Low-Dose or High-Dose Vincristine and Combination Chemotherapy in Treating Young Patients With Relapsed B-Cell Acute Lymphoblastic Leukemia

Inclusion Criteria:

   - Diagnosis of acute lymphoblastic leukemia (ALL)

      - Bone marrow with > 25% L1 or L2 lymphoblasts (M3 marrow)

         - Patients with > 25% L3 marrow lymphoblasts and/or evidence of c-myc
         translocation are not eligible (considered Burkitt's or mature B-cell
         leukemia)

   - Intermediate-risk relapsed disease, meeting 1 of the following criteria:

      - Bone marrow relapse ≥ 36 months after initial diagnosis (defined as M3 marrow
      after previous remission from ALL)

      - Combined bone marrow and extramedullary (CNS* and/or testicular**) relapse ≥ 36
      months after initial diagnosis

      - Isolated extramedullary (CNS* and/or testicular**) relapse < 18 months after
      initial diagnosis

   - The following subtypes are not allowed:

      - T-lineage ALL

      - Mature B-cell (Burkitt's) leukemia (defined as L3 morphology and/or evidence of
      c-myc translocation)

      - Philadelphia-chromosome positive disease

   - No Down syndrome (trisomy 21)

   - Shortening fraction >= 27% by echocardiogram OR ejection fraction >= 50% by
   radionuclide angiogram

   - Bilirubin < 3.0 mg/dL

   - Not pregnant

   - Fertile patients must use effective contraception

   - No history of peripheral neuropathy >= grade 3 within the past month

   - No toxicity (i.e. peripheral neuropathy) >= grade 3 attributable to vincristine within
   the past month

   - At least 5 days since prior intrathecal chemotherapy

   - No prior hematopoietic stem cell or marrow transplantation

   - No prior cranial radiotherapy > 1200 cGy (for patients with CNS relapse)

   - No concurrent stem cell transplant

   - No concurrent alternative therapy

   - No concurrent itraconazole in patients receiving vincristine

   - No concurrent intensity-modulated radiotherapy