RATIONALE: Drugs used in chemotherapy use different ways to stop cancer cells from dividing so they stop growing or die. Combining more than one drug may kill more cancer cells. PURPOSE: Phase II trial to study the effectiveness of combination chemotherapy in treating patients who have relapsed or refractory acute lymphocytic leukemia.

Condition	Treatment or Intervention	Phase
recurrent adult acute lymphoblastic leukemia	Drug: asparaginase  Drug: cytarabine  Drug: daunorubicin  Drug: dexamethasone  Drug: etoposide  Drug: filgrastim  Drug: idarubicin  Drug: ifosfamide  Drug: leucovorin calcium  Drug: methotrexate  Drug: prednisolone  Drug: vindesine	Phase II

Further Study Details: 

OBJECTIVES: I. Determine the toxic effects and feasibility of high-dose cytarabine and idarubicin in patients with refractory or relapsed acute lymphocytic leukemia (ALL) after a complete remission (CR) of less than 18 months. II. Determine the response of patients with ALL in first relapse after a CR of 18 months or more treated with a 2-phase re-induction regimen comprising prednisolone, vindesine, daunorubicin, asparaginase, intrathecal (IT) cytarabine, IT dexamethasone, and IT methotrexate followed by prednisolone, ifosfamide, high-dose methotrexate, leucovorin calcium, etoposide, and cytarabine (with a dose-escalation study of etoposide and cytarabine). III. Compare the effectiveness of these 2 regimens administered to these patients with the regimen administered to historic controls (protocol GER-ALL-REZ- 01/88).

PROTOCOL OUTLINE: This is a dose-escalation, multicenter study. Patients are stratified by center, duration of complete remission (CR) (less than 18 months vs 18 months or more), and refractory disease (yes vs no). Patients with refractory or relapsed disease after a CR of less than 18 months are treated on Regimen A. Patients in first relapse after a CR of 18 months or more are treated on Regimen B. Regimen A: Patients receive idarubicin IV over 30 minutes followed by cytarabine IV over 3 hours on days 1-3 and filgrastim (G-CSF) subcutaneously (SC) daily beginning on day 5 and continuing until blood counts recover. Regimen B (2-phase reinduction): Patients receive oral prednisolone on days 1-21; vindesine IV and daunorubicin IV on days 1, 8, and 15; asparaginase IV on days 7, 8, 14, and 15; and methotrexate intrathecally (IT), cytarabine IT, and dexamethasone IT on days 1 and 8. When blood counts recover, patients receive oral prednisolone and ifosfamide IV over 1 hour on days 1-4; high-dose methotrexate IV continuously on day 1 followed by standard leucovorin calcium rescue; etoposide IV over 1 hour followed at least 8 hours later by cytarabine IV over 3 hours on days 3 and 4; and G-CSF SC beginning on day 6 and continuing until blood counts recover. Cohorts of 6 patients or more receive escalating doses of etoposide and cytarabine until the maximum tolerated dose is determined.

PROJECTED ACCRUAL: Approximately 60 patients (30 per regimen) will be accrued for this study within 2 years.

Ages Eligible for Study:  15 Years   -   65 Years

Criteria

PROTOCOL ENTRY CRITERIA:

--Disease Characteristics--

• Diagnosis of refractory or relapsed acute lymphocytic leukemia; No isolated extramedullary relapse (e.g., testicular, CNS); Combined extramedullary and bone marrow relapse allowed
• No uncontrolled, severe leukemic complications, e.g.: Pneumonia with hypoxia; Shock; Cardiac failure; Hemorrhage
• No refractoriness to platelet transfusion
• No unaspirable pleural effusions or ascites in patients with first relapse

--Prior/Concurrent Therapy--

• Not specified

--Patient Characteristics--

• Age: 15 to 65
• Performance status: Karnofsky 50-100%
• Life expectancy: Not specified
• Hematopoietic: See Disease Characteristics; No uncontrolled bleeding
• Hepatic: No severe liver disease
• Renal: Creatinine clearance at least 60 mL/min in patients with first relapse after a complete remission of 18 months or more
• Cardiovascular: See Disease Characteristics; No severe cardiac disease (e.g., congestive heart failure, myocardial infarction within the past 6 months, or severe arrhythmia) Pulmonary: See Disease Characteristics; No severe pulmonary disease that would preclude aggressive chemotherapy
• Other: No hypersensitivity to E. coli proteins; No severe neurologic or other disease that would preclude aggressive chemotherapy; No severe psychiatric disease or other condition that would preclude study

Germany
      Medizinische Hochschule Hannover, Hannover,  D-30625,  Germany

Study chairs or principal investigators

Mathias Freund,  Study Chair,  Medizinische Hochschule Hannover   

Study ID Numbers:  CDR0000078432; GER-ALL-REZ-02/92; EU-93001
Record last reviewed:  February 2004
Last Updated:  October 13, 2004
Record first received:  November 1, 1999
ClinicalTrials.gov Identifier:  NCT00002532
Health Authority: Unspecified
ClinicalTrials.gov processed this record on 2005-04-08