Treatment of Pediatric Very High-risk Acute Lymphoblastic Leukemia in Korea

"▪ Arm A : Philadelphia chromosome-positive : Induction (Except Consolidation #3 using Blinatumomab, all administration should be given with Dasatinib.)~* Morphologic CR after the Induction : Consolidation #1 → Consolidation #2 → Consolidation #3~ 1. If MRD \& qPCR not detected after the post-consolidation #1 : Consolidation #3 using HD MTX, HD Cytarabine → DI #1 → IM #2 → DI #2 → Maintenance~ 2. If MRD or qPCR positive after the post-consolidation #1 : Consolidation #3 using Blinatumomab →Allogeneic HSCT~* M2 or M3 after the Induction : Re-induction → Consolidation #2 → Consolidation #3 → Allogeneic HSCT~ 1. If MRD \& qPCR not detected after the post-consolidation #1 : Consolidation #3 using HD MTX, HD Cytarabine~ 2. If MRD or qPCR positive after the post-reinduction : Consolidation #3 using Blinatumomab~ * In Arm A, except Consolidation #3 using Blinatumomab, all administration should be given with Dasatinib."

"▪ Arm B : Other VHR ALL except Philadelphia chromosome-positive : Induction~* Morphologic CR after the Induction : Consolidation #1 → Consolidation #2 → Consolidation #3~ 1. If MRD not detected after the post-consolidation #1 : Consolidation #3 using HD MTX, HD Cytarabine → Allogeneic HSCT~ 2. If MRD positive after the post-consolidation #1 : Consolidation #3 using Blinatumomab →Allogeneic HSCT~* M2 or M3 after the Induction : Re-induction → Consolidation #2 → Consolidation #3‡ → Allogeneic HSCT~ 1. If MRD not detected after the post-consolidation #1 : Consolidation #3 using HD MTX, HD Cytarabine~ 2. If MRD positive after the post-reinduction : Consolidation #3 using Blinatumomab"