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Ofatumumab and High-dose Methylprednisolone in Patients With Chronic Lymphocytic Leukemia (CLL) (CRC027)

Primary Purpose

CLL

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Ofatumumab/HDMP
Sponsored by
Januario Castro, M.D.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for CLL focused on measuring Leukemia, Chronic leukemia, Chronic Lymphocytic Leukemia, Relapsed, Refractory

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Previously treated patients with a diagnosis of CLL
  2. Previous treatment with any monoclonal antibody or chemotherapy regardless of response as defined by the iwCLL Working Group Guidelines as evidenced by:

    • progressive marrow failure as manifested by the development of, or worsening of, anemia and/or thrombocytopenia
    • massive (i.e. at least 6cm below the left costal margin) or progressive or symptomatic splenomegaly
    • massive nodes (i.e. at least 10cm in longest diameter) or progressive or symptomatic lymphadenopathy.
    • progressive lymphocytosis with an increase of more than 50% over a 2-month period or lymphocyte doubling time (LDT) of less than 6 months.
    • autoimmune anemia and/or thrombocytopenia that is poorly responsive to corticosteroids or other standard therapy (See Section 10.2)
  3. Constitutional symptoms, defined as any one or more of the following disease-related symptoms or signs: unintentional weight loss of 10% or more within the previous 6 months significant fatigue (i.e. ECOG PS 2 or worse, inability to work or perform usual activities), fevers higher than 100.5ºF or 38.0ºC for 2 or more weeks without other evidence of infection, night sweats for more than 1 month without evidence of infection
  4. Subjects must be 18 years of age or older, male or female.
  5. ECOG performance status of 0-2.
  6. Subjects must be able to give informed consent.
  7. Females of child bearing potential(FCBP)† must have a negative serum or urine pregnancy test within 10 - 14 days prior to and again within 24 hours of starting treatment and agree to use a medically accepted contraceptive method for the duration of this study.

Exclusion Criteria:

  1. Hepatitis BsAg positive, Hepatitis BcAb positive, and Hepatitis C positive patients.
  2. Known HIV positive patients.
  3. Diabetics.
  4. Patients with uncontrolled Autoimmune Hemolytic Anemia (AIHA) or autoimmune thrombocytopenia (ITP).
  5. Screening laboratory values within these ranges: platelets <50 x 109/L, neutrophils <1.0 x 109/L, creatinine >2.0 times upper normal limit,total bilirubin >1.5 times upper normal limit (unless a known history of Gilbert's disease), ALT >2.5 times upper normal limit (unless due to disease involvement of liver), alkaline phosphatase >2.5 times upper normal limit (unless due to disease involvement of the liver or bone marrow)
  6. Inability to provide informed consent.
  7. Concurrent malignancy (excluding basal and squamous cell skin cancers).
  8. Active fungal, bacterial, and/or viral infection.
  9. History of peptic ulcer disease resulting in GI bleeding within the last 6 months.
  10. Untreated metabolic disorders such as hypothyroidism and Cushing's disease.
  11. History of steroid-induced psychosis.
  12. Estimated life expectancy of less than 3 months by the investigator's best clinical judgment.
  13. Serious medical condition that would render the subject medically unstable.
  14. Women who are pregnant or breast-feeding.
  15. History of Pancreatitis.
  16. History of Diverticulitis.
  17. Patients with known hypersensitivity to ofatumumab or known history of anaphylaxis to Rituximab or alemtuzumab.
  18. Concurrent use of other anti-cancer agents or treatments.
  19. Subjects who have current active hepatic or biliary disease (with exception of patients with Gilbert's syndrome, asymptomatic gallstones, liver metastases or stable chronic liver disease per investigator assessment).

Sites / Locations

  • UC San Diego Moores Cancer Center
  • University of California San Diego, Moores Cancer Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Ofatumumab/HDMP

Arm Description

High dose methylprednisolone sodium succinate (HDMP) at 1gm/m2 daily as infusion for 3 consecutive days every cycle. Ofatumumab 300mg administered Day1 of cycle 1 followed by 12 doses of 1000mg administered. Each patient may receive 3 cycles of treatment in the absence of progressive disease or significant toxicity.

