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To improve the outcome of children and young adults with ALL by testing a number of randomised and non-randomised interventions.

These interventions are designed to either:

- decrease the risk of serious side-effects and therapy

- decrease the risk of relapse for patients at high risk of relapse and therapy

- decrease the risk of relapse and reduce toxic side-effects for patients with genetic lesions targetable by Tyrosine-kinase inhibition by the addition of Imatinib to standard chemotherapy.

- decrease the risk of serious side-effects for patients with high-risk B-cell precursor ALL by making them available for experimental immunotherapy

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Inclusion Criteria:

Patients with newly diagnosed T-lineage or precursor B-cell ALL.

Age between 1-29 years

Written informed consent from parents/guardians and patient

Exclusion Criteria:

Age ≥46 years at diagnosis.

Age <365 days at diagnosis.

Patients with a previous malignant diagnosis.

Relapse of ALL

Mature B-ALL

Philadelphia positive ALL

Treatment with systemic corticosteroids for more than one week and/or other chemotherapeutic agents within 4 weeks prior to diagnosis.

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TYA who fulfil SR criteria will be EXEMPT from the randomisation (R1)

TYA with IR Stratification will be EXEMPT from the IR-Low arm. All IR TYA will follow the IR-High therapy

TYA >25yrs will omit the PEG-Asparaginase dose on day 4. 1st dose will be on D18 with the D4 dose added in later in treatment (D113)

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Research Nurses - Elise Longworth & Beckie Weaver 01865 234982 (Becca Walker on MAT until May 2023)
elise.longworth@ouh.nhs.uk
rebecca.weaver@ouh.nhs.uk

Toxicity/Admission reporting - paedhaem.oncresearch@nhs.net

Kamran's Ward - 01865 234068

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Please leave any thoughts, ideas or feedback (it is anonymized so don't be afraid!) so I can make this a success!

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Beckie is putting together an SOP and sampling box containing all the necessary EDTA bottles, forms and packaging. She will deliver them to each POSCU in the new year and be on hand to help with any questions.

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Asparaginase Request Form for A2G trial v5_15.10.2021 - Copy

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SAE reporting in ALLTogether requires documentation of Toxicities of Special Interest at specific timepoints.

Please continue to inform paedhaem.oncresearch@nhs.net of all ALL admissions. Any specific information on the toxicities listed above (exact temp, blood results etc) is so helpful for our reporting and source data.