- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02981628
Inotuzumab Ozogamicin in Treating Younger Patients With B-Lymphoblastic Lymphoma or Relapsed or Refractory CD22 Positive B Acute Lymphoblastic Leukemia
A Phase 2 Study of Inotuzumab Ozogamicin (NSC# 772518) in Children and Young Adults With Relapsed or Refractory CD22+ B-Acute Lymphoblastic Leukemia (B-ALL)
Study Overview
Status
Conditions
Intervention / Treatment
- Procedure: Lumbar Puncture
- Procedure: Biospecimen Collection
- Drug: Cyclophosphamide
- Drug: Methotrexate
- Drug: Vincristine
- Biological: Inotuzumab Ozogamicin
- Drug: Leucovorin Calcium
- Drug: Pegaspargase
- Procedure: Bone Marrow Aspiration and Biopsy
- Drug: Cytarabine
- Drug: Calaspargase Pegol
- Drug: Asparaginase Erwinia chrysanthemi
- Procedure: Diagnostic Imaging Testing
Detailed Description
PRIMARY OBJECTIVE:
I. To determine the morphologic response rate (complete response [CR] + complete response with incomplete hematologic recovery [CRi]) following one cycle of treatment with inotuzumab ozogamicin in children with relapsed or refractory CD22+ B acute lymphoblastic leukemia (B-ALL). (Cohort 1)
SECONDARY OBJECTIVES:
I. To determine the CR/CRi rate following 2 cycles of inotuzumab ozogamicin therapy. (Cohort 1) II. To determine the safety of single agent inotuzumab ozogamicin administered at the adult recommended phase 2 dose (RP2D) to pediatric patients with relapsed or refractory CD22+ B-ALL. (Cohort 1) III. To determine the level of minimal residual disease (MRD) by flow cytometry in responding patients. (Cohorts 1 and 2) IV. To determine the incidence, severity, and outcomes of sinusoidal obstruction syndrome (SOS) of the liver in patients during inotuzumab ozogamicin therapy and following subsequent treatment, including myeloablative hematopoietic stem cell transplantation (HSCT). (Cohorts 1 and 2) V. To estimate the 3-year event-free survival (EFS), 3-year overall survival (OS), and among responders, duration of CR/CRi for pediatric patients with relapsed or refractory B-ALL treated with inotuzumab ozogamicin. (Cohort 1) VI. To describe inotuzumab ozogamicin pharmacokinetics and immunogenicity in pediatric patients in the presence of overt leukemia and in remission. (Cohort 1) VII. To determine the safe and tolerable dose of inotuzumab ozogamicin in combination with the augmented modified Berlin-Frankfurt-Munster (mBFM) consolidation chemotherapy backbone. (Cohort 2)
EXPLORATORY OBJECTIVES:
I. To describe the levels of leukemic blast CD22 surface expression and site density, and to explore the correlation with cytogenetics and clinical outcomes after treatment with inotuzumab ozogamicin. (Cohorts 1 and 2) II. To explore potential mechanisms of resistance to inotuzumab ozogamicin therapy including CD22 splice variants and intracellular signaling pathways. (Cohorts 1 and 2) III. To explore the impact of inotuzumab ozogamicin on humoral immune function and peripheral B cell populations. (Cohorts 1 and 2) IV. To describe the level of MRD by next-generation high-throughput sequencing (HTS) techniques which may detect low level leukemic blast populations that have altered CD22 expression. (Cohorts 1 and 2) V. To prospectively explore candidate SOS biomarkers including the endothelial marker of inflammation Angiopoietin 2 (Ang2) and the hepatic specific complement marker L-ficolin. (Cohorts 1 and 2) VI. To explore the use of prophylactic ursodeoxycholic acid (UDCA) to prevent hepatic damage and SOS during inotuzumab ozogamicin therapy and subsequent HSCT. (Cohorts 1 and 2) VII. To describe the interaction between inotuzumab ozogamicin and chimeric antigen receptor (CAR) T cell therapy before or after treatment with inotuzumab ozogamicin. (Cohorts 1 and 2) VIII. To estimate the CR/CRi rate following one cycle of inotuzumab ozogamicin plus augmented mBFM consolidation chemotherapy (first 42 days) and following 2 cycles within the confines of a pilot study. (Cohort 2)
OUTLINE: Patients are assigned to 1 of 2 cohorts.
COHORT I: Patients receive inotuzumab ozogamicin intravenously (IV) over 60 minutes on days 1, 8, and 15 of each cycle. Treatment repeats every 28 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity. (COMPLETE)
COHORT II: Patients receive inotuzumab ozogamicin IV over 60 minutes on days 1, and 8. Patients also receive cyclophosphamide IV over 30-60 on day 1; cytarabine IV over 1-30 minutes or subcutaneously (SC) on days 1-4 and 8-11; leucovorin calcium orally (PO) or IV on days 2, 9, 16, 23 and 37 of cycle 1 and days 9 and 37 of cycle 2; pegaspargase or calaspargase pegol IV over 1-2 hours or pegaspargase intramuscularly (IM) on day 15; and vincristine IV on days 15 and 22. Patients receive methotrexate intrathecally (IT) on days 1, 8 and 36 of cycle 1 and day 36 of cycle 2 for CNS 1 patients, days 1, 8, 15, 22 and 36 of cycle 1, and day 36 of cycle 2 for CNS 2 patients. CNS 3 patients receive methotrexate intrathecal triple therapy (ITT) IT on days 1, 8, 15, 22 and 36 of cycle 1 and days 8 and 36 of cycle 2. There are 3 dose levels. If excessive toxicity is observed at dose level 1, the dosing of inotuzumab ozogamicin will be decreased for dose level -1 and 6-mercaptopurine omitted. If excessive toxicity is observed at this dose, then for dose level -2, the dosing of inotuzumab ozogamicin and cyclophosphamide will be decreased. Treatment repeats every 42 days for up to 2 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo bone marrow aspiration or biopsy, lumbar puncture, and blood sample collection throughout the trial. Patients also undergo imaging on screening and on study.