Outcomes

Primary Outcome Measures

IwCLL-WG Defined Complete Response (CR)
Responses were assessed two months after completion of therapy. Criteria for complete remission is assessed with: a bone marrow biopsy and repeat CT scan (abdominal, chest and pelvis if initial was abnormal) to confirm iwCLL-WG defined CR. iwCLL-WG Complete Response is defined as: Peripheral blood lymphocytes (evaluated by blood and differential count) below 4 x 109/L (4000/L). Absence of lymphadenopathy (>1.5 cm)of physical exam; AND No hepatomegaly and splenomegaly on physical exam; AND Absence of constitutional symptoms; AND Normal complete blood count as exhibited by neutrophils ≥ 1,500/μl, platelets > 100,000/μl, hemoglobin > 11.0g/dL (non-transfused), and lymphocyte count < 5,000/μl; AND Bone marrow aspirate and biopsy must be normocellular for age with <30% of nucleated cells being lymphocytes. Lymphoid nodules must be absent

Secondary Outcome Measures

IwCLL-WG Defined Overall Response Rate (ORR)
Responses were assessed two months after completion of therapy. Overall Response Rate (ORR) = CR + PR
IwCLL-WG Defined Nodular Partial Response (PR)
Responses were assessed two months after completion of therapy. Partial Response is defined as: Greater than or equal to 50% decrease in blood absolute lymphocyte count from pre-treatment value; AND Greater than or equal to 50% reduction in lymphadenopathy from pre-treatment value; AND Greater than or equal to 50% reduction in splenomegaly/hepatomegaly from pre-treatment value. In addition, patients need to have at least ONE of the following: Neutrophils ≥ 1,500/μl or ≥ 50% improvement from pre-treatment value; AND / OR Platelets > 100,000/μl or 50% improvement from pre-treatment value; AND / OR Hemoglobin > 11.0 gm/dl (non-transfused) or 50% improvement from pre-treatment value.
IwCLL-WG Defined Partial Response (PR)
Responses were assessed two months after completion of therapy
IwCLL-WG Defined Stable Disease (SD)
Responses were assessed two months after completion of therapy. Subjects who do not fulfill the criteria for complete or partial response as defined above but do not exhibit progressive disease will be considered as having stable disease.
IwCLL-WG Defined Progressive Disease (PD)
Responses were assessed two months after completion of therapy Progressive Disease is defined as: Greater than or equal to 50% increase in the products of at least two lymph nodes on two consecutive determinations two weeks apart (at least one lymph node must be ≥ 2 cm; or the appearance of a new palpable lymph node; OR Greater than or equal to 50% increase in the size of the liver and/or spleen as determined by measurement below the respective costal margins; or appearance of palpable hepatomegaly or splenomegaly, which was not previously present; OR Greater than or equal to 50% increase in the absolute number of circulating lymphocytes to at least 5,000μl; OR Transformation to a more aggressive histology (i.e., Richter's syndrome or prolymphocytic leukemia with ≥ 56% prolymphocytes);
Progression-free Survival (PFS)
Treatment-Free Survival
Safety and Tolerability Measured Via Adverse Events
Please see Adverse Event module for additional details.
Detectable Minimal Residual Disease (MRD)
The patient who achieved a CR did not have detectable MRD in the bone marrow by four-color flow cytometry (<0.1% of cells).

Full Information

First Posted
August 26, 2010
Last Updated
April 9, 2018
Sponsor
Januario Castro, M.D.
Collaborators
GlaxoSmithKline
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1. Study Identification

Unique Protocol Identification Number
NCT01191190
Brief Title
Ofatumumab and High-dose Methylprednisolone in Patients With Chronic Lymphocytic Leukemia (CLL)
Acronym
CRC027
Official Title
A Phase II Study of Ofatumumab in Combination With High-dose Methylprednisolone in Patients With Relapsed or Refractory Chronic Lymphocytic Leukemia (CLL)
Study Type
Interventional

2. Study Status

Record Verification Date
April 2018
Overall Recruitment Status
Completed
Study Start Date
August 2010 (undefined)
Primary Completion Date
February 2012 (Actual)
Study Completion Date
August 2012 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Januario Castro, M.D.
Collaborators
GlaxoSmithKline

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Patients who have relapsed/refractory CLL and require therapy as per iwCLL guidelines will be eligible. Subjects will receive a treatment with ofatumumab and HDMP for three consecutive 4 week cycles. The primary endpoint is to determine the complete response (CR) to therapy and the secondary endpoints will assess the safety and tolerability of the regimen, the impact of the treatment on progression free, treatment free, overall survival, and pharmacokinetics of ofatumumab. Patients will receive allopurinol for tumor-lysis prophylaxis and antimicrobial prophylaxis.
Detailed Description
Patients who have relapsed/refractory CLL and require therapy as per iwCLL guidelines will be eligible. Subjects will receive a treatment with ofatumumab and HDMP for three consecutive 4 week cycles. The primary endpoint is to determine the complete response (CR) to therapy and the secondary endpoints will assess the safety and tolerability of the regimen, the impact of the treatment on progression free, treatment free, overall survival, and pharmacokinetics of ofatumumab. Cycles 1-3 will be administered without scheduled interruption every 28 days for a total of 12 weeks of therapy. Patients will receive allopurinol for tumor-lysis prophylaxis and antimicrobial prophylaxis. Blood glucose levels will be monitored immediately after HDMP infusion by finger stick glucometry. Two months following completion of treatment a response assessment will occur per iwCLL guidelines. The treatment will be administered as outpatient, and each cycle will be four weeks in duration.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
CLL
Keywords
Leukemia, Chronic leukemia, Chronic Lymphocytic Leukemia, Relapsed, Refractory

