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

From HemOnc.org - A Hematology Oncology Wiki
Jump to navigation Jump to search
m
 
(199 intermediate revisions by 5 users not shown)
Line 1: Line 1:
−
'''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]].'''
+
<span id="BackToTop"></span>
−
 
+
<div class="noprint" style="background-color:LightGray; position:fixed; bottom:2%; right:0.25%; padding-left:5px; padding-right:5px; margin: 15px; opacity:0.8; border-style: solid; border-color:DarkGray; border-width: 1px">
−
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]].
+
[[#top|Back to Top]]
−
 
+
</div>
 +
{{#lst:Editorial board transclusions|t-all}}
 +
<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>
 +
<big>'''Note: certain regimens have been moved to dedicated pages:
 +
*'''[[T-cell acute lymphoblastic leukemia, pediatric|Pediatric T-cell ALL]]
 +
</big>
 +
*''We have moved [[How I Treat]] articles to a dedicated page.''
 
{| class="wikitable" style="float:right; margin-right: 5px;"
 
{| class="wikitable" style="float:right; margin-right: 5px;"
 
|-
 
|-
−
|<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>
+
|<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>
−
<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>
+
<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>
 
|}
 
|}
 
{{TOC limit|limit=3}}
 
{{TOC limit|limit=3}}
 +
=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==
 +
*''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]
  
−
''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).
+
=Pre-phase=
−
 
+
==Prednisone monotherapy {{#subobject:30c275|Regimen=1}}==
−
=Induction therapy=
+
<div class="toccolours" style="background-color:#eeeeee">
−
==AALL0434 Induction {{#subobject:a39331|Regimen=1}}==
+
===Regimen {{#subobject:af8a3d|Variant=1}}===
−
{| class="wikitable" style="float:right; margin-left: 5px;"
+
{| class="wikitable" style="width: 40%; text-align:center;"
 +
!style="width: 25%"|Study
 +
!style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]]
 +
|-
 +
|[https://doi.org/10.1200/JCO.2015.61.5385 Lepretre et al. 2015 (GRAALL-LYSA LL03)]
 +
|style="background-color:#91cf61"|Phase 2
 +
|-
 +
|}
 +
<div class="toccolours" style="background-color:#b3e2cd">
 +
====Glucocorticoid therapy====
 +
*[[Prednisone (Sterapred)]] 60 mg/m<sup>2</sup>/day PO on days -7 to -1
 +
====CNS therapy, prophylaxis====
 +
*[[Methotrexate (MTX)]] 15 mg IT once at some point between days -7 and -4
 +
'''7-day course'''
 +
</div>
 +
<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===
 +
<!-- Presented at the 56th Annual Meeting of the American Society of Hematology, San Francisco, CA, December 6-9, 2014. -->
 +
#'''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]
 +
=Upfront induction therapy=
 +
==Cyclophosphamide, Daunorubicin, L-Asparaginase, Vincristine, Prednisone {{#subobject:b90dc3|Regimen=1}}==
 +
<div class="toccolours" style="background-color:#eeeeee">
 +
===Regimen, "Pediatric-like GRAALL reinforced induction" {{#subobject:56ea06|Variant=1}}===
 +
{| class="wikitable" style="width: 40%; text-align:center;"  
 +
!style="width: 25%"|Study
 +
!style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]]
 +
|-
 +
|[https://doi.org/10.1200/JCO.2015.61.5385 Lepretre et al. 2015 (GRAALL-LYSA LL03)]
 +
|style="background-color:#91cf61"|Phase 2
 
|-
 
|-
−
|[[#toc|back to top]]
 
 
|}
 
|}
−
===Regimen {{#subobject:1511c2|Variant=1}}===
+
''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.''
−
{| border="1" style="text-align:center;" !align="left"  
+
<div class="toccolours" style="background-color:#cbd5e8">
−
|'''Study'''
+
====Preceding treatment====
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+
*[[#Prednisone_monotherapy|Prednisone]] pre-phase
 +
</div>
 +
<div class="toccolours" style="background-color:#b3e2cd">
 +
====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 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
 +
*[[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
 +
====Glucocorticoid therapy====
 +
*[[Prednisone (Sterapred)]] 60 mg/m<sup>2</sup>/day PO on days 1 to 14
 +
====Supportive therapy====
 +
*[[Lenograstim (Granocyte)]] 150 mcg/m<sup>2</sup> SC once per day from day 17 until myeloid recovery
 +
====CNS therapy, prophylaxis====
 +
*[[Methotrexate (MTX)]] 15 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
 +
'''28-day course'''
 +
</div>
 +
<div class="toccolours" style="background-color:#cbd5e7">
 +
====Subsequent treatment====
 +
*See paper for details beyond induction
 +
</div></div>
 +
===References===
 +
<!-- Presented at the 56th Annual Meeting of the American Society of Hematology, San Francisco, CA, December 6-9, 2014. -->
 +
#'''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]]
 
|-
 
|-
−
|[http://onlinelibrary.wiley.com/doi/10.1002/pbc.25470/abstract Winter et al. 2015]
+
|[https://doi.org/10.1016/S1470-2045(12)70600-9 Vora et al. 2013 (UKALL 2003)]
−
|<span
+
|2003-2011
−
style="background:#EEEE00;
+
| style="background-color:#91cf61" |Non-randomized part of phase 2 RCT
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
 
