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Brentuximab Vedotin Prevention of (GVHD) After Unrelated Allogeneic Stem Cell Transplantation

Primary Purpose

Leukemia, Acute Myeloid, Leukemia, Lymphoblastic,Acute, Myelodysplastic Syndromes

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
brentuximab vedotin
Sponsored by
Washington University School of Medicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Leukemia, Acute Myeloid

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patient must be scheduled to undergo stem cell transplantation for one of the following diagnoses:

    • acute myeloid leukemia (AML) in CR1 (first complete remission, CR or CRi) or CR2 (second complete remission, CR or CRi),
    • acute lymphoblastic leukemia (ALL) in CR1 or CR2 (CR or CRi)
    • myelodysplastic syndrome (MDS) without progression to AML.
    • Chronic myelogenous leukemia (CML)
    • Non-Hodgkin's lymphoma (NHL) or Hodgkin's disease (HD)
    • Chronic lymphocytic leukemia (CLL)
    • Multiple myeloma (MM)
  • Patients must be the recipient of unrelated donor peripheral blood stem cell products. Mismatches at both antigen and allele level will be eligible. Match must be 6 or 7 out of 8 loci (HLA A, B, C, and DRB1).
  • Patient must receive any one of the following conditioning regimens: total body radiation (single or fractionated dose)/cyclophosphamide, busulfan/ cyclophosphamide, or fludarabine/busulfan/lymphocyte immune globulin (ATGAM/thymo).
  • Patient must be ≥ 18 years and ≤ 70 years of age.
  • Patient must have an ECOG performance status ≤ 2 or Karnofsky performance scale ≥ 60%
  • Patient must have CD34+ stem cells ≥ 2x106/kg (actual body weight of the recipient) available for transplantation.
  • Patient must have appropriate organ function as defined below (this criterion should be met on screening and on the day of the first dose of brentuximab vedotin (as assessed prior to dosing)):

    • Total bilirubin ≤ 2.0 x IULN
    • AST(SGOT)/ALT(SGPT) ≤ 3.0 x IULN
    • Serum creatinine ≤ 2.0 x IULN
    • Estimated Creatinine Clearance > 30 ml/min
    • Cardiac ejection fraction > 40%
    • DLCO/VA > 40%
  • Women of childbearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control, abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study, she must inform her treating physician immediately.
  • Patient must be able to understand and willing to sign an IRB approved written informed consent document.

Exclusion Criteria:

  • Patient must not have had prior exposure to brentuximab vedotin.
  • Patient must not have a history of other malignancy that has not been in remission for at least 3 years, with the exception of basal non-melanoma skin cancer which were treated with local resection only or intraepithelial lesions or carcinoma in situ of the cervix or prostate that has been curatively treated.
  • Patient must not be receiving any other investigational agents.
  • Patient must not have active CNS involvement.
  • Patient must not have a history of allergic reactions attributed to compounds of similar chemical or biologic composition to brentuximab vedotin or other agents used in the study.
  • Patients must not have had previous radiation therapy to the mediastinum or lungs.
  • Patient must not have an uncontrolled inter-current illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, active pulmonary diseases, or psychiatric illness/social situations that would limit compliance with study requirements (this criterion should be met on screening and on the day of but prior to first dose of brentuximab vedotin).
  • Patient must not be pregnant and/or breastfeeding.
  • Patient must not be known to be HIV-positive on combination antiretroviral therapies.
  • Patient must not have had a previous allogeneic or syngeneic transplant. Prior autologous transplant is allowed.

Sites / Locations

  • Washington University School of Medicine

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm Type

Experimental

Experimental

Experimental

Experimental

No Intervention

Arm Label

Dose Level 0 (starting dose)

Dose Level 1

Dose Level 2

Dose Level 3

Control Dose Level

Arm Description

brentuximab vedotin 0.3mg/kg, given IV on Days 7, 28, 49 & 70

brentuximab vedotin 0.6mg/kg, given IV on Days 7, 28, 49 & 70

brentuximab vedotin 1.2mg/kg, given IV on Days 7, 28, 49 & 70

brentuximab vedotin 1.8mg/kg, given IV on Days 7, 28, 49 & 70

The first 3 patients will not receive brentuximab vedotin.

Outcomes

Primary Outcome Measures

MTD of brentuximab vedotin when administered with a GVHD prophylaxis regimen
Defined as the dose level immediately below the dose level at which 2 patients of a cohort (of 2 to 6 patients) experience dose-limiting toxicity; Hematologic DLT is defined as ANC < 500/mm3 for three consecutive days beyond Day +21 that was determined by the investigator to be likely related to brentuximab vedotin. Non-hematologic DLT is defined as any grade 3 or higher non-hematologic toxicity that was determined by the investigator to be possibly, probably, or definitely related to brentuximab vedotin, with the following specific exceptions: Grade 3 or 4 nausea, vomiting, diarrhea, mucositis, or fatigue thought to be associated with conditioning regimens Grade 3 rash will only be considered a DLT for patients who have received two weeks of supportive care treatment with no improvement.

