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Inotuzumab Ozogamicin and Post-Induction Chemotherapy in Treating Patients With High-Risk B-ALL, Mixed Phenotype Acute Leukemia, and B-LLy

NCT03959085 · Children's Oncology Group
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Official title
A Phase 3 Randomized Trial of Inotuzumab Ozogamicin (IND#:133494, NSC#: 772518) for Newly Diagnosed High-Risk B-ALL; Risk-Adapted Post-Induction Therapy for High-Risk B-ALL, Mixed Phenotype Acute Leukemia, and Disseminated B-LLy
About this study
PRIMARY OBJECTIVE: I. To compare in a randomized manner the post-induction 5-year event-free survival (EFS) for children and young adults with High Risk (HR) B-cell acute lymphoblastic leukemia (B-ALL) treated with a modified Berlin-Frankfurt-Münster (mBFM) chemo-immunotherapy backbone that includes blinatumomab and replaces Consolidation Part 2 and Delayed Intensification (DI) Part 2 with two blocks of inotuzumab ozogamicin, versus those treated with a full mBFM chemo-immunotherapy backbone that includes blinatumomab and retains Consolidation Part 2 and DI Part 2 without the addition of inotuzumab ozogamicin. SECONDARY OBJECTIVES: I. To describe the 5-year disease-free survival (DFS) for a favorable risk subset of National Cancer Institute (NCI) HR B-ALL (HR-Fav) when treated with mBFM chemotherapy with a single high-dose methotrexate (HD-MTX) interim maintenance (IM) phase and treatment duration of 2 years from the start of IM regardless of sex. (Pre-Amendment #7B) II. To determine the toxicity and tolerability of inotuzumab ozogamicin integrated into the mBFM chemotherapy backbone in HR B-ALL, including toxicity experienced during phases of therapy subsequent to inotuzumab ozogamicin. III. To describe the 5-year event-free survival (EFS) for patients with mixed phenotype acute leukemia (MPAL) receiving mBFM HR B-ALL therapy that includes a second IM phase with Capizzi intravenous (IV) methotrexate without leucovorin rescue plus pegaspargase or calaspargase pegol (C-MTX). IV. To describe the 5-year EFS for patients with disseminated (Murphy stage III-IV) B-cell lymphoblastic lymphoma (B-LLy) receiving mBFM HR B-ALL therapy that includes a second IM phase with C-MTX. V. To compare health-related quality of life (HRQoL) for randomized HR B-ALL patients by study arm at two defined time points: Consolidation Part 2 Day 43 (Arm D)/inotuzumab ozogamicin Block 1 Day 15 (Arm E) and day 1 of IM2 (Arms D and E). VI. To compare symptomatic adverse events (AEs) for patients with HR B-ALL by study arm using Patient Reported Outcome (PRO) Measures. EXPLORATORY OBJECTIVES: I. To describe the 5-year overall survival (OS) and cumulative incidence of relapse (CIR) for randomized patients with HR B-ALL. II. To describe the therapy administered, disease response, and survival outcomes of patients with MPAL who come off protocol therapy due to poor disease response to ALL therapy either during Induction, at end of induction (EOI), or at end of consolidation (EOC). III. To define the prevalence and significance of minimal marrow disease (MMD) at diagnosis and bone marrow minimal residual disease (MRD) at EOI in disseminated B-LLy. IV. To determine the impact of proposed adherence-enhancing interventions on adherence to oral mercaptopurine in patients with ALL. V. To characterize the pharmacokinetics (PK) of inotuzumab ozogamicin when administered in the setting of first remission in pediatric and young adult patients with HR B-ALL. VI. To explore associations between family-reported social determinants of health and survival outcomes, toxicities, and blinatumomab patterns of delivery. VII. To describe both the short- and long-term impact of chemo-immunotherapy on measures of immune function and infectious toxicities. OUTLINE: B-ALL: All patients with B-ALL receive Induction therapy: INDUCTION: Patients receive cytarabine intrathecally (IT) on day 1. Patients also receive vincristine intravenously (IV) on days 1, 8, 15, and 22, daunorubicin IV over 1-15 minutes days 1, 8, 15, and 22, pegaspargase or calaspargase pegol IV over 1-2 hours or pegaspargase intramuscularly (IM) on day 4, and methotrexate IT on days 8 and 29 (and on days 15 and 22 for central nervous system \[CNS\]3 patients). Patients \< 10 years old receive dexamethasone orally (PO) twice daily (BID) or IV on days 1-14; patients \>= 10 years old receive prednisone or prednisolone PO BID or IV on days 1-28. Treatment continues for 5 weeks in the absence of disease progression or unacceptable toxicity. Calaspargase pegol can only be given to patients less than 22 years of age. After completion of Induction treatment, patients with HR Fav B-ALL discontinue study, and patients with HR B-ALL and CD22 positive at diagnosis are randomized to Arm D or Arm E. ARM D * CONSOLIDATION: Patients receive cyclophosphamide IV over 30-60 minutes on days 1 and 29, cytarabine IV over 1-30 minutes or subcutaneously (SC) on days 1-4, 8-11, 29-32, and 36-39, mercaptopurine PO QD on days 1-14 and 29-42, methotrexate IT on days 1, 8, 15, and 22 (also days 29 and 43 for CNS3 patients), vincristine IV on days 15, 22, 43, and 50, pegaspargase IM or IV over 1-2 hours OR calaspargase pegol (\< 22 years of age only) IV over 1-2 hours on days 15 and 43. Consolidation treatment continues for 57 days in the absence of disease progression or unacceptable toxicity. Patients with testicular disease at diagnosis also receive radiation therapy (RT) to the testes once daily (QD) over 12 treatment fractions. After completion of Consolidation treatment, patients with MRD ≥ 25% discontinue study treatment. * BLINATUMOMAB (BLINA) BLOCK 1: Patients receive dexamethasone PO or IV on day 1 (and day 8 for patients with MRD ≥ 5% - \<25% at end of Consolidation \[EOC\]), blinatumomab IV continuously on days 1-28, and