[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"health-study-detail:100386119":3},{"organization":4,"outcomesModule":7,"designInfo":193,"detailedDescription":201,"studyPopulation":198,"armGroups":202,"interventions":248,"overallOfficials":278,"centralContacts":282,"locations":288,"responsibleParty":1815,"collaborators":1819,"id":1867,"slug":1868,"hasResults":1869,"nctId":1870,"briefTitle":1871,"officialTitle":1872,"acronym":198,"eligibilityCriteria":1873,"healthyVolunteers":1869,"sex":1874,"minAge":1875,"maxAge":1876,"enrollmentInfo":1877,"targetDuration":198,"studyType":1880,"phases":1881,"briefSummary":1883,"conditions":1884,"keywords":1886,"overallStatus":291,"whyStopped":198,"lastUpdateSubmitDate":1896,"lastUpdatePostDateStruct":1897,"startDateStruct":1900,"completionDateStruct":1902,"leadSponsor":1904,"locationsCount":1905},{"fullName":5,"class":6},"Karolinska University Hospital","OTHER",{"primaryOutcomes":8,"secondaryOutcomes":29,"otherOutcomes":185},[9,13,17,21,25],{"measure":10,"description":11,"timeFrame":12},"Event-free survival (EFS) for the whole protocol","The primary endpoint for the whole protocol (compared with the legacy protocols of the participating study-groups forming the consortium) is event-free survival (EFS) - as defined in the protocol.","5 year estimates from the time of diagnosis will be measured but adequate follow-up for these estimates will be ensured: at least 5 years follow-up.",{"measure":14,"description":15,"timeFrame":16},"Event-free survival (EFS) for the TKI intervention","The primary endpoint for the TKI intervention is event-free survival (EFS) - as defined in the protocol, from the start of TKI until event or end of follow-up","From the start of TKI (day 15 or day 30), 5 year estimates will be measured but adequate follow-up for these estimates will be ensured: at least 5 years follow-up for all interventions except Inotuzumab-randomisation (minimum 2-year follow-up).",{"measure":18,"description":19,"timeFrame":20},"Disease-free survival (DFS) R1 + R2","The primary endpoint for Randomisation 1 and 2 is disease-free survival (DFS) - as defined in the protocol counting from the time of randomisation","5 and 8 year estimates from the time of randomisation will be measured but adequate follow-up for these estimates will be ensured: at least 5 years follow-up.",{"measure":22,"description":23,"timeFrame":24},"Disease-free survival (DFS) R3","The primary endpoint for Randomisation 3 and the ABL-class fusion intervention is disease-free survival (DFS) - as defined in the protocol counting from the time of randomisation (R3) and the start of TKI-therapy (ABL-class fusion intervention).","5 year estimates from the time of randomisation will be measured but adequate follow-up for these estimates will be ensured: at least 2-year follow-up",{"measure":26,"description":27,"timeFrame":28},"MRD response after 1 cycle of Blinatumomab","Fraction of patients with undetectable MRD (\"Complete MRD response\") at the end of one cycle of Blinatumomab (+\u002F- 1 week)","End of first Blinatumomab infusion +\u002F- 1 week",[30,34,38,41,44,48,51,55,59,62,65,67,70,73,77,80,83,86,89,92,95,98,101,104,108,110,113,116,119,122,124,127,130,133,135,138,142,146,150,154,158,162,165,169,173,177,181],{"measure":31,"description":32,"timeFrame":33},"Overall survival (OS) for the whole protocol","Overall survival defined as time from diagnosis to death or end of follow-up for surviving patients.","5 year estimates will be measured but adequate follow-up for these estimates will be ensured: at least 5 years follow-up.",{"measure":35,"description":36,"timeFrame":37},"Overall survival (OS) for R1 + R2","Overall survival defined as time from randomisation to death or end of follow-up for surviving patients.","5 and 8 year estimates will be measured but adequate follow-up for these estimates will be ensured: at least 5 years follow-up.",{"measure":39,"description":36,"timeFrame":40},"Overall survival (OS) for R3","5 year estimates will be measured but adequate follow-up for these estimates will be ensured: at least 2 years follow-up",{"measure":42,"description":43,"timeFrame":40},"Overall survival (OS) for R3-TEAM associated with DNA-TG","Overall survival as defined above in relation to DNA-TG.",{"measure":45,"description":46,"timeFrame":47},"Overall survival (OS) for TKI","Overall survival defined as time from start of TKI to death or end of follow-up for surviving patients","5 year estimates will be measured but adequate follow-up for these estimates will be ensured: at least 5 years follow-up (TKI).",{"measure":49,"description":50,"timeFrame":33},"Overall survival (OS) for ALLTogether1 DS","Overall survival defined as time from start of Blinatumomab to death or end of follow-up for surviving patients",{"measure":52,"description":53,"timeFrame":54},"Induction death","Fraction of patients who die as well as cumulative incidence of death before achieved complete remission (CR) within