Randomized Phase III Study for the Treatment of Newly Diagnosed Disseminated Lymphoblastic Lymphoma or Localized Lymphoblastic Lymphoma
OBJECTIVES:
- Compare the event-free survival and overall survival of children or adolescents with
newly diagnosed disseminated stage III or IV lymphoblastic lymphoma treated with 4
chemotherapy regimens*.
- Determine whether treatment with a regimen without methotrexate maintains the same
disease-free survival as NHL/BFM 90 in these patients.
- Determine whether intensification with anthracycline and cyclophosphamide improves
disease-free survival in these patients.
- Collect outcome data on uniformly treated patients with localized disease or
CNS-positive disease.
- Determine whether rapid reduction in tumor volume by chest radiography and CT scan is
predictive of improved outcome in patients treated with these regimens.
- Determine the prevalence of bone marrow involvement at presentation in these patients.
- Determine whether peripheral blood can replace bone marrow in the initial staging of
these patients.
- Determine the clinical significance of bone marrow and peripheral blood involvement in
these patients.
NOTE: *All patients as of 4/2006 receive treatment on Arm III regimen only
OUTLINE: Patients are stratified by disease characteristics (disseminated lymphoblastic
lymphoma vs localized lymphoblastic lymphoma [localized lymphoblastic lymphoma is closed to
accrual as of 10/2005]) and age. Patients with CNS negative disseminated lymphoblastic
lymphoma are randomized to 1 of 4 treatment arms*. Patients with testicular involvement at
diagnosis are nonrandomly assigned to arm IV and do not receive testicular radiotherapy.
Patients with localized lymphoblastic lymphoma (closed to accrual as of 10/2005) are not
randomized.
NOTE: *All patients as of 4/2006 receive treatment on Arm III only
- Localized lymphoblastic lymphoma (closed to accrual as of 10/2005):
- Induction (5 weeks): Patients receive vincristine IV and daunorubicin IV over 15
minutes to 2 hours on days 0, 7, 14, and 21; oral prednisone on days 0-27; and
asparaginase intramuscularly (IM) on days 3, 5, and 7 and then 3 times a week for
9 doses (during days 8-21). Patients also receive methotrexate intrathecally (IT)
on days 7 and 28 and cytarabine IT on day 0.
- Consolidation (5 weeks): Patients receive methotrexate IT on days 0, 7, 14, and 21
followed by cyclophosphamide IV over 1 hour on days 0 and 14; cytarabine IV on
days 0-3, 7-10, 14-17, and 21-24; oral mercaptopurine on days 0-27; and oral
prednisone over 10 days.
- Interim maintenance (8 weeks): Patients receive methotrexate IT on days 0 and 28;
oral mercaptopurine on days 0-41; and oral methotrexate on days 7, 14, 21, and 35.
- Delayed intensification (7 weeks): Patients receive vincristine IV and doxorubicin
IV over 15 minutes to 2 hours on days 0, 7, and 14; asparaginase IM on day 3 and
then 3 times a week for 6 doses; oral dexamethasone on days 0-30; cyclophosphamide
IV over 1 hour on day 28; and cytarabine IV or SC on days 28-31 and 35-38.
Patients also receive oral thioguanine on days 28-41 and methotrexate IT on days
28 and 35.
- Maintenance (84 day course): Patients receive vincristine IV on days 0, 28, and
56; oral prednisone on days 0-4, 28-32, and 56-60; oral methotrexate on days 7,
14, 21, 28, 35, 42, 49, 56, 63, 70, and 77; oral mercaptopurine on days 0-83; and
methotrexate IT on day 0.
- Disseminated lymphoblastic lymphoma:
- Arm I (closed to accrual as of 4/2006): Patients receive same induction,
consolidation, and interim maintenance therapy schedule as localized lymphoblastic
lymphoma patients.
- Delayed intensification (7 weeks): Patients receive vincristine IV and
doxorubicin IV over 15 minutes to 2 hours on days 0, 7, 14, and 21;
asparaginase IM on day 3 and then 3 times a week for 6 doses; and oral
dexamethasone on days 0-28. Patients also receive cyclophosphamide IV over 1
hour on day 35; cytarabine IV or SC on days 35-38 and 42-45; oral thioguanine
on days 35-48; and methotrexate IT on days 35 and 42.
- Maintenance (84 day course): Patients receive same therapy as localized
lymphoblastic lymphoma patients, except methotrexate IT is administered on
day 0 and 28 (for first 4 courses).
- Arm II (closed to accrual as of 4/2006): Patients receive consolidation, interim
maintenance, and maintenance therapy as in arm I.
