A Phase II Pilot Trial of Bortezomib (PS-341, Velcade®, IND #58,443) in Combination With Intensive Re-Induction Therapy for Children With Relapsed Acute Lymphoblastic Leukemia (ALL) and Lymphoblastic Lymphoma (LL)

Inclusion Criteria

DISEASE CHARACTERISTICS:

- Diagnosis of 1 of the following:

- Pre-B acute lymphoblastic leukemia (ALL) in first early (< 36 months from
diagnosis) isolated bone marrow or combined bone marrow/extramedullary relapse
as documented by histology and immunophenotyping

- T-cell ALL in first isolated bone marrow or combined relapse as documented by
histology and immunophenotyping

- T-cell lymphoblastic lymphoma in first relapse as documented by histology

- Measurable disease as documented by clinical, radiographic, or histologic
criteria

- Relapsed or refractory to conventional therapy

- No Ph+ ALL unless refractory to ≥ 1 tyrosine kinase inhibitor therapy

- Patients who are unable to tolerate tyrosine kinase inhibitor therapy due to
toxicity are eligible

- No mature B-cell ALL (i.e., sIg positive and kappa or lambda restricted positivity)
with FAB L3 morphology and/or myc translocation

- No known optic nerve and/or retinal involvement

- Patients presenting with visual disturbances should have an ophthalmological
exam and, if indicated, an MRI to determine optic nerve or retinal involvement

- No extramedullary disease (i.e., isolated CNS disease or isolated testicular disease)

- No concurrent genetic syndrome (e.g., Down syndrome, Fanconi anemia, Kostmann
syndrome, Shwachman syndrome, or any other known bone marrow failure syndrome)

PATIENT CHARACTERISTICS:

- Karnofsky performance status (PS) 60-100% (for patients > 16 years of age) OR Lansky
PS 60-100% (for patients ≤ 16 years of age)

- Creatinine clearance or radioisotope glomerular filtration rate ≥ 70 mL/min OR
maximum serum creatinine based on age/gender as follows:

- 0.4 mg/dL (for patients 1 to 5 months of age)

- 0.5 mg/dL (for patients 6 to 11 months of age)

- 0.6 mg/dL (for patients 1 year of age)

- 0.8 mg/dL (for patients 2 to 5 years of age)

- 1 mg/dL (for patients 6 to 9 years of age)

- 1.2 mg/dL (for patients 10 to 12 years of age)

- 1.5 mg/dL (males) or 1.4 mg/dL (females) (for patients 13 to 15 years of age)

- 1.7 mg/dL (males) or 1.4 mg/dL (females) (for patients ≥ 16 years of age)

- Total bilirubin ≤ 1.5 times upper limit of normal (ULN) for age

- ALT < 3 times ULN for age (unless elevation due to leukemia infiltration)

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception

- Shortening fraction ≥ 27% by echocardiogram OR ejection fraction ≥ 50% by gated
radionuclide study

- Pulse oximetry ≥ 94% at sea level (> 90% if at high altitude)

- No evidence of dyspnea at rest or exercise intolerance

- No evidence of acute pulmonary infiltrates on chest radiograph

- No known allergy to doxorubicin, cytarabine, etoposide, etoposide phosphate, boron,
mannitol, or bortezomib

- No CNS toxicity > grade 2

- Seizure disorder allowed provided patient is on anticonvulsants (e.g.,
benzodiazepines or gabapentin) and it is well controlled

- Able to receive any asparaginase products (E. coli, PEG-asparaginase, or Erwinia
asparaginase) on this study (i.e., no prior severe pancreatitis, stroke, or other
toxicity)

- Patients who initially receive asparaginase but discontinue drug due to toxicity
are eligible

- Patients with prior allergies to pegaspargase that are clinically significant
are eligible provided Erwinia L-asparaginase can be substituted

PRIOR CONCURRENT THERAPY:

- Fully recovered from the acute toxic effects of all prior chemotherapy,
immunotherapy, or radiotherapy (for patients who relapse on therapy other than
standard ALL maintenance therapy)*

- No prior cumulative anthracycline exposure > 400 mg/m²

- No prior bortezomib or other proteasome inhibitors

- No prior reinduction attempts or treatment for prior extramedullary relapse

- Patients with primary induction failure are not eligible

- At least 14 days since prior cytotoxic therapy (24 hours for hydroxyurea)

- At least 7 days since prior anticancer biologic agents or donor lymphocyte infusions

- At least 4 months since prior stem cell transplant or rescue

- No evidence of active graft-vs-host disease (GVHD)

- No concurrent GVHD prophylaxis

- No concurrent anticonvulsants known to activate the cytochrome p450 system (e.g.,
phenytoin, carbamazepine, and phenobarbital)

- Concurrent benzodiazepines or gabapentin allowed

- No concurrent corticosteroids (including steroids as antiemetics) except as treatment
or prophylaxis for anaphylactic reactions OR treatment for pulmonary toxicity

- No other concurrent anticancer chemotherapy or immunomodulating agents NOTE:
*Patients who relapse while receiving standard ALL maintenance chemotherapy will not
be required to undergo a waiting period prior to entry onto this study.