Augmented Berlin-Frankfurt-Munster Therapy Plus Ofatumumab for Young Adults With Acute Lymphoblastic Leukemia or Lymphoblastic Lymphoma

Study Drug Administration:

If you are found to be eligible to take part in this study, on Day 1 or during the spinal tap
procedure, you will be given cytarabine as an injection in your spinal fluid.

You will then receive the study drugs in Induction, Consolidation, and Maintenance Courses.
Induction Therapy is designed to remove the signs of leukemia that can be seen and to allow
normal blood cells to be restored. This is called remission. Consolidation and Maintenance
Therapies are designed to cause the disease to stay in remission.

The study drugs will be given the following ways:

- Daunorubicin by vein over about 30 minutes

- Vincristine by vein over 15-30 minutes

- PEG asparaginase by vein over 15-60 minutes

- Methotrexate either by mouth or as an injection into your spinal fluid (intrathecal),
depending on the course. When given through the spinal fluid, cerebrospinal fluid (CSF)
will be collected with each spinal tap to test the fluid for leukemia. If there is
disease in your spinal fluid before starting the treatment, you will be given additional
methotrexate doses each week until there is no disease present.

- Ofatumumab as an injection or by vein. If given by vein, the length of the infusion will
depend on how well you tolerate the drug. If ofatumumab is not available, you will be
given rituximab by vein over several (about 4-6) hours.

- Cyclophosphamide by vein over about 1 hour

- Cytarabine as an injection under the skin or by vein. If given by vein, the length of
the infusion will depend on how well you tolerate the drug.

- Doxorubicin by vein. If given by vein, the length of the infusion will depend on how
well you tolerate the drug.

- Prednisone, 6-Mercaptopurine, dexamethasone, and 6-Thioguanine are all taken by mouth

Within 3 days after you receive cytarabine, you will begin the Induction Course, which will
last for 4 weeks. In the Induction Course, you will receive:

- Daunorubicin and vincristine on Days 1, 8, 15, and 22

- PEG asparaginase 1 time during Week 1

- Prednisone each day on Days 1-28.

- Intrathecal methotrexate at Weeks 2 and 5 during a spinal tap. If the is disease in your
spinal fluid before starting the treatment, you will be given additional methotrexate
doses each week until there is no disease present.

- Ofatumumab or rituximab on Days 2 and 15

Depending on how you respond to Induction, you may begin the Consolidation Courses 1-4 weeks
after Induction.

You will then receive Consolidation Course 1. This course will last 8 weeks, and you will
receive:

- Cyclophosphamide at Weeks 1 and 5

- Cytarabine on or around Days 1-4 and Days 8-11 of each 4-week cycle

- 6-Mercaptopurine on Days 1-14 of each 4-week cycle

- Vincristine at Weeks 3 and 4 of each 4-week cycle

- PEG Asparaginase at Weeks 3 and 7

- Intrathecal methotrexate weekly during Month 1 only

- Ofatumumab or rituximab at Weeks 1 and 5

You will then receive 2 courses of Consolidation Course 2. Each course will last about 7
weeks, and you will receive:

- Vincristine and methotrexate every 10 (+/- 2) days for up to 5 doses

- PEG Asparaginase at Weeks 1 and 4

- Intrathecal methotrexate at Weeks 1 and 5

- Ofatumumab or rituximab at Weeks 1 and 5

You will then receive Consolidation 3 (Part A). This course will last for 4 weeks, and you
will receive:

- Vincristine and doxorubicin at Weeks 1, 2, and 3

- Dexamethasone on Days 1-7 and Days 15-21

- PEG asparaginase at Week 1

- Intrathecal methotrexate at Week 1

- Ofatumumab or rituximab on Weeks 1 and 3

You will then receive Consolidation 3 (Part B). This course will last for 4 weeks, and you
will receive:

- Cyclophosphamide at Week 1

- Cytarabine for 4 days in a row during Weeks 1-2

- 6-Thioguanine every day for the first 2 weeks.

- Intrathecal methotrexate at Weeks 1 and 2

- Vincristin at Weeks 3 and 4

- PEG Asparaginase at Week 3

Once you finish Consolidation, you will then receive 24 months of Maintenance Therapy.

- Vincristine every month.

- Dexamethasone for 5 days every month.

- 6-Mercaptopurine 1 time a day

- Methotrexate by mouth every week.

