Vanderbilt-Ingram Cancer Center

None Provided.

Criteria
 DISEASE CHARACTERISTICS:

 • Patients must have newly diagnosed B-precursor acute lymphoblastic leukemia (ALL); patients with Down syndrome (DS) are also eligible

 • Patients must have one of the following:

 • NCI high-risk ALL or NCI standard-risk ALL with central nervous system (CNS), testicular leukemia, and/or steroid pre-treatment, and be enrolled in COG AALL08B1; patients that begin therapy on this study (AALL1131) prior to enrollment on COG AALL08B1 are ineligible

 • NCI standard-risk ALL, be enrolled in COG AALL08B1 or COG AALL0932 and completed AALL0932 induction treatment and been classified as high-risk or very high-risk

 • Patients with BCR-ABL1 (Philadelphia chromosome positive) are not eligible for post-induction therapy on this study; non-DS patients may be eligible to enroll in COG AALL0622 or successor COG Ph+ ALL trial by day 15 induction

 • DS HR-ALL patients with induction failure or BCR-ABL1 are not eligible for post-induction

 • No VHR-ALL patients with significant hepatic dysfunction at the time of post-induction randomization defined as:

 • Direct bilirubin > 1.5 times upper limit of normal (ULN) for age

 • SGPT (ALT) ≥ 3 times ULN for age

 • Lipase > 2.0 times ULN for age

 • Patients cannot have secondary ALL that developed after treatment of a prior malignancy with cytotoxic chemotherapy

 PATIENT CHARACTERISTICS:

 • White blood cell count (WBC) criteria:

 • Age 1-9.99 years: WBC ≥ 50 000/μL

 • Age 10-30.99 years: Any WBC

 • Age 1-30.99 years: Any WBC with:

 • Testicular leukemia

 • CNS leukemia (CNS3)

 • Steroid pretreatment

 • No very high-risk (VHR) acute lymphoblastic leukemia (ALL) patients with hepatitis B or C infection or history of cirrhosis at the time of post-induction randomization

 • Negative pregnancy test

 • Patients of childbearing potential must agree to use an effective birth control method

 • Female patients who are lactating must agree to stop breast-feeding

 PRIOR CONCURRENT THERAPY:

 • See Disease Characteristics

 • Patients must not have received any prior cytotoxic chemotherapy for the current diagnosis of acute lymphoblastic leukemia (ALL) or any cancer diagnosed previously, with the exception of steroids and intrathecal cytarabine for the current diagnosis of ALL

 • Patients receiving prior steroid therapy may be eligible

 • No concurrent intensity-modulated radiotherapy