Official Title: “Treatment Protocol for T-Cell and B-Precursor Cell Lymphoblastic Lymphoma of the European Inter-Group Co-Operation on Childhood Non-Hodgkin-Lymphoma (EICNHL)”

RATIONALE: Drugs used in chemotherapy, such as prednisolone and dexamethasone, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Giving more than one drug (combination chemotherapy) may kill more cancer cells. It is not yet known whether prednisolone is more effective than dexamethasone when given together with combination chemotherapy in treating lymphoblastic lymphoma.

PURPOSE: This phase III randomized clinical trial is studying prednisolone to see how well it works compared to dexamethasone when given together with combination chemotherapy in treating young patients with newly diagnosed lymphoblastic lymphoma.

Study Type: Interventional

Study Design: Treatment, Randomized

OBJECTIVES:

Primary - Compare the event-free survival of young patients with newly diagnosed lymphoblastic lymphoma treated with induction prednisolone vs dexamethasone. - Compare the safety of standard maintenance treatment over 18 months vs 24 months in these patients.

Secondary - Determine prognostic factors highly predicative for treatment failure in patients treated with these regimens.

OUTLINE: This is a randomized, multicenter study. - Cytoreductive prephase: All patients receive methotrexate intrathecally (IT) once on day 1 and prednisolone IV or orally 3 times daily on days 1-7. - Induction phase (part 1): Patients with T-cell lymphoblastic lymphoma (T-LBL) are randomized to 1 of 2 induction treatment arms. Patients with LBL with an unknown immunophenotype are assigned to arm I. Patients with precursor B-cell lymphoblastic lymphoma (pB-LBL) are assigned to arm II. - Arm I (T-LBL or LBL with an unknown immunophenotype): Patients receive prednisolone IV or orally 3 times daily on days 8-28; vincristine IV and daunorubicin hydrochloride IV over 1 hour on days 8, 15, 22, and 29; asparaginase IV over 1 hour on days 12, 15, 18, 21, 24, 27, 30, and 33; and methotrexate IT on days 12 and 33; Patients with CNS involvement receive additional methotrexate IT on days 18 and 27.

Patients then proceed to part 2 of the induction phase. - Arm II (T-LBL or pB-LBL): Patients receive dexamethasone IV or orally 3 times daily on days 8-28. Patients also receive vincristine, daunorubicin hydrochloride, asparaginase, and methotrexate as in arm I. Patients then proceed to part 2 of the induction phase. - Induction phase (part 2): Patients receive cyclophosphamide IV over 1 hour on days 36 and 64; cytarabine IV on days 38-41, 45-48, 52-55, and 59-62; oral mercaptopurine on days 36-63; and methotrexate IT on days 45 and 59. Two weeks later, patients proceed to protocol M. - Protocol M: Patients receive oral mercaptopurine once daily on days 1-56 and high-dose methotrexate IV continuously over 24 hours, and methotrexate IT on days 8, 22, 36, and 50. Patients also receive leucovorin calcium IV 42, 48, and 54 hours after the start of high-dose methotrexate infusion. Patients are then stratified according to stage of disease (I or II vs III or IV). Patients with stage I or II disease proceed directly to maintenance therapy 2 weeks after completion of protocol M. Patients with stage III or IV disease proceed to the re-induction phase 2 weeks after completion of protocol M. - Re-induction phase: Patients receive dexamethasone IV or orally 3 times daily on days 1-21; vincristine IV and doxorubicin hydrochloride IV over 1 hour on days 8, 15, 22, and 29; asparaginase IV over 1 hour on days 8, 11, 15, and 18; cyclophosphamide IV over 1 hour on day 36; cytarabine IV on days 38-41 and 45-48; oral thioguanine on days 36-49; and methotrexate IT on days 38 and 45. Patients proceed to maintenance therapy 2 weeks after completion of the re-induction phase. - Maintenance therapy: Patients with T-LBL are randomized to 1 of 2 maintenance treatment arms. Patients with pB-LBL or LBL with an unknown immunophenotype are assigned to arm I.