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
21 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Ofatumumab/HDMP
Arm Type
Experimental
Arm Description
High dose methylprednisolone sodium succinate (HDMP) at 1gm/m2 daily as infusion for 3 consecutive days every cycle. Ofatumumab 300mg administered Day1 of cycle 1 followed by 12 doses of 1000mg administered. Each patient may receive 3 cycles of treatment in the absence of progressive disease or significant toxicity.
Intervention Type
Drug
Intervention Name(s)
Ofatumumab/HDMP
Other Intervention Name(s)
Arzerra, HuMax-CD20
Intervention Description
High dose methylprednisolone sodium succinate (HDMP) at 1gm/m2 daily as infusion for 3 consecutive days every cycle. Ofatumumab 300mg administered Day1 of cycle 1 followed by 12 doses of 1000mg administered based on specific schedule. Each patient will receive a maximum of 3 cycles (one cycle is 28 days)
Primary Outcome Measure Information:
Title
IwCLL-WG Defined Complete Response (CR)
Description
Responses were assessed two months after completion of therapy. Criteria for complete remission is assessed with: a bone marrow biopsy and repeat CT scan (abdominal, chest and pelvis if initial was abnormal) to confirm iwCLL-WG defined CR. iwCLL-WG Complete Response is defined as: Peripheral blood lymphocytes (evaluated by blood and differential count) below 4 x 109/L (4000/L). Absence of lymphadenopathy (>1.5 cm)of physical exam; AND No hepatomegaly and splenomegaly on physical exam; AND Absence of constitutional symptoms; AND Normal complete blood count as exhibited by neutrophils ≥ 1,500/μl, platelets > 100,000/μl, hemoglobin > 11.0g/dL (non-transfused), and lymphocyte count < 5,000/μl; AND Bone marrow aspirate and biopsy must be normocellular for age with <30% of nucleated cells being lymphocytes. Lymphoid nodules must be absent
Time Frame
2 months
Secondary Outcome Measure Information:
Title
IwCLL-WG Defined Overall Response Rate (ORR)
Description
Responses were assessed two months after completion of therapy. Overall Response Rate (ORR) = CR + PR
Time Frame
2 months
Title
IwCLL-WG Defined Nodular Partial Response (PR)
Description
Responses were assessed two months after completion of therapy. Partial Response is defined as: Greater than or equal to 50% decrease in blood absolute lymphocyte count from pre-treatment value; AND Greater than or equal to 50% reduction in lymphadenopathy from pre-treatment value; AND Greater than or equal to 50% reduction in splenomegaly/hepatomegaly from pre-treatment value. In addition, patients need to have at least ONE of the following: Neutrophils ≥ 1,500/μl or ≥ 50% improvement from pre-treatment value; AND / OR Platelets > 100,000/μl or 50% improvement from pre-treatment value; AND / OR Hemoglobin > 11.0 gm/dl (non-transfused) or 50% improvement from pre-treatment value.
Time Frame
2 months
Title
IwCLL-WG Defined Partial Response (PR)
Description
Responses were assessed two months after completion of therapy
Time Frame
2 months
Title
IwCLL-WG Defined Stable Disease (SD)
Description
Responses were assessed two months after completion of therapy. Subjects who do not fulfill the criteria for complete or partial response as defined above but do not exhibit progressive disease will be considered as having stable disease.
Time Frame
2 months
Title
IwCLL-WG Defined Progressive Disease (PD)
Description
Responses were assessed two months after completion of therapy Progressive Disease is defined as: Greater than or equal to 50% increase in the products of at least two lymph nodes on two consecutive determinations two weeks apart (at least one lymph node must be ≥ 2 cm; or the appearance of a new palpable lymph node; OR Greater than or equal to 50% increase in the size of the liver and/or spleen as determined by measurement below the respective costal margins; or appearance of palpable hepatomegaly or splenomegaly, which was not previously present; OR Greater than or equal to 50% increase in the absolute number of circulating lymphocytes to at least 5,000μl; OR Transformation to a more aggressive histology (i.e., Richter's syndrome or prolymphocytic leukemia with ≥ 56% prolymphocytes);
Time Frame
2 months
Title
Progression-free Survival (PFS)
Time Frame
2 years
Title
Treatment-Free Survival
Time Frame
2 years
Title
Safety and Tolerability Measured Via Adverse Events
Description
Please see Adverse Event module for additional details.
Time Frame
2 years
Title
Detectable Minimal Residual Disease (MRD)
Description
The patient who achieved a CR did not have detectable MRD in the bone marrow by four-color flow cytometry (<0.1% of cells).
Time Frame