the time-frame described in the protocol","From diagnosis until death before remission (at the earliest, day 29) or in case of no CR day 29, completion of induction and consolidation 1 (protocol day 99 - Down) and in addition 3 high-risk blocks (protocol day 134 - all other patients)",{"measure":56,"description":57,"timeFrame":58},"Resistant disease","Fraction of patients as well as cumulative incidence of resistant disease as described in the protocol. Induction death as competing risk.","From diagnosis until achieved complete remission (at the earliest, day 29) or in case of no CR day 29, assessment after induction and consolidation 1 (protocol day 99-Down patients) and in addition 3 high-risk blocks (protocol day 134-all other patients)",{"measure":60,"description":61,"timeFrame":33},"Cumulative incidence of relapse for the whole protocol","Time from achieved complete remission until relapse as defined in the protocol or end of follow-up. Second malignancy, death in complete remission as competing events.",{"measure":63,"description":64,"timeFrame":37},"Cumulative incidence of relapse for R1 + R2","Time from randomisation until relapse as defined in the protocol or end of follow-up. Second malignancy, death in complete remission as competing events.",{"measure":66,"description":64,"timeFrame":40},"Cumulative incidence relapse for R3",{"measure":68,"description":69,"timeFrame":40},"Cumulative incidence relapse for R3-TEAM in association with DNA-TG","Cumulative incidence of relapse as defined for R3 in association with DNA-TG for R3-TEAM. Second malignancy, death in complete remission as competing events.",{"measure":71,"description":72,"timeFrame":40},"Cumulative incidence CD22 negative relapse for R3","Time from randomisation until relapse without expression of CD22 as defined in the protocol or end of follow-up. Second malignancy, death in complete remission and relapse with CD22 expression as competing events.",{"measure":74,"description":75,"timeFrame":76},"Cumulative incidence relapse for TKI","Time from start of TKI until relapse as defined in the protocol or end of follow-up. Second malignancy, death in complete remission as competing events.","5 year estimates will be measured but adequate follow-up for these estimates will be ensured: at least 5 years follow-up",{"measure":78,"description":79,"timeFrame":76},"Cumulative incidence relapse for ALLTogether1 DS","Time from start of Blinatumomab until relapse as defined in the protocol or end of follow-up. Second malignancy, death in complete remission as competing events.",{"measure":81,"description":82,"timeFrame":76},"Cumulative incidence of CD19 negative relapse for ALLTogether1 DS","Time from start of Blinatumomab until CD19 negative relapse as defined in the protocol or end of follow-up. Second malignancy, death in complete remission and CD19 positive relapse as competing events.",{"measure":84,"description":85,"timeFrame":33},"Cumulative incidence of second malignant neoplasm (SMN) for the whole protocol","Time from achieved complete remission until diagnosis of second malignant neoplasm as defined in the protocol or end of follow-up. Relapse and death in complete remission as competing events.",{"measure":87,"description":88,"timeFrame":37},"Cumulative incidence of second malignancy for R1+R2","Time from randomisation until diagnosis of second malignant neoplasm as defined in the protocol or end of follow-up. Relapse and death in complete remission as competing events.",{"measure":90,"description":88,"timeFrame":91},"Cumulative incidence of second malignancy for R3","5 year estimates will be measured but adequate follow-up for these estimates will be ensured: at least 2 years follow-up.",{"measure":93,"description":94,"timeFrame":91},"Cumulative incidence of second malignancy for R3-TEAM in association with DNA-TG","Cumulative incidence of second malignancy as defined above for R3 in association with DNA-TG for R3-TEAM. Relapse and death in complete remission as competing events.",{"measure":96,"description":97,"timeFrame":33},"Cumulative incidence of second malignancy for TKI","Time from start of TKI until diagnosis of second malignant neoplasm as defined in the protocol or end of follow-up. Relapse and death in complete remission as competing events.",{"measure":99,"description":100,"timeFrame":33},"Cumulative incidence of second malignancy for ALLTogether1 DS","Time from start of Blinatumomab until diagnosis of second malignant neoplasm as defined in the protocol or end of follow-up. Relapse and death in complete remission as competing events.",{"measure":102,"description":103,"timeFrame":33},"Cumulative incidence of death in complete remission for the whole protocol","Time from achieved complete remission until death in complete remission as defined in the protocol or end of follow-up. Relapse and second malignant neoplasm as competing events.",{"measure":105,"description":106,"timeFrame":107},"Cumulative incidence of