- Induction (5 weeks): Patients receive vincristine IV on days 0, 7, 14, and
21; daunorubicin IV over 48 hours on days 0-2; oral prednisone on days 0-27;
and asparaginase IM on days 3, 5, and 7 and then 3 times a week for 9 doses
(during days 8-21). Patients also receive methotrexate IT on days 7 and 28;
cyclophosphamide IV over 1 hour on day 2; and cytarabine IT on day 0.
- Delayed intensification (7 weeks): Patients receive vincristine IV on days 0,
7, 14, 21; daunorubicin IV over 48 hours on days 0-2; asparaginase IM on day
3 and then 3 times a week for 6 doses; and oral dexamethasone on days 0-28.
Patients also receive cyclophosphamide IV over 1 hour on days 2 and 35;
cytarabine IV or SC on days 35-38 and 42-45; oral thioguanine on days 35-48;
and methotrexate IT on days 35 and 42.
- Arm III:
- Induction (5 weeks): Patients receive vincristine IV and daunorubicin IV over
1 hour on days 0, 7, 14, and 21 and oral prednisone on days 0-37. Patients
also receive asparaginase IM on day 11 and then 3 times a week for 9 doses;
methotrexate IT on days 7 and 28; and cytarabine IT on day 0.
- Consolidation (5 weeks): Patients receive methotrexate IT and
cyclophosphamide IV over 1 hour on days 0 and 14; cytarabine IV or SC on days
0-3, 7-10, 14-17, and 21-24; oral mercaptopurine on days 0-27; and oral
prednisone over 10 days.
- Interim maintenance (9 weeks): Patients receive methotrexate IT and IV on
days 7, 21, 35, and 49; oral mercaptopurine on days 0-55; and leucovorin
calcium IV at 42, 48, and 54 hours after methotrexate IV.
- Delayed intensification (10 weeks): Patients receive vincristine IV and
doxorubicin IV over 1 hour on days 0, 7, 14, and 21; asparaginase IM on day 3
and then 3 times a week for 6 doses; and oral dexamethasone on days 0-29.
Patients also receive cyclophosphamide IV over 1 hour on day 35; cytarabine
IV on days 35-38 and 42-45; oral thioguanine on days 35-48; and methotrexate
IT on days 35 and 42.
- Maintenance (84 day courses): Patients receive vincristine IV on days 0, 28,
and 56; oral prednisone on days 0-4, 28-32, and 56-60; oral methotrexate on
days 7, 14, 21, 28, 35, 42, 49, 56, 63, 70, and 77; and oral mercaptopurine
on days 0-83.
- Arm IV (closed to accrual as of 4/2006): Patients receive consolidation and
interim maintenance therapy as in arm III.
- Induction: Patients receive vincristine IV on days 0, 7, 14, and 21;
daunorubicin IV over 48 hours on days 0-2; oral prednisone on days 0-37;
asparaginase IM on day 11 and then 3 times a week for 9 doses; methotrexate
IT on days 7, 14, 21, and 28; cyclophosphamide IV on day 2; and cytarabine IT
on day 0.
- Delayed intensification (10 weeks): Patients receive vincristine IV on days
7, 14, 21, and 28; daunorubicin IV over 48 hours on days 0-2; asparaginase IM
on day 3 and then 3 times a week for 6 doses; and oral dexamethasone on days
0-29. Patients also receive cyclophosphamide IV over 1 hour on days 2 and 35;
cytarabine IV on days 35-38 and 42-45; oral thioguanine on days 35-48; and
methotrexate IT on days 35 and 42.
- Maintenance (84 day courses): Patients receive therapy as in arm III.
Patients who are over 1 year of age and have CNS disease at diagnosis undergo
cranial radiotherapy once daily 5 days a week beginning on day 0. Patients
over 2 years of age undergo radiotherapy over 11-14 days (6-9 days for 1-2
years of age).
Patients are followed monthly for one year, every 3 months for 1 year, every 6 months for
1.5 years, and then annually thereafter.
PROJECTED ACCRUAL: Approximately 250-400 patients will be accrued for this study within 5
years.