After completion of study treatment, patients are followed up at 30 days, every 3 months for 1 year, and then yearly for 4 years.
Study Type
Enrollment (Estimated)
Phase
- Phase 2
Contacts and Locations
Study Locations
-
-
-
Caguas, Puerto Rico, 00726
- HIMA San Pablo Oncologic Hospital
-
-
-
-
Alabama
-
Birmingham, Alabama, United States, 35233
- Children's Hospital of Alabama
-
-
Alaska
-
Anchorage, Alaska, United States, 99508
- Providence Alaska Medical Center
-
-
Arizona
-
Mesa, Arizona, United States, 85202
- Banner Children's at Desert
-
Phoenix, Arizona, United States, 85016
- Phoenix Childrens Hospital
-
Tucson, Arizona, United States, 85719
- Banner University Medical Center - Tucson
-
-
Arkansas
-
Little Rock, Arkansas, United States, 72202-3591
- Arkansas Children's Hospital
-
-
California
-
Downey, California, United States, 90242
- Kaiser Permanente Downey Medical Center
-
Duarte, California, United States, 91010
- City of Hope Comprehensive Cancer Center
-
Loma Linda, California, United States, 92354
- Loma Linda University Medical Center
-
Los Angeles, California, United States, 90048
- Cedars-Sinai Medical Center
-
Los Angeles, California, United States, 90027
- Children's Hospital Los Angeles
-
Madera, California, United States, 93636
- Valley Children's Hospital
-
Oakland, California, United States, 94609
- UCSF Benioff Children's Hospital Oakland
-
Oakland, California, United States, 94611
- Kaiser Permanente-Oakland
-
Orange, California, United States, 92868
- Children's Hospital of Orange County
-
Palo Alto, California, United States, 94304
- Lucile Packard Children's Hospital Stanford University
-
Sacramento, California, United States, 95816
- Sutter Medical Center Sacramento
-
Sacramento, California, United States, 95817
- University of California Davis Comprehensive Cancer Center
-
San Diego, California, United States, 92123
- Rady Children's Hospital - San Diego
-
San Francisco, California, United States, 94158
- UCSF Medical Center-Mission Bay
-
Torrance, California, United States, 90502
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center
-
-
Colorado
-
Aurora, Colorado, United States, 80045
- Children's Hospital Colorado
-
Denver, Colorado, United States, 80218
- Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center
-
-
Connecticut
-
Hartford, Connecticut, United States, 06106
- Connecticut Children's Medical Center
-
New Haven, Connecticut, United States, 06520
- Yale University
-
-
Delaware
-
Wilmington, Delaware, United States, 19803
- Alfred I duPont Hospital for Children
-
-
District of Columbia
-
Washington D.C., District of Columbia, United States, 20010
- Children's National Medical Center
-
-
Florida
-
Fort Myers, Florida, United States, 33908
- Golisano Children's Hospital of Southwest Florida
-
Gainesville, Florida, United States, 32610
- UF Health Cancer Institute - Gainesville
-
Hollywood, Florida, United States, 33021
- Memorial Regional Hospital/Joe DiMaggio Children's Hospital
-
Jacksonville, Florida, United States, 32207
- Nemours Children's Clinic-Jacksonville
-
Miami, Florida, United States, 33155
- Nicklaus Children's Hospital
-
Orlando, Florida, United States, 32827
- Nemours Children's Hospital
-
Orlando, Florida, United States, 32803
- AdventHealth Orlando
-
Pensacola, Florida, United States, 32504
- Nemours Children's Clinic - Pensacola
-
St. Petersburg, Florida, United States, 33701
- Johns Hopkins All Children's Hospital
-
Tampa, Florida, United States, 33606
- Tampa General Hospital
-
Tampa, Florida, United States, 33607
- Saint Joseph's Hospital/Children's Hospital-Tampa
-
West Palm Beach, Florida, United States, 33407
- Saint Mary's Medical Center
-
-
Georgia
-
Atlanta, Georgia, United States, 30329
- Children's Healthcare of Atlanta - Arthur M Blank Hospital
-
Savannah, Georgia, United States, 31404
- Memorial Health University Medical Center
-
-
Hawaii
-
Honolulu, Hawaii, United States, 96826
- Kapiolani Medical Center for Women and Children
-
-
Idaho
-
Boise, Idaho, United States, 83712
- Saint Luke's Cancer Institute - Boise
-
-
Illinois
-
Chicago, Illinois, United States, 60637
- University of Chicago Comprehensive Cancer Center
-
Chicago, Illinois, United States, 60611
- Lurie Children's Hospital-Chicago
-
Maywood, Illinois, United States, 60153
- Loyola University Medical Center
-
Peoria, Illinois, United States, 61637
- OSF Children's Hospital of Illinois
-
Springfield, Illinois, United States, 62702
- Southern Illinois University School of Medicine
-
-
Indiana
-
Indianapolis, Indiana, United States, 46202
- Riley Hospital for Children
-
Indianapolis, Indiana, United States, 46260
- Ascension Saint Vincent Indianapolis Hospital
-
-
Iowa
-
Des Moines, Iowa, United States, 50309
- Blank Children's Hospital
-
Iowa City, Iowa, United States, 52242
- University of Iowa/Holden Comprehensive Cancer Center
-
-
Kentucky
-
Lexington, Kentucky, United States, 40536
- University of Kentucky/Markey Cancer Center
-
Louisville, Kentucky, United States, 40202
- Norton Children's Hospital
-
-
Louisiana
-
New Orleans, Louisiana, United States, 70121
- Ochsner Medical Center Jefferson
-
New Orleans, Louisiana, United States, 70118
- Children's Hospital New Orleans
-
-
Maine
-
Bangor, Maine, United States, 04401
- Eastern Maine Medical Center
-
Scarborough, Maine, United States, 04074
- Maine Children's Cancer Program
-
-
Maryland
-
Baltimore, Maryland, United States, 21287
- Johns Hopkins University/Sidney Kimmel Cancer Center
-
Baltimore, Maryland, United States, 21215
- Sinai Hospital of Baltimore
-
