Imatinib Mesylate and Combination Chemotherapy in Treating Patients With Newly Diagnosed Philadelphia Chromosome Positive Acute Lymphoblastic Leukemia
Study Details
Study Description
Brief Summary
This randomized phase III trial studies how well imatinib mesylate works in combination with two different chemotherapy regimens in treating patients with newly diagnosed Philadelphia chromosome positive acute lymphoblastic leukemia (ALL). Imatinib mesylate has been shown to improve outcomes in children and adolescents with Philadelphia chromosome positive (Ph+) ALL when given with strong chemotherapy, but the combination has many side effects. This trial is testing whether a different chemotherapy regimen may work as well as the stronger one but have fewer side effects when given with imatinib. The trial is also testing how well the combination of chemotherapy and imatinib works in another group of patients with a type of ALL that is similar to Ph+ ALL. This type of ALL is called "ABL-class fusion positive ALL", and because it is similar to Ph+ ALL, is thought it will respond well to the combination of agents used to treat Ph+ ALL.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Phase 3 |
Detailed Description
PRIMARY OBJECTIVE:
- To compare disease-free survival (DFS) of standard risk (SR) pediatric Philadelphia chromosome (Ph)+ acute lymphoblastic leukemia (ALL) treated with continuous imatinib mesylate (imatinib) combined with either a high-risk Children's Oncology Group (COG) ALL chemotherapy backbone or the more intensive European (Es)PhALL chemotherapy backbone.
SECONDARY OBJECTIVES:
-
To compare disease free survival (DFS) of SR pediatric Ph+ and ABL-class fusion positive ALL patients treated with continuous imatinib combined with either a high-risk COG-ALL chemotherapy backbone or the more intensive EsPhALL chemotherapy backbone.
-
To determine the feasibility of administration of imatinib after allogeneic hematopoietic stem cell transplantation (HSCT) in high risk Ph+ ALL patients.
-
To determine event-free survival (EFS) of HR pediatric Ph+ ALL patients treated with EsPhALL chemotherapy, HSCT in first complete remission and post-HSCT imatinib.
-
To compare rates of grade 3 or higher infections in standard risk (SR) Ph+ ALL patients between the two randomized arms.
-
To evaluate event free survival (EFS) and overall survival (OS) of all eligible Ph+ALL patients enrolled on the study.
-
To evaluate OS in SR Ph+ ALL patients. VII. To evaluate OS in HR Ph+ ALL patients. VIII. To evaluate EFS and OS of all eligible ABL-class fusion positive ALL patients enrolled on the study.
EXPLORATORY OBJECTIVES:
-
To describe the toxicities associated with post-HSCT administration of imatinib in HR Ph+ALL patients.
-
To evaluate the long-term toxicities in SR Ph+ ALL patients treated with chemotherapy plus imatinib (no transplant), overall and between randomized arms.
-
To determine prognostic significance of minimal residual disease (MRD) in Ph+ ALL at various time points during therapy.
-
To determine the prognostic significance of MRD at end of Induction IA. V. To evaluate MRD in HR patients just prior to HSCT and then at regular intervals post-HSCT and explore the association of these measurements with long-term outcome.
-
To evaluate concordance of MRD assessments made by IGH-T cell receptor (TCR) polymerase chain reaction (PCR) assay and next generation sequencing (NGS) assays.
-
To determine prognostic significance of IKZF1 gene aberrations and deletions in Ph+ ALL patients.
-
To determine frequency and prognostic significance of p190 and p210 BCR-ABL1 fusion variants in pediatric Ph+ ALL.
-
To measure adherence to oral chemotherapeutic agents (imatinib, 6-mercaptopurine, and methotrexate) during the maintenance phase in SR Ph+ ALL patients in COG Centers only.
-
To identify factors associated with poor adherence. XI. To determine association between relapse risk and adherence to each oral chemotherapeutic agent (separately and combined).
-
To measure adherence to imatinib after allogeneic HSCT in HR Ph+ ALL patients and identify factors associated with poor adherence in COG Centers only.
-
To compare DFS of SR ABL-class fusion positive ALL patients treated with continuous imatinib combined with either a high-risk COG-ALL chemotherapy backbone or the more intensive EsPhALL chemotherapy backbone.
OUTLINE:
INDUCTION IA PART 1: Patients receive induction IA according to standard of care on days 1-14.
INDUCTION IA PART 2: Patients receive imatinib mesylate orally (PO) once daily (QD) or twice daily (BID) on days 15-33, prednisolone PO twice daily (BID) or methylprednisolone intravenously (IV) on days 15-28, vincristine sulfate IV over 1 minute on days 15 and 22, daunorubicin hydrochloride IV over 1-15 minutes on days 15 and 22, and methotrexate intrathecally (IT) on day 29.
INDUCTION IB: Patients receive imatinib mesylate PO QD or BID on days 1-35, cyclophosphamide IV over 30-60 minutes on days 1 and 28, mercaptopurine PO on days 1-28, cytarabine IV or subcutaneously (SC) on days 3-6, 10-13, 17-20, and 24-27, and methotrexate IT on days 10 and 24.
POST-INDUCTION THERAPY: Patients classified as standard risk are randomized to 1 of 2 arms. Patients with high risk are assigned to Arm C.
ARM A:
CONSOLIDATION BLOCK 1: Patients receive imatinib mesylate PO QD or BID on days 1-21, methotrexate IT, cytarabine IT, and therapeutic hydrocortisone IT on day 1, high dose methotrexate IV over 24 hours on day 1, vincristine sulfate IV over 1 minute on days 1 and 6, dexamethasone PO BID or IV on days 1-5, cyclophosphamide IV over 30-60 minutes on days 2-4, leucovorin calcium PO or IV on days 3 and 4, high dose cytarabine IV over 3 hours and pegaspargase IV over 1-2 hours on day 5, and filgrastim SC on days 7-11 in the absence of disease progression or unexpected toxicity.
CONSOLIDATION BLOCK 2: Patients receive imatinib mesylate PO QD or BID on days 1-21, methotrexate IT, cytarabine IT, and therapeutic hydrocortisone IT on day 1, high dose methotrexate IV over 24 hours on day 1, dexamethasone PO BID or IV on days 1-5, vincristine sulfate IV over 1 minute on days 1 and 6, ifosfamide IV over 1 hour on days 2-4, leucovorin calcium PO or IV on days 3 and 4, dexrazoxane hydrochloride IV over 5-15 minutes and daunorubicin hydrochloride IV over 1-15 minutes on day 5, pegaspargase IV over 1-2 hours on day 6, and filgrastim SC on days 7-11 in the absence of disease progression or unexpected toxicity.
