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LymphomaPhase 3ALCL 99NCT00006455

Combination Chemotherapy in Treating Children With Anaplastic Large Cell Lymphoma (ALCL 99)

A Phase 3 study testing cyclophosphamide, cytarabine and dexamethasone in people with Lymphoma, run by Gustave Roussy, Cancer Campus, Grand Paris at 10 sites in 10 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug may kill more tumor cells. It is not yet known which combination chemotherapy regimen is more effective for treating anaplastic large cell lymphoma. Read more about this study

Who is it for?
Ages 0 to 21 years
Conditions the study is for
Lymphoma
What is being tested?
cyclophosphamide, cytarabine and dexamethasone
How many people
885 participants
Where
10 sitesin 10 countries
Study dates
26 Nov 1999to 3 Sep 2020
Phase
Phase 3
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 0 to 21 years
  • All sexes
  • No healthy volunteers
  • Child, Adult

DISEASE CHARACTERISTICS:

  • Histologically proven standard-risk (SR) or high-risk (HR) anaplastic large cell lymphoma
  • SR disease defined by no involvement of the skin, mediastinum, liver, spleen, or lung
  • HR disease defined by any of the following:
  • Biopsy proven skin lesions (except skin lesions overlying an involved node or isolated skin disease)
  • Mediastinal involvement by x-ray or CT scan
  • Involvement of the liver (enlarged by at least 5 cm and/or nodular), spleen (enlarged and/or nodular), or lung (biopsy not needed for obvious lesions)
  • Histologic or cytologic slides must be available for national pathology review for all patients not meeting the classical criteria for diagnosis (typical histopathology, immunohistochemistry: CD30 positive, endomysial antibody positive, nucleophosmin negative, anaplastic lymphoma kinase (ALK) positive (if available), null or T-immunophenotype) unless proven t(2;5)
  • Must enroll within 1 week prior to beginning study regimen A
  • No CNS involvement (CSF or cerebral tumor)
  • First randomization (SR or HR disease):
  • Must have begun prephase therapy
  • No isolated primary skin disease
  • No low-risk disease defined as completely resected stage I disease
  • Second randomization (HR disease only):
  • Must have completed first randomization therapy without disease progression

PATIENT CHARACTERISTICS:

Age:

  • Under 22

Performance status:

  • Not specified

Life expectancy:

  • Not specified

Hematopoietic:

  • See Disease Characteristics

Hepatic:

  • See Disease Characteristics

Renal:

  • Not specified

Pulmonary:

  • See Disease Characteristics

Immunologic:

  • No congenital immunodeficiency
  • No AIDS

Other:

  • No prior malignancy

PRIOR CONCURRENT THERAPY:

Biologic therapy:

  • Not specified

Chemotherapy:

  • Not specified

Endocrine therapy:

  • Prior corticosteroids for anaplastic large cell lymphoma allowed if given for no more than 8 days

Radiotherapy:

  • Not specified

Surgery:

  • No prior organ transplantation

Other:

  • No other prior therapy for anaplastic large cell lymphoma

Trial locations and contacts

10 sites in 10 countries.

10 sites in 10 countries

Austria1 site
  • St. Anna Children's Hospital

    Vienna, A-1090

Other trials in Austria

Belgium1 site
  • U.Z. Gasthuisberg

    Leuven, B-3000

Other trials in Belgium

France1 site
  • Institut Gustave Roussy

    Villejuif, F-94805

Other trials in France

Germany1 site
  • Kinderklinik

    Giessen, D-35385

Other trials in Germany

Italy1 site
  • Azienda Ospedaliera di Padova

    Padova, 35128

Other trials in Italy

Netherlands1 site
  • Dutch Childhood Leukemia Study Group

    The Hague, 2504 AM

Other trials in Netherlands

Spain1 site
  • Hospital Clinico Universitario de Valencia

    Valencia, 46010

Other trials in Spain

Sweden1 site
  • Karolinska University Hospital - Huddinge

    Stockholm, S-171 76

Other trials in Sweden

Switzerland1 site
  • University Children's Hospital

    Zurich, CH-8032

Other trials in Switzerland

United Kingdom1 site
  • Addenbrooke's Hospital

    Cambridge, England, CB2 2QQ

Other trials in United Kingdom

About this study

Official title: International Protocol for the Treatment of Childhood Anaplastic Large Cell Lymphoma

RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug may kill more tumor cells. It is not yet known which combination chemotherapy regimen is more effective for treating anaplastic large cell lymphoma.

PURPOSE: This randomized phase III trial is studying several different regimens of combination chemotherapy to compare how well they work in treating children with anaplastic large cell lymphoma.