- If you have ALL, you will also receive intrathecal methotrexate every 3 months for the
first 12 months of maintenance.

Study Tests/Procedures:

Induction:

- Blood (about 3 teaspoons) will be drawn about 2 times each week during the Induction
Period for routine tests.

- You will have a bone marrow aspirate or biopsy on Days 15 and 29 and then as needed to
check the status of the disease.

- About 7 days after you receive your first dose of PEG asparaginase, blood (about 1
tablespoon) will be drawn to check the activity of the drug in your blood. If the drug
does not seem to be working well, your dose may be changed.

- If you have LL and bone marrow was not found to be involved with the disease at
screening, you will have a chest x-ray, CT scans, and positron emission tomography (PET)
scans to measure the disease. These scans will be done after about 28 days of therapy.

Consolidation 1:

- Blood (about 3 teaspoons) will be drawn for routine tests about 2 times each week.

- You will have a spinal tap during each intrathecal methotrexate dose. The spinal fluid
will be checked for leukemia cells.

- You will have a bone marrow aspiration at the end of Month 2 to check the status of the
disease.

Consolidation 2:

- Blood (about 3 teaspoons) will be drawn every 2 weeks for routine tests.

- You will have a spinal tap during each intrathecal methotrexate doses. The spinal fluid
will be checked for leukemia cells.

Consolidation 3 (Part A and B):

- Blood (about 3 teaspoons) will be drawn at least weekly for routine tests.

- You will have a spinal tap during each intrathecal methotrexate dose. The spinal fluid
will be checked for leukemia cells.

Maintenance:

- You will have a spinal tap during each intrathecal methotrexate dose. The spinal fluid
will be checked for leukemia cells.

- You will have a bone marrow aspiration at least every 3-6 months to check the status of
the disease.

Length of Study:

You may remain on study for as long as the study doctor thinks it is in your best interest.
If the disease does not appear to be improving after Induction, you will be taken off study.
You may be taken off study if the disease gets worse or comes back during treatment, if
intolerable side effects occur, if your doctor thinks it is in your best interest, or if you
cannot follow the study instructions.

Follow-up Visits:

Your study doctor will inform you of your follow-up visit schedule in the clinic. At each
follow-up visit there will be a physical exam and blood (about 1 tablespoon) will be drawn
for routine tests. You will be followed-up for the next 3 years after your the last dose of
your chemotherapy.

This is an investigational study. The chemotherapy drugs used in this study are all FDA
approved and commercially available for the treatment of various types of leukemia. The use
of ofatumumab/rituximab in this drug combination, as well as the drug combination's use in
pediatric patients, is investigational.

Up to 100 participants will be enrolled in this study. All will take part at MD Anderson.

Inclusion Criteria:

1. Patients must have precursor-B lymphoblastic leukemia or lymphoma.

2. Patients must be untreated or have had only one prior chemotherapy regimen for ALL or
LL . Previously treated patients will be analyzed separately.

3. Age between 12 to 30 years old

4. Patients with central nervous system (CNS) disease or testicular disease are eligible.

5. Intrathecal therapy with cytarabine is allowed prior to registration for patient
convenience. This is usually done at the time of the diagnostic bone marrow or venous
line placement to avoid a second lumbar puncture. Systemic chemotherapy must begin
within 72 hours of the first intrathecal treatment.

6. Signed informed consent prior to the start of systemic therapy. In the event of
enrollment of a minor patient, an attempt to obtain assent from the patient must be
documented, and parental consent must be signed.

7. Echocardiogram should be done within 7 days of starting therapy if there are cardiac
risk factors (e.g., history of hypertension or of myocardial infarction)

8. Creatinine should be < 3 mg/dL bilirubin < 3 mg/dl unless due to disease

9. Zubrod Performance status of <3

10. Patients who received steroids more than 72 hours prior to study enrollment are
eligible but will be analyzed separately.

11. Lymphoblasts may have any positive expression of cluster of differentiation antigen 20
(CD20) for ofatumumab administration.

Exclusion Criteria:

1. Age less than twelve years of age or greater than 30 years.

2. More than one prior treatment regimen for ALL or LL.

3. The patient is pregnant or unwilling to practice appropriate birth control.

4. Presence of the Philadelphia chromosome t(9;22)

5. Laboratory or clinical evidence of active infectious hepatitis.