methotrexate IT on day 1. Treatment continues for 35 days in the absence of disease progression or unacceptable toxicity. After completion of Blina Block 1 treatment, patients with MRD ≥ 0.01% discontinue study treatment. * INTERIM MAINTENANCE 1: Patients receive vincristine IV on days 1, 15, 29, and 43, high-dose methotrexate IV over 24 hours on days 1, 15, 29, and 43, leucovorin PO or IV on days 3-4, 17-18, 31-32, and 45-46, mercaptopurine PO QD on days 1-14, 15-28, 29-42, and 43-56, and methotrexate IT on days 1 and 29. Treatment continues for 63 days in the absence of disease progression or unacceptable toxicity. * BLINA BLOCK 2: Patients receive blinatumomab IV continuously on days 1-28 and methotrexate IT on day 1. Treatment continues for 35 days in the absence of disease progression or unacceptable toxicity. * DELAYED INTENSIFICATION PART 1: Patients receive methotrexate IT on day 1, dexamethasone PO BID or IV on days 1-7 and 15-21, vincristine IV on days 1, 8, and 15, doxorubicin IV over 3-15 minutes or up to 1 hour on days 1, 8, and 15, and pegaspargase IM or IV over 1-2 hours OR calaspargase pegol (\< 22 years of age only) IV over 1-2 hours on day 4 in the absence of disease progression or unacceptable toxicity. Patients then proceed to Delayed Intensification Part 2. * DELAYED INTENSIFICATION PART 2: Patients receive cyclophosphamide IV over 30-60 minutes on day 29, thioguanine PO QD 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 IV on days 43 and 50, and pegaspargase IM or IV over 1-2 hours OR calaspargase pegol (\< 22 years of age only) IV over 1-2 hours on day 43. Delayed Intensification Part 1 and 2 treatment continues for 63 days in the absence of disease progression or unacceptable toxicity. * INTERIM MAINTENANCE 2: Patients receive vincristine IV on days 1, 11, 21, 31 and 41, methotrexate IV over 2-5 or 10-15 minutes on days 1, 11, 21, 31 and 41, methotrexate IT on days 1 and 31, and pegaspargase IM or IV over 1-2 hours on days 2 and 22 OR calaspargase pegol (\< 22 years of age only) IV over 1-2 hours on days 2 and 23. Treatment continues for 56 days in the absence of disease progression or unacceptable toxicity. * MAINTENANCE: Patients receive vincristine IV on day 1 of each cycle, prednisone or prednisolone PO BID or IV on days 1-5 of each cycle, mercaptopurine PO QD on days 1-84 of each cycle, methotrexate PO on days 8, 15, 22, 29, 36, 43, 50, 57, 64, 71, and 78 of each cycle, and methotrexate IT on day 1 of each cycle. Patients with CNS3 at diagnosis also receive cranial RT over 10 treatment fractions QD, 5 days per week, during the first 4 weeks of Maintenance treatment. Cycles repeat every 84 days until 2 years from start of Blina Block 1 treatment in the absence of disease progression or unacceptable toxicity. ARM E: * CONSOLIDATION PART 1: Patients receive cyclophosphamide IV over 30-60 minutes on day 1, cytarabine IV over 1-30 minutes or SC on days 1-4 and 8-11, mercaptopurine PO QD on days 1-14, methotrexate IT on days 1, 8, 15, and 22 (NOTE: Patients with CNS3 omit days 15 and 22), vincristine IV on days 15 and 22, and pegaspargase IM or IV over 1-2 hours OR calaspargase pegol (\< 22 years of age only) IV over 1-2 hours on day 15. Treatment continues for 29 days in the absence of disease progression or unacceptable toxicity. Patients with testicular disease at diagnosis also receive RT to the testes QD over 12 treatment fractions. * INOTUZUMAB OZOGAMICIN (InO) BLOCK 1: Patients receive inotuzumab ozogamicin IV over 60 minutes on days 1, 8, and 15 and methotrexate IT on day 1 (and day 15 for patients with CNS3). Treatment continues for 28 days in the absence of disease progression or unacceptable toxicity. After completion of InO Block 1 treatment, patients with MRD ≥ 25% discontinue study treatment. * BLINA BLOCK 1: Patients receive dexamethasone PO or IV on day 1 (and day 8 for patients with MRD ≥ 5% - \<25% at end of InO Block 1), blinatumomab IV continuously on days 1-28, and methotrexate IT on day 1. Treatment continues for 35 days in the absence of disease progression or unacceptable toxicity. After completion of Blina Block 1 treatment, patients with MRD ≥ 0.01% discontinue study treatment. * INTERIM MAINTENANCE 1: Patients receive vincristine IV on days 1, 15, 29, and 43, high-dose methotrexate IV over 24 hours on days 1, 15, 29, and 43, leucovorin PO or IV on days 3-4, 17-18, 31-32, and 45-46, mercaptopurine PO QD on days 1-14, 15-28, 29-42, and 43-56, and methotrexate IT on days 1 and 29. Treatment continues for 63 days in the absence of disease progression or unacceptable toxicity. * BLINA BLOCK 2: Patients receive blinatumomab IV continuously on days 1-28 and methotrexate IT on day 1. Treatment continues for 35 days in the absence of disease progression or unacceptable toxicity. * DELAYED INTENSIFICATION PART 1: Patients receive methotrexate IT on day 1, dexamethasone PO BID or IV on days 1-7 and 15-21, vincristine IV on days 1, 8, and 15, doxorubicin IV over 3-15 minutes or up to 1 hour on days 1, 8, and 15, and pegaspargase IM or IV over 1-2 hours OR calaspargase pegol (\< 22 years of age only) IV over 1-2 hours on day 4 in the absence of disease progression or unacceptable toxicity. Patients then proceed to Delayed Intensification Part 2. * InO BLOCK 2: Patients receive inotuzumab ozogamicin IV over 60 minutes on days 1, 8, and 15 and methotrexate IT on day 1. Treatment continues for 28 days in the absence of disease progression or unacceptable toxicity. * INTERIM MAINTENANCE 2: Patients receive vincristine IV on days 1, 11, 21, 31 and 41, methotrexate IV over 2-5 or 10-15 minutes on days 1, 11, 21, 31 and 41, methotrexate IT on days 1 and 31, and pegaspargase IM or IV over 1-2 hours on days 2 and 22 OR calaspargase pegol (\< 22 years of age only) IV over 1-2 hours on days 2 and 23. Treatment