This is a nonrandomized study of ruxolitinib in combination with a standard multi-agent chemotherapy regimen for the treatment of B-ALL. The backbone multi-agent therapy is a modified augmented Berlin-Frankfurt-Münster (aBFM) regimen that is used in the Children's Oncology Group (COG) Study AALL1131 (control arm) for patients with de novo B-ALL. This chemotherapy backbone is the current standard of care for patients with NCI HR B-ALL. Ruxolitinib will be administered in conjunction with all post-Induction phases of the aBFM regimen.
Subjects with de novo B-ALL, aged 1 to 21 years at the time of diagnosis, will be evaluated for genetic eligibility during the Induction phase of a 4-drug regimen (modified aBFM or equivalent) received on Study AALL1131 (or its successor study) or with a similar 4-drug regimen. Genetic analysis of baseline diagnostic bone marrow aspirate or peripheral blood samples will be performed at COG ALL reference laboratories. Eligible genetic abnormalities include the following:
Rearranged CRLF2 (CRLF-R)
Mutations in JAK1 or JAK2 (JAK+)
Other alterations involving the JAK pathway (eg, JAK2 fusions, EPO-R fusions, SH2B3 deletions, IL7RA mutations)
At the end of Induction therapy, MRD will be assessed from bone marrow sampling via flow cytometric analysis, per the standard of care. For the purposes of this Protocol, end-Induction MRD status is defined as + or (-) as follows:
MRD 0.01% is MRD+
MRD < 0.01% is MRD(-)
Cohort assignment will be based upon genetic analysis and end-Induction MRD status, as follows:
Cohort A: CRLF2-R and JAK+ with MRD+
Cohort B: CRLF2-R and JAK- with MRD+
Cohort C: other JAK pathway alterations (+/- CRLF2-R) with MRD+
Cohort D: subjects otherwise eligible for Cohorts A, B, or C with MRD(-)
To determine in the context of a randomized trial whether the EFS of patients with newly diagnosed high-risk NBL is improved with the addition of 131I-MIBG during Induction, prior to tandem autologous stem cell transplantation (ASCT).
A research study of a new investigational (experimental) drug called VB-111 to treat advanced metastatic cancer (cancer that has spread to other parts of the body) and we want to learn if VB-111 will have a good effect on the cancer, such as keeping the cancer cells from dividing and growing. "Investigational" means that VB-111 has not been approved by the Food and Drug Administration (FDA) for commercial use, sale or marketing.