Interventional
Allocation: Randomized, Primary Purpose: Treatment
Event-free survival as assessed by time to treatment failure, occurrence of second malignant neoplasm, or death from any cause
No
Minnie Abromowitch, MD
Study Chair
Children's Hospital Medical Center, Cincinnati
United States: Federal Government
CDR0000067470
NCT00004228
June 2000
Name | Location |
---|---|
Roswell Park Cancer Institute | Buffalo, New York 14263 |
Children's Hospital of Philadelphia | Philadelphia, Pennsylvania 19104 |
Mayo Clinic Cancer Center | Rochester, Minnesota 55905 |
Cardinal Bernardin Cancer Center at Loyola University Medical Center | Maywood, Illinois 60153-5500 |
Barbara Ann Karmanos Cancer Institute | Detroit, Michigan 48201 |
Duke Comprehensive Cancer Center | Durham, North Carolina 27710 |
Hurley Medical Center | Flint, Michigan 48503 |
Medical City Dallas Hospital | Dallas, Texas 75230 |
University of Texas Health Science Center at San Antonio | San Antonio, Texas 78284-7811 |
CCOP - Kalamazoo | Kalamazoo, Michigan 49007-3731 |
Carole and Ray Neag Comprehensive Cancer Center at the University of Connecticut Health Center | Farmington, Connecticut 06360-2875 |
Van Elslander Cancer Center at St. John Hospital and Medical Center | Grosse Pointe Woods, Michigan 48236 |
CCOP - MeritCare Hospital | Fargo, North Dakota 58122 |
Geisinger Medical Center | Danville, Pennsylvania 17822-0001 |
Penn State Cancer Institute at Milton S. Hershey Medical Center | Hershey, Pennsylvania 17033-0850 |
Sanford Cancer Center at Sanford USD Medical Center | Sioux Falls, South Dakota 57117-5039 |
Vanderbilt-Ingram Cancer Center | Nashville, Tennessee 37232-6838 |
University of Wisconsin Paul P. Carbone Comprehensive Cancer Center | Madison, Wisconsin 53792-6164 |
Marshfield Clinic - Marshfield Center | Marshfield, Wisconsin 54449 |
Newark Beth Israel Medical Center | Newark, New Jersey 07112 |
New York Medical College | Valhalla, New York 10595 |
Holden Comprehensive Cancer Center at University of Iowa | Iowa City, Iowa 52242-1002 |
Ellis Fischel Cancer Center at University of Missouri - Columbia | Columbia, Missouri 65203 |
Siteman Cancer Center at Barnes-Jewish Hospital | Saint Louis, Missouri 63110 |
Lineberger Comprehensive Cancer Center at University of North Carolina - Chapel Hill | Chapel Hill, North Carolina 27599-7570 |
CCOP - Scott and White Hospital | Temple, Texas 76508 |
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins | Baltimore, Maryland 21231-2410 |
Cleveland Clinic Taussig Cancer Center | Cleveland, Ohio 44195 |
Sutter Cancer Center | Sacramento, California 95816 |
Children's Hospital of Orange County | Orange, California 92668 |
Children's National Medical Center | Washington, District of Columbia 20010-2970 |
Children's Mercy Hospital | Kansas City, Missouri 64108 |
St. Joseph's Hospital and Medical Center | Paterson, New Jersey 07503 |
Children's Hospital of Pittsburgh | Pittsburgh, Pennsylvania 15213 |
Children's Hospital and Regional Medical Center - Seattle | Seattle, Washington 98105 |
University of California Davis Cancer Center | Sacramento, California 95817 |
Nemours Children's Clinic | Jacksonville, Florida 32207 |
Miami Children's Hospital | Miami, Florida 33155-4069 |
All Children's Hospital | St. Petersburg, Florida 33701 |
Children's Memorial Hospital - Chicago | Chicago, Illinois 60614 |
Children's Hospital of New Orleans | New Orleans, Louisiana 70118 |
Cardinal Glennon Children's Hospital | Saint Louis, Missouri 63104 |
University of New Mexico Cancer Research and Treatment Center | Albuquerque, New Mexico 87131 |
Schneider Children's Hospital | New Hyde Park, New York 11042 |
St. Jude Children's Research Hospital | Memphis, Tennessee 38105-2794 |
Driscoll Children's Hospital | Corpus Christi, Texas 78466 |
Cook Children's Medical Center - Fort Worth | Fort Worth, Texas 76104 |
Inova Fairfax Hospital | Falls Church, Virginia 22042-3300 |
City of Hope Comprehensive Cancer Center | Duarte, California 91010 |
UCSF Comprehensive Cancer Center | San Francisco, California 94115 |