death in complete remission for R1+R2","Time from randomisation until death in complete remission as defined in the protocol or end of follow-up. Relapse and second malignant neoplasm as competing events.","5 and 8 year estimates will be measured but adequate follow-up for these estimates will be ensured: at least 2 years follow-up.",{"measure":109,"description":106,"timeFrame":40},"Cumulative incidence of death in complete remission for R3",{"measure":111,"description":112,"timeFrame":76},"Cumulative incidence of death in complete remission for TKI","Time from start of TKI until death in complete remission as defined in the protocol or end of follow-up. Relapse and second malignant neoplasm as competing events.",{"measure":114,"description":115,"timeFrame":76},"Cumulative incidence of death in complete remission for ALLTogether1 DS","Time from start of Blinatumomab until death in complete remission as defined in the protocol or end of follow-up. Relapse and second malignant neoplasm as competing events.",{"measure":117,"description":118,"timeFrame":33},"Cumulative incidence of treatment-related mortality for the whole protocol","Time from diagnosis until death during induction, death in complete remission or death from second malignant neoplasm (if not related to SMN-treatment).",{"measure":120,"description":121,"timeFrame":107},"Cumulative incidence of treatment-related mortality R1+R2","Time from randomisation until death in complete remission or death from second malignant neoplasm (if not related to SMN-treatment).",{"measure":123,"description":121,"timeFrame":40},"Cumulative incidence of treatment-related mortality R3",{"measure":125,"description":126,"timeFrame":76},"Cumulative incidence of treatment-related mortality TKI","Time from start of TKI until death in complete remission or death from second malignant neoplasm (if not related to SMN-treatment).",{"measure":128,"description":129,"timeFrame":33},"Leukaemia specific mortality for the whole protocol","Time from diagnosis until death after resistant disease or relapse - as defined in the protocol.",{"measure":131,"description":132,"timeFrame":37},"Leukaemia specific mortality for R1+R2","Time from randomisation until death after relapse - as defined in the protocol.",{"measure":134,"description":132,"timeFrame":40},"Leukaemia specific mortality for R3",{"measure":136,"description":137,"timeFrame":76},"Leukaemia specific mortality for TKI","Time from start of TKI until death after relapse - as defined in the protocol.",{"measure":139,"description":140,"timeFrame":141},"Incidence of Adverse Events of Special Interest (AESIs) per treatment-phase in the whole protocol and TKI intervention","Cumulative incidence of 19 AESIs as defined in the protocol","From time of diagnosis after each treatment-phase (one extra in the middle of maintenance) and annually until 5 years from discontinuation of therapy.",{"measure":143,"description":144,"timeFrame":145},"Incidence of Adverse Events of Special Interest (AESIs) extra assessment (R1+R2)","Cumulative incidence of 4 additional AESIs as defined in the protocol","Cumulative incidence of AESIs estimated 3 months after start of maintenance (R1+R2) and at the end of maintenance (R2)",{"measure":147,"description":148,"timeFrame":149},"Incidence of Adverse Events of Special Interest (AESIs) extra assessment (R3)","Cumulative incidence of 3 additional AESIs as defined in the protocol","Cumulative incidence of AESIs estimated at the end of maintenance.",{"measure":151,"description":152,"timeFrame":153},"Incidence of Serious Adverse Events (SAEs) and Adverse Events (AEs) related to R3","Cumulative incidence of SAEs and AEs (with limitations) as defined in the protocol","From time of randomisation until the end of maintenance therapy (approximately 77 weeks from randomisation)",{"measure":155,"description":156,"timeFrame":157},"Quantitative measures of toxicity R1+R2","Days: in hospital, with iv antibiotics, with iv analgesics, with iv nutritional support","From time of randomisation, assessment after delayed intensification and 6 weeks after start of maintenance",{"measure":159,"description":160,"timeFrame":161},"Metabolic consequences of steroid exposure (R2)","Measurements of BMI","At the end of therapy (approximately 94 weeks from randomisation) and 5 years after discontinuation of treatment",{"measure":163,"description":164,"timeFrame":24},"Association of Disease-free survival (DFS) with DNA-TG for R3-TEAM","Disease-free survival (DFS) - as defined above associated with DNA-TG.",{"measure":166,"description":167,"timeFrame":168},"Cumulative incidence of Sinusoidal Obstruction Syndrome (SOS) and Nodular Regenerative Hyperplasia (NRH) for R3-TEAM","Time from randomisation until diagnosis of SOS or NRH as defined in the protocol or end of follow-up.","Cumulative incidence of SOS\u002FNRH estimated at the end of follow-up.",{"measure":170,"description":171,"timeFrame":172},"Cumulative incidence of