Protocol for ICiCLe-ALL-14 (InPOG-ALL-15-01): a prospective, risk stratified, randomised, multicentre, open label, controlled therapeutic trial for newly diagnosed childhood acute lymphoblastic leukaemia in India

Abstract

Background In the west, survival following treatment of childhood acute lymphoblastic leukaemia (ALL) approaches 90%. Outcomes in India do not exceed 70%. To address this disparity, the Indian Collaborative Childhood Leukaemia group (ICiCLe) developed in 2013 a contemporary treatment protocol for uniform risk-stratified management of first presentation ALL based on cytogenetics and minimal residual disease levels (MRD). A multicentre randomised clinical trial opened in 2016 (ICiCLe-ALL-14) and examines the benefit of randomised interventions to decrease toxicity and improve outcomes. Methods Patients 1–18 years with newly diagnosed ALL are categorised into four risk groups based on presentation features, tumour genetics and treatment response. Standard risk includes young (< 10 years) B cell precursor ALL (BCP-ALL) patients with low presentation leucocyte count (< 50 × 109/L) and no high-risk features. Intermediate risk includes BCP-ALL patients with no high-risk features but are older and have high presentation leucocyte counts and/or bulky disease. High risk includes BCP-ALL patients with any high-risk feature, including high-risk genetics, central nervous system leukaemia, poor prednisolone response at treatment day 8 and high MRD (≥ 0·01%) at the end of induction. Patients with T-lineage ALL constitute the fourth risk group. All patients receive four intensive treatment blocks (induction, consolidation, interim maintenance, delayed intensification) followed by 96 weeks of maintenance. Treatment intensity varies by risk group. Clinical data management is based on a web-based remote data capture system. The first randomisation examines the toxicity impact of a shorter induction schedule of prednisolone (3 vs 5 weeks) in young non-high-risk BCP-ALL. The second randomisation examines the survival benefit of substituting doxorubicin with mitoxantrone in delayed intensification for all patients. Primary outcome measures include event-free survival (overall, by risk groups), sepsis rates in induction (first randomisation) and event-free survival rates following second randomisation. Discussion ICiCLe-ALL-14 is the first multicentre randomised childhood cancer clinical trial in India. The pre-trial phase allowed standardisation of risk-stratification diagnostics and established the feasibility of collaborative practice, uniform treatment, patient enrolment and data capture. Pre-trial observations confirm the impact of risk-stratified therapy in reducing treatment-related deaths and costs. Uniform practice across centres allows patients to access care locally, potentially decreasing financial hardship and dislocation. Trial registration Clinical Trials Registry-India (CTRI) CTRI/2015/12/006434. Registered on 11 December 2015

Prognostic utility of key copy number alterations in T cell acute lymphoblastic leukemia

“…Adult T‐ALL patients were treated with BFM98 protocol while pediatric patients received treatment according to the Indian Childhood Collaborative Leukemia group protocol (ICiCLe) 15 . These patients were initially treated with steroid prophase for 7 days and at day 8, absolute blast count was measured for assessment of prednisolone response.…”

“…Adult T-ALL patients were treated with BFM98 protocol while pediatric patients received treatment according to the Indian Childhood Collaborative Leukemia group protocol (ICiCLe). 15 These patients were initially treated with steroid prophase for 7 days and at day 8, absolute blast count was measured for assessment of prednisolone response. The patients were categorized into two groups into prednisolone good responder (PGR) and prednisolone poor responder (PPR) based on absolute blast count in PB on day 8 of initiation of therapy, as described previously.…”

Experience of Paediatric Acute Lymphoblastic Leukemia Service in A Newly Established Haemato-Oncology Center in Bangladesh: Opportunities and Challenges

“…All patients received treatment adapted from the standard arm of ICICLE (Indian Childhood Collaborative Leukemia Group) protocol. 12 Ethical clearance was obtained from the institutional review board. Informed written consent was taken, and confidentiality of data was maintained.…”

Pulmonary Aspergillosis Silently Presenting as Pneumothorax in Children with Leukemia: A Report of Three Cases.

“…He was diagnosed with B-ALL and started on remission induction chemotherapy as per the Indian Childhood Collaborative Leukemia Group (ICiCLe) protocol under the intermediate-risk arm. 4 On day 22 of induction, child complained of difficulty in breathing and chest pain on left side. On physical assessment, the trachea was shifted to the right and hyperresonant percussion note on left hemithorax.…”