Evaluate the Hematological Remission Rates and Survival Among Chinese Adult Patients With B-precursor ALL (BLING)

A Retrospective Study to Evaluate the Hematological Remission Rates and Survival Among Chinese Adult Patients With Relapsed or Refractory B-precursor Acute Lymphoblastic Leukemia(ALL)

Although the response rate by first-line treatment has been improved, most adult patients with relapsed or refractory ALL will eventually relapse with poor outcomes regardless of treatments. To further understand current status of the treatment of adult patients with relapsed or refractory ALL in China, the study retrospectively collected diagnosis and treatment data from ALL patients in 14 centers in China. Primary objective: to estimate the proportion of patients in overall response rate (ORR) for early relapsed or primary refractory Philadelphia chromosome negative (Ph-) B-precursor ALL patients following salvage treatment (i.e., proportion of patients in hematological complete remission [CR] and CR with partial recovery of blood cells [CRh*]); Secondary objectives included: to estimate the proportion of patients in CR, CRh* and CRi(CR/CRh*/CRi) and the duration of CR/CRh*/CRi, overall survival, duration of CR/CRh*and the proportion of patients receiving allogeneic hematopoietic stem cell transplantation (AlloHSCT) for early relapsed/primary refractory Ph-B-precursor ALL patients following salvage treatment; Exploratory objectives included: to estimate the efficacy in late relapsed Ph- B-precursor ALL (first remission duration > 12 months) patients and in Ph+ B-precursor ALL patients and specific subgroup patients following salvage treatment.

Study Overview

• Status: Completed
• Conditions: B-precursor Acute Lymphoblastic Leukemia
• Intervention / Treatment: Other: salvage therapy

Detailed Description

Title A Retrospective Study to Evaluate the Hematological Remission Rates and Survival Among Chinese Adult Patients with Relapsed or Refractory B-precursor Acute Lymphoblastic Leukemia (BLING)

Key Words Relapsed or refractory acute lymphoblastic leukemia, complete remission, duration of remission, overall survival, hematopoietic stem cell transplantation

Study Background and Rationale Although the response rate by first-line treatment has been improved, most adult patients with relapsed or refractory ALL will eventually relapse with poor outcome regardless of treatments. In order to improve the diagnosis and treatment level of adult ALL in China, Chinese Society of Hematology and Committee of Hematologic Malignancies of the Chinese Anti-Cancer Association released Expert Consensus on Diagnosis and Treatment of Acute Lymphoblastic Leukemia in Chinese Adult Patients in 2012. However, there is no nationwide multi-center retrospective observational study to evaluate the treatment status of adult patients with R/r ALL (including treatment regimens, and remission rate, overall survival and rate of allogeneic hematopoietic stem cell transplantation of R/r ALL patients following standard salvage chemotherapy), and these data will provide an important reference for further standardization of the treatment of ALL in China, improvement of the prognosis and the research and development of new drugs.

Study questions and Objectives

Primary objectives:

To estimate the proportion of patients in overall response rate (ORR) for early relapsed (a first remission duration of ≤12 months) or primary refractory R/r Philadelphia chromosome negative (Ph-) B-precursor ALL patients following salvage treatment (i.e., proportion of patients in hematological complete remission [CR] and CR with partial recovery of blood cells [CRh*]).

Secondary objectives:

To estimate the proportion of patients in CR, CRh* or CRi for early relapsed/primary refractory Ph-B-precursor ALL patients following salvage treatment (CR/CRh*/CRi) To estimate overall survival (OS) for early relapsed/primary refractory Ph-B-precursor ALL patients following salvage treatment To estimate the duration of CR/CRh* for early relapsed/primary refractory Ph-B-precursor ALL patients following salvage treatment To estimate the duration of CR/CRh*/CRi for early relapsed/primary refractory Ph- B-precursor ALL patients following salvage treatment To estimate the proportion of patients receiving allogeneic hematopoietic stem cell transplantation (AlloHSCT) among early relapsed/primary refractory Ph- B-precursor ALL patients following salvage treatment To examine the potential prognostic factors of early relapsed/primary refractory Ph-B-precursor ALL patients by performing subgroup and regression analyses To estimate overall response rate (CR/CRh*), CR/CRh*/CRi, overall survival (OS), duration of CR/CRh*/CRi, duration of CR/CRh* and the proportion of patients receiving allogeneic hematopoietic stem cell transplantation (AlloHSCT) after CR or CRh* among Ph- B-precursor ALL patients with duration of first CR ≤ 12 months following first salvage treatment