Osteonecrosis for R3-TEAM","Time from randomisation until diagnosis of osteonecrosis as defined in the protocol or end of follow-up.","Cumulative incidence of osteonecrosis estimated at the end of follow-up.",{"measure":174,"description":175,"timeFrame":176},"Event-free survival (EFS) for ALLTogether1 DS","Event-free survival as defined in the protocol, from the start of Blinatumomab until death from any cause, relapse, second malignancy, protocol therapy failure (MRD\\>1% after 2 cycles blinatumomab and Augmented BFM consolidation) or end of follow-up.","From the start of Blinatumomab, 5 year estimate will be measured but adequate follow-up for this estimate will be ensured: at least 5 years follow-up.",{"measure":178,"description":179,"timeFrame":180},"Incidence of Blinatumomab refractory disease for ALLTogether1 DS","Incidence of progressive disease under Blinatumomab treatment or MRD ≥1% at the end of the 2nd cycle of Blinatumomab.","From the start of Blinatumomab until end of 2nd cycle of Blinatumomab (each cycle is 4 weeks followed by a 2-week treatment free period)",{"measure":182,"description":183,"timeFrame":184},"Incidence of Protocol Therapy Failure for ALLTogether1 DS","Incidence of patients who have MRD ≥1 % post 2 cycles of Blinatumomab followed by Augmented BFM consolidation, corresponding to original protocol day 99, or unchanged\u002Fincreasing MRD during Augmented BFM consolidation corresponding to original protocol day 57.","From the start of Blinatumomab until the end of Consolidation 1 (85-140 days: 15-70 days of Blinatumomab therapy + 70 days of Consolidation 1)",[186,190],{"measure":187,"description":188,"timeFrame":189},"6-mercaptopurine and Methotrexate metabolite pharmacokinetics (i.e. Ery-TGN\u002FMeMP\u002FMTXpg) for R3-TEAM","Measurements of metabolites Ery-TGN\u002FMeMP\u002FMTXpg during Maintenance therapy.","From start of Maintenance therapy until the end of Maintenance therapy (protocol week 38 until protocol week 108)",{"measure":191,"description":192,"timeFrame":189},"Abnormal liver function parameters (including hypoglycemia) for R3-TEAM","Liver function parameters including hypoglycemia during Maintenance therapy",{"allocation":194,"interventionModel":195,"interventionModelDescription":196,"primaryPurpose":197,"observationalModel":198,"timePerspective":198,"maskingInfo":199},"RANDOMIZED","SEQUENTIAL","Master protocol with risk-stratification. The risk-stratified groups will proceed to non-randomised or randomised interventions in single arm (TKI) and (Blinatumomab) and parallel (R1\u002FR2\u002FR3) models respectively.","TREATMENT",null,{"masking":200,"maskingDescription":198,"whoMasked":198},"NONE","ALLTogether is a European clinical treatment study for acute lymphoblastic leukaemia (ALL) in infants, children and young adults. The aims are to improve survival and quality of survival. In young people, ALL has excellent outcome with an overall survival of about 92% in children and 75% in young adults. Infants with BCP-ALL and KMT2A-rearrangements have a worse outcome and are treated according to separate protocols, but infants with KMT2A-germline and T-cell ALL have acceptable outcome on standard ALL therapy. However, patients still die of disease - from relapse because of under-treatment and a large fraction of patients are also over-treated: All patients risk treatment-related death and some suffer long-term side-effects or secondary cancer. To show improvement with such good survival, large populations are needed.\n\nStudy groups from Sweden, Norway, Iceland, Denmark, Finland, Estonia and Lithuania (NOPHO), the UK (UKALL), the Netherlands (DCOG), Germany (COALL), Belgium (BSPHO), Portugal (SHOP), Ireland (PHOAI), and France (SFCE), have designed a common treatment protocol.\n\nThe study has a complex clinical trial design with sub-protocols (the randomisations \u002F intervention) connected to a master protocol. The master protocol consists of well established therapy-elements and in its design typical for current ALL therapy. The master protocol therapy is in the study design considered as standard of care (SOC) therapy for infants, children and young adults with ALL.\n\nThe study structure is defined by a master protocol onto which randomised and interventional sub-protocols as well as sub-studies may be added, run and stop in a modular fashion.\n\nThe randomisations \u002F intervention may identify therapy that is less toxic, but equally efficacious for sub-groups of patients and innovative therapy that may reduce relapses and death from ALL. In the master protocol, improved risk-stratification is likely to increase survival and reduce unnecessary toxicity and the introduction of therapeutic drug monitoring (TDM) of Asparaginase activity will make the use of Asparaginase more rational and efficient and may thus improve overall outcomes.