Bethesda, Maryland, United States, 20892
- National Institutes of Health Clinical Center
-
-
Massachusetts
-
Boston, Massachusetts, United States, 02215
- Dana-Farber Cancer Institute
-
Boston, Massachusetts, United States, 02111
- Tufts Children's Hospital
-
Worcester, Massachusetts, United States, 01655
- UMass Memorial Medical Center - University Campus
-
-
Michigan
-
Ann Arbor, Michigan, United States, 48109
- C S Mott Children's Hospital
-
East Lansing, Michigan, United States, 48823
- Michigan State University
-
Grand Rapids, Michigan, United States, 49503
- Corewell Health Grand Rapids Hospitals - Helen DeVos Children's Hospital
-
Royal Oak, Michigan, United States, 48073
- Corewell Health Children's
-
-
Minnesota
-
Minneapolis, Minnesota, United States, 55404
- Children's Hospitals and Clinics of Minnesota - Minneapolis
-
Minneapolis, Minnesota, United States, 55455
- University of Minnesota/Masonic Cancer Center
-
Rochester, Minnesota, United States, 55905
- Mayo Clinic in Rochester
-
-
Mississippi
-
Jackson, Mississippi, United States, 39216
- University of Mississippi Medical Center
-
-
Missouri
-
Columbia, Missouri, United States, 65212
- University of Missouri Children's Hospital
-
Kansas City, Missouri, United States, 64108
- Children's Mercy Hospitals and Clinics
-
St Louis, Missouri, United States, 63110
- Washington University School of Medicine
-
St Louis, Missouri, United States, 63141
- Mercy Hospital Saint Louis
-
St Louis, Missouri, United States, 63104
- Cardinal Glennon Children's Medical Center
-
-
Nebraska
-
Omaha, Nebraska, United States, 68198
- University Of Nebraska Medical Center
-
Omaha, Nebraska, United States, 68114
- Children's Hospital and Medical Center of Omaha
-
-
Nevada
-
Las Vegas, Nevada, United States, 89144
- Summerlin Hospital Medical Center
-
Las Vegas, Nevada, United States, 89109
- Sunrise Hospital and Medical Center
-
Las Vegas, Nevada, United States, 89135
- Alliance for Childhood Diseases/Cure 4 the Kids Foundation
-
Reno, Nevada, United States, 89502
- Renown Regional Medical Center
-
-
New Hampshire
-
Lebanon, New Hampshire, United States, 03756
- Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center
-
-
New Jersey
-
Hackensack, New Jersey, United States, 07601
- Hackensack University Medical Center
-
Morristown, New Jersey, United States, 07960
- Morristown Medical Center
-
New Brunswick, New Jersey, United States, 08901
- Saint Peter's University Hospital
-
New Brunswick, New Jersey, United States, 08903
- Rutgers Cancer Institute of New Jersey-Robert Wood Johnson University Hospital
-
Newark, New Jersey, United States, 07112
- Newark Beth Israel Medical Center
-
Paterson, New Jersey, United States, 07503
- Saint Joseph's Regional Medical Center
-
-
New York
-
Albany, New York, United States, 12208
- Albany Medical Center
-
Brooklyn, New York, United States, 11219
- Maimonides Medical Center
-
Buffalo, New York, United States, 14263
- Roswell Park Cancer Institute
-
Mineola, New York, United States, 11501
- NYU Langone Hospital - Long Island
-
New Hyde Park, New York, United States, 11040
- The Steven and Alexandra Cohen Children's Medical Center of New York
-
New York, New York, United States, 10065
- Memorial Sloan Kettering Cancer Center
-
New York, New York, United States, 10029
- Mount Sinai Hospital
-
New York, New York, United States, 10016
- Laura and Isaac Perlmutter Cancer Center at NYU Langone
-
Rochester, New York, United States, 14642
- University of Rochester
-
Stony Brook, New York, United States, 11794
- Stony Brook University Medical Center
-
Syracuse, New York, United States, 13210
- State University of New York Upstate Medical University
-
The Bronx, New York, United States, 10467
- Montefiore Medical Center - Moses Campus
-
Valhalla, New York, United States, 10595
- New York Medical College
-
-
North Carolina
-
Asheville, North Carolina, United States, 28801
- Mission Hospital
-
Chapel Hill, North Carolina, United States, 27599
- UNC Lineberger Comprehensive Cancer Center
-
Durham, North Carolina, United States, 27710
- Duke University Medical Center
-
Greenville, North Carolina, United States, 27834
- East Carolina University
-
Winston-Salem, North Carolina, United States, 27157
- Wake Forest University Health Sciences
-
-
North Dakota
-
Fargo, North Dakota, United States, 58122
- Sanford Broadway Medical Center
-
-
Ohio
-
Akron, Ohio, United States, 44308
- Children's Hospital Medical Center of Akron
-
Cincinnati, Ohio, United States, 45229
- Cincinnati Children's Hospital Medical Center
-
Cleveland, Ohio, United States, 44195
- Cleveland Clinic Foundation
-
Columbus, Ohio, United States, 43205
- Nationwide Children's Hospital
-
Dayton, Ohio, United States, 45404
- Dayton Children's Hospital
-
Toledo, Ohio, United States, 43606
- ProMedica Toledo Hospital/Russell J Ebeid Children's Hospital
-
-
Oklahoma
-
Oklahoma City, Oklahoma, United States, 73104
- University of Oklahoma Health Sciences Center
-
-
Oregon
-
Portland, Oregon, United States, 97239
- Oregon Health and Science University
-
Portland, Oregon, United States, 97227
- Legacy Emanuel Children's Hospital
-
-
Pennsylvania
-
Allentown, Pennsylvania, United States, 18103
- Lehigh Valley Hospital-Cedar Crest
-
Danville, Pennsylvania, United States, 17822
- Geisinger Medical Center
-
Hershey, Pennsylvania, United States, 17033
- Penn State Children's Hospital
-
Philadelphia, Pennsylvania, United States, 19104
- Children's Hospital of Philadelphia
-
Philadelphia, Pennsylvania, United States, 19134
- Saint Christopher's Hospital for Children