continues for 56 days in the absence of disease progression or unacceptable toxicity. * MAINTENANCE: Patients receive vincristine IV on day 1 of each cycle, prednisone or prednisolone PO BID or IV on days 1-5 of each cycle, mercaptopurine PO QD on days 1-84 of each cycle, methotrexate PO on days 8, 15, 22, 29, 36, 43, 50, 57, 64, 71, and 78 of each cycle, and methotrexate IT on day 1 of each cycle. Patients with CNS3 at diagnosis also receive cranial RT over 10 treatment fractions QD, 5 days per week, during the first 4 weeks of Maintenance treatment. Cycles repeat every 84 days for 2 years in the absence of disease progression or unacceptable toxicity. ARM I: MPAL * INDUCTION: Patients receive cytarabine IT on day 1, vincristine IV on days 1, 8, 15, and 22, daunorubicin IV over 1-15 minutes days 1, 8, 15, and 22, pegaspargase or calaspargase pegol IV over 1-2 hours or pegaspargase IM on day 4, and methotrexate IT on days 8 and 29 (and on days 15 and 22 for CNS3 patients). Patients \< 10 years old receive dexamethasone PO BID or IV on days 1-14; patients \>= 10 years old receive prednisone or prednisolone PO BID or IV on days 1-28. Treatment continues for 35 days in the absence of disease progression or unacceptable toxicity. Calaspargase pegol can only be given to patients less than 22 years of age. Patients with MRD ≥ 5% at EOI discontinue study treatment. * CONSOLIDATION: Patients receive cyclophosphamide IV over 30-60 minutes on days 1 and 29, cytarabine IV over 1-30 minutes or SC on days 1-4, 8-11, 29-32, and 36-39, mercaptopurine PO on days 1-14 and 29-42, methotrexate IT on days 1, 8, 15, and 22 (excluded on days 15 and 22 for CNS3 patients), vincristine IV on days 15, 22, 43, and 50, and pegaspargase or calaspargase pegol IV over 1-2 hours or pegaspargase IM on days 15 and 43. Treatment continues for 56 days in the absence of disease progression or unacceptable toxicity. Patients with testicular disease at diagnosis that does not resolve by EOC and continued evidence of testicular disease at end of induction (EOI) undergo testicular RT over 12 once-daily fractions. Calaspargase pegol can only be given to patients less than 22 years of age. Patients with MRD ≥ 0.01% at EOC discontinue study treatment. ARM II: B-LLY * INDUCTION: Patients receive cytarabine IT on day 1, vincristine IV on days 1, 8, 15, and 22, daunorubicin IV over 1-15 minutes days 1, 8, 15, and 22, pegaspargase or calaspargase pegol IV over 1-2 hours or pegaspargase IM on day 4, and methotrexate IT on days 8 and 29 (and on days 15 and 22 for CNS3 patients). Patients \< 10 years old receive dexamethasone PO BID or IV on days 1-14; patients \>= 10 years old receive prednisone or prednisolone PO BID or IV on days 1-28. Treatment continues for 35 days in the absence of disease progression or unacceptable toxicity. Calaspargase pegol can only be given to patients less than 22 years of age. * CONSOLIDATION: Patients receive cyclophosphamide IV over 30-60 minutes on days 1 and 29, cytarabine IV over 1-30 minutes or SC on days 1-4, 8-11, 29-32, and 36-39, mercaptopurine PO on days 1-14 and 29-42, methotrexate IT on days 1, 8, 15, and 22 (excluded on days 15 and 22 CNS3 patients), vincristine IV on days 15, 22, 43, and 50, and pegaspargase or calaspargase pegol IV over 1-2 hours or pegaspargase IM on days 15 and 43. Treatment continues for 56 days in the absence of disease progression or unacceptable toxicity. Patients with testicular disease at diagnosis that does not resolve by the EOI will and continued evidence of testicular disease at EOI undergo testicular RT over 12 once-daily fractions. Calaspargase pegol can only be given to patients less than 22 years of age. Patients without complete response (CR) at EOC discontinue study treatment. ARM I AND II: MPAL AND B-LLY (POST-CONSOLIDATION THERAPY) * INTERIM MAINTENANCE 1: Patients receive vincristine IV on days 1, 15, 29, and 43, high dose methotrexate IV over 24 hours on days 1, 15, 29, and 43, leucovorin PO or IV on days 3-4, 17-18, 31-32, and 45-46, methotrexate IT on days 1 and 29 and mercaptopurine PO QD on days 1-14, 15-28, 29-42, and 43-56. Treatment continues for 63 days in the absence of disease progression or unacceptable toxicity. * DELAYED INTENSIFICATION (PART 1): Patients receive methotrexate IT on day 1, dexamethasone PO BID or IV on days 1-7 and 15-21, vincristine IV on days 1, 8, and 15, doxorubicin IV over 3-15 minutes or up to 1 hour on days 1, 8, and 15, and pegaspargase or calaspargase pegol IV over 1-2 hours or pegaspargase IM on day 4. Treatment (Parts 1 and 2 of Delayed Intensification) continues for 63 days in the absence of disease progression or unacceptable toxicity. Calaspargase pegol can only be given to patients less than 22 years of age. * DELAYED INTENSIFICATION (PART 2): Patients receive 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 IV or IV push over 1 minute on days 43 and 50, and pegaspargase or calaspargase pegol IV over 1-2 hours or pegaspargase IM on day 43. Treatment (Parts 1 and 2 of Delayed Intensification) continues for 63 days in the absence of disease progression or unacceptable toxicity. Calaspargase pegol can only be given to patients less than 22 years of age. * INTERIM MAINTENANCE 2: Patients receive vincristine IV on days 1, 11, 21, 31, and 41, methotrexate IV or infusion over 2-15 minutes or 10-15 minutes on days 1, 11, 21, 31, and 41, methotrexate IT on days 1 and 31, and pegaspargase or calaspargase pegol IV over 1-2 hours on days 2 and 22 (pegaspargase) or (calaspargase) 23 or pegaspargase IM on days 2 and 22. Treatment continues for 56 days in the absence of disease progression or unacceptable toxicity. Calaspargase pegol can only be given to patients less than 22 years of age. * MAINTENANCE: Patients receive vincristine IV on days 1, prednisone or prednisolone PO BID or IV on days 1-5, mercaptopurine PO on days 1-84, methotrexate PO on days 8, 15, 22, 29 (excluded in cycles 1 and 2), 36, 43, 50, 57, 64, 71, and 78, and methotrexate IT on days 1 (and 29 of cycles 1-2 for patients who do not receive cranial radiation). Cycles repeat every 12 weeks for up to 2 years in the absence of disease progression or unacceptable toxicity. Patients with CNS3 disease at diagnosis undergo cranial radiation therapy for 10 fractions over 4 weeks. Patients undergo blood sample collection and bone marrow aspiration and biopsy on study. B-LLy patients undergo computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and/or bone scan on study. After completion of study treatment, patients are followed up at 4 weeks, then every 3 months for 2 years, every 4-6 months for the third year, then every 6-12 months for years 4-5.