Exploratory objectives:

To estimate the proportion of patients in CR/CRh*, duration of CR/CRh*, proportion of patients in CR/CRh*/CRi, duration of CR/CRh*/CRi, OS and proportion of patients receiving AlloHSCT following salvage treatment for late relapsed (a first remission duration of >12 months) Ph- B-precursor ALL To estimate the proportion of patients in CR/CRh*, duration of CR/CRh*, proportion of patients in CR/CRh*/CRi, duration of CR/CRh*/CRi, OS and the proportion of patients receiving AlloHSCT for Ph+ B-precursor ALL patients and specific subgroup of patients following treatment for R/r B-precursor ALL To examine the potential prognostic factors of late relapsed Ph- B-precursor ALL patients and Ph+ B-precursor ALL patients To describe the types of chemotherapy regimens received and the corresponding efficacy results of main regimens, among patients following primary and salvage treatment for R/r B-precursor ALL Study Design This study was a retrospective study in which data were retrospectively collected from patients with R/r B-precursor ALL in 14 main hematologic malignancy centers in China. Patient subgroups were defined by factors that might influence ORR and OS to better understand their effects on study endpoints.

Subjects and Study Size

The study selected patients with R/r B-precursor ALL meeting inclusion criteria. Specific inclusion criteria were as follows:

Chinese adult patients with R/r B-precursor ALL who had received salvage treatment At least one complete response evaluation results available for salvage treatment With definite Ph chromosome status Age ≥15 years at time of de novo (initial) diagnosis of ALL. For relapsed patients who met the above conditions must also have

1. Evaluable duration of CR by initial therapy, 2. No central nervous system involved at relapsed, 3. No isolated extramedullary relapse.

Patients were divided into 3 analysis sets based on molecular genetic factor and type, and time from initial response to relapse. Ph- Primary Analysis Set included patients who are diagnosed with Ph- disease and meet one of the following criteria: in first relapse or salvage treatment after a first complete remission duration of ≤12 months, or refractory to initial treatment, or relapsed/refractory after first or subsequent salvage treatment, or Relapsed/refractory within 12 months after allogeneic hematopoietic stem cell transplantation (AlloHSCT). The Ph- Late Relapse Analysis Set included patients who had a first remission duration of >12 months and were in first relapse or salvage treatment. The Ph+ Analysis Set included patients who were diagnosed with Ph+ disease.

• Study Type: Observational
• Enrollment (Actual): 632

Contacts and Locations

Study Locations

• China
  • Heilongjiang
    • Harbin, Heilongjiang, China, 150000
      • Institute of Harbin Hematology Oncology

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 15 years and older (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

Relapsed or Refractory B-precursor Acute Lymphoblastic Leukemia

Description

Inclusion Criteria:

• Chinese adult patients with R/r B-precursor ALL who had received salvage treatment
• At least one complete response evaluation results available for salvage treatment
• With definite Ph chromosome status
• Age ≥15 years at time of de novo (initial) diagnosis of ALL.
• For relapsed patients who met the above conditions must also have
• Evaluable duration of CR by initial therapy
• No central nervous system involved at relapsed
• No isolated extramedullary relapse Patients were divided into 3 analysis sets based on molecular genetic factor and type, and time from initial response to relapse.
• Ph- Primary Analysis Set included patients who are diagnosed with Ph- disease and meet one of the following criteria:
• in first relapse or salvage treatment after a first complete remission duration of ≤12 months, or refractory to initial treatment, or relapsed/refractory after first or subsequent salvage treatment, or Relapsed/refractory within 12 months after alloHSCT.
• The Ph- Late Relapse Analysis Set included patients who had a first remission duration of >12 months and were in first relapse or salvage treatment.
• The Ph+ Analysis Set included patients who were diagnosed with Ph+ disease.