-
Pittsburgh, Pennsylvania, United States, 15224
- Children's Hospital of Pittsburgh of UPMC
-
-
Rhode Island
-
Providence, Rhode Island, United States, 02903
- Rhode Island Hospital
-
-
South Carolina
-
Charleston, South Carolina, United States, 29425
- Medical University of South Carolina
-
Columbia, South Carolina, United States, 29203
- Prisma Health Richland Hospital
-
Greenville, South Carolina, United States, 29605
- BI-LO Charities Children's Cancer Center
-
-
South Dakota
-
Sioux Falls, South Dakota, United States, 57117-5134
- Sanford USD Medical Center - Sioux Falls
-
-
Tennessee
-
Chattanooga, Tennessee, United States, 37403
- T C Thompson Children's Hospital
-
Knoxville, Tennessee, United States, 37916
- East Tennessee Childrens Hospital
-
Memphis, Tennessee, United States, 38105
- Saint Jude Children's Research Hospital
-
Nashville, Tennessee, United States, 37232
- Vanderbilt University/Ingram Cancer Center
-
Nashville, Tennessee, United States, 37203
- The Children's Hospital at TriStar Centennial
-
-
Texas
-
Austin, Texas, United States, 78723
- Dell Children's Medical Center of Central Texas
-
Corpus Christi, Texas, United States, 78411
- Driscoll Children's Hospital
-
Dallas, Texas, United States, 75390
- UT Southwestern/Simmons Cancer Center-Dallas
-
Dallas, Texas, United States, 75230
- Medical City Dallas Hospital
-
El Paso, Texas, United States, 79905
- El Paso Children's Hospital
-
Fort Worth, Texas, United States, 76104
- Cook Children's Medical Center
-
Houston, Texas, United States, 77030
- Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center
-
Lubbock, Texas, United States, 79410
- Covenant Children's Hospital
-
Lubbock, Texas, United States, 79415
- UMC Cancer Center / UMC Health System
-
San Antonio, Texas, United States, 78229
- University of Texas Health Science Center at San Antonio
-
San Antonio, Texas, United States, 78207
- Children's Hospital of San Antonio
-
San Antonio, Texas, United States, 78229
- Methodist Children's Hospital of South Texas
-
-
Utah
-
Salt Lake City, Utah, United States, 84113
- Primary Children's Hospital
-
-
Vermont
-
Burlington, Vermont, United States, 05405
- University of Vermont and State Agricultural College
-
-
Virginia
-
Charlottesville, Virginia, United States, 22908
- University of Virginia Cancer Center
-
Falls Church, Virginia, United States, 22042
- Inova Fairfax Hospital
-
Norfolk, Virginia, United States, 23507
- Children's Hospital of The King's Daughters
-
-
Washington
-
Seattle, Washington, United States, 98105
- Seattle Children's Hospital
-
Spokane, Washington, United States, 99204
- Providence Sacred Heart Medical Center and Children's Hospital
-
-
West Virginia
-
Morgantown, West Virginia, United States, 26506
- West Virginia University Healthcare
-
-
Wisconsin
-
Marshfield, Wisconsin, United States, 54449
- Marshfield Medical Center-Marshfield
-
Milwaukee, Wisconsin, United States, 53226
- Children's Hospital of Wisconsin
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Patients must be >= 1 year and < 22 years of age at the time of enrollment
Patients must have B-ALL, or previously diagnosed B lymphoblastic lymphoma (B-LL), with >= 5% (M2 or M3) bone marrow blasts with or without extramedullary disease
- NOTE: Relapsed patients previously diagnosed with B-lymphoblastic lymphoma (B-LL) are eligible if they have an M2 or M3 marrow at the time of enrollment on this study
- Patients with ALL or B-LL who have M2 morphology must have local confirmatory testing showing >= 5% blasts by flow cytometry, fluorescence in situ hybridization (FISH) testing or other molecular method
Leukemic blasts must demonstrate surface expression of CD22 at the time of relapse by local/institutional flow cytometry of a bone marrow aspirate sample; (assessment of CD22 using a bright fluorophore such as phycoerythrin [PE] is strongly recommended)
- In the case of an inadequate aspirate sample (dry tap) or if bone marrow aspirate is unable to be performed due to patient clinical status, flow cytometry of peripheral blood specimen may be substituted if the patient has at least 1,000/uL circulating blasts; alternatively, CD22 expression may be documented by immunohistochemistry of a bone marrow biopsy specimen
Patients with one of the following:
- Second or greater relapse;
- Primary refractory disease with at least 2 prior induction attempts;
- First relapse refractory to at least one prior re-induction attempt
- Any relapse after HSCT (Cohort 1 ONLY)
Patients with Down syndrome are eligible ONLY for Cohort 1 with:
- Any of above disease status, OR
First relapse with no prior re-induction attempt NOTE: Patients with Down syndrome or prior HSCT are NOT eligible for Cohort 2 combination therapy
- Patients with Philadelphia chromosome (Ph)+ ALL must have had two prior therapy attempts including two different tyrosine kinase inhibitors (TKIs)
- Patients must have fully recovered from the acute toxic effects of all prior anti-cancer therapy, defined as resolution of all such toxicities to =< grade 2 or lower per the inclusion/exclusion criteria prior to entering this study. Apply to Cohort 2:
Cytotoxic chemotherapy or other anti-cancer agents known to be myelosuppressive. For agents not listed, the duration of this interval must be discussed with the study chair and the study-assigned Research Coordinator prior to enrollment.
- A waiting period prior to enrollment is not required for patients receiving standard cytotoxic maintenance chemotherapy (i.e., corticosteroid, vincristine, 6MP, and/or methotrexate).