Eligibility criteria
Inclusion Criteria: * B-ALL and MPAL patients must be enrolled on APEC14B1 and consented to eligibility studies (Part A) prior to treatment and enrollment on AALL1732. Note that central confirmation of MPAL diagnosis must occur within 22 days of enrollment for suspected MPAL patients. If not performed within this time frame, patients will be taken off protocol. * APEC14B1 is not a requirement for B-LLy patients but for institutional compliance every patient should be offered participation in APEC14B1. B-LLy patients may directly enroll on AALL1732. * Patients must be \> 365 days and \< 25 years of age * White blood cell count (WBC) criteria for patients with B-ALL (within 7 days prior to the start of protocol-directed systemic therapy): * Age 1-9.99 years: WBC \>= 50,000/uL * Age 10-24.99 years: Any WBC * Age 1-9.99 years: WBC \< 50,000/uL with one or more of the following: * Testicular leukemia * CNS leukemia (CNS3) * Steroid pretreatment. * White blood cell count (WBC) criteria for patients with MPAL (within 7 days prior to the start of protocol-directed systemic therapy): * Age 1-24.99 years: any WBC NOTE: Patients enrolled as suspected MPAL but found on central confirmatory testing to have B-ALL must meet the B-ALL criteria above (age, WBC, extramedullary disease, steroid pretreatment) to switch to the B-ALL stratum before the end of induction. * Patient has newly diagnosed B-ALL or MPAL (by World Health Organization \[WHO\] 2016 criteria) with \>= 25% blasts on a bone marrow (BM) aspirate; * OR If a BM aspirate is not obtained or is not diagnostic of acute leukemia, the diagnosis can be established by a pathologic diagnosis of acute leukemia on a BM biopsy; * OR A complete blood count (CBC) documenting the presence of at least 1,000/uL circulating leukemic cells if a bone marrow aspirate or biopsy cannot be performed. * Patient has newly diagnosed B-LLy Murphy stages III or IV. * Patient has newly diagnosed B-LLy Murphy stages I or II with steroid pretreatment. * Note: For B-LLy patients with tissue available for flow cytometry, the criterion for diagnosis should be analogous to B-ALL. For tissue processed by other means (i.e., paraffin blocks), the methodology and criteria for immunophenotypic analysis to establish the diagnosis of B-LLy defined by the submitting institution will be accepted. * Central nervous system (CNS) status must be determined prior to enrollment based on a sample obtained prior to administration of any systemic or intrathecal chemotherapy, except for steroid pretreatment and cytoreduction. It is recommended that intrathecal cytarabine be administered at the time of the diagnostic lumbar puncture. This is usually done at the time of the diagnostic bone marrow or venous line placement to avoid a second lumbar puncture. This is allowed prior to enrollment. Systemic chemotherapy must begin within 72 hours of this intrathecal therapy. * All patients and/or their parents or legal guardians must sign a written informed consent. * All institutional, Food and Drug Administration (FDA), and NCI requirements for human studies must be met. Exclusion Criteria: * Patients with Down syndrome are not eligible * With the exception of steroid pretreatment and steroid cytoreduction or the administration of intrathecal cytarabine, patients must not have received any prior cytotoxic chemotherapy for the current diagnosis of B-ALL, MPAL, or B-LLy or for any cancer diagnosed prior to initiation of protocol therapy on AALL1732. * Patients who have received \> 72 hours of hydroxyurea within one week prior to start of systemic protocol therapy. * Patients with B-ALL or MPAL who do not have sufficient diagnostic bone marrow submitted for APEC14B1 testing and who do not have a peripheral blood sample submitted containing \> 1,000/uL circulating leukemia cells. * Patients with acute undifferentiated leukemia (AUL) are not eligible. * For Murphy stage III/IV B-LLy patients, or stage I/II patients with steroid pretreatment, the following additional exclusion criteria apply: * T-lymphoblastic lymphoma. * Morphologically unclassifiable lymphoma. * Absence of both B-cell and T-cell phenotype markers in a case submitted as lymphoblastic lymphoma. * Patients with known Charcot-Marie-Tooth disease. * Patients with known MYC translocation associated with mature (Burkitt) B-cell ALL, regardless of blast immunophenotype. * Patients requiring radiation at diagnosis. * 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 women who plan to breastfeed their infants while on study and for 2 months after the last dose of inotuzumab ozogamicin. * Sexually active patients of reproductive potential who have not agreed to use an effective contraceptive method for the duration of study participation. For those patients randomized to inotuzumab ozogamicin, there is a minimum of 8 months after the last dose of inotuzumab ozogamicin for females and 5 months after the last dose of inotuzumab ozogamicin for males.