Exclusion Criteria:

-

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
R/r B-precursor ALL; This study selected patients with Relapsed or Refractory (R/r) B-precursor Acute Lymphoblastic Leukemia	Other: salvage therapy; VDC(L)P regimen or High-dose cytarabine based regimen or High-dose methotrexate based regimen or Hyper-CVAD regimen or FLAG (Flu, Ara-C, G-CSF) ± anthracyclines based regimen or Repeated original induction regimen or VDP or other; Other Names: Ph-PAS

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
overall response rate	overall response rate after the last salvage therapy, i.e., CR/CRh*. CR is generally defined as no blasts in peripheral blood, absence of extramedullary leukemia, full recovery of peripheral blood counts, ≤ 5% blasts in the bone marrow, ANC > 1.0×109/L, PLT > 100×109/L, no relapse within 4 weeks. CRh* was CR with partial recovery of peripheral blood counts, ANC > 0.5×109/L, PLT > 50×109/L, with other conditions meeting the criteria for CR	up to 3 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
proportion of patients in CR, CRh* or CRi	the proportion of patients in CR, CRh* or CRi for early relapsed/primary refractory Ph- B-precursor ALL patients following last salvage treatment	up to 3 years
overall survival	overall survival (OS) for early relapsed/primary refractory Ph- B-precursor ALL patients after CR or CRh* achieved	up to 3 years
duration of remission (CR/CRh*, CR/CRh*/CRi)	duration of remission (CR/CRh*, CR/CRh*/CRi) for early relapsed/primary refractory Ph- B-precursor ALL patients after CR or CRh* achieved	up to 3 years
proportion of patients receiving allogeneic hematopoietic stem cell transplantation	the proportion of patients receiving allogeneic hematopoietic stem cell transplantation (AlloHSCT) among early relapsed/primary refractory Ph- B-precursor ALL patients following salvage treatment	up to 3 years
overall survival	overall survival (OS) among R/r Ph- B-precursor ALL patients after achieving CR or CRh* after the first salvage therapy	up to 3 years
duration of CR/CRh*/CRi	duration of CR/CRh* among R/r Ph- B-precursor ALL patients after achieving CR or CRh* after the first salvage therapy	up to 3 years
the proportion of patients receiving allogeneic hematopoietic stem cell transplantation (AlloHSCT)	the proportion of patients receiving allogeneic hematopoietic stem cell transplantation (AlloHSCT) after CR or CRh* achieved among R/r Ph- B-precursor ALL patients after achieving CR or CRh* after the first salvage therapy	up to 3 years
Complete Response	Complete Response among R/r Ph- B-precursor ALL patients after achieving CR or CRh* after the first salvage therapy	up to 3 years
Complete Response with incomplete recovery of blood cells	Complete Response with incomplete recovery of blood cells among R/r Ph- B-precursor ALL patients after achieving CR or CRh* after the first salvage therapy	up to 3 years
Complete Response with partial recovery of blood cells	Complete Response with partial recovery of blood cells among R/r Ph- B-precursor ALL patients after achieving CR or CRh* after the first salvage therapy	up to 3 years
duration of CR/CRh*	duration of CR/CRh* with partial recovery of blood cells among R/r Ph- B-precursor ALL patients after achieving CR or CRh* after the first salvage therapy	up to 3 years

Collaborators and Investigators

• Sponsor: Harbin Hematology and Oncology Institute
• Investigators: Study Chair: Jun Ma, director, Institute of Harbin Hematology Oncology