- A waiting period is not required for patients receiving a single dose of intrathecal methotrexate, hydrocortisone, and/or cytarabine within 7 days prior to enrollment
>= 14 days must have elapsed after the completion of other cytotoxic therapy, with the exception of hydroxyurea, for patients not receiving standard maintenance therapy. For patients who previously received calaspargase pegol, >= 21 days must have elapsed after the last dose. Additionally, patients must have fully recovered from all acute toxic effects of prior therapy.
- Note: Cytoreduction with hydroxyurea must be discontinued >= 24 hours prior to the start of protocol therapy.
- Anti-cancer agents not known to be myelosuppressive (e.g., not associated with reduced platelet or absolute neutrophil count [ANC] counts): >= 7 days after the last dose of agent. For agents not listed, the duration of this interval must be discussed with the study chair and the study-assigned research coordinator prior to enrollment.
- Anti-cancer agents that are antibodies: >= 21 days must have elapsed from infusion of last dose of antibody, and toxicity related to prior antibody therapy must be recovered to grade =< 1. There is an exception for blinatumomab infusions, for which patients must have been off for at least 3 days and all drug related toxicity must have resolved to grade 2 or lower as outlined in the inclusion/exclusion criteria.
- Corticosteroids: If used to modify immune adverse events related to prior therapy, >= 14 days must have elapsed since last dose of corticosteroid. A waiting period prior to enrollment is not required for patients receiving corticosteroid for leukemia therapy/cytoreduction.
- Radiotherapy: >= 2 weeks must have elapsed since local palliative radiation therapy (XRT) (small port); >= 3 months must have elapsed if prior cranial or craniospinal XRT was received, if >= 50% of the pelvis was irradiated, or if total body irradiation (TBI) was received; >= 6 weeks must have elapsed if other substantial bone marrow irradiation was given.
- Stem cell transplant or rescue without TBI: For Cohort 1, at least 90 days must have elapsed since stem cell transplant and at least 30 days from donor lymphocyte infusion. Patient must have had no more than one previous HSCT and currently have no evidence of active graft vs. host disease (GVHD). For Cohort 2, no prior HSCT is allowed.
Chimeric antigen receptor (CAR) T cell therapy: At least 30 days must have elapsed from the last CAR-T cell infusion
- Patients must have a performance status corresponding to Eastern Cooperative Oncology Group (ECOG) scores of 0, 1, or 2; use Karnofsky for patients > 16 years of age and Lansky for patients =< 16 years of age; patients who are unable to walk because of paralysis, but who are up in a wheelchair, will be considered ambulatory for the purpose of assessing the performance score
- Creatinine clearance or radioisotope glomerular filtration rate (GFR) >= 70 mL/min/1.73 m^2 or
- A serum creatinine based on age/sex as follows:
- 1 to < 2 years: maximum serum creatinine 0.6 mg/dL (both male and female)
- 2 to < 6 years: maximum serum creatinine 0.8 mg/dL (both male and female)
- 6 to < 10 years: maximum serum creatinine 1 mg/dL (both male and female)
- 10 to < 13 years: maximum serum creatinine 1.2 mg/dL (both male and female)
- 13 to < 16 years: maximum serum creatinine 1.5 mg/dL (male), 1.4 mg/dL (female)
>= 16 years: maximum serum creatinine 1.7 mg/dL (male), 1.4 mg/dL (female)
- Direct bilirubin =< 1.5 x upper limit of normal (ULN) for age, and
- Serum glutamic pyruvic transaminase (SGPT) (alanine aminotransferase [ALT]) =< 5 x ULN for age; for the purpose of this study, the ULN for ALT will be 45 U/L
Exclusion Criteria:
- Patients with any prior history of SOS irrespective of severity
- Patients with isolated central nervous system (CNS), testicular, or any other extramedullary site of relapse
- Patients who have been previously treated with inotuzumab ozogamicin
- Patients who have previously received HSCT (Cohort 2 only)
- Patients with Down syndrome (Cohort 2 only)
History of allergic reaction attributed to compounds of similar or biologic composition to inotuzumab ozogamicin or other agents in the study
- Note: Patients with history of allergy to pegaspargase/calaspargase pegol are eligible for enrollment on Cohort 2 if Erwinia formulation of asparaginase can be obtained
- Patients with active optic nerve and/or retinal involvement are not eligible; patients who are presenting with visual disturbances should have an ophthalmologic exam and, if indicated, a magnetic resonance imaging (MRI) to assess optic nerve or retinal involvement
- Patients who are currently receiving another investigational drug
- Patients who are currently receiving or plan to receive other anti-cancer agents (except hydroxyurea, which may be continued until 24 hours prior to start of protocol therapy, and intrathecal chemotherapy)
- Anti-GVHD or agents to prevent organ rejection post-transplant; patients who are receiving cyclosporine, tacrolimus, or other agents to prevent either graft-versus-host disease post bone marrow transplant or organ rejection post-transplant are not eligible for this trial; at least 3 half-lives must have elapsed after the last dose of GVHD or anti-rejection medications
Patients who are currently receiving or plan to receive corticosteroids except as described below
- Systemic corticosteroids may be administered for cytoreduction up to 24 hours prior to the start of protocol therapy, (Cohort 1 only) for all patients, corticosteroids may be administered as a premedication for inotuzumab ozogamicin and as treatment for allergic reactions or for physiologic replacement/stress dosing of hydrocortisone for documented adrenal insufficiency; corticosteroids are not allowed for other indications
- Patients with known human immunodeficiency virus (HIV), hepatitis B or C infections; testing to prove negative status is not required for enrollment unless it is deemed necessary for usual medical care of the patient
Patients who have an active uncontrolled infection defined as:
- Positive bacterial blood culture within 48 hours of study enrollment;