Study design
Enrollment target: 5951 participants
Allocation: randomized
Masking: none
Age groups: child, adult
Timeline
Starts: 2019-10-31
Estimated completion: 2032-03-31
Last updated: 2026-03-31
Interventions
Procedure: Biospecimen CollectionBiological: BlinatumomabProcedure: Bone Marrow AspirationProcedure: Bone Marrow BiopsyProcedure: Bone ScanDrug: Calaspargase PegolProcedure: Computed TomographyDrug: CyclophosphamideDrug: CytarabineDrug: Daunorubicin HydrochlorideDrug: DexamethasoneDrug: Doxorubicin HydrochlorideBiological: Inotuzumab OzogamicinDrug: Leucovorin CalciumProcedure: Magnetic Resonance ImagingDrug: MercaptopurineDrug: MethotrexateDrug: PegaspargaseProcedure: Positron Emission TomographyDrug: PrednisoloneDrug: PrednisoneOther: Questionnaire AdministrationRadiation: Radiation TherapyRadiation: Radiation TherapyDrug: ThioguanineDrug: Vincristine Sulfate
Primary outcomes
  • Post-induction 5-year event-free survival (EFS) (From study entry to first event (induction failure, induction death, end of induction [EOI] minimal residual disease [MRD] ≥ 5%,EO consolidation [C] MRD ≥ 0.01%, relapse, second malignancy, remission death) or date of last contact, assessed up to 5 years)
Sponsor
Children's Oncology Group · network
With: National Cancer Institute (NCI)
Contacts & investigators
InvestigatorJennifer L McNeer · principal_investigator, Children's Oncology Group
All locations (230)
Children's Hospital of AlabamaRecruiting
Birmingham, Alabama, United States
USA Health Strada Patient Care CenterRecruiting
Mobile, Alabama, United States
Providence Alaska Medical CenterRecruiting
Anchorage, Alaska, United States
Banner Children's at DesertRecruiting
Mesa, Arizona, United States
Phoenix Childrens HospitalRecruiting
Phoenix, Arizona, United States
Banner University Medical Center - TucsonRecruiting
Tucson, Arizona, United States
Arkansas Children's HospitalRecruiting
Little Rock, Arkansas, United States
Kaiser Permanente Downey Medical CenterRecruiting
Downey, California, United States
City of Hope Comprehensive Cancer CenterRecruiting
Duarte, California, United States
Loma Linda University Medical CenterRecruiting
Loma Linda, California, United States
Miller Children's and Women's Hospital Long BeachRecruiting
Long Beach, California, United States
Children's Hospital Los AngelesRecruiting
Los Angeles, California, United States
Cedars Sinai Medical CenterRecruiting
Los Angeles, California, United States
Mattel Children's Hospital UCLASuspended
Los Angeles, California, United States
Valley Children's HospitalRecruiting
Madera, California, United States
UCSF Benioff Children's Hospital OaklandRecruiting
Oakland, California, United States
Kaiser Permanente-OaklandRecruiting
Oakland, California, United States
Children's Hospital of Orange CountyRecruiting
Orange, California, United States
Lucile Packard Children's Hospital Stanford UniversityRecruiting
Palo Alto, California, United States
Sutter Medical Center SacramentoRecruiting
Sacramento, California, United States
University of California Davis Comprehensive Cancer CenterRecruiting
Sacramento, California, United States
Rady Children's Hospital - San DiegoRecruiting
San Diego, California, United States
Naval Medical Center -San DiegoRecruiting
San Diego, California, United States
UCSF Medical Center-Mission BayRecruiting
San Francisco, California, United States
Santa Barbara Cottage HospitalRecruiting
Santa Barbara, California, United States
Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical CenterActive Not Recruiting
Torrance, California, United States
Children's Hospital ColoradoRecruiting
Aurora, Colorado, United States
Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical CenterRecruiting
Denver, Colorado, United States
Connecticut Children's Medical CenterRecruiting
Hartford, Connecticut, United States
Yale UniversityRecruiting
New Haven, Connecticut, United States
Alfred I duPont Hospital for ChildrenRecruiting
Wilmington, Delaware, United States
MedStar Georgetown University HospitalSuspended
Washington D.C., District of Columbia, United States
Children's National Medical CenterRecruiting
Washington D.C., District of Columbia, United States
Broward Health Medical CenterRecruiting
Fort Lauderdale, Florida, United States
Golisano Children's Hospital of Southwest FloridaRecruiting
Fort Myers, Florida, United States
UF Health Cancer Institute - GainesvilleRecruiting
Gainesville, Florida, United States
Memorial Regional Hospital/Joe DiMaggio Children's HospitalRecruiting
Hollywood, Florida, United States
Nemours Children's Clinic-JacksonvilleRecruiting
Jacksonville, Florida, United States
Palms West Radiation TherapyActive Not Recruiting
Loxahatchee Groves, Florida, United States
University of Miami Miller School of Medicine-Sylvester Cancer CenterRecruiting
Miami, Florida, United States
Nicklaus Children's HospitalRecruiting
Miami, Florida, United States
Miami Cancer InstituteActive Not Recruiting
Miami, Florida, United States
AdventHealth OrlandoRecruiting
Orlando, Florida, United States
Arnold Palmer Hospital for ChildrenRecruiting
Orlando, Florida, United States