CONSOLIDATION BLOCK 3: Patients receive imatinib mesylate PO QD or BID on days 1-21, high dose cytarabine IV over 3 hours on days 1-3, dexamethasone PO BID or IV on days 1-5, etoposide IV over 1-2 hours on days 3-5, methotrexate IT, cytarabine IT, and therapeutic hydrocortisone IT on day 5, pegaspargase IV over 1-2 hours on day 6, and filgrastim SC on days 7-11 in the absence of disease progression or unexpected toxicity.
DELAYED INTENSIFICATION 1 PART 1: Patients receive imatinib mesylate PO QD or BID on days 1-35, methotrexate IT on day 1, dexamethasone PO BID or IV on days 1-7 and 15-21, vincristine sulfate IV over 1 minute, dexrazoxane hydrochloride IV over 5-15 minutes, and doxorubicin IV over 1-15 minutes on days 8, 15, 22, and 29, and pegaspargase IV over 1-2 hours on day 8 in the absence of disease progression or unexpected toxicity.
DELAYED INTENSIFICATION 1 PART 2: Patients receive imatinib mesylate PO QD on days 36-63, cyclophosphamide IV over 30-60 minutes on day 36, thioguanine PO on days 36-49, cytarabine IV over 1-30 minutes or SC on days 38-41 and 45-48, and methotrexate IT on days 38 and 45in the absence of disease progression or unexpected toxicity.
INTERIM MAINTENANCE: Patients receive imatinib mesylate PO QD or BID on days 1-28, methotrexate PO on days 1, 8, 15, and 22, and mercaptopurine PO on days 1-28 in the absence of disease progression or unexpected toxicity.
DELAYED INTENSIFICATION 2 PART 1: Patients receive imatinib mesylate PO QD or BID on days 1-35, methotrexate IT on day 1, dexamethasone PO BID or IV on days 1-7 and 15-21, vincristine sulfate IV over 1 minute, dexrazoxane hydrochloride IV over 5-15 minutes, and doxorubicin IV over 1-15 minutes on days 8, 15, 22, and 29, and pegaspargase IV over 1-2 hours on day 8 in the absence of disease progression or unexpected toxicity.
DELAYED INTENSIFICATION 2 PART 2: Patients receive imatinib mesylate PO QD on days 36-49, cyclophosphamide IV over 30-60 minutes on day 36, thioguanine PO on days 36-49, cytarabine IV over 1-30 minutes or SC on days 36-39 and 43-46, and methotrexate IT on days 36 and 43 in the absence of disease progression or unexpected toxicity.
MAINTENANCE: Patients receive imatinib mesylate PO QD or BID on days 1-84, methotrexate PO once weekly (QW) and IT on days 1 and 43 of cycles 1, 2, and 3, and mercaptopurine PO on days 1-84. Cycles with imatinib mesylate and mercaptopurine repeat every 84 days for up to 104 weeks from the start of Induction IA in the absence of disease progression or unexpected toxicity.
ARM B:
INTERIM MAINTENANCE: Patients receive imatinib mesylate PO QD or BID on days 1-63, vincristine sulfate IV over 1 minute and high dose methotrexate IV over 24 hours on days 1, 15, 29, and 43, leucovorin calcium PO or IV on days 3-4, 17-18, 31-32, and 45-46, mercaptopurine PO on days 1-56, and methotrexate IT on days 1 and 29 in the absence of disease progression or unexpected toxicity.
DELAYED INTENSIFICATION PART 1: Patients receive imatinib mesylate PO QD or BID on days 1-28, methotrexate IT on day 1, dexamethasone PO BID or IV on days 1-7 and 15-21, vincristine sulfate IV over 1 minute, dexrazoxane hydrochloride IV over 5-15 minutes, and doxorubicin IV over 1-15 minutes on days 1, 8, and 15, and pegaspargase IV over 1-2 hours or IM on day 4 in the absence of disease progression or unexpected toxicity.
DELAYED INTENSIFICATION PART 2: Patients receive imatinib mesylate PO QD on days 29-56, cyclophosphamide IV over 30-60 minutes on day 29, thioguanine PO on days 29-42, cytarabine IV over 1-30 minutes or SC on days 29-32 and 36-39, methotrexate IT on days 29 and 36, vincristine sulfate IV over 1 minute on days 43 and 50, and pegaspargase IV over 1-2 hours on day 43 in the absence of disease progression or unexpected toxicity.
INTERIM MAINTENANCE WITH CAPIZZI METHOTREXATE: Patients receive imatinib mesylate PO QD or BID on days 1-56, vincristine sulfate IV over 1 minute and methotrexate IV over 2-15 minutes on days 1, 11, 21, 31, and 41, methotrexate IT on days 1 and 31, and pegaspargase IV over 1-2 hours on days 2 and 22 in the absence of disease progression or unexpected toxicity.
MAINTENANCE: Patients receive imatinib mesylate PO QD or BID on days 1-84, vincristine sulfate IV over 1 minute on days 1, 29, and 57, prednisolone PO BID (or methylprednisolone IV for cycle 1 and 2) on days 1-5, 29-33, and 57-61, mercaptopurine PO on days 1-84, methotrexate PO QW, and methotrexate IT on day 1 (and day 29 for cycle 1 and 2). Cycles repeat every 84 days for up to 104 weeks from the start of Induction IA in the absence of disease progression or unexpected toxicity.
ARM C:
CONSOLIDATION BLOCK 1: Patients receive imatinib mesylate, methotrexate, cytarabine, therapeutic hydrocortisone, high dose methotrexate, vincristine sulfate, dexamethasone, leucovorin calcium, high dose cytarabine, and pegaspargase as in Arm A Consolidation Block 1, and filgrastim SC on day 7 in the absence of disease progression or unexpected toxicity.
CONSOLIDATION BLOCK 2: Patients receive imatinib mesylate, methotrexate, cytarabine, therapeutic hydrocortisone, high dose methotrexate, dexamethasone, vincristine sulfate, ifosfamide, leucovorin calcium, dexrazoxane hydrochloride, daunorubicin hydrochloride, pegaspargase, and filgrastim as Arm A Consolidation Block 2 in the absence of disease progression or unexpected toxicity.
