Patient selection
acute lymphoblastic leukemia, Active leukemia, hyperglycemia
HYPERGLYCEMIA, DISEASE, ACUTE LYMPHOBLASTIC LEUKEMIA, PHILADELPHIA CHROMOSOME
Adult patients with B‐ or T‐cell acute lymphoblastic leukemia who failed (relapsed or refractory) two prior treatments but had good performance status (<3) and organ function were initially enrolled. The protocol was later amended due to low accrual to allow any number of prior lines of therapy and patients who were newly diagnosed but unfit for standard induction therapy. Active leukemia (≥10% blasts in the bone marrow) was mandated to assess response to therapy. Prior hematopoietic cell transplant or the presence of Philadelphia chromosome‐positive (as long as they failed all available therapy against Philadelphia chromosome) disease were allowed. Fasting blood glucose <130 mg/dL was mandated because of the known hyperglycemia associated with mTOR inhibitors. Concurrent proton pump inhibitors and prolonged QT interval (corrected QT >480 milliseconds) were not allowed.