- Fever above 38.2 degree Celsius (C) within 48 hours of study enrollment with clinical signs of infection; fever that is determined to be due to tumor burden is allowed if patients have documented negative blood cultures for at least 48 hours prior to enrollment and no concurrent signs or symptoms of active infection or hemodynamic instability
- A positive fungal culture within 30 days of study enrollment or active therapy for presumed invasive fungal infection
- Patients may be receiving IV or oral antibiotics to complete a course of therapy for a prior documented infection as long as cultures have been negative for at least 48 hours and signs or symptoms of active infection have resolved; for patients with clostridium (C.) difficile diarrhea, at least 72 hours of antibacterial therapy must have elapsed and stools must have normalized to baseline
- Active viral or protozoal infection requiring IV treatment
- Patients known to have one of the following concomitant genetic syndromes: Bloom syndrome, ataxia-telangiectasia, Fanconi anemia, Kostmann syndrome, Schwachman (Schwachman-Diamond-Blackfan) syndrome or any other known bone marrow failure syndrome
There have been no human studies of inotuzumab ozogamicin in pregnant women and no reports of exposure in utero; based on nonclinical safety studies, inotuzumab ozogamicin has the potential to impair human male and female fertility and to adversely affect human embryo fetal development; women of childbearing potential should be advised to avoid becoming pregnant while receiving inotuzumab ozogamicin; there is no information regarding the presence of inotuzumab ozogamicin in human milk, the effects on the breast-fed infant, or the effects on milk production; because of the potential for adverse reactions in breast-fed infants, women should not breast-feed during treatment with inotuzumab ozogamicin and for at least 2 months after the final dose
- Female patients of childbearing potential are not eligible unless a negative pregnancy test result has been obtained within 7 days prior to enrollment
- Female patients who are sexually active and of reproductive potential are not eligible unless they agree to use an effective contraceptive method for the duration of their study participation and for 8 months after the last dose of inotuzumab ozogamicin
- Men with female partners of childbearing potential should use effective contraception during treatment with inotuzumab ozogamicin and for at least 5 months after the last dose of inotuzumab ozogamicin
- Lactating females are not eligible unless they agree not to breastfeed their infants
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Non-Randomized
- Interventional Model: Sequential Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
|---|---|
|
Experimental: Cohort I (inotuzumab ozogamicin)
Patients receive inotuzumab ozogamicin IV over 60 minutes on days 1, 8, and 15 of each cycle.
Treatment repeats every 28 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity.
(COMPLETE)
|
Given IV
Other Names:
|
|
Experimental: Cohort II (inotuzumab ozogamicin, mBFM chemotherapy)
See Detailed Description
|
Undergo lumbar puncture
Other Names:
Undergo blood sample collection
Other Names:
Given IV
Other Names:
Given IT
Other Names:
Given IV
Other Names:
Given IV
Other Names:
Given PO or IV
Other Names:
Given IV or IM
Other Names:
Undergo a bone marrow aspiration and biopsy
Given IV or SC
Other Names:
Given IV
Other Names:
Given Asparaginase Erwinia chrysanthemi
Other Names:
Undergo imaging
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Morphologic response (complete response [CR]+ incomplete hematologic recovery [CRi]) following one cycle of treatment with inotuzumab ozogamicin (Cohort 1)
Time Frame: Up to 28 days
|
The response rate will be estimated using the proportion of eligible/evaluable patients with CR/CRi response.
A one-sided lower 95% Agresti-Coull confidence limit will be calculated.
|
Up to 28 days
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Morphologic response (CR + CRi) following 2 cycles of inotuzumab ozogamicin therapy (Cohort1)
Time Frame: Up to 56 days
|
The response rate will be estimated using the proportion of eligible/evaluable patients with CR/CRi response.
|
Up to 56 days
|
|
Level of minimal residual disease (MRD) assessed in bone marrow by flow cytometry (Cohort 1 and 2)
Time Frame: Up to 2 cycles
|
MRD negativity rates (< 0.01% detectable leukemia cells) will be estimated.
|
Up to 2 cycles
|
|
Incidence of adverse events of sinusoidal obstruction syndrome (SOS) of liver (Cohort 1 and 2)
Time Frame: Up to 1 year from last dose of Inotuzumab ozogamicin
|
Evaluated according to NCI CTCAE version 5.0.
The incidence of SOS of the liver in patients during inotuzumab ozogamicin therapy and following subsequent treatment including myeloablative hematopoietic cell transplantation (HSCT) will be described.
|
Up to 1 year from last dose of Inotuzumab ozogamicin
|
|
Duration of CR, CRi (Cohort 1)
Time Frame: Up to 3 years
|
Among responding patients, three-year complete continuous response will also be estimated using duration of CR/CRi for the overall responding group and stratified by whether or not the patients proceed to HSCT.
|
Up to 3 years
|
|
Pharmacokinetic (PK) parameters, i.e., inotuzumab ozogamicin trough levels (Cohort 1)
Time Frame: Cycles 1 and 2 (each cycle is 28 days)
|
Inotuzumab ozogamicin trough levels (ng/mL) will be determined in serum by validated, high sensitivity liquid chromatography-mass spectrometry (LCMS) assays.
Descriptive summary statistics will be provided for the trough levels at scheduled visits for Cycles 1 and 2.
|
Cycles 1 and 2 (each cycle is 28 days)
|
|
Immunogenicity (Cohort 1)
Time Frame: Cycles 1 and 2
|
Enhanced chemiluminescence (ECL) and cell-based assays will be used to detect anti-drug antibodies and neutralizing antibodies to inotuzumab ozogamicin in serum.
Inotuzumab ozogamicin trough levels will be compared between patients with and without antibodies.
|
Cycles 1 and 2
|
|
Incidence of dose-limiting toxicities at recommended phase II dose (RP2D) (Cohort 1)
Time Frame: During Cycle 1, up to 28 days
|
Evaluated according to National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.
Toxicity tables will be constructed to summarize the observed incidence by type of toxicity and grade.
