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Childhood Acute Lymphoblastic Leukemia Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Risk-based Treatment Assignment

Table 1. Risk Groups for B-Precursor Acute Lymphoblastic Leukemiaa

Low RiskAverage RiskHigh RiskVery High Risk
EFS = event-free survival; HR = age and WBC count risk group is high risk; MRD = minimal residual disease; NCI = National Cancer Institute; PB = peripheral blood; SR = age/WBC count risk group is standard risk; WBC = white blood cell.
a From the Children's Oncology GroupClassification of Newly Diagnosed ALL protocol.
NCI Risk (Age/WBC)SRSRSRSRSRHR (age <13 y)SRHRHR (age ≥13 y)SR or HR
Favorable GeneticsYesYesNoYesNoYes or NoNoYes or NoYes or NoYes or No
Unfavorable CharacteristicsNoneNoneNoneNoneNoneNoneNoneNoneNoneYes
Day 8 PB MRD<0.01%≥0.01%<1%Any Level≥1%Any LevelAny LevelAny LevelAny LevelAny Level
Day 29 Marrow MRDLowLowLowHighLowLowHighHigh<0.01%Any Level
% of Patients (Estimated)15%36%25%24%
Anticipated 5-year EFS>95%90%–95%88%–90%<80%

DFCI-11-001 (NCT01574274) (SC-PEG Asparaginase vs. Oncaspar in Pediatric ALL and Lymphoblastic Lymphoma): On the current clinical trial conducted by the Dana-Farber Cancer Institute ALL Consortium, patients with B-precursor ALL are initially classified as either standard risk or high risk based on age, presenting leukocyte count, and the presence or absence of CNS disease (CNS3). At the completion of a five-drug remission induction regimen (4 weeks from diagnosis), the level of MRD is determined via PCR assay. Patients with high MRD (≥0.001) are classified as very-high risk and receive a more intensive postremission consolidation. Patients with low MRD (<0.001) continue to receive treatment based on their initial risk group classification. The goal of this new classification schema is to determine whether intensification of therapy will improve the outcome of patients with high MRD at the end of remission induction. Patients with T-cell ALL are treated as high risk, regardless of MRD status. All patients with MLL translocations or hypodiploidy (<44 chromosomes) are classified as very-high risk, regardless of MRD status or phenotype. Ph+ patients are removed from study midinduction and are eligible to enroll on the COG protocol for patients with Ph+ ALL.

SJCRH: Risk classification is based mainly on MRD level (assessed by flow cytometry) after 6 weeks of remission induction therapy as follows: low risk (<0.01%), standard risk (0.01% – <1%), and high risk (≥1%). Patients with early T-cell precursor ALL are also considered to be high risk.[32]

Current Clinical Trials

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with childhood acute lymphoblastic leukemia. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.

General information about clinical trials is also available from the NCI Web site.

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