search
Back to results

Chemotherapy With Liposomal Cytarabine CNS Prophylaxis for Adult Acute Lymphoblastic Leukemia & Lymphoblastic Lymphoma

Primary Purpose

Acute Lymphocytic Leukemia, Adult Lymphoblastic Lymphoma

Status
Terminated
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
DNR
VCR
PEG-asp
CTX
Prednisone
Liposomal AraC
MTX
LCV
AraC
Etoposide
Dasatinib
Rituximab
Hydrocortisone
Sponsored by
University of California, San Diego
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Acute Lymphocytic Leukemia focused on measuring Acute lymphoblastic leukemia, Lymphoblastic leukemia, Lymphoblastic lymphoma

Eligibility Criteria

18 Years - 60 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Ability to understand and the willingness to sign a written informed consent.
  • Diagnosis of acute lymphoblastic leukemia or lymphoblastic lymphoma as defined by the World Health Organization [94]
  • Untreated disease EXCEPT for corticosteroids, hydroxyurea, leukapheresis, and/or tyrosine kinase inhibitors for up to 2 weeks prior to initiation of study therapy.
  • Age 18 through 60 years
  • ECOG performance status 0,1, or 2 (see Appendix A)
  • Adequate organ function defined as:
  • Total bilirubin < 2 mg/dL (unless due to ALL)
  • AST(SGOT)/ALT(SGPT) < 3 times institutional upper limit of normal (unless due to ALL)
  • Serum creatinine < 2 mg/dL (unless elevated creatinine felt by investigator to be acute and reversible) OR creatinine clearance >60 mL/min/1.73 m2 for patients with creatinine levels above institutional normal
  • Left ventricular ejection fraction ≥50%
  • Women of child-bearing potential and men with partners of child- bearing potential must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study participation, and for 90 days following completion of therapy. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately.
  • A woman of child-bearing potential is any female (regardless of sexual orientation, having undergone a tubal ligation, or remaining celibate by choice) who meets the following criteria:

    • Has not undergone a hysterectomy or bilateral oophorectomy; or
    • Has not been naturally postmenopausal for at least 12 consecutive months (i.e., has had menses at any time in the preceding 12 consecutive months)

Exclusion Criteria:

  • Current or anticipated use of other investigational agents during the study
  • Known central nervous system mass lesion
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to liposomal cytarabine or other agents used in study inclusive of known allergy to polyethylene glycol.
  • History of unprovoked venous thrombosis/thromboembolism
  • Recurrent or chronic pancreatitis
  • Uncontrolled diabetes mellitus
  • Uncontrolled intercurrent illness that would limit compliance with study requirements including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
  • Pregnant or nursing.
  • Any condition, in the opinion of the investigator, that compromises compliance with study requirements
  • Known HIV positivity

Sites / Locations

  • UCSD, Division of Blood and Marrow Transplantation, Moores Cancer Center
  • Hematological Malignancies/Stem Cell Transplantation Unit, David Geffen School of Medicine at UCLA
  • University of California Davis Comprehensive Cancer Center
  • UCSF Comprehensive Cancer Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Chemotherapy for ALL

