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ALL-IC REL

ALL-IC relapsed ALL project

The Acute Lymphoblastic Leukaemia Inter Continental (ALL-IC) Study Group has completed its second frontline ALL trial. By standardizing therapy and involving flow cytometry based MRD in treatment stratification, patient outcomes improved further. Still 15-20% of patients relapse. When looked up in 2013, survival of relapsed patients in the ALL-IC Study Group lagged behind that achieved in best contemporary studies. Hence, a project was initiated by Prof. Janez Jazbec specifically dedicated to improve ALL 1st relapse results. This is the ALL-IC REL project, by the ALL-IC REL Study Group. There is much but not total overlap between countries / centres joining the 1st line ALL-IC trials and the ALL-IC REL project.

Steering committee:

  • Dániel Erdélyi, Semmelweis University, Budapest, Hungary (Chair from 2023)
  • Juan Tordecilla, Clinica Santa Maria, Santiago, Chile
  • Marko Kavčič, University Medical Centre, Ljubljana, Slovenia
  • Mirella Ampatzidou, Aghia Sophia Children’s Hospital, Athens, Greece)
  • Monica Makiya, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
  • Sophia Polychronopoulou, Aghia Sophia Children’s Hospital, Athens, Greece
  • Volkan Hazar, Memorial Health Group Medstar Yildiz Hospital, Antalya, Turkey

NATIONAL COORDINATORS:

Argentina (GATLA)

Bulgaria

  • Boryana Avramova,  University Hospital “Tsaritsa Johanna-ISUL” , Sofia, Bulgaria (b.avramova@sbaldohz.com)
  • Tanya Dimitrova Hristova, University Hospital “Tsaritsa Johanna-ISUL”, Sofia, Bulgaria (dr.tanyahris@gmail.com)

Chile

Croatia

Georgia

Greece

  • Sophia Polychronopoulou, Aghia Sophia Children’s Hospital, Athens, Greece (sophpol@otenet.gr)
  • Mirella Ampatzidou, Aghia Sophia Children’s Hospital, Athens, Greece (mirellaaba@yahoo.gr)

Hungary

Iran

Lebanon

Romania

  • Anca Colita, “Carol Davila” University of Medicine and Pharmacy, Fundeni Clinical Institute, Bucharest, Romania (ancacolita@yahoo.com)
  • Letitia Elena Radu, “Carol Davila” University of Medicine and Pharmacy, Fundeni Clinical Institute, Bucharest, Romania (letitia_radu@yahoo.com)

Russia

  • Natalia Batmanova, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia (batmanova_nataly@mail.ru)
  • Timur Valiev, Timur,  N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia (timurvaliev@mail.ru)
  • Mery Shervashidze, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia (shervashidze85@gmail.com)
  • Valeria Fominih, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia (valeryafominih@yandex.ru)

Serbia

Slovenia

Turkey

  • Volkan Hazar, Memorial Health Group Medstar Yildiz Hospital, Antalya, Turkey (volkanhazar62@gmail.com)
  • Koray Yalçın, Bahcesehir University Medical Park Göztepe Hospital, Istanbul, Turkey (koray.ylc@gmail.com)

Ukraine

  • Mykhailo Adyrov, Lviv Territorial Medical Association #1, Lviv, Ukraine (adyrov.m@gmail.com)
  • Oleksandr Lysytsia, National Specialized Children’s Hospital “Ohmtadyt”, Kyiv, Ukraine (a.lysystsiabmt@gmail.com)
  • Oleksandr Istomin, National Specialized Children’s Hospital “Ohmtadyt”, Kyiv, Ukraine (alexis19950107@gmail.com)

Uruguay

In 2017, the group agreed and distributed a unified treatment protocol addressing first relapse cases. This and later protocol versions are based mostly on the non-experimental arms of the IntReALL study protocols, and we regard them as current best practice guidance optimized for the resources available in ALL-IC conuntries. As flow-cytometric determination of minimal residual disease was already an integral part of the frontline ALL-IC studies and is a technology available, standardised, quality controlled in ALL-IC countries, flow-cytometry is used for assessment of treatment response in these protocols.

A common patient-registry was also established using the REDCap platform. Pseudonimised patient data are entered here with follow up MRD values, toxicity grading and data on outcome.

A monthly virtual tumour board meeting was initiated, which later merged into the FEDRRAL tumour board meetings organized by the IntReALL Study Group. We recommend submitting difficult cases for discussion there.

In 2021, we presented preliminary results at the virtual Childhood Leukemia and Lymphoma Conference (CLLS 2021, 11th-12th March 2021):(https://semmelweis.hu/tuzoltoklinika/files/2022/05/ALL-.IC-REL_e-poster_CLLS-2020-2021_v4.pdf). Results of a larger cohort with longer follow up and subgroup analyses are being prepared in the format of an original journal article.

Old protocol versions:

Actual protocol, with many relevant changes from the previous versions:

As per the knowledge of the steering committee, our guidance is applied in the following countries, either in all or just some of the centres: Argentina (GATLA), Armenia, Bulgaria, Chile, Croatia, Georgia, Greece, Hungary, Iran, Lebanon, North Macedonia, Romania, Russia, Serbia, Slovenia, Turkey. The ALL-IC REL study group would welcome further centres or countries to join. The protocol is open for use to anyone.

We encourage non-ALL-IC member centres or countries, too, to use the registry and upload data of patients treated (even if just partly) along this protocol. These data make it possible for us to learn and continuously improve our protocol. The register is at REDCap, a free secure IT platform. Patient stories, even modified or totally different treatment backbones, can be easily and conveniently recorded here. All users can download their or their countries’ own uploaded data any time. Those who contribute to the data registry will be acknowledged, possibly highlighted as co-authors in publications of this project. For access to the registry, please email Marko Kavcic at marko.kavcic@kclj.si