For a given reporting period, a patient will be counted only once for a given toxicity for the worst grade of that toxicity reported for that patient.
|
During Cycle 1, up to 28 days
|
|
Event free survival (EFS) (Cohort 1)
Time Frame: From study entry to first event (induction failure, induction death, relapse, second malignancy, remission death), or date of last follow-up for event free subjects, assessed up to 3 years
|
The EFS rate will be estimated using Kaplan Meier approach.
|
From study entry to first event (induction failure, induction death, relapse, second malignancy, remission death), or date of last follow-up for event free subjects, assessed up to 3 years
|
|
Overall survival (OS) (Cohort 1)
Time Frame: From the time from study entry to death or date of last follow-up, assessed up to 3 years
|
The OS rate will be estimated using Kaplan Meier approach.
|
From the time from study entry to death or date of last follow-up, assessed up to 3 years
|
|
Incidence of dose-limiting toxicities at the selected dose level of inotuzumab ozogamicin in combination with the augmented modified Berlin-Frankfurt-Munster (mBFM) consolidation chemotherapy (Cohort 2)
Time Frame: Up to cycle 1 (each cycle is 42 days)
|
Evaluated according to National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.
Toxicity tables will be constructed to summarize the observed incidence by type of toxicity and grade.
For a given reporting period, a patient will be counted only once for a given toxicity for the worst grade of that toxicity reported for that patient.
|
Up to cycle 1 (each cycle is 42 days)
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Changes in CD22 surface expression (Cohorts 1 and 2)
Time Frame: Baseline, post Cycle 1, and at time of relapse
|
Exploratory analysis of CD22 will focus primarily on the comparison of paired pre-treatment and post-treatment samples at the following times, 1) End of cycle 1 and 2) at relapse to evaluate for changes in CD22 expression pre and post-inotuzumab ozogamicin.
Specifically, samples will be evaluated for change in CD22 expression that occurs over time to study the role of CD22 expression as it relates to resistance to therapy or mechanism for relapse.
Correlation between changes in CD22 expression and patient's clinical response to inotuzumab ozogamicin as well as cytogenetic/molecular features will be described, in particular to explore the association of CD22-negative subpopulations in patients with KMT2A-rearranged acute lymphoblastic leukemia (ALL).
|
Baseline, post Cycle 1, and at time of relapse
|
|
Change in CD22 site density (Cohorts 1 and 2)
Time Frame: Baseline, post Cycle 1, and at time of relapse
|
Exploratory analysis of CD22 will focus primarily on the comparison of paired pre-treatment and post-treatment samples at the following times, 1) End of cycle 1 and 2) at relapse to evaluate for changes in CD22 site density pre and post-inotuzumab ozogamicin.
Samples will be evaluated for any change in CD22 site density that occurs over time and to evaluate for the emergence of a CD22 "dim" or "negative" population to study the role of CD22 site density as it relates to resistance to therapy or mechanism for relapse.
Correlation between changes in CD22 site density and patient's clinical response to inotuzumab ozogamicin as well as cytogenetic/molecular features will be described, in particular to explore the association of CD22-negative subpopulations in patients with KMT2A-rearranged acute lymphoblastic leukemia (ALL).
|
Baseline, post Cycle 1, and at time of relapse
|
|
Leukemic blast CD22 splice variants (Cohorts 1 and 2)
Time Frame: Baseline, post-Cycle 1, and at time of relapse
|
Will be analyzed by ribonucleic acid-sequencing (RNA-Seq).
The MAJIQ and VOILA software will be used to identify splicing variations in CD22 from RNA Seq and to quantitate the percent spliced in (PSI) of the alternative exons.
CD22 protein levels will be determined by immunoblotting of whole cell protein lysates using several anti-CD22 antibodies recognizing either extracellular or intracellular domains.
Both protein sizes and preservation of individual epitopes will be assessed and correlated with alterations in exon inclusion.
|
Baseline, post-Cycle 1, and at time of relapse
|
|
Intracellular signaling pathways in leukemic blasts treated with inotuzumab ozogamicin (Cohorts 1 and 2)
Time Frame: Baseline up to 5 years
|
Peripheral blood samples will be evaluated by comprehensive protein profiling using CyTOF panels for the two major areas of analyses, surface immunophenotyping to assess the developmental stage of both normal and abnormal B cells and measure their responses to inotuzumab ozogamicin , as well as intracellular epitopes to assess the cellular consequences of treatment with inotuzumab ozogamicin.
Exploratory analysis will be performed using Cytobank software tools (viSNE, SPADE and CITRUS) for subpopulations clustering, dimensionality reduction and hierarchical organization.
|
Baseline up to 5 years
|
|
Changes in peripheral blood absolute B cell numbers and maturation of developing B cell populations with inotuzumab ozogamicin therapy (Cohorts 1 and 2)
Time Frame: Baseline up to 5 years
|
Descriptive statistics will be used to characterize patterns of B-cell development including selective loss of subsets.
Changes in B cell number and subsets will be described, and exploratory analysis will be conducted to assess their correlation with clinical features including immunoglobulin levels, occurrence of infections, and need for intravenous immunoglobulin (IVIG) replacement during inotuzumab ozogamicin therapy.
|
Baseline up to 5 years
|
|
Level of MRD by next-generation high-throughput sequencing (HTS) techniques (Cohorts 1 and 2)
Time Frame: Up to 2 cycles
|
Compared to MRD measured by flow cytometry.
MRD levels at each bone marrow evaluation time point will be measured by standard flow cytometry (MRD-negative defined as < 0.01% or 1 leukemic cell in 10-4 nucleated cells).
At the end of cycles 1 and 2, MRD will also be assessed by HTS.
The correlation between the measurements with each technique will be described and the sensitivity of flow-based MRD methodology in the setting of CD22-targeted therapy will be explored.
|
Up to 2 cycles
|
|
Serum levels of candidate SOS biomarkers Ang2 and L ficolin (Cohorts 1 and 2)
Time Frame: Up to 12 months from last dose of inotuzumab ozogamicin
|
Correlated with clinical development of SOS.
Descriptive statistics will be used to characterize clinical features of patients experiencing SOS.
L-ficolin and Ang2 absolute levels and change in level over time with inotuzumab ozogamicin exposure will be evaluated and correlated with development of SOS.
