Risk-Based Classification System of Patients With Newly Diagnosed Acute Lymphoblastic Leukemia

Study ID

Cancer Related

Healthy Volunteers

Study Sites

  • UT Southwestern-Other
  • Children’s Medical Center (Dallas, Plano, Southlake)

Darla Tate-Sozansky

Principal Investigator
Tamra Slone, M.D.

Official Title

Classification of Newly Diagnosed Acute Lymphoblastic Leukemia (ALL)

Brief Overview

This research trial studies a risk-based classification system for patients with newly
diagnosed acute lymphoblastic leukemia. Gathering health information about patients with
acute lymphoblastic leukemia may help doctors learn more about the disease and plan the best



I. To provide a risk classification scheme for all patients with newly diagnosed acute
lymphoblastic leukemia (ALL), which will be used to assign treatment on Children's Oncology
Group (COG) frontline ALL treatment studies.

II. To capture classification data for correlative studies accompanying current COG ALL
treatment protocols.

III. To provide a central reference guide for all required and research studies that will be
conducted in local and reference laboratories for all newly diagnosed ALL patients.

IV. To provide a mechanism for optional banking of leukemia and germline specimens for
current and future research.


Patients undergo blood sample collection and bone marrow biopsies at baseline and during and
after induction therapy for immunophenotyping for ALL confirmation and classification,
deoxyribonucleic acid (DNA) ploidy, genomic variation, and cytogenetic (BCR-ABL, trisomies
4+10, and molecular testing for translocations) analysis by flow cytometry and fluorescent
in situ hybridization (FISH). Immunophenotype results obtained on this study are used to
determine patient's assignment to specific clinical-trial treatments. Some samples (leukemic
and germline) may be banked for current and/or future analyses.

Participant Eligibility

Inclusion Criteria:

- Patient has newly diagnosed acute leukemia:

- > 25% blasts on a bone marrow (BM) aspirate or

- If a BM aspirate is not obtained or is not diagnostic of acute leukemia, the
diagnosis can be established by a pathologic diagnosis of acute leukemia on a BM
biopsy or

- A complete blood count (CBC) documenting the presence of at least 1,000/uL
circulating leukemic blasts

- Adequate samples must be provided to the reference and/or COG-approved cytogenetics
laboratories to allow completion of the studies needed for risk-stratification

- If a BM aspirate is not performed, or adequate material cannot be obtained,
peripheral blood (PB) can be substituted for BM if there are at least 1,000
circulating blasts/uL (i.e., a white blood cell [WBC] count of 10,000/uL with
10% blasts or a WBC count of 5,000/uL with 20% blasts); if only PB is submitted,
please obtain and send twice the volume of PB as the recommended BM volume
specified; the patient will remain on AALL08B1 as long as all required central
laboratory tests can be successfully performed; as long as there are at least
1,000/uL PB blasts, institutions are encouraged to submit PB in addition to BM
samples to make sure that adequate material is available to perform the required

- If an adequate BM aspirate cannot be obtained and there are fewer than 1,000/uL
PB blasts, the patient is not eligible for AALL08B1 or a frontline COG ALL
clinical trial (there are NO exceptions to this rule)

- Patient has suspected ALL:

- Patients whose blast morphology is obviously myeloid, or whose blasts are
myeloperoxidase positive, should not be enrolled on AALL08B1; however, patients
with true biphenotypic or bilineage leukemia (i.e., patient presents with blasts
with significant expression of multiple lymphoid and myeloid markers such that
assignment to a single lineage is not possible) are eligible to enroll in
AALL08B1 for cell banking

- Samples must be sent to a COG-approved cytogenetics laboratory, and COG Reference
Laboratory studies; if informative results needed for treatment stratification are
not available at specified time-points during induction, patients will not be
eligible to receive post-induction therapy on a COG ALL trial

- All patients and/or their parents or legal guardians must sign a written informed

- All institutional, Food and Drug Administration (FDA) and National Cancer Institute
(NCI) requirements for human studies must be met

Exclusion Criteria:

- Patient must not have received prior cytotoxic therapy except for steroids or
intrathecal chemotherapy

- Patient must not have secondary ALL that developed after treatment of a prior
malignancy with cytotoxic chemotherapy