Publications and helpful links

General Publications

• Gokbuget N, Stanze D, Beck J, Diedrich H, Horst HA, Huttmann A, Kobbe G, Kreuzer KA, Leimer L, Reichle A, Schaich M, Schwartz S, Serve H, Starck M, Stelljes M, Stuhlmann R, Viardot A, Wendelin K, Freund M, Hoelzer D; German Multicenter Study Group for Adult Acute Lymphoblastic Leukemia. Outcome of relapsed adult lymphoblastic leukemia depends on response to salvage chemotherapy, prognostic factors, and performance of stem cell transplantation. Blood. 2012 Sep 6;120(10):2032-41. doi: 10.1182/blood-2011-12-399287. Epub 2012 Apr 4.
• Bassan R, Gatta G, Tondini C, Willemze R. Adult acute lymphoblastic leukaemia. Crit Rev Oncol Hematol. 2004 Jun;50(3):223-61. doi: 10.1016/j.critrevonc.2003.11.003.
• Fielding AK, Richards SM, Chopra R, Lazarus HM, Litzow MR, Buck G, Durrant IJ, Luger SM, Marks DI, Franklin IM, McMillan AK, Tallman MS, Rowe JM, Goldstone AH; Medical Research Council of the United Kingdom Adult ALL Working Party; Eastern Cooperative Oncology Group. Outcome of 609 adults after relapse of acute lymphoblastic leukemia (ALL); an MRC UKALL12/ECOG 2993 study. Blood. 2007 Feb 1;109(3):944-50. doi: 10.1182/blood-2006-05-018192. Epub 2006 Oct 10.
• Jabbour EJ, Faderl S, Kantarjian HM. Adult acute lymphoblastic leukemia. Mayo Clin Proc. 2005 Nov;80(11):1517-27. doi: 10.4065/80.11.1517.
• Larson RA. Acute lymphoblastic leukemia: older patients and newer drugs. Hematology Am Soc Hematol Educ Program. 2005:131-6. doi: 10.1182/asheducation-2005.1.131.
• Le QH, Thomas X, Ecochard R, Iwaz J, Lheritier V, Michallet M, Fiere D. Proportion of long-term event-free survivors and lifetime of adult patients not cured after a standard acute lymphoblastic leukemia therapeutic program: adult acute lymphoblastic leukemia-94 trial. Cancer. 2007 May 15;109(10):2058-67. doi: 10.1002/cncr.22632.
• Liu L, Jiao W, Zhang Y, Qu Q, Li X, Wu D. Efficacy of low-dose cytarabine and aclarubicin in combination with granulocyte colony-stimulating factor (CAG regimen) compared to Hyper-CVAD regimen as salvage chemotherapy in relapsed/refractory Philadelphia chromosome-negative acute lymphoblastic leukemia. Leuk Res. 2015 Mar;39(3):323-8. doi: 10.1016/j.leukres.2015.01.003. Epub 2015 Jan 16.
• Oriol A, Vives S, Hernandez-Rivas JM, Tormo M, Heras I, Rivas C, Bethencourt C, Moscardo F, Bueno J, Grande C, del Potro E, Guardia R, Brunet S, Bergua J, Bernal T, Moreno MJ, Calvo C, Bastida P, Feliu E, Ribera JM; Programa Espanol de Tratamiento en Hematologia Group. Outcome after relapse of acute lymphoblastic leukemia in adult patients included in four consecutive risk-adapted trials by the PETHEMA Study Group. Haematologica. 2010 Apr;95(4):589-96. doi: 10.3324/haematol.2009.014274. Epub 2010 Feb 9.
• Pui CH, Evans WE. Acute lymphoblastic leukemia. N Engl J Med. 1998 Aug 27;339(9):605-15. doi: 10.1056/NEJM199808273390907. No abstract available.
• Thomas DA, Kantarjian H, Smith TL, Koller C, Cortes J, O'Brien S, Giles FJ, Gajewski J, Pierce S, Keating MJ. Primary refractory and relapsed adult acute lymphoblastic leukemia: characteristics, treatment results, and prognosis with salvage therapy. Cancer. 1999 Oct 1;86(7):1216-30. doi: 10.1002/(sici)1097-0142(19991001)86:73.0.co;2-o.
• Yan CH, Wang JZ, Liu DH, Xu LP, Chen H, Liu KY, Huang XJ. Chemotherapy followed by modified donor lymphocyte infusion as a treatment for relapsed acute leukemia after haploidentical hematopoietic stem cell transplantation without in vitro T-cell depletion: superior outcomes compared with chemotherapy alone and an analysis of prognostic factors. Eur J Haematol. 2013 Oct;91(4):304-14. doi: 10.1111/ejh.12168. Epub 2013 Aug 17.

Study record dates

Study Major Dates

• Study Start (Actual): July 10, 2015
• Primary Completion (Actual): June 3, 2016
• Study Completion (Actual): October 10, 2016

Study Registration Dates

• First Submitted: April 13, 2017
• First Submitted That Met QC Criteria: April 17, 2017
• First Posted (Actual): April 21, 2017

Study Record Updates

• Last Update Posted (Actual): April 21, 2017
• Last Update Submitted That Met QC Criteria: April 17, 2017
• Last Verified: April 1, 2017

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Immune System Diseases; Neoplasms by Histologic Type; Neoplasms; Lymphoproliferative Disorders; Lymphatic Diseases; Immunoproliferative Disorders; Leukemia; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Leukemia, Lymphoid
• Other Study ID Numbers: TA-ALL-150182

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: To protect the privacy of individual who participate in this trial we would not share the individual data with other researchers

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: Yes
• product manufactured in and exported from the U.S.: No