Arm Description

Course 1A: DNR 60 mg/m2 IV d1,2,3; VCR 1.4 mg/m2 d1,8,15,22 (cap 2 mg age >50); PEG-asp 2000 IU/m2 IV d16, age >50 1000 IU/m2, cap 3750 IU/m2; CTX 750 mg/m2 d1,15 age < 40; Prednisone 60 mg/m2 PO d1-28; Liposomal AraC 25 mg IT d1, 15 1B: MTX 220 mg/m2 IV then 60 mg/m2/h for 36h d2-3,d16-17; LCV 50 mg/m2 IV q6h x3 then 10 mg/m2 PO/IV q6h til MTX <0.1 uM; 6-MP 60 mg/m2 PO d2-8, d16-22; PEG-asp 2000 IU/m2 IV d18, age >50 1000 IU/m2, cap 3750 IU/m2 1C: AraC 2 g/m2 IV d1-4; Etoposide 500 mg/m2 IV d1-4 1A-C repeat x1(2A-C) then 3rd Course B (3B) Maintenance (monthly, 24 mo): Prednisone 60 mg/m2 PO d1-5; VCR 1.4 mg/m2 IV d1 (cap 2 mg age >50); MTX 20 mg/m2 PO wkly; 6-MP 60 mg/m2 PO qd PEG-asp 2000 IU/m2 IV d16, age >50 1000 IU/m2, cap 3,750 IU/m2 (Mo. 1) Maintenance mo. 1-4: Liposomal AraC 50 mg IT d1 Dasatinib 140 mg PO qd if Ph/BCR-ABL+; Rituximab 375 mg/m2 IV d1,15 of 1A-C, 2A (Pre-B) 1:1 randomization: hydrocortisone v. placebo before PEG-asp 1B, 2B, & Maint.

Outcomes

Primary Outcome Measures

Event-free survival

Secondary Outcome Measures

Liposomal cytarabine toxicity
CNS relapse rate
Overall survival
Leukemia-free survival
Efficacy of hydrocortisone premedication for reduced PEG-asparaginase allergic reactions
PEG-asparaginase toxicities
Complete and overall response rates
Non-relapse mortality

Full Information

First Posted
January 21, 2014
Last Updated
April 26, 2022
Sponsor
University of California, San Diego
Collaborators
Leadiant Biosciences, Inc.
search

1. Study Identification

Unique Protocol Identification Number
NCT02043587
Brief Title
Chemotherapy With Liposomal Cytarabine CNS Prophylaxis for Adult Acute Lymphoblastic Leukemia & Lymphoblastic Lymphoma
Official Title
A Phase II Study of Punctual, Cyclic, and Intensive Chemotherapy With Liposomal Cytarabine (Depocyt®) CNS Prophylaxis for Adults With Acute Lymphoblastic Leukemia and Lymphoblastic Lymphoma
Study Type
Interventional

2. Study Status

Record Verification Date
April 2022
Overall Recruitment Status
Terminated
Why Stopped
Original investigator for the trial has left
Study Start Date
January 2014 (undefined)
Primary Completion Date
April 14, 2022 (Actual)
Study Completion Date
April 14, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of California, San Diego
Collaborators
Leadiant Biosciences, Inc.

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The objective of this protocol is to improve survival for adults with acute lymphoblastic leukemia or acute lymphoblastic lymphoma by reducing systemic and central nervous system (CNS) relapse with acceptable toxicity using intensive chemotherapy with liposomal cytarabine (Depocyt®) CNS prophylaxis.
Detailed Description
This treatment regimen builds on the "Linker" regimen/UCSF Protocol 8707 ALL regimen backbone with the goal of improved efficacy and acceptable toxicity by substituting pegylated asparaginase for native L-asparaginase, the addition of rituximab for pre-B-cell ALL, and the addition of dasatinib for Philadelphia chromosome/BCR-ABL positive ALL, and the addition of cyclophosphamide for younger adults. In addition, the study regimen aims to reduce CNS relapse through the use of intrathecal liposomal cytarabine in place of intrathecal methotrexate for CNS relapse prophylaxis and The regimen uses 3 modules of therapy with non-cross-resistant chemotherapy agents. Rituximab is added for a total of 8 doses for patients with pre-B-cell ALL. Dasatinib is added for patients with Ph+ ALL. Course 1A (Induction): Daunorubicin, vincristine, PEG-asparaginase, and prednisone for all patients with the addition of cyclophosphamide for patients 18-39 years of age. Treatment is intensified for patients with disease present on a day 14 bone marrow biopsies during Induction Course 1A. In addition to standard analyses, minimal residual disease will be assessed on day 14 and remission bone marrow aspirates and correlated with outcomes. Course 1B: High-dose methotrexate, oral 6-mercaptopurine, and PEG-asparaginase. Course 1C: High-dose cytarabine and etoposide. The 3 courses then repeat (2A (Intensification), 2B, 2C) followed by a final "B" cycle (3B) of high-dose methotrexate, 6-mercaptopurine, and PEG-asparaginase. After completion of Course 3B, patients proceed to maintenance chemotherapy with monthly methotrexate, vincristine, 6-mercaptopurine, and prednisone cycles for 24 months with a single dose PEG-asparaginase given in month 1 of Maintenance. CNS prophylaxis: Intrathecal liposomal cytarabine replaces intrathecal methotrexate CNS prophylaxis and is given every 2 weeks during the "A" Induction and Intensification courses then every 3 months during Maintenance for a total of 8 doses. Given the presence of CNS penetrating chemotherapy in the "B" and "C" cycles, intrathecal liposomal cytarabine is not given due to risk of excessive CNS toxicity. There is a randomization to hydrocortisone or placebo premedication prior to PEG-asparaginase.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Lymphocytic Leukemia, Adult Lymphoblastic Lymphoma
Keywords
Acute lymphoblastic leukemia, Lymphoblastic leukemia, Lymphoblastic lymphoma