CONSOLIDATION BLOCK 3: Patients receive imatinib mesylate, dexamethasone, etoposide, methotrexate, cytarabine, therapeutic hydrocortisone, pegaspargase, and filgrastim as in Arm A Consolidation Block 3, and high dose cytarabine IV over 3 hours on days 1-2 in the absence of disease progression or unexpected toxicity.
HSCT: Patients undergo HSCT on day 0. Patients who do not proceed to HSCT receive Delayed Intensification 1, Interim Maintenance, Delayed Intensification 2, and Maintenance as in Arm A.
POST-HSCT: Patients receive imatinib mesylate PO QD or BID starting on days 56-365 in the in the absence of disease progression or unexpected toxicity.
After completion of study treatment, patients are followed up every year for 3 years.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Arm A (imatinib mesylate, EsPhALL chemotherapy) See Detailed Description |
Drug: Cyclophosphamide
Given IV
Drug: Cytarabine
Given IV, SC, or IT
Drug: Daunorubicin Hydrochloride
Given IV
Drug: Dexamethasone
Given PO or IV
Drug: Dexrazoxane Hydrochloride
Given IV
Drug: Doxorubicin
Given IV
Drug: Etoposide
Given IV
Biological: Filgrastim
Given IV
Drug: Ifosfamide
Given IV
Drug: Imatinib Mesylate
Given PO
Other: Laboratory Biomarker Analysis
Correlative studies
Drug: Leucovorin Calcium
Given PO or IV
Drug: Mercaptopurine
Given PO
Drug: Mercaptopurine
Given PO
Drug: Methotrexate
Given IT
Drug: Methylprednisolone
Given IV
Drug: Pegaspargase
Given IV
Drug: Prednisolone
Given PO
Other: Questionnaire Administration
Ancillary studies
Drug: Therapeutic Hydrocortisone
Given IT
Drug: Thioguanine
Given PO
Drug: Vincristine Sulfate
Given IV
|
| Experimental: Arm B (imatinib mesylate, COG/BFM chemotherapy) See Detailed Description. |
Drug: Cyclophosphamide
Given IV
Drug: Cytarabine
Given IV, SC, or IT
Drug: Dexamethasone
Given PO or IV
Drug: Dexrazoxane Hydrochloride
Given IV
Drug: Doxorubicin
Given IV
Drug: Imatinib Mesylate
Given PO
Other: Laboratory Biomarker Analysis
Correlative studies
Drug: Leucovorin Calcium
Given PO or IV
Drug: Mercaptopurine
Given PO
Drug: Methotrexate
Given IT
Drug: Methylprednisolone
Given IV
Drug: Pegaspargase
Given IV
Drug: Prednisolone
Given PO
Other: Questionnaire Administration
Ancillary studies
Drug: Thioguanine
Given PO
Drug: Vincristine Sulfate
Given IV
|
| Experimental: Arm C (imatinib mesylate, EsPhALL chemotherapy, HSCT) See Detailed Description |
Procedure: Allogeneic Hematopoietic Stem Cell Transplantation
Undergo HSCT
Drug: Cyclophosphamide
Given IV
Drug: Cytarabine
Given IV, SC, or IT
Drug: Daunorubicin Hydrochloride
Given IV
Drug: Dexamethasone
Given PO or IV
Drug: Dexrazoxane Hydrochloride
Given IV
Drug: Doxorubicin
Given IV
Drug: Etoposide
Given IV
Biological: Filgrastim
Given IV
Drug: Ifosfamide
Given IV
Drug: Imatinib Mesylate
Given PO
Other: Laboratory Biomarker Analysis
Correlative studies
Drug: Leucovorin Calcium
Given PO or IV
Drug: Mercaptopurine
Given PO
Drug: Mercaptopurine
Given PO
Drug: Methotrexate
Given IT
Drug: Methylprednisolone
Given IV
Drug: Pegaspargase
Given IV
Drug: Prednisolone
Given PO
Other: Questionnaire Administration
Ancillary studies
Drug: Therapeutic Hydrocortisone
Given IT
Drug: Thioguanine
Given PO
Drug: Vincristine Sulfate
Given IV
|
Outcome Measures
Primary Outcome Measures
- Disease free survival (DFS) of Randomized Arms (standard risk [SR] Philadelphia chromosome [Ph+] acute lymphoblastic leukemia [ALL] patients) [Up to 3 years]
Three-year DFS and 95% confidence intervals (CI) of SR Ph+ ALL patients treated continuous imatinib mesylate with high risk Children's Oncology Group (COG)-ALL chemotherapy backbone or more intensive European (Es)PhALL chemotherapy backbone.
Secondary Outcome Measures
- DFS on Randomized Arms (SR Ph+ ALL and ABL-class fusion positive patients) [Up to 3 years]
Three-year DFS (time from randomization to relapse, second malignancy, or death in complete remission) and 95% CI of SR pediatric Ph+ and ABL-class fusion positive patients treated with continuous imatinib combined with either a high-risk COG-ALL chemotherapy backbone or the more intensive EsPhALL chemotherapy backbone.
- Feasibility of post hematopoietic stem cell transplantation (HSCT) imatinib mesylate administration after allogenic HSCT in high risk Ph+ ALL patients [Up to 2 years]
The proportion of patients who receive at least 75% of intended doses.
- Event free survival (EFS) of high risk pediatric Ph+ ALL patients treated with EsPhALL chemotherapy, HSCT in first complete remission, and post-HSCT imatinib mesylate [Up to 3 years]
Will be estimated using the Kaplan-Meier method and standard errors estimated by Greenwood. Three-year EFS and 95% CI for high risk pediatric Ph+ ALL patients treated with EsPhALL chemotherapy, HSCT in first complete remission, and post-HSCT imatinib mesylate. EFS is defined as the time from the date of bone marrow for minimal residual disease (MRD) assessment at end-IB to first event (resistant disease [MRD >= 10-2 or morphologic residual disease at end of consolidation block 3], relapse, progressive disease [i.e., MRD >= 10-2 at two post-HSCT time points separated by at least 2 weeks], second malignancy, or death in complete remission), or time to last follow-up for patients without events.
- Incidence of grade 3 or higher infections in standard risk Ph+ ALL patients in the two randomized arms [Up to 3 years]
Evaluated according to National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. The rate of infections during the post IB/pre-maintenance phases of treatment will be described for each randomization group.
- EFS of all Ph+ patients [Up to 3 years]
Three-year EFS and 95% CI for Ph+ ALL patients. EFS here is defined as the time from enrollment until resistant disease, relapse, progressive disease post-HSCT, second malignant, or death, whichever occurs first.
