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- Klinische proef NCT00562328
Rituximab, Alemtuzumab, and GM-CSF As First-Line Therapy in Treating Patients With Early-Stage Chronic Lymphocytic Leukemia
Antibody Therapy With Alemtuzumab, Rituximab and GM-CSF for Initial Treatment of High Risk Chronic Lymphocytic Leukemia
RATIONALE: Monoclonal antibodies, such as rituximab and alemtuzumab, can block cancer growth in different ways. Some block the ability of cancer cells to grow and spread. Others find cancer cells and help kill them or carry cancer-killing substances to them. Colony-stimulating factors, such as GM-CSF, may increase the number of immune cells found in bone marrow or peripheral blood. Giving monoclonal antibody therapy together with GM-CSF may be an effective treatment for early-stage chronic lymphocytic leukemia.
PURPOSE: This phase II trial is studying the side effects of giving rituximab and alemtuzumab together with GM-CSF and to see how well it works in treating patients with early-stage chronic lymphocytic leukemia.
Studie Overzicht
Toestand
Conditie
Interventie / Behandeling
Gedetailleerde beschrijving
OBJECTIVES:
Primary
- To assess the rate of complete and overall response in patients with high-risk, early-stage, chronic lymphocytic leukemia (CLL) treated with alemtuzumab, rituximab, and sargramostim (GM-CSF).
- To monitor and assess toxicity of this regimen in these patients through clinical evaluation and serial monitoring of cytomegalovirus antigenemia by polymerase chain reaction (PCR).
Secondary
- To determine the overall and progression-free survival, time to response, time to next treatment, and duration of response in patients treated with this regimen.
- To assess the correlation between individual prognostic markers (i.e., 17p-, 11q-, unmutated VH gene, use of VH3-21, ZAP70+, CD38+) and clinical outcome.
Correlative Studies
- To assess response in these patients using an expanded definition of response, including minimal residual disease (MRD) by sensitive flow cytometry in patients in complete clinical remission.
- To assess MRD status of responding patients using sensitive flow cytometry and molecular assays (i.e., spectral karyotype analysis of CLL cells) before treatment and at relapse to identify subpopulations that could contribute to disease resistance and relapse.
- To detail the in vivo effect of this regimen on critical aspects of the immune system in CLL.
- To determine if GM-CSF, β-glucan, and CpG7909 can increase antibody dependent cellular cytotoxicity to improve efficacy against CLL cells and clinical response to treatment.
OUTLINE: Patients receive rituximab IV over 30 minutes on day 3 of weeks 2-5, alemtuzumab subcutaneously (SC) on days 3, 4, and 5 in week 1 and on days 1, 3, and 5 in weeks 2-5, and sargramostim SC on days 1, 3, and 5 in weeks 1-6. Treatment continues in the absence of disease progression or unacceptable toxicity.
Patients undergo blood sample collection for measurement of serum cytomegalovirus DNA copy number by polymerase chain reaction at baseline, weekly during treatment, and monthly for the 6 months after completion of treatment. Patients also undergo bone marrow biopsy and aspirate at two months and then again at 12 months (if in complete remission). Blood samples are collected periodically during study for evaluation of prognostic biomarkers (i.e., 11q-, 17p-, unmutated IgVH gene, VH3-21 gene segment use, and CD38 and ZAP-70 expression) by fluorescent in situ hybridization (FISH) and for immunophenotyping by flow cytometry. Blood samples are collected from patients at the Mayo Clinic Rochester site at baseline and periodically during study for immunological and other correlative studies, including minimal residual disease (in responding patients only).
After completion of study therapy, patients are followed periodically for up to 5 years.
Studietype
Inschrijving (Werkelijk)
Fase
- Fase 2
Contacten en locaties
Studie Locaties
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Arizona
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Scottsdale, Arizona, Verenigde Staten, 85259-5499
- Mayo Clinic Scottsdale
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Minnesota
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Rochester, Minnesota, Verenigde Staten, 55905
- Mayo Clinic Cancer Center
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Deelname Criteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
Accepteert gezonde vrijwilligers
Geslachten die in aanmerking komen voor studie
Beschrijving
DISEASE CHARACTERISTICS:
Diagnosis of chronic lymphocytic leukemia (CLL) meeting the following criteria:
- Minimum threshold peripheral blood lymphocyte count 5 x 10^9/L
Monoclonality (light chain exclusion) of B lymphocytes detected by immunophenotyping (CD19-positive), demonstrating ≥ 3 of the following characteristics:
- CD5-positive
- CD23-positive
- Dim surface light chain expression
- Dim surface CD20 expression
- Negative for IGH/CCND1 translocation AND/OR immunostaining is negative for cyclin D1 expression by fluorescent in-situ hybridization (FISH) analysis
- Rai stage 0, I, or II disease that does not meet standard NCI-Working Group criteria for treatment of CLL
Poor prognosis as defined by ≥ 1 of the following factors:
- Unmutated IgVH mutation status AND CD38 expression (i.e., ≥ 30% cells positive on flow cytometry)
- Unmutated IgVH mutation status AND ZAP-70 expression (i.e., ≥ 20% cells positive on flow cytometry)
- VH3-21 gene segment use irrespective of mutation status AND CD38 expression (≥ 30% cells positive on flow cytometry)
- VH3-21 gene segment use irrespective of mutation status AND ZAP-70 expression (≥ 20% cells positive on flow cytometry)
- 11q-negative*
- 17p-negative* NOTE: *Determination of IgVH mutation status is not required in patients whose eligibility is based on 17p13- or 11q22- deletions
PATIENT CHARACTERISTICS:
- ECOG performance status 0- 2
- Creatinine ≤ 1.5 times upper limit of normal (ULN)
- Total bilirubin ≤ 3.0 times ULN OR direct bilirubin ≤ 1.5 ULN
- AST ≤ 3.0 times ULN (unless due to hemolysis or CLL)
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must practice effective contraception