Nemours Children's HospitalRecruiting
Orlando, Florida, United States
Nemours Children's Clinic - PensacolaRecruiting
Pensacola, Florida, United States
Sacred Heart HospitalSuspended
Pensacola, Florida, United States
Johns Hopkins All Children's HospitalRecruiting
St. Petersburg, Florida, United States
Tampa General HospitalRecruiting
Tampa, Florida, United States
Saint Joseph's Hospital/Children's Hospital-TampaRecruiting
Tampa, Florida, United States
Saint Mary's Medical CenterRecruiting
West Palm Beach, Florida, United States
Children's Healthcare of Atlanta - Arthur M Blank HospitalRecruiting
Atlanta, Georgia, United States
Augusta University Medical CenterRecruiting
Augusta, Georgia, United States
Atrium Health NavicentRecruiting
Macon, Georgia, United States
Memorial Health University Medical CenterRecruiting
Savannah, Georgia, United States
Kapiolani Medical Center for Women and ChildrenRecruiting
Honolulu, Hawaii, United States
Saint Luke's Cancer Institute - BoiseRecruiting
Boise, Idaho, United States
Lurie Children's Hospital-ChicagoRecruiting
Chicago, Illinois, United States
University of IllinoisRecruiting
Chicago, Illinois, United States
University of Chicago Comprehensive Cancer CenterRecruiting
Chicago, Illinois, United States
Loyola University Medical CenterRecruiting
Maywood, Illinois, United States
Advocate Children's Hospital-Oak LawnRecruiting
Oak Lawn, Illinois, United States
Advocate Children's Hospital-Park RidgeRecruiting
Park Ridge, Illinois, United States
Saint Jude Midwest AffiliateRecruiting
Peoria, Illinois, United States
Southern Illinois University School of MedicineSuspended
Springfield, Illinois, United States
Northwestern Medicine Central DuPage HospitalRecruiting
Winfield, Illinois, United States
Riley Hospital for ChildrenRecruiting
Indianapolis, Indiana, United States
Ascension Saint Vincent Indianapolis HospitalRecruiting
Indianapolis, Indiana, United States
Blank Children's HospitalRecruiting
Des Moines, Iowa, United States
University of Iowa/Holden Comprehensive Cancer CenterRecruiting
Iowa City, Iowa, United States
Wesley Medical CenterRecruiting
Wichita, Kansas, United States
University of Kentucky/Markey Cancer CenterRecruiting
Lexington, Kentucky, United States
Norton Children's HospitalRecruiting
Louisville, Kentucky, United States
Children's Hospital New OrleansRecruiting
New Orleans, Louisiana, United States
Ochsner Medical Center JeffersonRecruiting
New Orleans, Louisiana, United States
Eastern Maine Medical CenterRecruiting
Bangor, Maine, United States
Maine Children's Cancer ProgramRecruiting
Scarborough, Maine, United States
University of Maryland/Greenebaum Cancer CenterRecruiting
Baltimore, Maryland, United States
Sinai Hospital of BaltimoreRecruiting
Baltimore, Maryland, United States
Johns Hopkins University/Sidney Kimmel Cancer CenterRecruiting
Baltimore, Maryland, United States
Walter Reed National Military Medical CenterRecruiting
Bethesda, Maryland, United States
Tufts Children's HospitalActive Not Recruiting
Boston, Massachusetts, United States
Massachusetts General Hospital Cancer CenterRecruiting
Boston, Massachusetts, United States
Dana-Farber Cancer InstituteRecruiting
Boston, Massachusetts, United States
Baystate Medical CenterRecruiting
Springfield, Massachusetts, United States
UMass Memorial Medical Center - University CampusRecruiting
Worcester, Massachusetts, United States
C S Mott Children's HospitalRecruiting
Ann Arbor, Michigan, United States
Children's Hospital of MichiganRecruiting
Detroit, Michigan, United States
Henry Ford Health Saint John HospitalActive Not Recruiting
Detroit, Michigan, United States
Michigan State UniversityActive Not Recruiting
East Lansing, Michigan, United States
Corewell Health Grand Rapids Hospitals - Helen DeVos Children's HospitalRecruiting
Grand Rapids, Michigan, United States
Bronson Methodist HospitalRecruiting
Kalamazoo, Michigan, United States
Corewell Health Children'sRecruiting
Royal Oak, Michigan, United States
Children's Hospitals and Clinics of Minnesota - MinneapolisRecruiting
Minneapolis, Minnesota, United States
University of Minnesota/Masonic Cancer CenterRecruiting
Minneapolis, Minnesota, United States
Mayo Clinic in RochesterRecruiting
Rochester, Minnesota, United States
University of Mississippi Medical CenterRecruiting
Jackson, Mississippi, United States
University of Missouri Children's HospitalRecruiting
Columbia, Missouri, United States
Children's Mercy Hospitals and ClinicsRecruiting
Kansas City, Missouri, United States
Cardinal Glennon Children's Medical CenterRecruiting
St Louis, Missouri, United States
Washington University School of MedicineRecruiting
St Louis, Missouri, United States
Mercy Hospital Saint LouisRecruiting
St Louis, Missouri, United States
Children's Hospital and Medical Center of OmahaRecruiting
Omaha, Nebraska, United States
University of Nebraska Medical CenterRecruiting
Omaha, Nebraska, United States
University Medical Center of Southern NevadaSuspended
Las Vegas, Nevada, United States
Sunrise Hospital and Medical CenterSuspended
Las Vegas, Nevada, United States