Read the detailed description

OBJECTIVES:

  • Compare the event-free survival in children with anaplastic large cell lymphoma treated with various induction and maintenance chemotherapy regimens with or without vinblastine.
  • Compare the impact of different doses and schedules of methotrexate from the Berlin-Frankfurt-Munster-K2 Protocol in terms of overall survival, complete remission rate, CNS relapse rate, and nonlymphoma-related death and early death rates in these patients.

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to country, vinblastine (VBL) (yes vs no), and prognostic factors (standard-risk (SR) vs high-risk (HR) disease).

Beginning immediately after confirmation of diagnosis, patients receive prephase therapy comprising dexamethasone (DM) IV or orally daily on days 1 and 2 and every 12 hours on days 3-5; cyclophosphamide (CTX) IV over 1 hour on days 1 and 2; and methotrexate (MTX) intrathecally (IT), doxorubicin (DOX) IV, and hydrocortisone (HC) IT on day 1.

Patients are then assigned to one of two treatment groups based on prognosis:

  • Group 1 (SR disease): Patients are randomized to arm I or III:
  • Arm I: Patients receive treatment on arm I as defined below on day 1, and then the following courses as defined below in the following order beginning on day 6: A1, B1, A2, B2, A3, and B3.
  • Arm III: Patients receive treatment on arm III as defined below on day 1, and then the following courses as defined below in the following order beginning on day 6: regimen AM1, BM1, AM2, BM2, AM3, and BM3.
  • Group 2 (HR disease):
  • First randomization: Patients are randomized to arm I or III:
  • Arm I: Patients receive treatment on arm I as defined below on day 1 and then course A1 as defined below on day 6.
  • Arm III: Patients receive treatment on arm III as defined below on day 1 and then course AM1 as defined below on day 6.
  • Second randomization: Patients without disease progression after completion of the above therapy are randomized to arm I, II, III, or IV.
  • Arm I: Patients receive treatment on arm I as defined below on day 1, and then the following courses as defined below in the following order after blood counts recover: B1, A2, B2, A3, and B3.
  • Arm II: Patients receive treatment on arm II as defined below on day 1, and then the following courses as defined below in the following order after blood counts recover: BV1, AV2, BV2, AV3, and BV3.
  • Arm III: Patients receive treatment on arm III as defined below on day 1, and then the following courses as defined below in the following order after blood counts recover: BM1, AM2, BM2, AM3, and BM3.
  • Arm IV: Patients receive treatment on arm IV as defined below on day 1, and then the following courses as defined below in the following order after blood counts recover: BMV1, AMV2, BMV2, AMV3, and BMV3.

Patients are followed every 2 months for 1 year, every 4 months for 2 years, every 6 months for 2 years, and then annually thereafter.

DEFINITIONS:

  • Arms I-IV are defined below:
  • Arm I: Patients receive lower dose MTX IV over 24 hours and MTX IT.
  • Arm II: Patients receive lower dose MTX IV over 24 hours and MTX IT. Patients with HR disease also receive VBL IV weekly for 1 year beginning 3 weeks after initiation of course BV3.
  • Arm III: Patients receive higher dose MTX IV over 3 hours without intrathecal therapy.
  • Arm IV: Patients receive treatment as in arm III. Patients with HR disease also receive VBL IV weekly for 1 year beginning 3 weeks after initiation of course BMV3.
  • Regimens A, B, AV, BV, AM, BM, AMV, and BMV are defined below:
  • Regimen A (courses A1, A2, and A3): Patients receive DM IV or orally every 12 hours on days 1-5; MTX IV over 24 hours on day 1; MTX IT, DOX IV and HC IT (beginning 2-4 hours after initiation of MTX infusion) on day 1; leucovorin calcium (CF) IV rescue at 42, 48, and 54 hours after initiation of MTX infusion; ifosfamide (IFF) IV over 1 hour on days 1-5 (before initiation of MTX infusion); cytarabine (ARA-C) IV over 1 hour every 12 hours and etoposide (VP-16) IV over 2 hours once (beginning after completion of ARA-C infusion) on days 4 and 5. Each course lasts 3 weeks.
  • Regimen B (courses B1, B2, and B3): Patients receive DM, MTX, intrathecal therapy, and CF rescue as in regimen A. Patients also receive CTX IV over 1 hour on days 1-5 and DOX IV over 1 hour on days 4 and 5. Each course lasts 3 weeks.
  • Regimen AV (courses AV1, AV2, and AV3): Patients receive treatment as in regimen A and VBL IV on day 1. Each course lasts 3 weeks.
  • Regimen BV (courses BV1, BV2, and BV3): Patients receive treatment as in regimen B and VBL IV as in regimen AV. Each course lasts 3 weeks.
  • Regimen AM (courses AM1, AM2, and AM3): Patients receive DM IV or orally every 12 hours on days 1-5; MTX IV over 3 hours on day 1; and CF IV rescue every 6 hours for a total of 12 doses beginning 24 hours after initiation of MTX infusion. Patients also receive IFF, ARA-C, and VP-16 as in regimen A. Each course lasts 3 weeks.
  • Regimen BM (courses BM1, BM2, and BM3): Patients receive CTX and DOX as in regimen B. Patients also receive DM, MTX, and CF rescue as in regimen AM. Each course lasts 3 weeks.
  • Regimen AMV (courses AMV1, AMV2, and AMV3): Patients receive treatment as in regimen AM and VBL as in regimen AV. Each course lasts 3 weeks.
  • Regimen BMV (courses BMV1, BMV2, and BMV3): Patients receive treatment as in regimen BM and VBL as in regimen AV. Each course lasts 3 weeks.