- Willing to provide mandatory blood samples (for patients at the Mayo Clinic in Rochester only) for research studies as required by the protocol
No comorbid conditions, including any of the following:
- New York Heart Association Class III or IV heart disease
- Myocardial infarction within the past month
- Uncontrolled infection
- HIV infection or AIDS
- Serological evidence of active hepatitis B infection (i.e., serum antigen or e-antigen positivity) or positive hepatitis C serology
- No other active primary malignancy requiring treatment or limiting survival to ≤ 2 years
- No active autoimmune hemolytic anemia, immune thrombocytopenia, or pure red blood cell aplasia
PRIOR CONCURRENT THERAPY:
- More than 4 weeks since prior major surgery
- No prior chemotherapy or monoclonal antibody treatment for CLL
- No concurrent corticosteroids
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Behandeling
- Toewijzing: NVT
- Interventioneel model: Opdracht voor een enkele groep
- Masker: Geen (open label)
Wapens en interventies
Deelnemersgroep / Arm |
Interventie / Behandeling |
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Experimenteel: Alemtuzumab + Rituximab + GM-CSF
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Week 1 (dose escalation): Day 3: 3mg subcutaneously; Day 4: 10mg subcutaneously; Day 5 30mg subcutaneously Weeks 2-5: 30mg subcutaneously three times a week. Weeks 2-5: 375 mg/m^2 by IV once weekly Week 1-6: 250 mcg subcutaneously three time as week
Andere namen:
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Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
---|---|---|
Number of Confirmed Responses (Complete or Partial Response Noted as the Objective Status for a Duration of at Least 2 Months) at 6 Months
Tijdsspanne: 6 months
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Response, as defined by the National Cancer Institute Working Group (NCIWG), requires the following for a period of at least 2 months:
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6 months
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Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
---|---|---|
Progression Free Survival
Tijdsspanne: Time from registration to progression (up to 5 years)
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Progression free survival (PFS) is defined as the time from the date of randomization to the date of disease progression or death resulting from any cause, whichever comes first.
Progression is defined according to the standard NCI-WG96 criteria.
The median and 95% confidence intervals are estimated using the Kaplan-Meier estimator.
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Time from registration to progression (up to 5 years)
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Duration of Response
Tijdsspanne: time from start of response to progression (up to 5 years)
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Duration of response (DOR) is defined as the time from documentation of response (CR or PR) to disease progression. The median DOR with 95% CI was estimated using the Kaplan Meier method.Response, as defined by the National Cancer Institute Working Group (NCIWG), requires the following for a period of at least 2 months:
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time from start of response to progression (up to 5 years)
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Time to Next Treatment
Tijdsspanne: time from end of protocol treatment to subsequent treatment (up to 5 years)
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Time to next treatment was defined as the time from end of active (protocol) treatment to the start of subsequent treatment.
The median and 95% CI was estimated using the Kaplan Meier method.
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time from end of protocol treatment to subsequent treatment (up to 5 years)
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Overall Survival
Tijdsspanne: Time from registration to death (up to 5 years)
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Overall Survival (OS) was defined as the time from registration to death of any cause.
Participants were followed for a maximum of 5 years from registration.
The median OS with 95% CI was estimated using the Kaplan Meier method.
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Time from registration to death (up to 5 years)
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Medewerkers en onderzoekers
Sponsor
Medewerkers
Onderzoekers
- Studie stoel: Clive S. Zent, MD, Mayo Clinic
Publicaties en nuttige links
Studie record data
Bestudeer belangrijke data
Studie start (Werkelijk)
Primaire voltooiing (Werkelijk)
Studie voltooiing (Werkelijk)
Studieregistratiedata
Eerst ingediend
Eerst ingediend dat voldeed aan de QC-criteria
Eerst geplaatst (Schatting)
Updates van studierecords
Laatste update geplaatst (Werkelijk)
Laatste update ingediend die voldeed aan QC-criteria
Laatst geverifieerd
Meer informatie
Termen gerelateerd aan deze studie
Trefwoorden
Aanvullende relevante MeSH-voorwaarden
- Ziekten van het immuunsysteem
- Neoplasmata per histologisch type
- Neoplasmata
- Lymfoproliferatieve aandoeningen
- Lymfatische ziekten
- Immunoproliferatieve aandoeningen
- Leukemie, B-cel
- Leukemie
- Leukemie, lymfatische, chronische, B-cel
- Leukemie, Lymfoïde
- Fysiologische effecten van medicijnen
- Antireumatische middelen
- Antineoplastische middelen
- Immunologische factoren
- Antineoplastische middelen, immunologisch
- Rituximab
- Sargramostim
- Alemtuzumab
Andere studie-ID-nummers
- CDR0000574754
- P30CA015083 (Subsidie/contract van de Amerikaanse NIH)
- MC0785 (Andere identificatie: Mayo Clinic Cancer Center)
- U4449s (Andere identificatie: Genentech)
- 001.0888 (Andere identificatie: Bayer)
- 07-002087 (Andere identificatie: Mayo Clinic IRB)
Deze informatie is zonder wijzigingen rechtstreeks van de website clinicaltrials.gov gehaald. Als u verzoeken heeft om uw onderzoeksgegevens te wijzigen, te verwijderen of bij te werken, neem dan contact op met register@clinicaltrials.gov. Zodra er een wijziging wordt doorgevoerd op clinicaltrials.gov, wordt deze ook automatisch bijgewerkt op onze website .
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