- Overall survival (OS) of all Ph+ patients [Up to 3 years]
Three-year OS and 95% CI for Ph+ ALL patients. OS is defined as the time from study enrollment to death from any cause.
- OS of SR Ph+ patients [Up to 3 years]
Three-year OS (time from randomization to death from any cause) and 95% CI of SR pediatric Ph+ patients
- OS of SR Ph+ patients by randomization group [Up to 3 years]
Three-year OS (time from randomization to death from any cause) and 95% CI of SR pediatric Ph+ patients by randomization group: treated with continuous imatinib combined with either a high-risk COG-ALL chemotherapy backbone or the more intensive EsPhALL chemotherapy backbone.
- OS of high risk Ph+ patients [Up to 3 years]
Three-year OS (time from the date of MRD assessment at end-IB to death from any cause) and 95% CI of HR pediatric Ph+ patients.
- EFS of all eligibility ABL-class fusion positive ALL patients [Up to 3 years]
Three-year EFS (time from enrollment until resistant disease, relapse, progressive disease post-HSCT, second malignancy, or death, whichever occurs first) and 95% CI of ABL-class fusion positive patients.
- OS of all eligibility ABL-class fusion positive ALL patients [Up to 3 years]
Three-year OS (the time from study enrollment to death from any cause) and 95% CI of ABL-class fusion positive patients.
Other Outcome Measures
- Incidence of toxicities associated with post-HSCT administration of imatinib mesylate [Up to 1 year post-HSCT]
Evaluated according to NCI CTCAE version 5.0. Frequencies of target toxicities in high risk patients after the initiation of post-HSCT imatinib mesylate will be described. For the high risk patients, the specific targeted toxicities will include grade 4 neutropenia, grade 4 thrombocytopenia, grade 3 or higher bilirubin, grade 4 or higher transaminitis, and grade 3 or higher infection.
- Incidence of long-term toxicities in patients treated with chemotherapy plus imatinib mesylate (no transplant) in both arms [Up to 3 years]
Evaluated according to NCI CTCAE version 5.0. Frequencies of long-term toxicities will be described and differences between randomized arms will be explored. Specific long-term toxicities to be explored include cardiac (echocardiographic abnormalities, including decreased left ventricular (LV) function and decreased LV wall thickness), growth (linear height, bone age), and second malignant neoplasm.
- MRD measured by IGH-T cell receptor (TCR) polymerase chain reaction (PCR) and next generation sequencing (NGS) assay [Up to 6 months]
For all patients, frequencies and prognostic significance (DFS, EFS, OS) will be explored for MRD levels (i.e., MRD negative, detectable at < 5 x 10^-4, and dectectable at >= 5 x 10^-4) at end of Induction IB.
- MRD in high risk Ph+ patients measured by IGH-TCR PCR and NGS assay [Up to 3 years]
The outcome of high risk Ph+ patients will be described, including proportion of patients who achieve MRD-negativity just prior to HSCT, and at regular intervals post-HSCT. Associations between these findings and long-term outcomes (e.g., OS, DFS) will be explored.
- MRD assessments made by IGH-TCR PCR assay and NGS assay [Up to 3 years]
Concordance of MRD assessments made by IGH-TCR PCR assay and NGS assay will be described and evaluated. Scatter plots and diagrams will be used to examine agreements and patterns of agreement or any differences found. Concordance will be explored both for the overall cohort, as well as by risk group. The increased sensitivity of the NGS will be closely examined to find cases where the MRD levels are detectable by NGS but undetectable by PCR, as well as cases in which one test yields results and the other does not (test failure). Prognostic relationships on outcomes for these subjects will be inspected.
- IKZF1 gene aberrations and deletions [Up to 3 years]
For both standard risk and high risk groups, frequencies and prognostic significance (OS, DFS) will be explored for IKZF1 gene aberrations and deletions.
- Frequency of p190 and p210 BCR-ABL1 fusion variants [Up to 3 years]
For both standard risk and high risk groups, frequencies and prognostic significance (OS, DFS) will be explored for p190 and p210 BCR-ABL1 fusion variants in pediatric Ph+ ALL.
- Adherence to oral chemotherapeutic agents in standard risk Ph+ ALL patients [Up to 2 years]
Adherence to imatinib mesylate, 6-mercaptopurine, and methotrexate will be evaluated in COG-enrolled participants using an electronic monitoring device. Adherence rate will be computed for each month of adherence monitoring. Longitudinal binomial regression will be conducted using generalized estimating equation methods by modeling monthly adherence rate as an unstructured mean model using five indicator variables of time for the study months. Time in months will also be treated as a continuous variable to explore temporal trends in adherence rate. Compound symmetry will be assumed as the working correlation matrix over time. Covariates that will be considered for adjustment include those hypothesized to be predictors of adherence, annual household income, parental education, time since start of maintenance, risk classification for ALL, and imatinib, 6-mercaptopurine (6MP), and methotrexate dose-intensity.
- Adherence to imatinib mesylate after allogeneic HSCT in high risk Ph+ ALL patients [Up to 2 years]
Longitudinal binomial regression will be conducted using generalized estimating equation methods by modeling monthly adherence rate as an unstructured mean model using five indicator variables of time for the study months. Time in months will also be treated as a continuous variable to explore temporal trends in adherence rate. Compound symmetry will be assumed as the working correlation matrix over time. Covariates that will be considered for adjustment include those hypothesized to be predictors of adherence, annual household income, parental education, time since start of maintenance, risk classification for ALL, and imatinib, 6MP, and methotrexate dose-intensity.