2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Previously treated patients with a diagnosis of CLL Previous treatment with any monoclonal antibody or chemotherapy regardless of response as defined by the iwCLL Working Group Guidelines as evidenced by: progressive marrow failure as manifested by the development of, or worsening of, anemia and/or thrombocytopenia massive (i.e. at least 6cm below the left costal margin) or progressive or symptomatic splenomegaly massive nodes (i.e. at least 10cm in longest diameter) or progressive or symptomatic lymphadenopathy. progressive lymphocytosis with an increase of more than 50% over a 2-month period or lymphocyte doubling time (LDT) of less than 6 months. autoimmune anemia and/or thrombocytopenia that is poorly responsive to corticosteroids or other standard therapy (See Section 10.2) Constitutional symptoms, defined as any one or more of the following disease-related symptoms or signs: unintentional weight loss of 10% or more within the previous 6 months significant fatigue (i.e. ECOG PS 2 or worse, inability to work or perform usual activities), fevers higher than 100.5ºF or 38.0ºC for 2 or more weeks without other evidence of infection, night sweats for more than 1 month without evidence of infection Subjects must be 18 years of age or older, male or female. ECOG performance status of 0-2. Subjects must be able to give informed consent. Females of child bearing potential(FCBP)† must have a negative serum or urine pregnancy test within 10 - 14 days prior to and again within 24 hours of starting treatment and agree to use a medically accepted contraceptive method for the duration of this study. Exclusion Criteria: Hepatitis BsAg positive, Hepatitis BcAb positive, and Hepatitis C positive patients. Known HIV positive patients. Diabetics. Patients with uncontrolled Autoimmune Hemolytic Anemia (AIHA) or autoimmune thrombocytopenia (ITP). Screening laboratory values within these ranges: platelets <50 x 109/L, neutrophils <1.0 x 109/L, creatinine >2.0 times upper normal limit,total bilirubin >1.5 times upper normal limit (unless a known history of Gilbert's disease), ALT >2.5 times upper normal limit (unless due to disease involvement of liver), alkaline phosphatase >2.5 times upper normal limit (unless due to disease involvement of the liver or bone marrow) Inability to provide informed consent. Concurrent malignancy (excluding basal and squamous cell skin cancers). Active fungal, bacterial, and/or viral infection. History of peptic ulcer disease resulting in GI bleeding within the last 6 months. Untreated metabolic disorders such as hypothyroidism and Cushing's disease. History of steroid-induced psychosis. Estimated life expectancy of less than 3 months by the investigator's best clinical judgment. Serious medical condition that would render the subject medically unstable. Women who are pregnant or breast-feeding. History of Pancreatitis. History of Diverticulitis. Patients with known hypersensitivity to ofatumumab or known history of anaphylaxis to Rituximab or alemtuzumab. Concurrent use of other anti-cancer agents or treatments. Subjects who have current active hepatic or biliary disease (with exception of patients with Gilbert's syndrome, asymptomatic gallstones, liver metastases or stable chronic liver disease per investigator assessment).
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Januario Castro, MD
Organizational Affiliation
University of California, San Diego
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Thomas J Kipps, MD, PhD
Organizational Affiliation
Director of the CLL Research Consortium and University of California San Diego
Official's Role
Principal Investigator
Facility Information:
Facility Name
UC San Diego Moores Cancer Center
City
La Jolla
State/Province
California
ZIP/Postal Code
92093
Country
United States
Facility Name
University of California San Diego, Moores Cancer Center
City
La Jolla
State/Province
California
ZIP/Postal Code
92093
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
19693094
Citation
Castro JE, James DF, Sandoval-Sus JD, Jain S, Bole J, Rassenti L, Kipps TJ. Rituximab in combination with high-dose methylprednisolone for the treatment of chronic lymphocytic leukemia. Leukemia. 2009 Oct;23(10):1779-89. doi: 10.1038/leu.2009.133. Epub 2009 Aug 20. Erratum In: Leukemia. 2009 Dec;23(12):2326.
Results Reference
background
PubMed Identifier
18754025
Citation
Castro JE, Sandoval-Sus JD, Bole J, Rassenti L, Kipps TJ. Rituximab in combination with high-dose methylprednisolone for the treatment of fludarabine refractory high-risk chronic lymphocytic leukemia. Leukemia. 2008 Nov;22(11):2048-53. doi: 10.1038/leu.2008.214. Epub 2008 Aug 28.
Results Reference
background
Links:
URL
http://cancer.ucsd.edu/
Description
Moore's UCSD Cancer Center
URL
http://cllresearch.com/
Description
Website for the Chronic Lymphocytic Leukemia Research Consortium

Learn more about this trial

Ofatumumab and High-dose Methylprednisolone in Patients With Chronic Lymphocytic Leukemia (CLL)

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