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Ofatumumab and Fresh Frozen Plasma in Patients With Chronic Lymphocytic Lymphoma

Primary Purpose

Chronic Lymphocytic Leukemia

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Ofatumumab + Fresh Frozen Plasma
Sponsored by
Joseph Tuscano
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Chronic Lymphocytic Leukemia focused on measuring Fresh Frozen Plasma, Complement, Monoclonal Antibody

Eligibility Criteria

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

Inclusion Criteria:

  • Patients must have a pathological diagnosis of B-cell CLL.
  • Patients must have received prior rituximab therapy and must have recovered from all non-hematologic toxicities. (Previous radiation is allowed as long as patients have recovered from all treatment related toxicities).
  • Patients must meet the following laboratory values:

    • Hgb > 9.0 g/dl
    • Platelets > 50,000/mm3
    • Creatinine < 2.0 times the institutional upper limit of normal
    • SGOT/SGPT < 2.5 times the institutional upper limit of normal
    • Total Bilirubin <1. 5 times the institutional upper limit of normal
    • Alkaline phosphatase <2.5 times upper limit of normal (unless due to disease involvement of the liver or bone marrow)
  • Patients must be at least 18 years of age.
  • Patients must have a performance status of 0-2 by ECOG criteria.
  • All patients must be informed of the investigational nature of this study and must sign and give written consent in accordance with institutional and federal guidelines.

Exclusion Criteria:

  • Subjects who have current active hepatic or biliary disease.
  • Having received rituximab or rituximab-containing therapy within the prior 3 months.
  • Treatment with any known therapeutic or experimental therapy within 4 weeks prior to enrollment, or currently participating in any other interventional clinical study.
  • Other past or current malignancy.
  • Prior treatment with anti-CD20 monoclonal antibody or alemtuzumab within 3 months prior to start of therapy.
  • Chronic or current infectious disease requiring systemic antibiotics, antifungal, or antiviral treatment such as, but not limited to, chronic renal infection, chronic chest infection with bronchiectasis, tuberculosis and active Hepatitis C.
  • History of significant cerebrovascular disease in the past 6 months or ongoing event with active symptoms or sequelae.
  • Known HIV positive.
  • Clinically significant cardiac disease including unstable angina, acute myocardial infarction within six months prior to randomization, congestive heart failure, and arrhythmia unless controlled by therapy, with the exception of extra systoles or minor conduction abnormalities.
  • Significant concurrent, uncontrolled medical condition including, but not limited to, renal, hepatic, gastrointestinal, endocrine, pulmonary, neurological, cerebral or psychiatric disease which in the opinion of the investigator may represent a risk for the patient.
  • Positive serology for Hepatitis B (HB) defined as a positive test for HBsAg.
  • Positive serology for hepatitis C (HC) defined as a positive test for HCAb, in which case reflexively perform a HC RIBA immunoblot assay on the same sample to confirm the result.
  • Pregnant or lactating women.
  • Women of childbearing potential, including women whose last menstrual period was less than one year prior to screening, unable or unwilling to use adequate contraception from study start to one year after the last dose of protocol therapy.
  • Male subjects unable or unwilling to use adequate contraception methods from study start to one year after the last dose of protocol therapy.
  • Receiving warfarin.

Sites / Locations

  • University of California Comprehensive Cancer Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Ofatumumab + Fresh Frozen Plasma

Arm Description

Ofatumumab will be infused intravenously on day 1 (300 mg initial dose), followed one week later by 2000 mg weekly for 7 doses, followed 4 weeks later by 2000 mg every 4 weeks for 4 doses. Two units (approximately 200 or 250 ml) of FFP will be administered prior to ofatumumab(with the exception of the first dose). A unit of fresh frozen plasma is approximately 250ml (or half a pint).

Outcomes

Primary Outcome Measures

Response to Therapy
Defined as complete, or partial response, and progression-free survival. Measured by National Cancer Institute - Working Group and International Workshop on Chronic Lymphocytic Leukemia

Secondary Outcome Measures

Number of Participants With Toxicities
Toxicities will be graded according to the NCI CTCAE v4.0.
Overall Survival
Count of participants known to be alive up to two years from the time from start of treatment.
Percent Reduction in Complement Levels (CH50)
Complement CH50 is a blood test that helps us determine whether protein abnormalities and deficiencies in the complement system are responsible for any increase in autoimmune activity.

Full Information

First Posted
October 25, 2012
Last Updated
April 17, 2021
Sponsor
Joseph Tuscano
Collaborators
GlaxoSmithKline
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1. Study Identification

Unique Protocol Identification Number
NCT01716208
Brief Title
Ofatumumab and Fresh Frozen Plasma in Patients With Chronic Lymphocytic Lymphoma
Official Title
Phase II Trial of Ofatumumab and Fresh Frozen Plasma in Patients With Relapsed or Refractory Chronic Lymphocytic Leukemia
Study Type
Interventional

2. Study Status

Record Verification Date
April 2021
Overall Recruitment Status
Completed
Study Start Date
January 14, 2013 (Actual)
Primary Completion Date
October 1, 2019 (Actual)
Study Completion Date
October 1, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Joseph Tuscano
Collaborators
GlaxoSmithKline