Fletcher Allen Health Care - University Health Center Campus | Burlington, Vermont 05401 |
Phoenix Children's Hospital | Phoenix, Arizona 85016-7710 |
Southern California Permanente Medical Group | Downey, California 90242 |
Children's Hospital Central California | Madera, California 93638-8762 |
Kosair Children's Hospital | Louisville, Kentucky 40202-3830 |
Sunrise Hospital and Medical Center | Las Vegas, Nevada 89109-2306 |
Brooklyn Hospital Center | Brooklyn, New York 11201 |
Children's Hospital Medical Center of Akron | Akron, Ohio 44308 |
Children's Medical Center - Dayton | Dayton, Ohio 45404 |
East Tennessee Children's Hospital | Knoxville, Tennessee 37901 |
Children's Hospital of Austin | Austin, Texas 78701 |
Covenant Children's Hospital | Lubbock, Texas 79410 |
Children's Hospital of the King's Daughters | Norfolk, Virginia 23507 |
Arkansas Cancer Research Center at University of Arkansas for Medical Sciences | Little Rock, Arkansas 72205 |
Kansas Masonic Cancer Research Institute at the University of Kansas Medical Center | Kansas City, Kansas 66160-7353 |
Markey Cancer Center at University of Kentucky Chandler Medical Center | Lexington, Kentucky 40536-0084 |
Blumenthal Cancer Center at Carolinas Medical Center | Charlotte, North Carolina 28232-2861 |
Overlook Hospital | Summit, New Jersey 07902-0220 |
Winthrop University Hospital | Mineola, New York 11501 |
Loma Linda University Cancer Institute at Loma Linda University Medical Center | Loma Linda, California 92354 |
Jonathan Jaques Children's Cancer Center at Miller Children's Hospital | Long Beach, California 90801 |
Kaiser Permanente Medical Center - Oakland | Sacramento, California 95825 |
Children's Hospital and Health Center - San Diego | San Diego, California 92123-4282 |
Lee Cancer Care of Lee Memorial Health System | Fort Myers, Florida 33901 |
Broward General Medical Center Cancer Center | Ft. Lauderdale, Florida 33316 |
University of Florida Shands Cancer Center | Gainesville, Florida 32610-0232 |
Nemours Children's Clinic - Orlando | Orlando, Florida 32806 |
Florida Hospital Cancer Institute at Florida Hospital Orlando | Orlando, Florida 32803-1273 |
Sacred Heart Cancer Center at Sacred Heart Hospital | Pensacola, Florida 32504 |
St. Joseph's Cancer Institute at St. Joseph's Hospital | Tampa, Florida 33607 |
Kaplan Cancer Center at St. Mary's Medical Center | West Palm Beach, Florida 33407 |
Winship Cancer Institute of Emory University | Atlanta, Georgia 30322 |
Curtis & Elizabeth Anderson Cancer Institute at Memorial Health University Medical Center | Savannah, Georgia 31403-3089 |
St. Luke's Mountain States Tumor Institute - Boise | Boise, Idaho 83712-6297 |
Blank Children's Hospital | Des Moines, Iowa 50309 |
Ochsner Cancer Institute at Ochsner Clinic Foundation | New Orleans, Louisiana 70121 |
CancerCare of Maine at Eastern Maine Medial Center | Bangor, Maine 04401 |
Alvin and Lois Lapidus Cancer Institute at Sinai Hospital | Baltimore, Maryland 21215 |
Floating Hospital for Children at Tufts - New England Medical Center | Boston, Massachusetts 02111 |
Breslin Cancer Center at Ingham Regional Medical Center | Lansing, Michigan 48910 |
Hackensack University Medical Center Cancer Center | Hackensack, New Jersey 07601 |
NYU Cancer Institute at New York University Medical Center | New York, New York 10016 |
Mount Sinai Medical Center | New York, New York 10029 |
Stony Brook University Cancer Center | Stony Brook, New York 11794-8174 |
SUNY Upstate Medical University Hospital | Syracuse, New York 13210 |
Presbyterian Cancer Center at Presbyterian Hospital | Charlotte, North Carolina 28233-3549 |
Wake Forest University Comprehensive Cancer Center | Winston-Salem, North Carolina 27157-1096 |
Cincinnati Children's Hospital Medical Center | Cincinnati, Ohio 45229-3039 |
Rainbow Babies and Children's Hospital | Cleveland, Ohio 44106-5000 |
Medical University of Ohio Cancer Center | Toledo, Ohio 43614 |
Toledo Hospital | Toledo, Ohio 43606 |
Legacy Emanuel Hospital and Health Center & Children's Hospital | Portland, Oregon 97227 |
Rhode Island Hospital Comprehensive Cancer Center | Providence, Rhode Island 02903 |