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Diagnostic samples will be collected and analyzed according to the procedures of the National front-line protocol
-
Patients should be enrolled on National ALL protocol prior to enrollment on EsPhALL2017/COGAALL1631. Regardless of initial front-line protocol baseline diagnostic samples must be available to develop an MRD probe
-
BCR-ABL1 fusion (Ph+): newly diagnosed ALL (B-ALL or T-ALL) or mixed phenotypic acute leukemia (MPAL meeting 2016 World Health Organization [WHO] definition) with definitive evidence of BCR-ABL1 fusion by karyotype, fluorescence in situ hybridization (FISH) and/or reverse transcriptase (RT)-PCR
-
ABL-class fusion: newly diagnosed B-ALL with definitive evidence of ABL-class fusions identified according to National/Center procedures of each participating country. ABL-class fusions are defined as those involving the following genes: ABL1, ABL2, CSF1R, PDGFRB, PDGFRA, LYN. Methods of detection include fluorescence in-situ hybridization (FISH, e.g. using break-apart or colocalization signals probes), multiplex or singleplex reverse-transcription polymerase chain reaction (RT-PCR), whole transcriptome or panel-based ribonucleic acid (RNA)-sequencing
-
Regardless of initial front-line protocol, laboratory reports detailing evidence of BCR-ABL1 or ABL-class fusion must be available for the National Trial Unit
-
Ph+ ALL patients must have previously started induction therapy, which includes vincristine, a corticosteroid, usually PEG-L-asparaginase, with or without anthracycline, and/or other standard cytotoxic chemotherapy
-
Ph+ ALL patients have not received more than 14 days of multiagent induction therapy beginning with the first dose of vincristine
-
Ph+ ALL patients may have started imatinib prior to study entry but have not received more than 14 days of imatinib
-
ABL-class fusion patients must have previously completed the 4 or 5 weeks of multiagent Induction chemotherapy
-
ABL-class fusion patients may have started imatinib during Induction IA, at the same time of or after the first vincristine dose
-
Patients must have a performance status corresponding to Eastern Cooperative Oncology Group (ECOG) scores of 0, 1, or 2
-
Direct bilirubin =< 2.0 mg/dL
-
Shortening fraction of >= 27% by echocardiogram
-
Ejection fraction of >= 50% by radionuclide angiogram or echocardiogram
-
Corrected QT interval, QTc < 480 msec
-
Note: Repeat echocardiogram and electrocardiogram are not required if they were performed at or after initial ALL diagnosis, before study enrollment
-
Creatinine clearance or radioisotope glomerular filtration rate (GFR) >= 70 mL/min/1.73 m^2 or serum creatinine within normal limits based on age/gender, as follows:
-
1 to < 2 years: maximum serum creatinine 0.6 mg/dL (both male and female)
-
2 to < 6 years: maximum serum creatinine 0.8 mg/dL (both male and female)
-
6 to < 10 years: maximum serum creatinine 1 mg/dL (both male and female)
-
10 to < 13 years: maximum serum creatinine 1.2 mg/dL (both male and female)
-
13 to < 16 years: maximum serum creatinine 1.5 mg/dL (male), 1.4 mg/dL (female)
-
= 16 years: maximum serum creatinine 1.7 mg/dL (male), 1.4 mg/dL (female)
Exclusion Criteria:
-
Known history of chronic myelogenous leukemia (CML)
-
ALL developing after a previous cancer treated with cytotoxic chemotherapy
-
Active, uncontrolled infection, or active systemic illness that requires ongoing vasopressor support or mechanical ventilation
-
Down syndrome
-
Pregnancy and breast feeding
-
Female patients who are pregnant since fetal toxicities and teratogenic effects have been noted for several of the study drugs; a pregnancy test is required for female patients of childbearing potential
-
Lactating females who plan to breastfeed their infants
-
Sexually active patients of reproductive potential who have not agreed to use an effective contraceptive method for the duration of treatment according to protocol
-
Patients with congenital long QT syndrome, history of ventricular arrhythmias or heart block
-
Prior treatment with dasatinib, or any TKI inhibitor other than imatinib
-
All patients and/or their parents or legal guardians must sign a written informed consent
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Children's Hospital of Alabama | Birmingham | Alabama | United States | 35233 |
| 2 | USA Health Strada Patient Care Center | Mobile | Alabama | United States | 36604 |
| 3 | Providence Alaska Medical Center | Anchorage | Alaska | United States | 99508 |
| 4 | Banner Children's at Desert | Mesa | Arizona | United States | 85202 |
| 5 | Phoenix Childrens Hospital | Phoenix | Arizona | United States | 85016 |
| 6 | Banner University Medical Center - Tucson | Tucson | Arizona | United States | 85719 |
| 7 | Arkansas Children's Hospital | Little Rock | Arkansas | United States | 72202-3591 |
| 8 | Kaiser Permanente Downey Medical Center | Downey | California | United States | 90242 |
| 9 | City of Hope Comprehensive Cancer Center | Duarte | California | United States | 91010 |
| 10 | Loma Linda University Medical Center | Loma Linda | California | United States | 92354 |
| 11 | Miller Children's and Women's Hospital Long Beach | Long Beach | California | United States | 90806 |
| 12 | Children's Hospital Los Angeles | Los Angeles | California | United States | 90027 |
| 13 | Cedars Sinai Medical Center | Los Angeles | California | United States | 90048 |
| 14 | Valley Children's Hospital | Madera | California | United States | 93636 |
| 15 | UCSF Benioff Children's Hospital Oakland | Oakland | California | United States | 94609 |
| 16 | Kaiser Permanente-Oakland | Oakland | California | United States | 94611 |
| 17 | Children's Hospital of Orange County | Orange | California | United States | 92868 |
| 18 | Lucile Packard Children's Hospital Stanford University | Palo Alto | California | United States | 94304 |
| 19 | University of California Davis Comprehensive Cancer Center | Sacramento | California | United States | 95817 |
| 20 | Rady Children's Hospital - San Diego | San Diego | California | United States | 92123 |
| 21 | UCSF Medical Center-Mission Bay | San Francisco | California | United States | 94158 |