Secondary Outcome Measures

Safety and tolerability of brentuximab vedotin when administered with a GVHD prophylaxis regimen
Toxicities described and graded using CTCAE version 4.0; described by patient, type, and grade for each dose level; summarized by counts and percentage of patients in the corresponding categories
Rate of acute GVHD
Proportion of all subjects who experience symptoms consistent with grade 2-4 acute GVHD; using the standard grading system adapted from the Glucksberg clinical stage and grade of acute GVHD
Rate of chronic GVHD
Proportion of all subjects who experience symptoms consistent with chronic GVHD; assessment will begin after Day 100 using the NIH consensus criteria for diagnosis and staging of chronic GVHD
Progression-free survival
Duration from the time of transplant to time of first progression, death, relapse after complete response, or the date the patient was last known to be in remission; estimated with Kaplan-Meier methods.
Overall survival.
Duration from the time of transplant to death or last follow-up; estimated with Kaplan-Meier methods.
1-year non-relapse mortality rate
Defined as the percentage of patients dying from etiologies other than disease relapse; estimated with Kaplan-Meier methods.
2-year non-relapse mortality rate
Defined as the percentage of patients dying from etiologies other than disease relapse; estimated with Kaplan-Meier methods.
1-year disease relapse rate
Defined as the percentage of patients who have disease relapse; estimated with Kaplan-Meier methods.
2-year disease relapse rate
Defined as the percentage of patients who have disease relapse; estimated with Kaplan-Meier methods.

Full Information

First Posted
September 18, 2012
Last Updated
April 12, 2019
Sponsor
Washington University School of Medicine
Collaborators
Seagen Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT01700751
Brief Title
Brentuximab Vedotin Prevention of (GVHD) After Unrelated Allogeneic Stem Cell Transplantation
Official Title
A Pilot Study of Brentuximab Vedotin in the Prevention of Graft-Versus-Host Disease (GVHD) After Unrelated Allogeneic Stem Cell Transplantation
Study Type
Interventional

2. Study Status

Record Verification Date
April 2019
Overall Recruitment Status
Completed
Study Start Date
February 25, 2013 (Actual)
Primary Completion Date
November 11, 2015 (Actual)
Study Completion Date
November 21, 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Washington University School of Medicine
Collaborators
Seagen Inc.

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This pilot clinical trial studies the safety and maximum tolerated dose of brentuximab vedotin when given with tacrolimus and methotrexate after unrelated allogeneic donor stem cell transplant in patients with acute myeloid leukemia, acute lymphoblastic leukemia, or myelodysplastic syndromes. The addition of brentuximab vedotin to tacrolimus and methotrexate may result in a significant reduction of graft versus host disease in these patients.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Leukemia, Acute Myeloid, Leukemia, Lymphoblastic,Acute, Myelodysplastic Syndromes

