Testing the Addition of Daratumumab to Chemotherapy for Treating Patients With Newly-Diagnosed T-Cell Lymphoblastic Leukemia (T-ALL) and T-Cell Lymphoblastic Lymphoma (T-LL)

Launched by CHILDREN'S ONCOLOGY GROUP · Jul 9, 2025

Keywords

ClinConnect Summary

This clinical trial is studying whether adding a medicine called daratumumab to standard chemotherapy can help treat children and young adults newly diagnosed with certain types of T-cell leukemia or lymphoma, which are cancers affecting the blood and lymphatic system. Daratumumab is a special kind of drug called a monoclonal antibody that targets a protein on cancer cells, helping the immune system recognize and kill them. The goal is to see if combining this drug with chemotherapy—which works by stopping cancer cells from growing and spreading—can improve treatment outcomes.

The trial is open to patients between about 1 year and 21 years old who have been newly diagnosed with T-cell acute lymphoblastic leukemia or T-cell lymphoblastic lymphoma at certain stages. To join, patients should not have had previous chemotherapy for their cancer, with some exceptions for short steroid treatments or other specific medications. Pregnant or breastfeeding patients, those with certain medical conditions like uncontrolled asthma or severe nerve problems, and some infections may exclude participation. If eligible, participants will receive the usual chemotherapy along with daratumumab and will be closely monitored to see how well the combination works and how safe it is. All patients and their families will receive detailed information and support throughout the study to help them understand and manage the treatment.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • All patients must be enrolled on APEC14B1 and consented to eligibility screening (part A) prior to treatment and enrolled on AALL2331.
• • Patients must be \> 365 days and \< 21 years of age at the time of diagnosis.
• • \* Newly diagnosed T-cell acute lymphoblastic leukemia (T-ALL) or T-lineage lymphoblastic lymphoma (T-LL) stages II-IV.
• • Note: A diagnosis of T-ALL is established when leukemic blasts lack myeloperoxidase or evidence of B-lineage derivation (CD19/CD22/CD20), and express either surface or cytoplasmic CD3 or two or more of the antigens CD8, CD7, CD5, CD4, CD2 or CD1a, and are present either in peripheral blood or \> 25% in the bone marrow. If surface CD3 is expressed on all leukemic cells, additional markers of immaturity, including TdT, CD34 or CD99 will be assessed for expression. Cases with uncertain expression will receive additional review within the appropriate Children's Oncology Group (COG) reference laboratory.
• • For T-LL patients with tissue available for flow cytometry, the criterion for diagnosis should be analogous to T-ALL. For tissue processed by other means (i.e. paraffin blocks), the methodology and criteria for immunophenotypic analysis to establish the diagnosis of T-LL defined by the submitting institution will be accepted.
• Exclusion Criteria:
• • Diagnosis of Down syndrome (trisomy 21).
• • Patients with known Charcot-Marie-Tooth disease.
• * \* Patients must not have received any cytotoxic chemotherapy for either the current diagnosis of T-ALL, T-LL or for any cancer diagnosis prior to the initiation of protocol therapy on AALL2331 with the exception of:
• • Steroid pretreatment: Prednisone or methylprednisolone for ≤ 120 hours (5 days) in the 7 days prior to initiating induction chemotherapy or for ≤ 336 hours (14 days) in the 28 days prior to initiation of protocol therapy does not affect eligibility.
• • Intrathecal cytarabine; or
• • Pretreatment with hydroxyurea; or
• • 600 cGy of chest irradiation, if medically necessary.
• • Pre-treatment with dexamethasone in the 28 days prior to initiation of protocol therapy is not allowed with the exception of a single dose of dexamethasone used during sedation to prevent or treat airway edema. Patients who receive a single dose of dexamethasone to prevent or treat airway edema in the 28 days preceding diagnosis are eligible for this study.
• • \* Female patients who are pregnant since fetal toxicities and teratogenic effects have been noted for several of the study drugs. A pregnancy test is required for female patients of childbearing potential.
• • Lactating females who plan to breastfeed their infants.
• • Sexually active patients of reproductive potential who have not agreed to use an effective contraceptive method for the duration of their study participation.
• • Known severe persistent asthma anytime in the previous two years or uncontrolled asthma of any classification.
• • Peripheral neurotoxicity: Pre-existing ≥ grade 2 sensory or motor peripheral neurotoxicity.
• • Seizure disorder: Patients must not have an uncontrolled seizure disorder. Patients with a seizure history or a controlled seizure disorder are eligible. A controlled seizure disorder is defined as having stable or decreasing symptoms over the past 3 months without anti-epileptic medications or is on a stable or decreasing dose of anti-epileptic medication.
• • \* Patients who are previously known to be seropositive for HIV except for HIV-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months of enrollment on this trial.
• • Patients with evidence of chronic hepatitis B (HBV) infection, except for patients who have an HBV viral load that is undetectable on suppressive therapy.
• • Patients with a history of hepatitis C virus (HCV) infection, except for those patients who have been treated and cured, or patients who are currently on HCV treatment who have an undetectable HCV viral load.
• • Patients with significant hepatic dysfunction defined as those with an alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase \[SGPT\]) \> 10x upper limit of normal (ULN) or direct bilirubin \> 2x ULN unless the patient has known Gilbert's syndrome or has hepatic involvement from leukemic or lymphomatous infiltration.
• • All patients and/or their parents or legal guardians must sign a written informed consent.
• • All institutional, Food and Drug Administration (FDA), and National Cancer Institute (NCI) requirements for human studies must be met.