| 22 | Children's Hospital Colorado | Aurora | Colorado | United States | 80045 |
| 23 | Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center | Denver | Colorado | United States | 80218 |
| 24 | Connecticut Children's Medical Center | Hartford | Connecticut | United States | 06106 |
| 25 | Alfred I duPont Hospital for Children | Wilmington | Delaware | United States | 19803 |
| 26 | MedStar Georgetown University Hospital | Washington | District of Columbia | United States | 20007 |
| 27 | Children's National Medical Center | Washington | District of Columbia | United States | 20010 |
| 28 | Broward Health Medical Center | Fort Lauderdale | Florida | United States | 33316 |
| 29 | Golisano Children's Hospital of Southwest Florida | Fort Myers | Florida | United States | 33908 |
| 30 | University of Florida Health Science Center - Gainesville | Gainesville | Florida | United States | 32610 |
| 31 | Memorial Regional Hospital/Joe DiMaggio Children's Hospital | Hollywood | Florida | United States | 33021 |
| 32 | Nemours Children's Clinic-Jacksonville | Jacksonville | Florida | United States | 32207 |
| 33 | Palms West Radiation Therapy | Loxahatchee Groves | Florida | United States | 33470 |
| 34 | University of Miami Miller School of Medicine-Sylvester Cancer Center | Miami | Florida | United States | 33136 |
| 35 | Nicklaus Children's Hospital | Miami | Florida | United States | 33155 |
| 36 | Miami Cancer Institute | Miami | Florida | United States | 33176 |
| 37 | AdventHealth Orlando | Orlando | Florida | United States | 32803 |
| 38 | Arnold Palmer Hospital for Children | Orlando | Florida | United States | 32806 |
| 39 | Nemours Children's Hospital | Orlando | Florida | United States | 32827 |
| 40 | Sacred Heart Hospital | Pensacola | Florida | United States | 32504 |
| 41 | Johns Hopkins All Children's Hospital | Saint Petersburg | Florida | United States | 33701 |
| 42 | Tampa General Hospital | Tampa | Florida | United States | 33606 |
| 43 | Saint Joseph's Hospital/Children's Hospital-Tampa | Tampa | Florida | United States | 33607 |
| 44 | Saint Mary's Hospital | West Palm Beach | Florida | United States | 33407 |
| 45 | Children's Healthcare of Atlanta - Egleston | Atlanta | Georgia | United States | 30322 |
| 46 | Medical Center of Central Georgia | Macon | Georgia | United States | 31201 |
| 47 | Memorial Health University Medical Center | Savannah | Georgia | United States | 31404 |
| 48 | Kapiolani Medical Center for Women and Children | Honolulu | Hawaii | United States | 96826 |
| 49 | Saint Luke's Cancer Institute - Boise | Boise | Idaho | United States | 83712 |
| 50 | Lurie Children's Hospital-Chicago | Chicago | Illinois | United States | 60611 |
| 51 | University of Illinois | Chicago | Illinois | United States | 60612 |
| 52 | University of Chicago Comprehensive Cancer Center | Chicago | Illinois | United States | 60637 |
| 53 | Advocate Children's Hospital-Oak Lawn | Oak Lawn | Illinois | United States | 60453 |
| 54 | Advocate Children's Hospital-Park Ridge | Park Ridge | Illinois | United States | 60068 |
| 55 | Saint Jude Midwest Affiliate | Peoria | Illinois | United States | 61637 |
| 56 | Southern Illinois University School of Medicine | Springfield | Illinois | United States | 62702 |
| 57 | Riley Hospital for Children | Indianapolis | Indiana | United States | 46202 |
| 58 | Saint Vincent Hospital and Health Care Center | Indianapolis | Indiana | United States | 46260 |
| 59 | Blank Children's Hospital | Des Moines | Iowa | United States | 50309 |
| 60 | University of Iowa/Holden Comprehensive Cancer Center | Iowa City | Iowa | United States | 52242 |
| 61 | University of Kentucky/Markey Cancer Center | Lexington | Kentucky | United States | 40536 |
| 62 | Norton Children's Hospital | Louisville | Kentucky | United States | 40202 |
| 63 | Ochsner Medical Center Jefferson | New Orleans | Louisiana | United States | 70121 |
| 64 | Eastern Maine Medical Center | Bangor | Maine | United States | 04401 |
| 65 | Maine Children's Cancer Program | Scarborough | Maine | United States | 04074 |
| 66 | Sinai Hospital of Baltimore | Baltimore | Maryland | United States | 21215 |
| 67 | Johns Hopkins University/Sidney Kimmel Cancer Center | Baltimore | Maryland | United States | 21287 |
| 68 | Walter Reed National Military Medical Center | Bethesda | Maryland | United States | 20889-5600 |
| 69 | Tufts Children's Hospital | Boston | Massachusetts | United States | 02111 |
| 70 | Massachusetts General Hospital Cancer Center | Boston | Massachusetts | United States | 02114 |
| 71 | Dana-Farber Cancer Institute | Boston | Massachusetts | United States | 02215 |
| 72 | UMass Memorial Medical Center - University Campus | Worcester | Massachusetts | United States | 01655 |
| 73 | C S Mott Children's Hospital | Ann Arbor | Michigan | United States | 48109 |
| 74 | Ascension Saint John Hospital | Detroit | Michigan | United States | 48236 |
| 75 | Michigan State University Clinical Center | East Lansing | Michigan | United States | 48824-7016 |
| 76 | Helen DeVos Children's Hospital at Spectrum Health | Grand Rapids | Michigan | United States | 49503 |
| 77 | Bronson Methodist Hospital | Kalamazoo | Michigan | United States | 49007 |
| 78 | Beaumont Children's Hospital-Royal Oak | Royal Oak | Michigan | United States | 48073 |
| 79 | Children's Hospitals and Clinics of Minnesota - Minneapolis | Minneapolis | Minnesota | United States | 55404 |
| 80 | University of Minnesota/Masonic Cancer Center | Minneapolis | Minnesota | United States | 55455 |
| 81 | Mayo Clinic in Rochester | Rochester | Minnesota | United States | 55905 |
| 82 | University of Mississippi Medical Center | Jackson | Mississippi | United States | 39216 |
| 83 | Columbia Regional | Columbia | Missouri | United States | 65201 |
| 84 | Children's Mercy Hospitals and Clinics | Kansas City | Missouri | United States | 64108 |
| 85 | Washington University School of Medicine | Saint Louis | Missouri | United States | 63110 |
| 86 | Mercy Hospital Saint Louis | Saint Louis | Missouri | United States | 63141 |
| 87 | Children's Hospital and Medical Center of Omaha | Omaha | Nebraska | United States | 68114 |