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
It has been shown that many patients with lymphoma or chronic lymphocytic leukemia (CLL)have low levels of complement. Several drugs have been approved by the Food and Drug Administration (FDA) for use in this cancer. However, these drugs are often used as combination therapies which means two or more drugs are part of the treatment. Many people, especially elderly patients, cannot put up with the use of multiple drugs because of the side effects. The main purpose of this study is to see if patients respond to therapy with human plasma (known as fresh frozen plasma or FFP) and ofatumumab. Another purpose of the study is to find out if this therapy will increase chances of getting rid of leukemia. This study will also look at the levels of complement in your blood. The levels of complement may allow better understanding of whether increasing the levels of complement by giving FFP may help control leukemia.
Detailed Description
The vast majority of patients with CLL are elderly and often they cannot tolerate standard multi-agent chemotherapeutic or biochemotherapeutic approaches. Based on this, less toxic and more effective treatment options are needed. Ofatumumab has proven to be effective in patients with relapsed and/or refractory CLL. Previous studies have shown that ofatumumab is more effective than rituximab at activating complement and utilizing complement-dependent cytotoxicity (CDC). This study will investigate treating relapsed/refractory CLL patients with FFP in combination with ofatumumab. The hypothesis is that patients with CLL have low complement levels and when they get treated with humanized antibodies like rituximab or ofatumumab these levels drop even further. Both these antibodies utilize complement to exert their cytotoxic effect, thus we hypothesize that by replacing complement levels with FFP we can enhance the efficacy of ofatumumab.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chronic Lymphocytic Leukemia
Keywords
Fresh Frozen Plasma, Complement, Monoclonal Antibody

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Ofatumumab + Fresh Frozen Plasma
Arm Type
Experimental
Arm Description
Ofatumumab will be infused intravenously on day 1 (300 mg initial dose), followed one week later by 2000 mg weekly for 7 doses, followed 4 weeks later by 2000 mg every 4 weeks for 4 doses. Two units (approximately 200 or 250 ml) of FFP will be administered prior to ofatumumab(with the exception of the first dose). A unit of fresh frozen plasma is approximately 250ml (or half a pint).
Intervention Type
Drug
Intervention Name(s)
Ofatumumab + Fresh Frozen Plasma
Other Intervention Name(s)
Azerra
Primary Outcome Measure Information:
Title
Response to Therapy
Description
Defined as complete, or partial response, and progression-free survival. Measured by National Cancer Institute - Working Group and International Workshop on Chronic Lymphocytic Leukemia
Time Frame
Up to 37 months.
Secondary Outcome Measure Information:
Title
Number of Participants With Toxicities
Description
Toxicities will be graded according to the NCI CTCAE v4.0.
Time Frame
Up to two years
Title
Overall Survival
Description
Count of participants known to be alive up to two years from the time from start of treatment.
Time Frame
Up to two years
Title
Percent Reduction in Complement Levels (CH50)
Description
Complement CH50 is a blood test that helps us determine whether protein abnormalities and deficiencies in the complement system are responsible for any increase in autoimmune activity.
Time Frame
Up to two weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients must have a pathological diagnosis of B-cell CLL. Patients must have received prior rituximab therapy and must have recovered from all non-hematologic toxicities. (Previous radiation is allowed as long as patients have recovered from all treatment related toxicities). Patients must meet the following laboratory values: Hgb > 9.0 g/dl Platelets > 50,000/mm3 Creatinine < 2.0 times the institutional upper limit of normal SGOT/SGPT < 2.5 times the institutional upper limit of normal Total Bilirubin <1. 5 times the institutional upper limit of normal Alkaline phosphatase <2.5 times upper limit of normal (unless due to disease involvement of the liver or bone marrow) Patients must be at least 18 years of age. Patients must have a performance status of 0-2 by ECOG criteria. All patients must be informed of the investigational nature of this study and must sign and give written consent in accordance with institutional and federal guidelines. Exclusion Criteria: Subjects who have current active hepatic or biliary disease. Having received rituximab or rituximab-containing therapy within the prior 3 months. Treatment with any known therapeutic or experimental therapy within 4 weeks prior to enrollment, or currently participating in any other interventional clinical study. Other past or current malignancy. Prior treatment with anti-CD20 monoclonal antibody or alemtuzumab within 3 months prior to start of therapy. Chronic or current infectious disease requiring systemic antibiotics, antifungal, or antiviral treatment such as, but not limited to, chronic renal infection, chronic chest infection with bronchiectasis, tuberculosis and active Hepatitis C. History of significant cerebrovascular disease in the past 6 months or ongoing event with active symptoms or sequelae. Known HIV positive. Clinically significant cardiac disease including unstable angina, acute myocardial infarction within six months prior to randomization, congestive heart failure, and arrhythmia unless controlled by therapy, with the exception of extra systoles or minor conduction abnormalities. Significant concurrent, uncontrolled medical condition including, but not limited to, renal, hepatic, gastrointestinal, endocrine, pulmonary, neurological, cerebral or psychiatric disease which in the opinion of the investigator may represent a risk for the patient. Positive serology for Hepatitis B (HB) defined as a positive test for HBsAg. Positive serology for hepatitis C (HC) defined as a positive test for HCAb, in which case reflexively perform a HC RIBA immunoblot assay on the same sample to confirm the result. Pregnant or lactating women. Women of childbearing potential, including women whose last menstrual period was less than one year prior to screening, unable or unwilling to use adequate contraception from study start to one year after the last dose of protocol therapy. Male subjects unable or unwilling to use adequate contraception methods from study start to one year after the last dose of protocol therapy. Receiving warfarin.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Joseph Tuscano, MD
Organizational Affiliation
University of California, Davis
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of California Comprehensive Cancer Center
City
Sacramento
State/Province
California
ZIP/Postal Code
95817
Country
United States

12. IPD Sharing Statement

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Ofatumumab and Fresh Frozen Plasma in Patients With Chronic Lymphocytic Lymphoma

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