Any patients with evidence of initial CNS involvement undergo cranial radiotherapy before starting maintenance therapy. Patients must show no evidence of progressive disease before starting maintenance therapy. - Arm I: Patients receive oral mercaptopurine once a day and oral methotrexate once a week for up to 2 years (from the first day of the cytoreductive phase) in the absence of disease progression or unacceptable toxicity. - Arm II: Patients receive treatment as in arm I for up to 1½ years (from the first day of the cytoreductive phase) in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed periodically for up to 10 years.

PROJECTED ACCRUAL: Approximately 600 patients will be accrued for this study.

Primary:

• Conditional event-free survival No

Secondary:

• Overall survival No
• Acute and long-term toxicity Yes
• Non-lymphoma-related deaths and early deaths (excluding deaths occurring after second line treatment for failure or relapse) No

DISEASE CHARACTERISTICS:

• Histologically or cytologically confirmed lymphoblastic lymphoma (LBL)
• Stage I-IV disease
• T-cell LBL, precursor B-cell LBL, or LBL with an unknown immunophenotype

PATIENT CHARACTERISTICS:

• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception during and for 3 months after completion of study treatment
• No known HIV or AIDS infection
• No severe immunodeficiency
• No other prior malignancy
• No prior disease that would preclude treatment with chemotherapy

PRIOR CONCURRENT THERAPY:

• More than 2 months since prior systemic corticosteroids for a duration of > 8 days
• No prior chemotherapy
• No prior radiotherapy
• No prior organ transplant
• No trimethoprim-sulfamethoxazole 6 days before or during methotrexate therapy
• No concurrent participation in another clinical trial

Lead Sponsor: Children's Cancer and Leukaemia Group

Kinderklinik

Giessen  D-35385 Germany

Our Lady's Hospital for Sick Children Crumlin

Dublin  12 Ireland

Addenbrooke's Hospital

Cambridge England CB2 2QQ United Kingdom

Birmingham Children's Hospital

Birmingham England B4 6NH United Kingdom

Children's Hospital - Sheffield

Sheffield England S10 2TH United Kingdom

Great Ormond Street Hospital for Children

London England WC1N 3JH United Kingdom

Institute of Child Health at University of Bristol

Bristol England BS2 8AE United Kingdom

Leeds Cancer Centre at St. James's University Hospital

Leeds England LS9 7TF United Kingdom

Leicester Royal Infirmary

Leicester England LE1 5WW United Kingdom

Oxford Radcliffe Hospital

Oxford England 0X3 9DU United Kingdom

Queen's Medical Centre

Nottingham England NG7 2UH United Kingdom

Royal Liverpool Children's Hospital, Alder Hey

Liverpool England L12 2AP United Kingdom

Royal London Hospital

London England E1 1BB United Kingdom

Royal Manchester Children's Hospital

Manchester England M27 4HA United Kingdom

Royal Marsden - Surrey

Sutton England SM2 5PT United Kingdom

Sir James Spence Institute of Child Health

Newcastle-Upon-Tyne England NE1 4LP United Kingdom

Southampton General Hospital

Southampton England SO16 6YD United Kingdom

Royal Belfast Hospital for Sick Children

Belfast Northern Ireland BT12 6BE United Kingdom

Royal Aberdeen Children's Hospital

Aberdeen Scotland AB25 2ZG United Kingdom

Royal Hospital for Sick Children

Glasgow Scotland G3 8SJ United Kingdom

Royal Hospital for Sick Children

Edinburgh Scotland EH9 1LF United Kingdom

Childrens Hospital for Wales

Cardiff Wales CF14 4XW United Kingdom

Overall Clinical Trial Officials and Contacts

Robert F. Wynn, MD Study Chair Royal Manchester Children's Hospital  

Information obtained from ClinicalTrials.gov on July 23, 2008

Link to the current ClinicalTrials.gov record. http://clinicaltrials.gov/show/NCT00275106

Study ID Number: CDR0000454508

ClinicalTrials.gov Identifier: NCT00275106

Health Authority: Unspecified

Clinical trial summary from the National Cancer Institute's PDQ® database