\n\nThe investigators hypothesise that patients stratified to the standard-risk group are over-treated. Therefore, it will be tested if the treatment can be safely reduced. In the R1 randomisation, patients will be randomised to receiving the Delayed Intensification (DI) phase of therapy with or without the anthracycline Doxorubicin.\n\nA similar hypothesis of over-treatment will also be tested in patients stratified to the intermediate risk-low group. In the R2 randomisation patients will be randomly assigned to either removal of Doxorubicin during the DI phase or removal of Vincristine and Dexamethasone pulses during the maintenance phase or to the control group, which will be treated with Doxorubicin in DI as well as Vincristine and Dexamethasone pulses during maintenance. Patients will only be randomised once.\n\nRandomisation R1 and R2 are only considered for children since adults have worse outcome and very poor survival after relapse, but the risk-stratification is likely to reduce the number of high-risk cases also in the adult-group.\n\nPatients stratified as intermediate risk-high (IR-high) are identified as having an increased risk of relapse and thus a less favourable prognosis than the standard- and intermediate risk-low groups, but a more favourable prognosis than the high risk patients. The majority of all relapses in childhood ALL is expected to occur in the IR-high group. Following a relapse, only approximately 40% of the children can be successfully treated again and for adults the corresponding figure is less than 20 %, so preventing relapses is very important. New treatment options that improves the antileukaemic efficacy and which have an improved safety profile are urgently needed.\n\nFor IR-high patients Randomisation 3 (R3) is available. In R3 patients will be randomised to receive either:\n\n1. the first six weeks of maintenance treatment are replaced by two 3- week cycles of Inotuzumab ozogamicin (InO) - Besponsa®. This is followed by maintenance therapy similar to the standard arm.\n2. the addition of low dose 6-tioguanine (6TG) as an addition to the standard maintenance therapy.\n3. standard maintenance therapy.\n\nPatients with ABL-class fusions in their leukaemic clone will, as a non-randomised experimental intervention, be treated with an addition of a tyrosine-kinase inhibitor during the induction phase (for patients \\\u003C25 years) and from the consolidation phase (patients ≥25 years). This intervention may shift therapy for previously resistant cases to lower intensity treatment with the associated reduced morbidity and may also reduce the number of relapses in analogy with the results in Ph+ ALL. The reason for not performing a randomised comparison is the rarity of the aberration and also the diversity of ABL-class fusions, reducing statistical power for any comparison further. For this reason, the results of this intervention may be pooled with other study-groups trying similar approaches.\n\nA new intervention is introduced for Down syndrome patients with CD19 positive ALL: ALLTogether1 DS (NRI2). For Down syndrome-ALL patients who have end of Induction MRD detectable but \\\u003C25% two conventional chemotherapy consolidation blocks will be replaced with two blocks of Blinatumomab. Recruitment to this intervention was closed at the end of August 2024.\n\nFor high-risk B-lineage patients, CAR-T therapy can be an alternative to high-risk blocks and stem-cell transplant, but in this case the intervention (CAR-T infusion) will be performed outside the ALLTogether1 study. However, the stratification-system in ALLTogether1 will define the population with a potential CAR-T indication.\n\nALLTogether1 also includes five sub-studies:\n\nEfficacy and pharmacokinetics of Imatinib in ABL-class fusion positive ALL\n\nTarget population: All ABL-class patients enrolled in the ALLTogether study. Biomaterials to be collected at diagnosis, during TKI treatment, follow-up and relapse.\n\nAims\n\n1. To determine the efficacy and dosing target of imatinib in the treatment of ABL-class leukemia\n2. To find the best discriminative biomarkers for TKI response in ABL-class ALL\n3. To determine the frequency of intrinsic (at diagnosis) and acquired TKI resistance (due to treatment), including backtracking of mutations using imatinib PK\u002FPD findings during treatment\n4. To find causes of TKI resistance in ABL-class patients\n5. To describe the pharmacokinetics of Imatinib in TKI-treated patients\n\nObjectives\n\n1. To determine the percent of ABL-class patients who need to switch from IR-high to HR because of high MRD levels\n2. To determine the effect of imatinib exposure on clinical outcome, including pharmacokinetic measurements of imatinib\n3. To determine the molecular response to imatinib by monitoring fusion gene levels and mutational spectrum at diagnosis and during follow up\n4. To determine whether the molecular response parameters reflect the Ig\u002FTCR MRD or flow-MRD response or are a better predictor of therapy failure than Ig\u002FTCR or flow-based MRD monitoring\n5. To