolidation after upfront therapy

Etoposide & TBI, then allo HSCT

Regimen

Study Evidence
Rowe et al. 2005 (MRC UKALL XII/ECOG E2993) Non-randomized part of phase 3 RCT

Chemotherapy

Radiotherapy

Immunotherapy

One course

References

  1. 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
    1. 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
    2. 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
    3. 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

Relapsed or refractory

Nelarabine monotherapy

Regimen variant #1, 5-day dosing

Study Dates of enrollment Evidence Efficacy
Berg et al. 2005 1997-2002 Phase 2 (RT) ORR: 14-55%
Zwaan et al. 2017 (GSK 111081) 2009-2014 Phase 4 ORR: 39%

Chemotherapy

21-day cycles


Regimen variant #2, intermittent dosing

Study Dates of enrollment Evidence Efficacy
DeAngelo et al. 2007 (CALGB 19801) 1998-2001 Phase 2 (RT) ORR: 41% (95% CI, 15-43)

Note: See paper for details about the schedule.

Chemotherapy

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

References

  1. Berg SL, Blaney SM, Devidas M, Lampkin TA, Murgo A, Bernstein M, Billett A, Kurtzberg J, Reaman G, Gaynon P, Whitlock J, Krailo M, Harris MB; Children's Oncology Group. Phase II study of nelarabine (compound 506U78) in children and young adults with refractory T-cell malignancies: a report from the Children's Oncology Group. J Clin Oncol. 2005 May 20;23(15):3376-82. link to original article contains dosing details in abstract PubMed
  2. CALGB 19801: DeAngelo DJ, Yu D, Johnson JL, Coutre SE, Stone RM, Stopeck AT, Gockerman JP, Mitchell BS, Appelbaum FR, Larson RA. Nelarabine induces complete remissions in adults with relapsed or refractory T-lineage acute lymphoblastic leukemia or lymphoblastic lymphoma: Cancer and Leukemia Group B study 19801. Blood. 2007 Jun 15;109(12):5136-42. Epub 2007 Mar 7. link to original article contains dosing details in manuscript link to PMC article PubMed
  3. GSK 111081: Zwaan CM, Kowalczyk J, Schmitt C, Bielorai B, Russo MW, Woessner M, Ranganathan S, Leverger G. Safety and efficacy of nelarabine in children and young adults with relapsed or refractory T-lineage acute lymphoblastic leukaemia or T-lineage lymphoblastic lymphoma: results of a phase 4 study. Br J Haematol. 2017 Oct;179(2):284-293. Epub 2017 Aug 2. link to original article contains dosing details in manuscript PubMed NCT00866671
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