Hollings Cancer Center at Medical University of South Carolina | Charleston, South Carolina 29425 |
Greenville Hospital System Cancer Center | Greenville, South Carolina 29605 |
Texas Tech University Health Sciences Center School of Medicine - Amarillo | Amarillo, Texas 79106 |
Simmons Comprehensive Cancer Center at University of Texas Southwestern Medical Center - Dallas | Dallas, Texas 75390 |
Baylor University Medical Center - Houston | Houston, Texas 77030-2399 |
Methodist Children's Hospital of South Texas | San Antonio, Texas 78229-3993 |
Primary Children's Medical Center | Salt Lake City, Utah 84113-1100 |
Carilion Cancer Center of Western Virginia | Roanoke, Virginia 24029 |
Providence Cancer Center at Sacred Heart Medical Center | Spokane, Washington 99220-2555 |
Edwards Comprehensive Cancer Center at Cabell Huntington Hospital | Huntington, West Virginia 25701 |
Mary Babb Randolph Cancer Center at West Virginia University Hospitals | Morgantown, West Virginia 26506 |
St. Vincent Hospital Regional Cancer Center | Green Bay, Wisconsin 54307-3508 |
James P. Wilmot Cancer Center at University of Rochester Medical Center | Rochester, New York 14642 |
William Beaumont Hospital - Royal Oak Campus | Royal Oak, Michigan 48073 |
UNMC Eppley Cancer Center at the University of Nebraska Medical Center | Omaha, Nebraska 68198-7680 |
Memorial Cancer Institute at Memorial Regional Hospital | Hollywood, Florida 33021 |
Jonsson Comprehensive Cancer Center at UCLA | Los Angeles, California 90095-1781 |
Childrens Hospital Los Angeles | Los Angeles, California 90027 |
M.D. Anderson Cancer Center at Orlando | Orlando, Florida 32806 |
MBCCOP - Medical College of Georgia Cancer Center | Augusta, Georgia 30912-3730 |
University of Illinois Cancer Center | Chicago, Illinois 60612-7243 |
Indiana University Melvin and Bren Simon Cancer Center | Indianapolis, Indiana 46202-5289 |
Maine Children's Cancer Program at Barbara Bush Children's Hospital | Scarborough, Maine 04074-9308 |
C.S. Mott Children's Hospital at University of Michigan Medical Center | Ann Arbor, Michigan 48109-0286 |
Children's Hospitals and Clinics of Minnesota - Minneapolis | Minneapolis, Minnesota 55404 |
University of Mississippi Cancer Clinic | Jackson, Mississippi 39216-4505 |
Children's Hospital | Omaha, Nebraska 68114-4113 |
St. Barnabas Medical Center Cancer Center | Livingston, New Jersey 07039 |
Cancer Institute of New Jersey at UMDNJ - Robert Wood Johnson Medical School | New Brunswick, New Jersey 08903 |
Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center | New York, New York 10032 |
Tod Children's Hospital | Youngstown, Ohio 44501 |
Oklahoma University Cancer Institute | Oklahoma City, Oklahoma 73104 |
M. D. Anderson Cancer Center at University of Texas | Houston, Texas 77030-4009 |
Virginia Commonwealth University Massey Cancer Center | Richmond, Virginia 23298-0037 |
Madigan Army Medical Center - Tacoma | Tacoma, Washington 98431 |
Mary Bridge Children's Hospital and Health Center - Tacoma | Tacoma, Washington 98405 |
Spectrum Health Hospital - Butterworth Campus | Grand Rapids, Michigan 49503 |
Children's Hospital Cancer Center | Denver, Colorado 80218 |
Columbus Children's Hospital | Columbus, Ohio 43205-2696 |
University of Virginia Cancer Center | Charlottesville, Virginia 22908 |
Tulane Cancer Center | New Orleans, Louisiana 70112 |
University of Miami Sylvester Comprehensive Cancer Center - Miami | Miami, Florida 33136 |
Leo W. Jenkins Cancer Center at ECU Medical School | Greenville, North Carolina 27834 |
Oregon Health & Science University Cancer Institute | Portland, Oregon 97239-3098 |
Lurleen Wallace Comprehensive Cancer at University of Alabama - Birmingham | Birmingham, Alabama 35294 |
Stanford Comprehensive Cancer Center - Stanford | Stanford, California 94305 |
University of Minnesota Children's Hospital - Fairview | Minneapolis, Minnesota 55455 |
Norris Cotton Cancer Center at Dartmouth - Hitchcock Medical Center | Lebanon, New Hampshire 03756-0002 |
T.C. Thompson Children's Hospital | Chattanooga, Tennessee 37403 |