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Chemotherapy for ALL
Arm Type
Experimental
Arm Description
Course 1A: DNR 60 mg/m2 IV d1,2,3; VCR 1.4 mg/m2 d1,8,15,22 (cap 2 mg age >50); PEG-asp 2000 IU/m2 IV d16, age >50 1000 IU/m2, cap 3750 IU/m2; CTX 750 mg/m2 d1,15 age < 40; Prednisone 60 mg/m2 PO d1-28; Liposomal AraC 25 mg IT d1, 15 1B: MTX 220 mg/m2 IV then 60 mg/m2/h for 36h d2-3,d16-17; LCV 50 mg/m2 IV q6h x3 then 10 mg/m2 PO/IV q6h til MTX <0.1 uM; 6-MP 60 mg/m2 PO d2-8, d16-22; PEG-asp 2000 IU/m2 IV d18, age >50 1000 IU/m2, cap 3750 IU/m2 1C: AraC 2 g/m2 IV d1-4; Etoposide 500 mg/m2 IV d1-4 1A-C repeat x1(2A-C) then 3rd Course B (3B) Maintenance (monthly, 24 mo): Prednisone 60 mg/m2 PO d1-5; VCR 1.4 mg/m2 IV d1 (cap 2 mg age >50); MTX 20 mg/m2 PO wkly; 6-MP 60 mg/m2 PO qd PEG-asp 2000 IU/m2 IV d16, age >50 1000 IU/m2, cap 3,750 IU/m2 (Mo. 1) Maintenance mo. 1-4: Liposomal AraC 50 mg IT d1 Dasatinib 140 mg PO qd if Ph/BCR-ABL+; Rituximab 375 mg/m2 IV d1,15 of 1A-C, 2A (Pre-B) 1:1 randomization: hydrocortisone v. placebo before PEG-asp 1B, 2B, & Maint.
Intervention Type
Drug
Intervention Name(s)
DNR
Other Intervention Name(s)
Daunorubicin, Daunorubicin Hydrochloride, Cerubidine, Daunomycin, Rubidomycin
Intervention Description
Daunorubicin 60 mg/m2 IV (in the vein) daily 1,2,3 Courses 1A, 2A
Intervention Type
Drug
Intervention Name(s)
VCR
Other Intervention Name(s)
Vincristine, Oncovin, Vincasar, PFS, Vincrex, Leurocritine, LCR
Intervention Description
1.4 mg/m2 IV, days 1, 8, 15, 22 (cap at 2mg for ages >50) during Courses 1A, 2A; Maintenance: Day 1 during months 2-12
Intervention Type
Drug
Intervention Name(s)
PEG-asp
Other Intervention Name(s)
PEG-L-asparaginase, Oncaspar, PEG-asparaginase, pegasparagase
Intervention Description
2,000 IU/m2 IV for ages </= 50, age > 50, 1000 IU/m2 IV Day 16, Courses 1A & 2A; Day 18, Course 1B; Day 17, Course 2B; Day 16, Maintenance, Month 1
Intervention Type
Drug
Intervention Name(s)
CTX
Other Intervention Name(s)
Cyclophosphamide, Cytoxan, Endoxan, Neosar, Procytox, Revimmune, cytophosphane, CPM, CYT
Intervention Description
750 mg/m2 IV, days 1 &15 for subjects <40 year of age, substitute cyclophosphamide 500 mg/m2 IV over 60 minutes every 12 hours for 4 doses on days 15 & 16 for subjects < 40 years of age if day 14 bone marrow M2 or M3; Courses 1A & 2A
Intervention Type
Drug
Intervention Name(s)
Prednisone
Other Intervention Name(s)
Deltasone
Intervention Description
60 mg/m2 orally once daily on days 1-28 during Courses 1A & 2A; Maintenance: Monthly, days 1-5
Intervention Type
Drug
Intervention Name(s)
Liposomal AraC
Other Intervention Name(s)
Liposomal cytarabine, DepoCyt
Intervention Description
25 mg intrathecal (IT), on days 1 & 15 during Courses 1A & 2A; 50 mg intrathecal on day 1 during Maintenance Months 1 through 4
Intervention Type
Drug
Intervention Name(s)
MTX
Other Intervention Name(s)
Methotrexate, Rheumatrex, Trexall
Intervention Description