| 88 | University of Nebraska Medical Center | Omaha | Nebraska | United States | 68198 |
| 89 | University Medical Center of Southern Nevada | Las Vegas | Nevada | United States | 89102 |
| 90 | Sunrise Hospital and Medical Center | Las Vegas | Nevada | United States | 89109 |
| 91 | Alliance for Childhood Diseases/Cure 4 the Kids Foundation | Las Vegas | Nevada | United States | 89135 |
| 92 | Summerlin Hospital Medical Center | Las Vegas | Nevada | United States | 89144 |
| 93 | Renown Regional Medical Center | Reno | Nevada | United States | 89502 |
| 94 | Dartmouth Hitchcock Medical Center | Lebanon | New Hampshire | United States | 03756 |
| 95 | Hackensack University Medical Center | Hackensack | New Jersey | United States | 07601 |
| 96 | Morristown Medical Center | Morristown | New Jersey | United States | 07960 |
| 97 | Saint Peter's University Hospital | New Brunswick | New Jersey | United States | 08901 |
| 98 | Rutgers Cancer Institute of New Jersey-Robert Wood Johnson University Hospital | New Brunswick | New Jersey | United States | 08903 |
| 99 | Newark Beth Israel Medical Center | Newark | New Jersey | United States | 07112 |
| 100 | Saint Joseph's Regional Medical Center | Paterson | New Jersey | United States | 07503 |
| 101 | University of New Mexico Cancer Center | Albuquerque | New Mexico | United States | 87102 |
| 102 | Albany Medical Center | Albany | New York | United States | 12208 |
| 103 | Montefiore Medical Center - Moses Campus | Bronx | New York | United States | 10467 |
| 104 | Maimonides Medical Center | Brooklyn | New York | United States | 11219 |
| 105 | Roswell Park Cancer Institute | Buffalo | New York | United States | 14263 |
| 106 | NYU Winthrop Hospital | Mineola | New York | United States | 11501 |
| 107 | The Steven and Alexandra Cohen Children's Medical Center of New York | New Hyde Park | New York | United States | 11040 |
| 108 | Laura and Isaac Perlmutter Cancer Center at NYU Langone | New York | New York | United States | 10016 |
| 109 | Mount Sinai Hospital | New York | New York | United States | 10029 |
| 110 | NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center | New York | New York | United States | 10032 |
| 111 | Memorial Sloan Kettering Cancer Center | New York | New York | United States | 10065 |
| 112 | University of Rochester | Rochester | New York | United States | 14642 |
| 113 | Stony Brook University Medical Center | Stony Brook | New York | United States | 11794 |
| 114 | State University of New York Upstate Medical University | Syracuse | New York | United States | 13210 |
| 115 | New York Medical College | Valhalla | New York | United States | 10595 |
| 116 | Mission Hospital | Asheville | North Carolina | United States | 28801 |
| 117 | UNC Lineberger Comprehensive Cancer Center | Chapel Hill | North Carolina | United States | 27599 |
| 118 | Carolinas Medical Center/Levine Cancer Institute | Charlotte | North Carolina | United States | 28203 |
| 119 | Novant Health Presbyterian Medical Center | Charlotte | North Carolina | United States | 28204 |
| 120 | Duke University Medical Center | Durham | North Carolina | United States | 27710 |
| 121 | East Carolina University | Greenville | North Carolina | United States | 27834 |
| 122 | Wake Forest University Health Sciences | Winston-Salem | North Carolina | United States | 27157 |
| 123 | Sanford Broadway Medical Center | Fargo | North Dakota | United States | 58122 |
| 124 | Children's Hospital Medical Center of Akron | Akron | Ohio | United States | 44308 |
| 125 | Cincinnati Children's Hospital Medical Center | Cincinnati | Ohio | United States | 45229 |
| 126 | Rainbow Babies and Childrens Hospital | Cleveland | Ohio | United States | 44106 |
| 127 | Cleveland Clinic Foundation | Cleveland | Ohio | United States | 44195 |
| 128 | Nationwide Children's Hospital | Columbus | Ohio | United States | 43205 |
| 129 | Dayton Children's Hospital | Dayton | Ohio | United States | 45404 |
| 130 | ProMedica Toledo Hospital/Russell J Ebeid Children's Hospital | Toledo | Ohio | United States | 43606 |
| 131 | University of Oklahoma Health Sciences Center | Oklahoma City | Oklahoma | United States | 73104 |
| 132 | Oregon Health and Science University | Portland | Oregon | United States | 97239 |
| 133 | Lehigh Valley Hospital-Cedar Crest | Allentown | Pennsylvania | United States | 18103 |
| 134 | Geisinger Medical Center | Danville | Pennsylvania | United States | 17822 |
| 135 | Penn State Children's Hospital | Hershey | Pennsylvania | United States | 17033 |
| 136 | Children's Hospital of Philadelphia | Philadelphia | Pennsylvania | United States | 19104 |
| 137 | Saint Christopher's Hospital for Children | Philadelphia | Pennsylvania | United States | 19134 |
| 138 | Children's Hospital of Pittsburgh of UPMC | Pittsburgh | Pennsylvania | United States | 15224 |
| 139 | Rhode Island Hospital | Providence | Rhode Island | United States | 02903 |
| 140 | Medical University of South Carolina | Charleston | South Carolina | United States | 29425 |
| 141 | Prisma Health Richland Hospital | Columbia | South Carolina | United States | 29203 |
| 142 | BI-LO Charities Children's Cancer Center | Greenville | South Carolina | United States | 29605 |
| 143 | Sanford USD Medical Center - Sioux Falls | Sioux Falls | South Dakota | United States | 57117-5134 |
| 144 | T C Thompson Children's Hospital | Chattanooga | Tennessee | United States | 37403 |
| 145 | East Tennessee Childrens Hospital | Knoxville | Tennessee | United States | 37916 |
| 146 | The Children's Hospital at TriStar Centennial | Nashville | Tennessee | United States | 37203 |
| 147 | Vanderbilt University/Ingram Cancer Center | Nashville | Tennessee | United States | 37232 |
| 148 | Texas Tech University Health Sciences Center-Amarillo | Amarillo | Texas | United States | 79106 |
| 149 | Dell Children's Medical Center of Central Texas | Austin | Texas | United States | 78723 |
| 150 | Driscoll Children's Hospital | Corpus Christi | Texas | United States | 78411 |
| 151 | Medical City Dallas Hospital | Dallas | Texas | United States | 75230 |
| 152 | UT Southwestern/Simmons Cancer Center-Dallas | Dallas | Texas | United States | 75390 |
| 153 | El Paso Children's Hospital | El Paso | Texas | United States | 79905 |