determine the phosphorylation status of ABL-class proteins and presence of TKI-resistance associated mutations in ABL genes prior to imatinib treatment and the emergence of such mutations during treatment with imatinib\n6. To determine the presence of mutations in regulatory \u002Fother genes before and during imatinib treatment and functionally address the importance of these mutations in TKI resistance\n7. To determine whether the efficacy of TKIs depends on the type of fusion gene\n8. To describe inter- and intraindividual variations in imatinib PK (=trough levels) during therapy of ABL-class ALL\n9. To describe associations between PK of imatinib and end-of-induction MRD (\\\u003C25 yrs only) and end-of-consolidation MRD (all patients)\n10. To describe associations between imatinib PK and relapse rates (overall, bone-marrow and CNS), event-free survival as well as overall survival;\n11. To describe associations between imatinib PK and toxicities (including e.g. height z-scores at diagnosis and end of therapy, pancreatitis, treatment delays) with focus on those toxicities that are routinely monitored in ALLTogether.\n\nBiomarkers to Reform Approaches to therapy-Induced Neurotoxicity (BRAIN)\n\nTarget population: All patients registered on ALLTogether1 aged ≥ 4 years at end of therapy (Arm A) and all patients registered on ALLTogether1 aged 2-21 years at start of therapy (Arm B) and without:\n\n1. Pre-existing neurodevelopmental delay (e.g Trisomy 21) prior to diagnosis of ALL\n2. Significant visual or motor impairment preventing use of a computer\u002Ftouch screen ipad\n\nAll centres are invited to enrol to arm A (Main BRAIN) of the study. Arm B (Longitudinal BRAIN) will be carried out in selected centres.\n\nAims\n\n1. To implement universal screening of all children for adverse neurocognitive outcomes at the end of treatment using a validated user-friendly computer software programme (CogState) and compare neurocognitive outcomes by treatment allocation (Arm A).\n2. To identify risk factors for adverse outcomes including whether acute neurotoxic events are associated with poor performance on cognitive tests at end of therapy compared to patients without acute neurotoxicity (Arm A).\n3. To examine changes in neurocognitive performance over time and the risk\u002Fprotective factors associated with differences in outcome, such as demographic, clinical, and physical\u002Fpsychosocial factors (Arm B).\n\nPrimary end-point\n\na. Proportion of children with a z-score \\\u003C1.5 on detection and\u002For identification CogState tasks in each treatment arm at the end of ALL therapy. A z-score \\\u003C 1.5 correlates with moderate cognitive impairment at a level that may require additional support.\n\nSecondary and exploratory end-points\n\n1. Association between CogState scores at end of treatment and overt neurotoxic episodes as recorded on the trial adverse event database.\n2. Association between Cogstate scores and clinical and demographic variables - age, sex, ethnicity, CNS status.\n3. Proportion of children with scores \\\u003C1.5SD for one card learning (learning), one back (working memory), Groton's maze (executive function), digit symbol substitution (processing speed) on different treatment arms.\n4. Association between CogState scores and patient reported outcome measures\u002FQuality of life measurements collected as part of the main ALLTogether1 trial.\n5. Changes in neurocognitive scores over time, including CogState and BRIEF-2\u002FBRIEF-A scores.\n6. Association between neurocognitive scores over time and interactions with demographic variables (age, sex), clinical variables (treatment arm, neurotoxicity), social-emotional and physical functioning (SDQ, PedsQL 4.0 Generic; PedsQL 3.0 Fatigue), and family factors (MEES; PedsQL FIM).\n\nAssociation between asparaginase activity levels and outcome\n\nTarget population: All patients included in the ALLTogether1 protocol are eligible for participation.\n\nPrimary aim\n\nTo study the association between asparaginase activity levels and outcome (MRD, relapse, survival)\n\nSecondary aims\n\n1. To evaluate the association between asparaginase activity levels and toxicities, such as pancreatitis, infections and deep venous thrombosis (DVT)\n2. To evaluate the association between asparaginase activity levels and hepatotoxicity in a subset of patients\n\nCSF-Flow\n\nTarget population: All patients included in the ALLTogether1 protocol are eligible for participation\n\nAims\n\n1. To use cerebrospinal fluid (CSF) flow cytometry (FCM) to improve the accuracy of diagnostic tests for CNS leukaemia compared to conventional CSF cytology. An associated objective will be to develop a recommended protocol for CSF flow cytometry with external quality assessment to ensure uniformity of measurement across the ALLTogether consortium.\n2. To investigate whether negative FCM identifies a group of children at very low risk of CNS relapse, suitable for testing de-escalation of CNS-directed therapy in future trials.