PROJECTED ACCRUAL: A total of 400 patients will be accrued for this study within 5.4-6.7 years.

Conditions
Lymphoma
Keywords
stage I childhood anaplastic large cell lymphoma, stage II childhood anaplastic large cell lymphoma, stage III childhood anaplastic large cell lymphoma, stage IV childhood anaplastic large cell lymphoma, recurrent childhood anaplastic large cell lymphoma
Medical subject headings
Lymphoma, Lymphoma, Large-Cell, Anaplastic

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Event-free survival

Secondary outcomes (5)
  1. Overall survival

  2. Complete remission achieved after treatment course B3 and lasting ≥ 4 weeks

  3. Short- and long-term toxicity

  4. Nonlymphoma related death and early deaths (excluding deaths occurring after second-line treatment for failure or relapse)

  5. CNS relapses

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted27 Jan 2003 (estimated)
  2. Study start26 Nov 1999
  3. Primary completion12 Jan 2009
  4. Study completion3 Sep 2020

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Single group
Enrolment
885 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00006455
Sponsor's protocol ID
CDR0000068133
Other IDs
FRE-IGR-ALCL99, EU-20031, NHL2000/06
Acronym
ALCL 99
Status last verified
May 2022
First submitted
6 Nov 2000
Last updated
31 May 2022
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Attarbaschi A, Mann G, Rosolen A, Williams D, Uyttebroeck A, Marky I, Lamant L, Horibe K, Wrobel G, Beishuizen A, Wossmann W, Reiter A, Mauguen A, Le Deley MC, Brugieres L; European Intergroup for Childhood Non-Hodgkin Lymphoma (EICNHL) ALCL99 Trial. Limited stage I disease is not necessarily indicative of an excellent prognosis in childhood anaplastic large cell lymphoma. Blood. 2011 May 26;117(21):5616-9. doi: 10.1182/blood-2010-12-324012. Epub 2011 Mar 28.

    PubMed 21444917
  • Wrobel G, Mauguen A, Rosolen A, Reiter A, Williams D, Horibe K, Brugieres L, Le Deley MC; European Inter-Group for Childhood, Non-Hodgkin Lymphoma (EICNHL). Safety assessment of intensive induction therapy in childhood anaplastic large cell lymphoma: report of the ALCL99 randomised trial. Pediatr Blood Cancer. 2011 Jul 1;56(7):1071-7. doi: 10.1002/pbc.22940. Epub 2011 Jan 28.

    PubMed 21280197
  • Le Deley MC, Rosolen A, Williams DM, Horibe K, Wrobel G, Attarbaschi A, Zsiros J, Uyttebroeck A, Marky IM, Lamant L, Woessmann W, Pillon M, Hobson R, Mauguen A, Reiter A, Brugieres L. Vinblastine in children and adolescents with high-risk anaplastic large-cell lymphoma: results of the randomized ALCL99-vinblastine trial. J Clin Oncol. 2010 Sep 1;28(25):3987-93. doi: 10.1200/JCO.2010.28.5999. Epub 2010 Aug 2.

    PubMed 20679620

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing cyclophosphamide, cytarabine and dexamethasone in people with Lymphoma, run by Gustave Roussy, Cancer Campus, Grand Paris at 10 sites in 10 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 31 May 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 10 sites in Austria, Belgium, France, Germany, Italy and 5 more countries. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Event-free survival. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00006455, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 31 May 2022.

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