Biomarker levels will be compared using simple comparative statistics between subgroups.
|
Up to 12 months from last dose of inotuzumab ozogamicin
|
|
Incidence of SOS in patients who receive prophylaxis with ursodeoxycholic acid (UDCA) during inotuzumab ozogamicin therapy (Cohorts 1 and 2)
Time Frame: Up to 12 months from last dose of inotuzumab ozogamicin
|
Descriptive statistics will be used to characterize clinical features of patients experiencing SOS, potential clinical risk factors, and the impact of ursodeoxycholic acid prophylaxis.
|
Up to 12 months from last dose of inotuzumab ozogamicin
|
|
Interaction between CAR- T therapy and inotuzumab ozogamicin (Cohorts 1 and 2)
Time Frame: Up to 5 years
|
Will be evaluated by incidence of hematologic DLT in patients with CAR-T therapy prior to inotuzumab ozogamicin, incidence of post-inotuzumab ozogamicin CAR-T therapy, time to CAR-T therapy after inotuzumab ozogamicin, and B-cell recovery prior to CAR-T therapy after inotuzumab ozogamicin.
Will be summarized using descriptive statistics.
|
Up to 5 years
|
|
Morphologic response (CR/CRi) (Cohort 2)
Time Frame: Up to 2 cycles (each cycle is 42 days)
|
Will be estimated using the proportion of eligible/evaluable patients with CR/CRi response.
Analysis will be mostly descriptive.
|
Up to 2 cycles (each cycle is 42 days)
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Maureen M O'Brien, Children's Oncology Group
Publications and helpful links
General Publications
- O'Brien MM, Ji L, Shah NN, Rheingold SR, Bhojwani D, Yuan CM, Xu X, Yi JS, Harris AC, Brown PA, Borowitz MJ, Militano O, Kairalla J, Devidas M, Raetz EA, Gore L, Loh ML. Phase II Trial of Inotuzumab Ozogamicin in Children and Adolescents With Relapsed or Refractory B-Cell Acute Lymphoblastic Leukemia: Children's Oncology Group Protocol AALL1621. J Clin Oncol. 2022 Mar 20;40(9):956-967. doi: 10.1200/JCO.21.01693. Epub 2022 Jan 10.
- Shi Z, Zhu Y, Zhang J, Chen B. Monoclonal antibodies: new chance in the management of B-cell acute lymphoblastic leukemia. Hematology. 2022 Dec;27(1):642-652. doi: 10.1080/16078454.2022.2074704.
- Davis KL, Yao CC, Zimmerman JAO, Rau RE. Immunotherapy in B-Cell Acute Lymphoblastic Leukemia. J Natl Compr Canc Netw. 2025 Dec;23(12):e257067. doi: 10.6004/jnccn.2025.7067.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimated)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Neoplasms
- Immune System Diseases
- Infections
- Virus Diseases
- Neoplasms by Histologic Type
- Hematologic Diseases
- DNA Virus Infections
- Lymphatic Diseases
- Lymphoproliferative Disorders
- Immunoproliferative Disorders
- Lymphoma, Non-Hodgkin
- Lymphoma, B-Cell
- Lymphoma
- Leukemia, Lymphoid
- Leukemia
- Epstein-Barr Virus Infections
- Herpesviridae Infections
- Tumor Virus Infections
- Precursor Cell Lymphoblastic Leukemia-Lymphoma
- Hemic and Lymphatic Diseases
- Burkitt Lymphoma
- Precursor B-Cell Lymphoblastic Leukemia-Lymphoma
- Amino Acids, Peptides, and Proteins
- Proteins
- Organic Chemicals
- Heterocyclic Compounds, 1-Ring
- Heterocyclic Compounds
- Heterocyclic Compounds, 2-Ring
- Heterocyclic Compounds, Fused-Ring
- Investigative Techniques
- Therapeutics
- Clinical Laboratory Techniques
- Diagnostic Techniques and Procedures
- Diagnosis
- Punctures
- Surgical Procedures, Operative
- Cytological Techniques
- Nucleic Acids, Nucleotides, and Nucleosides
- Cytodiagnosis
- Hydrocarbons
- Carbohydrates
- Physical Phenomena
- Alkaloids
- Glycosides
- Hydrolases
- Enzymes
- Enzymes and Coenzymes
- Indoles
- Antibodies, Monoclonal, Humanized
- Antibodies, Monoclonal
- Antibodies
- Immunoglobulins
- Immunoproteins
- Blood Proteins
- Serum Globulins
- Globulins
- Cytidine
- Pyrimidine Nucleosides
- Pyrimidines
- Diagnostic Techniques, Surgical
- Phosphoramide Mustards
- Nitrogen Mustard Compounds
- Mustard Compounds
- Hydrocarbons, Halogenated
- Phosphoramides
- Organophosphorus Compounds
- Nucleosides
- Formyltetrahydrofolates
- Tetrahydrofolates
- Folic Acid
- Pterins
- Pteridines
- Amidohydrolases
- Vinca Alkaloids
- Secologanin Tryptamine Alkaloids
- Indole Alkaloids
- Indolizidines
- Indolizines
- Arabinonucleosides
- Aminopterin
- Aminoglycosides
- Coenzymes
- Electromagnetic Phenomena
- Magnetic Phenomena
- Diagnostic Techniques, Neurological
- Electromagnetic Radiation
- Radiation
- Radiation, Ionizing
- Calicheamicins
- Inotuzumab Ozogamicin
- Methotrexate
- Cyclophosphamide
- Cytarabine
- Leucovorin
- Vincristine
- Asparaginase
- Biopsy
- Specimen Handling
- Spinal Puncture
- X-Rays
- calaspargase pegol
- merphos
- pegaspargase
- asparaginase erwinia chrysanthemi recombinant
Other Study ID Numbers
- AALL1621 (Other Identifier: CTEP)
- U10CA180886 (U.S. NIH Grant/Contract)
- NCI-2016-01494 (Registry Identifier: CTRP (Clinical Trial Reporting Program))
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.