|-
 
|-
 
|}
 
|}
−
To be completed
+
<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>
  
 
===References===
 
===References===
−
# Winter SS, Dunsmore KP, Devidas M, Eisenberg N, Asselin BL, Wood BL, Leonard Rn MS, Murphy J, Gastier-Foster JM, Carroll AJ, Heerema NA, Loh ML, Raetz EA, Winick NJ, Carroll WL, Hunger SP. Safe integration of nelarabine into intensive chemotherapy in newly diagnosed T-cell acute lymphoblastic leukemia: Children's Oncology Group Study AALL0434. Pediatr Blood Cancer. 2015 Jul;62(7):1176-83. Epub 2015 Mar 8. [http://onlinelibrary.wiley.com/doi/10.1002/pbc.25470/abstract link to original article] [http://www.ncbi.nlm.nih.gov/pubmed/25755211 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
  
−
==Pediatric-like GRAALL induction {{#subobject:b90dc3|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">
−
|[[#toc|back to top]]
+
===Regimen {{#subobject:e4216b|Variant=1}}===
−
|}
+
{| class="wikitable" style="width: 40%; text-align:center;"  
−
===Regimen {{#subobject:56ea06|Variant=1}}===
+
!style="width: 25%"|Study
−
{| border="1" style="text-align:center;" !align="left"  
+
!style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]]
−
|'''Study'''
 
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 
 
|-
 
|-
−
|[http://jco.ascopubs.org/content/early/2015/12/07/JCO.2015.61.5385.long Lepretre et al. 2015 (GRAALL-LYSA LL03)]
+
|[https://doi.org/10.1182/blood-2005-04-1623 Rowe et al. 2005 (MRC UKALL XII/ECOG E2993)]
−
|<span
+
| style="background-color:#91cf61" |Non-randomized part of phase 3 RCT
−
style="background:#EEEE00;
 
−
padding:3px 6px 3px 6px;
 
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
 
|-
 
|-
 
|}
 
|}
−
 
+
{{#lst:Allogeneic HSCT|e4216b}}
−
''This regimen was meant for patients less than 60 years old (up to age 59). Regimen is reportedly as per the [[Acute_lymphocytic_leukemia#Pediatric-like_GRAALL_induction|GRAALL-2003 Study]]; data supplement was not available for review. 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></div>
−
 
 
 
===References===
 
===References===
−
<!-- Presented at the 56th Annual Meeting of the American Society of Hematology, San Francisco, CA, December 6-9, 2014. -->
+
# '''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]
−
# 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. 2015 Dec 7. [Epub ahead of print] [http://jco.ascopubs.org/content/early/2015/12/07/JCO.2015.61.5385.long link to early article] '''contains protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/26644537 PubMed]
+
## '''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. [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]
  
−
=Relapsed/Refractory=
+
=Relapsed or refractory=
−
 
+
==Nelarabine monotherapy {{#subobject:bb7a38|Regimen=1}}==
−
==Nelarabine (Arranon) {{#subobject:bb7a38|Regimen=1}}==
+
<div class="toccolours" style="background-color:#eeeeee">
−
{| class="wikitable" style="float:right; margin-left: 5px;"
+
===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%
 
|-
 
|-
−
|[[#toc|back to top]]
 
 
|}
 
|}
−
 
+
<div class="toccolours" style="background-color:#b3e2cd">
−
===Regimen {{#subobject:b5ce00|Variant=1}}===
+
====Chemotherapy====
−
{| border="1" style="text-align:center;" !align="left"  
+
*[[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]]
 
|-
 
|-
−
|[http://www.bloodjournal.org/content/109/12/5136.long DeAngelo et al. 2007 (CALGB 19801)]  
+
|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1941786/ DeAngelo et al. 2007 (CALGB 19801)]
−
|<span
+
|1998-2001
−
style="background:#EEEE00;
+
|style="background-color:#91cf61"|Phase 2 (RT)
−
padding:3px 6px 3px 6px;
+
|style="background-color:#666666; color:white"|ORR: 41% (95% CI, 15-43)
−
border-color:black;
 
−
border-width:2px;
 
−
border-style:solid;">Phase II</span>
 
 
|-
 
|-
 
|}
 
|}
−
 
+
''Note: See paper for details about the schedule.''
−
''See paper for details about the schedule.''
+
<div class="toccolours" style="background-color:#b3e2cd">
−
 
+
====Chemotherapy====
−
*[[Nelarabine (Arranon)]] 1.5 g/m2 IV over 2 hours 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 x 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''' [http://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:Disease-specific pages]]
 +
[[Category:Acute lymphoblastic leukemias]]
 +
[[Category:T-cell leukemias]]

Latest revision as of 01:37, 26 June 2024

Back to Top

Section editor Section editor
Bdholaria.jpg
 Bhagirathbhai Dholaria, MBBS
Vanderbilt University
Nashville, TN, USA
LinkedIn
AK.JPG
 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
Retrieved from "https://hemonc.org/w/index.php?title=T-cell_acute_lymphoblastic_leukemia&oldid=86687"