| 154 | Cook Children's Medical Center | Fort Worth | Texas | United States | 76104 |
| 155 | Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center | Houston | Texas | United States | 77030 |
| 156 | M D Anderson Cancer Center | Houston | Texas | United States | 77030 |
| 157 | Covenant Children's Hospital | Lubbock | Texas | United States | 79410 |
| 158 | UMC Cancer Center / UMC Health System | Lubbock | Texas | United States | 79415 |
| 159 | Children's Hospital of San Antonio | San Antonio | Texas | United States | 78207 |
| 160 | Methodist Children's Hospital of South Texas | San Antonio | Texas | United States | 78229 |
| 161 | University of Texas Health Science Center at San Antonio | San Antonio | Texas | United States | 78229 |
| 162 | Scott and White Memorial Hospital | Temple | Texas | United States | 76508 |
| 163 | Primary Children's Hospital | Salt Lake City | Utah | United States | 84113 |
| 164 | University of Vermont and State Agricultural College | Burlington | Vermont | United States | 05405 |
| 165 | University of Virginia Cancer Center | Charlottesville | Virginia | United States | 22908 |
| 166 | Inova Fairfax Hospital | Falls Church | Virginia | United States | 22042 |
| 167 | Children's Hospital of The King's Daughters | Norfolk | Virginia | United States | 23507 |
| 168 | Naval Medical Center - Portsmouth | Portsmouth | Virginia | United States | 23708-2197 |
| 169 | Virginia Commonwealth University/Massey Cancer Center | Richmond | Virginia | United States | 23298 |
| 170 | Carilion Children's | Roanoke | Virginia | United States | 24014 |
| 171 | Seattle Children's Hospital | Seattle | Washington | United States | 98105 |
| 172 | Providence Sacred Heart Medical Center and Children's Hospital | Spokane | Washington | United States | 99204 |
| 173 | Mary Bridge Children's Hospital and Health Center | Tacoma | Washington | United States | 98405 |
| 174 | Madigan Army Medical Center | Tacoma | Washington | United States | 98431 |
| 175 | West Virginia University Healthcare | Morgantown | West Virginia | United States | 26506 |
| 176 | Saint Vincent Hospital Cancer Center Green Bay | Green Bay | Wisconsin | United States | 54301 |
| 177 | University of Wisconsin Carbone Cancer Center | Madison | Wisconsin | United States | 53792 |
| 178 | Marshfield Medical Center-Marshfield | Marshfield | Wisconsin | United States | 54449 |
| 179 | Children's Hospital of Wisconsin | Milwaukee | Wisconsin | United States | 53226 |
| 180 | John Hunter Children's Hospital | Hunter Regional Mail Centre | New South Wales | Australia | 2310 |
| 181 | Sydney Children's Hospital | Randwick | New South Wales | Australia | 2031 |
| 182 | The Children's Hospital at Westmead | Westmead | New South Wales | Australia | 2145 |
| 183 | Queensland Children's Hospital | South Brisbane | Queensland | Australia | 4101 |
| 184 | Princess Margaret Hospital for Children | Perth | Western Australia | Australia | 6008 |
| 185 | Perth Children's Hospital | Perth | Western Australia | Australia | 6009 |
| 186 | St. Anna Children's Hospital | Vienna | Austria | 1090 | |
| 187 | Hospitals Leuven | Leuven | Flemish Brabant | Belgium | 3000 |
| 188 | Alberta Children's Hospital | Calgary | Alberta | Canada | T3B 6A8 |
| 189 | University of Alberta Hospital | Edmonton | Alberta | Canada | T6G 2B7 |
| 190 | British Columbia Children's Hospital | Vancouver | British Columbia | Canada | V6H 3V4 |
| 191 | CancerCare Manitoba | Winnipeg | Manitoba | Canada | R3E 0V9 |
| 192 | IWK Health Centre | Halifax | Nova Scotia | Canada | B3K 6R8 |
| 193 | McMaster Children's Hospital at Hamilton Health Sciences | Hamilton | Ontario | Canada | L8N 3Z5 |
| 194 | Kingston Health Sciences Centre | Kingston | Ontario | Canada | K7L 2V7 |
| 195 | Children's Hospital | London | Ontario | Canada | N6A 5W9 |
| 196 | Children's Hospital of Eastern Ontario | Ottawa | Ontario | Canada | K1H 8L1 |
| 197 | Hospital for Sick Children | Toronto | Ontario | Canada | M5G 1X8 |
| 198 | The Montreal Children's Hospital of the MUHC | Montreal | Quebec | Canada | H3H 1P3 |
| 199 | Centre Hospitalier Universitaire Sainte-Justine | Montreal | Quebec | Canada | H3T 1C5 |
| 200 | Jim Pattison Children's Hospital | Saskatoon | Saskatchewan | Canada | S7N 0W8 |
| 201 | Saskatoon Cancer Centre | Saskatoon | Saskatchewan | Canada | S7N 4H4 |
| 202 | Centre Hospitalier Universitaire de Quebec | Quebec | Canada | G1V 4G2 | |
| 203 | Hospital Roberto del Rio-Universidad de Chile | Santiago | Chile | ||
| 204 | University Hospital Motol | Praha | Czechia | 15018, 5-Motol | |
| 205 | Tampere University Hospital | Tampere | Finland | 33521 | |
| 206 | CHU Hopital Sud | Rennes | France | 35203 | |
| 207 | University Medical Center chleswig- Campus Kiel | Kiel | Schleswig-Holstein | Germany | 24105 |
| 208 | Universitätsklinik Eppendorf | Hamburg | Germany | 20246 | |
| 209 | Hong Kong Children's Hospital | Kowloon Bay | Kowloon | Hong Kong | |
| 210 | Schneider Children's Medical Center of Israel | Petah-Tikva | Central District | Israel | 4920235 |
| 211 | Clinica Pediatrica Università Milano-Bicocca Ospedale S. Gerardo/Fondazione MBBM | Monza | Italy | 20900 | |
| 212 | Princess Máxima Center for Pediatric Oncology | Utrecht | Netherlands | 3584 CT | |
| 213 | Starship Children's Hospital | Grafton | Auckland | New Zealand | 1145 |
| 214 | Christchurch Hospital | Christchurch | New Zealand | 8011 | |
| 215 | HIMA San Pablo Oncologic Hospital | Caguas | Puerto Rico | 00726 | |
| 216 | San Jorge Children's Hospital | San Juan | Puerto Rico | 00912 | |
| 217 | University Pediatric Hospital | San Juan | Puerto Rico | 00926 | |
| 218 | King Faisal Specialist Hospital and Research Centre | Riyadh | Saudi Arabia | 11211 | |
| 219 | Skane University Hospital | Lund | Scania | Sweden | 22185 |
| 220 | University Children's Hospital | Zurich | Switzerland | CH8032 |
Sponsors and Collaborators
- Children's Oncology Group
- National Cancer Institute (NCI)
Investigators
- Principal Investigator: Lewis B Silverman, Children's Oncology Group
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- AALL1631
- NCI-2016-01588
- AALL1631
- AALL1631
- AALL1631
- U10CA180886