220 mg/m2 IV bolus over 15 minutes then 60 mg/m2/hour for 36 hours once on days 2-3 and 16-17 during Courses 1B & 2B; 20 mg/m2 orally one day per week every 7 days during Maintenance Months
Intervention Type
Drug
Intervention Name(s)
LCV
Other Intervention Name(s)
Leucovorin
Intervention Description
50 mg/m2 IV over 15-30 minutes every 6 hours for 3 doses to begin immediately after completion of methotrexate infusion, then 10 mg/m2 orally or IV over 15-30 minutes every 6 hours until methotrexate level less than 0.1 micromolar during Courses 1B & 2B
Intervention Type
Drug
Intervention Name(s)
AraC
Other Intervention Name(s)
Cytarabine, Ara-C, Arabinosylcytosine, Cytosar-U
Intervention Description
2,000 mg/m2 IV, days 1-4 during Courses 1C & 2C
Intervention Type
Drug
Intervention Name(s)
Etoposide
Other Intervention Name(s)
VP-16, VePesid, Toposar
Intervention Description
500 mg/m2 IV over 3 hours once daily on days 1-4 during Courses 1C & 2C
Intervention Type
Drug
Intervention Name(s)
Dasatinib
Other Intervention Name(s)
Sprycel
Intervention Description
140 mg orally daily if BCR/ABL positive and/or Ph+
Intervention Type
Drug
Intervention Name(s)
Rituximab
Other Intervention Name(s)
Rituxan
Intervention Description
375 mg/m2 IV once daily on days 1 & 15 (precursor B-cell ALL only, administer per institutional protocol) during Courses 1A, 1B, 1C & 2A
Intervention Type
Drug
Intervention Name(s)
Hydrocortisone
Other Intervention Name(s)
Hydrocortisone sodium succinate, Solu-Cortef
Intervention Description
Randomize patients proceeding to Course 1B to hydrocortisone versus placebo prior to PEG-asparaginase treatments in Courses 1B, 2B, 3B, and Maintenance month 1
Primary Outcome Measure Information:
Title
Event-free survival
Time Frame
3-year
Secondary Outcome Measure Information:
Title
Liposomal cytarabine toxicity
Time Frame
3 years
Title
CNS relapse rate
Time Frame
3-year
Title
Overall survival
Time Frame
3-year
Title
Leukemia-free survival
Time Frame
3-year
Title
Efficacy of hydrocortisone premedication for reduced PEG-asparaginase allergic reactions
Time Frame
3 years
Title
PEG-asparaginase toxicities
Time Frame
3 years
Title
Complete and overall response rates
Time Frame
3 years
Title
Non-relapse mortality
Time Frame
3-year
Other Pre-specified Outcome Measures:
Title
Minimal residual disease and outcomes
Time Frame
3 years
Title
Asparaginase antibodies and asparaginase activity
Time Frame
3 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Ability to understand and the willingness to sign a written informed consent. Diagnosis of acute lymphoblastic leukemia or lymphoblastic lymphoma as defined by the World Health Organization [94] Untreated disease EXCEPT for corticosteroids, hydroxyurea, leukapheresis, and/or tyrosine kinase inhibitors for up to 2 weeks prior to initiation of study therapy. Age 18 through 60 years ECOG performance status 0,1, or 2 (see Appendix A) Adequate organ function defined as: Total bilirubin < 2 mg/dL (unless due to ALL) AST(SGOT)/ALT(SGPT) < 3 times institutional upper limit of normal (unless due to ALL) Serum creatinine < 2 mg/dL (unless elevated creatinine felt by investigator to be acute and reversible) OR creatinine clearance >60 mL/min/1.73 m2 for patients with creatinine levels above institutional normal Left ventricular ejection fraction ≥50% Women of child-bearing potential and men with partners of child- bearing potential must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study participation, and for 90 days following completion of therapy. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately. A woman of child-bearing potential is any female (regardless of sexual orientation, having undergone a tubal ligation, or remaining celibate by choice) who meets the following criteria: Has not undergone a hysterectomy or bilateral oophorectomy; or Has not been naturally postmenopausal for at least 12 consecutive months (i.e., has had menses at any time in the preceding 12 consecutive months) Exclusion Criteria: Current or anticipated use of other investigational agents during the study Known central nervous system mass lesion History of allergic reactions attributed to compounds of similar chemical or biologic composition to liposomal cytarabine or other agents used in study inclusive of known allergy to polyethylene glycol. History of unprovoked venous thrombosis/thromboembolism Recurrent or chronic pancreatitis Uncontrolled diabetes mellitus Uncontrolled intercurrent illness that would limit compliance with study requirements including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements. Pregnant or nursing. Any condition, in the opinion of the investigator, that compromises compliance with study requirements Known HIV positivity
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
James K Mangan, MD, PhD
Organizational Affiliation
UC San Diego, Division of Blood and Marrow Transplantation
Official's Role
Principal Investigator
Facility Information:
Facility Name
UCSD, Division of Blood and Marrow Transplantation, Moores Cancer Center
City
La Jolla
State/Province
California
ZIP/Postal Code
92093
Country
United States
Facility Name
Hematological Malignancies/Stem Cell Transplantation Unit, David Geffen School of Medicine at UCLA
City
Los Angeles
State/Province
California
ZIP/Postal Code
90095
Country
United States
Facility Name
University of California Davis Comprehensive Cancer Center
City
Sacramento
State/Province
California
ZIP/Postal Code
95817
Country
United States
Facility Name
UCSF Comprehensive Cancer Center
City
San Francisco
State/Province
California
ZIP/Postal Code
94143-0324
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
12011123
Citation
Linker C, Damon L, Ries C, Navarro W. Intensified and shortened cyclical chemotherapy for adult acute lymphoblastic leukemia. J Clin Oncol. 2002 May 15;20(10):2464-71. doi: 10.1200/JCO.2002.07.116.
Results Reference
result

Learn more about this trial

Chemotherapy With Liposomal Cytarabine CNS Prophylaxis for Adult Acute Lymphoblastic Leukemia & Lymphoblastic Lymphoma

We'll reach out to this number within 24 hrs