Alliance for Childhood Diseases/Cure 4 the Kids FoundationRecruiting
Las Vegas, Nevada, United States
Summerlin Hospital Medical CenterRecruiting
Las Vegas, Nevada, United States
Renown Regional Medical CenterRecruiting
Reno, Nevada, United States
Dartmouth Hitchcock Medical Center/Dartmouth Cancer CenterRecruiting
Lebanon, New Hampshire, United States
Hackensack University Medical CenterRecruiting
Hackensack, New Jersey, United States
Morristown Medical CenterRecruiting
Morristown, New Jersey, United States
Jersey Shore Medical CenterRecruiting
Neptune City, New Jersey, United States
Saint Peter's University HospitalRecruiting
New Brunswick, New Jersey, United States
Rutgers Cancer Institute of New Jersey-Robert Wood Johnson University HospitalRecruiting
New Brunswick, New Jersey, United States
Newark Beth Israel Medical CenterRecruiting
Newark, New Jersey, United States
Saint Joseph's Regional Medical CenterRecruiting
Paterson, New Jersey, United States
Presbyterian HospitalRecruiting
Albuquerque, New Mexico, United States
University of New Mexico Cancer CenterRecruiting
Albuquerque, New Mexico, United States
Albany Medical CenterRecruiting
Albany, New York, United States
Maimonides Medical CenterRecruiting
Brooklyn, New York, United States
Roswell Park Cancer InstituteRecruiting
Buffalo, New York, United States
NYU Langone Hospital - Long IslandRecruiting
Mineola, New York, United States
The Steven and Alexandra Cohen Children's Medical Center of New YorkRecruiting
New Hyde Park, New York, United States
Laura and Isaac Perlmutter Cancer Center at NYU LangoneRecruiting
New York, New York, United States
Mount Sinai HospitalRecruiting
New York, New York, United States
NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer CenterRecruiting
New York, New York, United States
Memorial Sloan Kettering Cancer CenterRecruiting
New York, New York, United States
NYP/Weill Cornell Medical CenterRecruiting
New York, New York, United States
University of RochesterRecruiting
Rochester, New York, United States
Stony Brook University Medical CenterRecruiting
Stony Brook, New York, United States
State University of New York Upstate Medical UniversityRecruiting
Syracuse, New York, United States
Montefiore Medical Center - Moses CampusRecruiting
The Bronx, New York, United States
New York Medical CollegeRecruiting
Valhalla, New York, United States
Mission HospitalRecruiting
Asheville, North Carolina, United States
UNC Lineberger Comprehensive Cancer CenterRecruiting
Chapel Hill, North Carolina, United States
Carolinas Medical Center/Levine Cancer InstituteRecruiting
Charlotte, North Carolina, United States
Novant Health Presbyterian Medical CenterRecruiting
Charlotte, North Carolina, United States
Duke University Medical CenterRecruiting
Durham, North Carolina, United States
East Carolina UniversityRecruiting
Greenville, North Carolina, United States
Wake Forest University Health SciencesRecruiting
Winston-Salem, North Carolina, United States
Sanford Broadway Medical CenterRecruiting
Fargo, North Dakota, United States
Children's Hospital Medical Center of AkronRecruiting
Akron, Ohio, United States
Cincinnati Children's Hospital Medical CenterRecruiting
Cincinnati, Ohio, United States
Rainbow Babies and Childrens HospitalRecruiting
Cleveland, Ohio, United States
Cleveland Clinic FoundationRecruiting
Cleveland, Ohio, United States
Nationwide Children's HospitalRecruiting
Columbus, Ohio, United States
Dayton Children's HospitalRecruiting
Dayton, Ohio, United States
ProMedica Toledo Hospital/Russell J Ebeid Children's HospitalRecruiting
Toledo, Ohio, United States
University of Oklahoma Health Sciences CenterRecruiting
Oklahoma City, Oklahoma, United States
Natalie Warren Bryant Cancer Center at Saint FrancisRecruiting
Tulsa, Oklahoma, United States
Legacy Emanuel Children's HospitalRecruiting
Portland, Oregon, United States
Oregon Health and Science UniversityRecruiting
Portland, Oregon, United States
Lehigh Valley Hospital-Cedar CrestRecruiting
Allentown, Pennsylvania, United States
Geisinger Medical CenterRecruiting
Danville, Pennsylvania, United States
Penn State Children's HospitalRecruiting
Hershey, Pennsylvania, United States
Children's Hospital of PhiladelphiaRecruiting
Philadelphia, Pennsylvania, United States
Saint Christopher's Hospital for ChildrenRecruiting
Philadelphia, Pennsylvania, United States
Children's Hospital of Pittsburgh of UPMCRecruiting
Pittsburgh, Pennsylvania, United States
Rhode Island HospitalRecruiting
Providence, Rhode Island, United States
Medical University of South CarolinaRecruiting
Charleston, South Carolina, United States
Prisma Health Richland HospitalRecruiting
Columbia, South Carolina, United States
BI-LO Charities Children's Cancer CenterRecruiting
Greenville, South Carolina, United States
Sanford USD Medical Center - Sioux FallsRecruiting
Sioux Falls, South Dakota, United States
T C Thompson Children's HospitalRecruiting
Chattanooga, Tennessee, United States
East Tennessee Childrens HospitalRecruiting
Knoxville, Tennessee, United States
The Children's Hospital at TriStar CentennialRecruiting
Nashville, Tennessee, United States