\n3. To investigate whether positive FCM can identify children at increased risk of CNS relapse and whether patients with persistent positivity (FCM positive at day 15 onwards) might benefit from studies testing escalated CNS-directed therapy or a switch to more intensive treatment arms.\n4. To collect matching CSF supernatant for studies comparing CSF FCM with soluble biomarkers (e.g. metabolic, cell-free DNA, proteomic and microRNA).\n\nMaintenance therapy pharmacokinetics\u002F-dynamics study\n\nTarget population: All patients included in the ALLTogether1 protocol are eligible for participation. For IR-high patients participating in the randomised InO- and TEAM sub-protocols, the monitoring of 6-mercaptopurine (6MP)\u002FMethotrexate (MTX) metabolites at three months intervals is mandatory.\n\nAims and specific objectives\n\n1. To map pharmacokinetics of 6MP and MTX during maintenance therapy in all patients in the ALLTogether protocol.\n2. To associate metabolite profiles with TPMT and NUDT15 variants, as routinely analysed in ALLTogether.\n3. To explore the association of event-free survival with DNA-TG and other 6MP\u002FMTX metabolites.\n4. To explore the association between risk of second cancers with DNA-TG and other 6MP\u002FMTX metabolites.\n5. To explore the association of risk of invasive infections with DNA-TG and other 6MP\u002FMTX metabolites.\n6. To explore the association of risk of osteonecrosis with DNA-TG and other 6MP\u002FMTX metabolites.\n7. To explore the association of sinusoidal obstruction syndrome with DNA-TG and other 6MP\u002FMTX metabolites.",[203,207,213,216,220,223,228,233,238,243],{"label":204,"type":205,"description":206,"interventionNames":198},"R1 - SR standard arm","NO_INTERVENTION","Standard risk arm receiving standard treatment (Delayed Intensification including Doxorubicin).",{"label":208,"type":209,"description":210,"interventionNames":211},"R1 - SR experimental arm","EXPERIMENTAL","Standard risk arm, receiving Delayed Intensification without Doxorubicin IV 3 x 30 mg\u002Fm2\u002Fdose.",[212],"Drug: Omitted Doxorubicin",{"label":214,"type":205,"description":215,"interventionNames":198},"R2 - IR-low standard arm","Standard treatment with Delayed Intensification including Doxorubicin and Maintenance including Vincristine+Dexamethasone pulses.",{"label":217,"type":209,"description":218,"interventionNames":219},"R2 - IR-low experimental arm A","Standard treatment with omission of Doxorubicin IV 3 x 30 mg\u002Fm2\u002Fdose in the Delayed Intensification phase.",[212],{"label":221,"type":205,"description":222,"interventionNames":198},"R3 - IR-high standard arm","Intermediate risk high arm receiving Standard Maintenance Therapy.",{"label":224,"type":209,"description":225,"interventionNames":226},"R3-InO - IR-high experimental arm","Inotuzumab IV 0,5 mg\u002Fm2, given on days 253, 260, 267 and on days 274, 281, 288 before start of Standard Maintenance Therapy.",[227],"Drug: Inotuzumab Ozogamicin+Standard Maintenance Therapy",{"label":229,"type":209,"description":230,"interventionNames":231},"ABL-class fusions intervention","Imatinib p.o. 340 mg\u002Fm2 given daily from day 15 or 30 (depending on age) to the end of therapy (week 106) in addition to Standard IR-high chemotherapy.",[232],"Drug: Imatinib",{"label":234,"type":209,"description":235,"interventionNames":236},"R3-TEAM - IR-high experimental arm","6-tioguanine p.o, 2,5-12,5 mg\u002Fm2, given daily in addition to Standard Maintenance Therapy.",[237],"Drug: 6-tioguanine+Standard Maintenance Therapy",{"label":239,"type":209,"description":240,"interventionNames":241},"ALLTogether1 DS Blinatumomab intervention","Blinatumomab IV, 5 mcg\u002Fm2\u002Fday up to 28 mcg\u002Fday (detailed dosing in protocol) continous infusion. 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KG)",{"name":1840,"class":1822},"Belgium Health Care Knowledge Centre",{"name":1842,"class":6},"Karolinska Institutet",{"name":1844,"class":6},"Cancer Research UK",{"name":1846,"class":1825},"Fundação Rui Osório de Castro",{"name":1848,"class":1825},"Acreditar - Associação de Pais e Amigos das Crianças com Cancro",{"name":1850,"class":1825},"Grupo Português De Leucemias Pediátricas",{"name":1852,"class":1828},"Amgen",{"name":1854,"class":1828},"Nova Laboratories Limited",{"name":1856,"class":6},"Danish Child Cancer Foundation",{"name":1858,"class":6},"Danish Cancer Society",{"name":1860,"class":6},"The Novo Nordic Foundation",{"name":1862,"class":6},"Assistance Publique - Hôpitaux de Paris",{"name":1864,"class":1822},"Direction Générale de l'Offre de Soins",{"name":1866,"class":6},"Swedish Cancer Society","100386119","phase-3-a-treatment-study-protocol-for-participants-0-45-years-with-acute-lymphoblastic-leukaemia-100386119",false,"NCT04307576","A Treatment Study Protocol for Participants 0-45 Years With Acute Lymphoblastic Leukaemia","ALLTogether1 - A Treatment Study Protocol of the ALLTogether Consortium for Children and Young Adults (0-45 Years of Age) With Newly Diagnosed Acute Lymphoblastic Leukaemia (ALL)","Inclusion Criteria:\n\n* Patients newly diagnosed with T-lymphoblastic (T-cell) or B-lymphoblastic precursor (BCP) leukaemia (ALL) according to the WHO-classification of Tumours of Haematopoetic and Lymphoid Tissues (Revised 4th edition 2017) and with a diagnosis confirmed by an accredited laboratory at a participating paediatric oncology or adult haematology centre.