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
17 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Dose Level 0 (starting dose)
Arm Type
Experimental
Arm Description
brentuximab vedotin 0.3mg/kg, given IV on Days 7, 28, 49 & 70
Arm Title
Dose Level 1
Arm Type
Experimental
Arm Description
brentuximab vedotin 0.6mg/kg, given IV on Days 7, 28, 49 & 70
Arm Title
Dose Level 2
Arm Type
Experimental
Arm Description
brentuximab vedotin 1.2mg/kg, given IV on Days 7, 28, 49 & 70
Arm Title
Dose Level 3
Arm Type
Experimental
Arm Description
brentuximab vedotin 1.8mg/kg, given IV on Days 7, 28, 49 & 70
Arm Title
Control Dose Level
Arm Type
No Intervention
Arm Description
The first 3 patients will not receive brentuximab vedotin.
Intervention Type
Drug
Intervention Name(s)
brentuximab vedotin
Other Intervention Name(s)
Adcetris
Primary Outcome Measure Information:
Title
MTD of brentuximab vedotin when administered with a GVHD prophylaxis regimen
Description
Defined as the dose level immediately below the dose level at which 2 patients of a cohort (of 2 to 6 patients) experience dose-limiting toxicity; Hematologic DLT is defined as ANC < 500/mm3 for three consecutive days beyond Day +21 that was determined by the investigator to be likely related to brentuximab vedotin. Non-hematologic DLT is defined as any grade 3 or higher non-hematologic toxicity that was determined by the investigator to be possibly, probably, or definitely related to brentuximab vedotin, with the following specific exceptions: Grade 3 or 4 nausea, vomiting, diarrhea, mucositis, or fatigue thought to be associated with conditioning regimens Grade 3 rash will only be considered a DLT for patients who have received two weeks of supportive care treatment with no improvement.
Time Frame
37 days
Secondary Outcome Measure Information:
Title
Safety and tolerability of brentuximab vedotin when administered with a GVHD prophylaxis regimen
Description
Toxicities described and graded using CTCAE version 4.0; described by patient, type, and grade for each dose level; summarized by counts and percentage of patients in the corresponding categories
Time Frame
100 days
Title
Rate of acute GVHD
Description
Proportion of all subjects who experience symptoms consistent with grade 2-4 acute GVHD; using the standard grading system adapted from the Glucksberg clinical stage and grade of acute GVHD
Time Frame
100 days
Title
Rate of chronic GVHD
Description
Proportion of all subjects who experience symptoms consistent with chronic GVHD; assessment will begin after Day 100 using the NIH consensus criteria for diagnosis and staging of chronic GVHD
Time Frame
2 years
Title
Progression-free survival
Description
Duration from the time of transplant to time of first progression, death, relapse after complete response, or the date the patient was last known to be in remission; estimated with Kaplan-Meier methods.
Time Frame
2 years
Title
Overall survival.
Description
Duration from the time of transplant to death or last follow-up; estimated with Kaplan-Meier methods.
Time Frame
2 years
Title
1-year non-relapse mortality rate
Description
Defined as the percentage of patients dying from etiologies other than disease relapse; estimated with Kaplan-Meier methods.
Time Frame
1 year
Title
2-year non-relapse mortality rate
Description
Defined as the percentage of patients dying from etiologies other than disease relapse; estimated with Kaplan-Meier methods.
Time Frame
2 years
Title
1-year disease relapse rate
Description
Defined as the percentage of patients who have disease relapse; estimated with Kaplan-Meier methods.
Time Frame
1 year
Title
2-year disease relapse rate
Description
Defined as the percentage of patients who have disease relapse; estimated with Kaplan-Meier methods.
Time Frame
2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patient must be scheduled to undergo stem cell transplantation for one of the following diagnoses: acute myeloid leukemia (AML) in CR1 (first complete remission, CR or CRi) or CR2 (second complete remission, CR or CRi), acute lymphoblastic leukemia (ALL) in CR1 or CR2 (CR or CRi) myelodysplastic syndrome (MDS) without progression to AML. Chronic myelogenous leukemia (CML) Non-Hodgkin's lymphoma (NHL) or Hodgkin's disease (HD) Chronic lymphocytic leukemia (CLL) Multiple myeloma (MM) Patients must be the recipient of unrelated donor peripheral blood stem cell products. Mismatches at both antigen and allele level will be eligible. Match must be 6 or 7 out of 8 loci (HLA A, B, C, and DRB1). Patient must receive any one of the following conditioning regimens: total body radiation (single or fractionated dose)/cyclophosphamide, busulfan/ cyclophosphamide, or fludarabine/busulfan/lymphocyte immune globulin (ATGAM/thymo). Patient must be ≥ 18 years and ≤ 70 years of age. Patient must have an ECOG performance status ≤ 2 or Karnofsky performance scale ≥ 60% Patient must have CD34+ stem cells ≥ 2x106/kg (actual body weight of the recipient) available for transplantation. Patient must have appropriate organ function as defined below (this criterion should be met on screening and on the day of the first dose of brentuximab vedotin (as assessed prior to dosing)): Total bilirubin ≤ 2.0 x IULN AST(SGOT)/ALT(SGPT) ≤ 3.0 x IULN Serum creatinine ≤ 2.0 x IULN Estimated Creatinine Clearance > 30 ml/min Cardiac ejection fraction > 40% DLCO/VA > 40% Women of childbearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control, abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study, she must inform her treating physician immediately. Patient must be able to understand and willing to sign an IRB approved written informed consent document. Exclusion Criteria: Patient must not have had prior exposure to brentuximab vedotin. Patient must not have a history of other malignancy that has not been in remission for at least 3 years, with the exception of basal non-melanoma skin cancer which were treated with local resection only or intraepithelial lesions or carcinoma in situ of the cervix or prostate that has been curatively treated. Patient must not be receiving any other investigational agents. Patient must not have active CNS involvement. Patient must not have a history of allergic reactions attributed to compounds of similar chemical or biologic composition to brentuximab vedotin or other agents used in the study. Patients must not have had previous radiation therapy to the mediastinum or lungs. Patient must not have an uncontrolled inter-current illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, active pulmonary diseases, or psychiatric illness/social situations that would limit compliance with study requirements (this criterion should be met on screening and on the day of but prior to first dose of brentuximab vedotin). Patient must not be pregnant and/or breastfeeding. Patient must not be known to be HIV-positive on combination antiretroviral therapies. Patient must not have had a previous allogeneic or syngeneic transplant. Prior autologous transplant is allowed.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Mark Schroeder, M.D.
Organizational Affiliation
Washington University School of Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
Washington University School of Medicine
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Links:
URL
http://www.siteman.wustl.edu
Description
Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine

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Brentuximab Vedotin Prevention of (GVHD) After Unrelated Allogeneic Stem Cell Transplantation

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