Vanderbilt University/Ingram Cancer CenterRecruiting
Nashville, Tennessee, United States
Texas Tech University Health Sciences Center-AmarilloRecruiting
Amarillo, Texas, United States
Dell Children's Medical Center of Central TexasRecruiting
Austin, Texas, United States
Driscoll Children's HospitalRecruiting
Corpus Christi, Texas, United States
Medical City Dallas HospitalRecruiting
Dallas, Texas, United States
UT Southwestern/Simmons Cancer Center-DallasRecruiting
Dallas, Texas, United States
El Paso Children's HospitalRecruiting
El Paso, Texas, United States
Cook Children's Medical CenterRecruiting
Fort Worth, Texas, United States
Baylor College of Medicine/Dan L Duncan Comprehensive Cancer CenterRecruiting
Houston, Texas, United States
M D Anderson Cancer CenterRecruiting
Houston, Texas, United States
Covenant Children's HospitalRecruiting
Lubbock, Texas, United States
UMC Cancer Center / UMC Health SystemRecruiting
Lubbock, Texas, United States
Vannie Cook Children's ClinicRecruiting
McAllen, Texas, United States
Children's Hospital of San AntonioRecruiting
San Antonio, Texas, United States
Methodist Children's Hospital of South TexasRecruiting
San Antonio, Texas, United States
University of Texas Health Science Center at San AntonioRecruiting
San Antonio, Texas, United States
Scott and White Memorial HospitalRecruiting
Temple, Texas, United States
Primary Children's HospitalRecruiting
Salt Lake City, Utah, United States
University of Vermont and State Agricultural CollegeRecruiting
Burlington, Vermont, United States
University of Virginia Cancer CenterRecruiting
Charlottesville, Virginia, United States
Inova Fairfax HospitalRecruiting
Falls Church, Virginia, United States
Children's Hospital of The King's DaughtersRecruiting
Norfolk, Virginia, United States
Naval Medical Center - PortsmouthRecruiting
Portsmouth, Virginia, United States
VCU Massey Comprehensive Cancer CenterRecruiting
Richmond, Virginia, United States
Carilion Children'sRecruiting
Roanoke, Virginia, United States
Seattle Children's HospitalRecruiting
Seattle, Washington, United States
Providence Sacred Heart Medical Center and Children's HospitalRecruiting
Spokane, Washington, United States
Mary Bridge Children's Hospital and Health CenterRecruiting
Tacoma, Washington, United States
Madigan Army Medical CenterSuspended
Tacoma, Washington, United States
West Virginia University Charleston DivisionRecruiting
Charleston, West Virginia, United States
Edwards Comprehensive Cancer CenterSuspended
Huntington, West Virginia, United States
West Virginia University HealthcareSuspended
Morgantown, West Virginia, United States
Saint Vincent Hospital Cancer Center Green BayRecruiting
Green Bay, Wisconsin, United States
University of Wisconsin Carbone Cancer Center - University HospitalRecruiting
Madison, Wisconsin, United States
Marshfield Medical Center-MarshfieldRecruiting
Marshfield, Wisconsin, United States
Children's Hospital of WisconsinRecruiting
Milwaukee, Wisconsin, United States
John Hunter Children's HospitalSuspended
Hunter Regional Mail Centre, New South Wales, Australia
The Children's Hospital at WestmeadSuspended
Westmead, New South Wales, Australia
Queensland Children's HospitalSuspended
South Brisbane, Queensland, Australia
Women's and Children's Hospital-AdelaideSuspended
North Adelaide, South Australia, Australia
Monash Medical Center-Clayton CampusSuspended
Clayton, Victoria, Australia
Royal Children's HospitalSuspended
Parkville, Victoria, Australia
Perth Children's HospitalSuspended
Perth, Western Australia, Australia
Alberta Children's HospitalSuspended
Calgary, Alberta, Canada
University of Alberta HospitalSuspended
Edmonton, Alberta, Canada
British Columbia Children's HospitalSuspended
Vancouver, British Columbia, Canada
CancerCare ManitobaSuspended
Winnipeg, Manitoba, Canada
Janeway Child Health CentreSuspended
St. John's, Newfoundland and Labrador, Canada
IWK Health CentreSuspended
Halifax, Nova Scotia, Canada
McMaster Children's Hospital at Hamilton Health SciencesSuspended
Hamilton, Ontario, Canada
Kingston Health Sciences CentreSuspended
Kingston, Ontario, Canada
Children's HospitalSuspended
London, Ontario, Canada
Children's Hospital of Eastern OntarioSuspended
Ottawa, Ontario, Canada
Hospital for Sick ChildrenSuspended
Toronto, Ontario, Canada
The Montreal Children's Hospital of the MUHCSuspended
Montreal, Quebec, Canada
Centre Hospitalier Universitaire de Sherbrooke-FleurimontSuspended
Sherbrooke, Quebec, Canada
Jim Pattison Children's HospitalSuspended
Saskatoon, Saskatchewan, Canada
Saskatoon Cancer CentreSuspended
Saskatoon, Saskatchewan, Canada
CHU de Quebec-Centre Hospitalier de l'Universite Laval (CHUL)Suspended
Québec, Canada
Starship Children's HospitalSuspended
Grafton, Auckland, New Zealand
Christchurch HospitalSuspended
Christchurch, New Zealand
HIMA San Pablo Oncologic HospitalActive Not Recruiting
Caguas, Puerto Rico
University Pediatric HospitalRecruiting
San Juan, Puerto Rico
Inotuzumab Ozogamicin and Post-Induction Chemotherapy in Treating Patients With High-Risk B-ALL, Mixed Phenotype Acute Leukemia, and B-LLy · TrialPath