\n* Age 0 - \\\u003C 46 years (one day before 46th birthday) at the time of diagnosis with the exception of infants with KMT2A-rearranged (KMT2A-r) BCP ALL.\n* Patients with surface immunoglobulin negative (sIG-) BCP-ALL and an IG::MYC rearrangement, unless they have a concurrent BCL2\u002F6 rearrangement. T-ALL patients with MYC translocations.\n* Informed consent signed by the patient and\u002For parents\u002Flegal guardians according to country-specific age-related guidelines.\n* The ALL diagnosis should be confirmed by an accredited laboratory at a participating paediatric oncology or adult haematology centre.\n* The patient should be diagnosed and treated at a participating paediatric oncology or adult haematology centre in the participating countries.\n* The patient should be a resident in one of the participating countries on a permanent basis or should intend to settle in a participating country, for instance by an application for asylum. Patients who are visiting the country as tourists should not be included. However, returning expatriots with primary diagnosis abroad may be included if no treatment has been administered and the diagnostic procedures are repeated at a participating centre.\n* All women of childbearing potential (WOCBP) have to have a negative pregnancy test within 2 weeks prior to the start of treatment.\n* For each intervention\u002Frandomisation an additional set of inclusion-criteria is provided.\n\nExclusion Criteria:\n\n* Age \\\u003C 365 days and KMT2A-rearranged (KMT2A-r) BCP-ALL (documented presence of a KMT2A-split by FISH and\u002For a KMT2A fusion transcript).\n* Age \\>45 years at diagnosis.\n* Patients with a previous malignant diagnosis (ALL as a second malignant neoplasm - SMN).\n* Relapse of ALL.\n* Patients with mature B-ALL (as defined by surface IG positivity) or any patients with IG::MYC and a concurrent BCL2\u002F6 rearrangement.\n* Patients with Ph-positive ALL (documented presence of t(9;22)(q34;q11) and\u002For of the BCR::ABL fusion transcript). These patients will be transferred to an appropriate trial for t(9;22) if available.\n* Previously known ALL prone syndromes (e.g. Li-Fraumeni syndrome, germline ETV6 mutation), except for Down syndrome. Exploration for such ALL prone syndromes is not mandatory and patients in whom genetic work-up reveals a new germ-line mutation (index-cases) will remain in the study.\n* Treatment with systemic corticosteroids corresponding to (\\>10mg prednisolone\u002Fm2\u002Fday) for more than one week and\u002For other chemotherapeutic agents in a 4-week interval prior to diagnosis (pre-treatment).\n* Pre-existing contraindications to any treatment according to the ALLTogether protocol (constitutional or acquired disease prior to the diagnosis of ALL preventing adequate treatment).\n* Any other disease or condition, as determined by the investigator, which could interfere with the participation in the study according to the study protocol, or with the ability of the patients to cooperate and comply with the study procedures.\n* Women of childbearing potential who are pregnant at the time of diagnosis.\n* Women of childbearing potential and fertile men who are sexually active and are unwilling to use adequate contraception during therapy. Efficient birth control is required.\n* Female patients, who are breast-feeding.\n* Essential data missing from the registration of characteristics at diagnosis (in consultation with the protocol chair).\n* For each intervention\u002Frandomisation an additional set of exclusion-criteria is provided.","ALL","0 Years","45 Years",{"count":1878,"type":1879},6430,"ESTIMATED","INTERVENTIONAL",[1882],"PHASE3","ALLTogether collects the experience of previously successful treatment of infants, children and young adults, with ALL from a number of well-renowned study groups into a new master protocol, which is both a comprehensive system for stratification and treatment of ALL in this age-group as well as the basis for several randomised and interventional trials included in the study-design.",[1885],"Leukemia, Acute Lymphoblastic",[1887,1888,1874,1889,1890,1891,1892,1893,273,277,1894,1895],"Leukemia","Acute Leukemia","ALLTogether","Leukaemia","Inotuzumab ozogamicin","Besponsa","ALLTogether1","6-tioguanine","6-thioguanine","2026-08-11",{"date":1898,"type":1899},"2026-08-12","ACTUAL",{"date":1901,"type":1899},"2020-07-13",{"date":1903,"type":1879},"2033-06",{"name":1817,"class":6},137]