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BL-8040 and Nelarabine for Relapsed or Refractory T-Acute Lymphoblastic Leukemia/ Lymphoblastic Lymphoma

Primary Purpose

T-Acute Lymphoblastic Leukemia, Adult T Lymphoblastic Lymphoma

Status
Terminated
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
BL-8040
Nelarabine
Sponsored by
Washington University School of Medicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for T-Acute Lymphoblastic Leukemia

Eligibility Criteria

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

Inclusion Criteria:

  • Diagnosis of T-acute lymphoblastic leukemia/ lymphoblastic lymphoma according to WHO criteria which has relapsed or is refractory to chemotherapy.
  • Peripheral blood lymphoblasts ≤ 50,000 mcL. Hydroxyurea and/or leukapheresis is permitted to reduce the peripheral blast count prior to enrollment and treatment.
  • Age ≥ 18 years
  • ECOG performance status ≤ 2.
  • Adequate organ function defined as:

    • Calculated creatinine clearance ≥ 50 ml/min using the Cockroft-Gault formula
    • AST, ALT, total bilirubin ≤ 2 x institutional ULN except for Gilbert's disease or when in the opinion of treating physician elevated levels are due to direct involvement of leukemia (e.g., hepatic infiltration or biliary obstruction due to leukemia), in which case ALT and AST may be elevated up to ≤ 5 x IULN.
  • Women of childbearing potential and men must agree to use adequate contraception with a highly effective method (hormonal or barrier method of birth control, abstinence) prior to study entry and for the duration of study participation. Abstinence is acceptable if this is the established and preferred contraception for the subject.
  • Female subjects must have a negative urine or serum pregnancy test within 72 hours prior to start of study treatment if of childbearing potential or be of non-childbearing potential. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required. The serum pregnancy test must be negative for the subject to be eligible. Non-childbearing potential is defined as:

    *≥ 45 years of age and has not had menses for > 2 years

    • Amenorrheic for > 2 years without a hysterectomy and oophorectomy and a FSH value in the postmenopausal range upon pretrial (screening) evaluation
    • Post-hysterectomy, oophorectomy, or tubal ligation. Documented hysterectomy or oophorectomy must be confirmed with medical records of the actual procedure or confirmed by an ultrasound. Tubal ligation must be confirmed with medical records of the actual procedure.
  • Able to understand and willing to sign an IRB-approved written informed consent document.

Exclusion Criteria:

  • Previous treatment with nelarabine for relapsed or refractory disease.
  • Pregnant or nursing.
  • Received any other investigational agent or systemic cytotoxic chemotherapy within the preceding 2 weeks.
  • Active CNS involvement with leukemia
  • Active HIV or hepatitis B or C infection.
  • Any medical condition which, in the opinion of the clinical investigator, would interfere with the evaluation of the patient. Subjects with a clinically significant or unstable medical or surgical condition or any other condition that cannot be well-controlled by the allowed medications permitted in the study protocol that would preclude safe and complete study participation, as determined by medical history, physical examinations, laboratory tests, and according to the investigator's judgment.

Sites / Locations

  • Washington University School of Medicine
  • The University of Texas MD Anderson Cancer Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Arm 1: BL-8040 and Nelarabine

Arm Description

Cycle 1: BL-8040 subcutaneous daily from Day 1 to Day 6 and nelarabine intravenously over 2 hours on Days 2, 4, and 6 Cycles 2-4: BL-8040 subcutaneous daily from Day 1 to Day 5 and nelarabine intravenously over 2 hours on Days 1, 3, and 5 Treatment may be repeated every 21 days for up to 4 cycles

Outcomes

Primary Outcome Measures

Safety and tolerability of regimen as measured by frequency and grade of adverse events
The descriptions and grading scales found in the revised NCI Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 will be utilized for all adverse event reporting.

Secondary Outcome Measures

Pharmacodynamic effects of BL-8040 on T-lymphoblasts as measured by inhibition of CXCR4 signaling on lymphoblasts
Pharmacodynamic effects of BL-8040 on T-lymphoblasts as measured by inhibition of CXCR4 signaling on lymphoblasts
Pharmacodynamic effects of BL-8040 on T-lymphoblasts as measured by mobilization of lymphoblasts into the peripheral circulation
Pharmacodynamic effects of BL-8040 on T-lymphoblasts as measured by mobilization of lymphoblasts into the peripheral circulation
Pharmacodynamic effects of BL-8040 on T-lymphoblasts as measured by induction of apoptosis in lymphoblasts
Pharmacodynamic effects of BL-8040 on T-lymphoblasts as measured by induction of apoptosis in lymphoblasts
Pharmacodynamic effects of BL-8040 on T-lymphoblasts as measured by alterations in lymphoblast cell cycle status
Pharmacodynamic effects of BL-8040 on T-lymphoblasts as measured by alterations in lymphoblast cell cycle status
Estimate composite complete remission rate (CRc=CR+CRi)
Complete remission (CR) = an absolute neutrophil count (segs and bands) > 1,000/mcL, no circulating lymphoblasts, platelets ≥ 100,000/mcL; and < 5% marrow leukemia blast cells with complete disappearance of all measurable disease as confirmed by physical examination, CT scan and/or FDG-PET (Deauville criteria score of 1, 2, or 3) -Morphologic complete remission with incomplete blood count recovery (CRi)=Defined as CR with the exception of neutropenia < 1,000/mcL or thrombocytopenia <100,000/mcL
Estimate overall response rate (CR, CRi + PR)
Complete remission (CR) = an absolute neutrophil count (segs and bands) > 1,000/mcL, no circulating lymphoblasts, platelets ≥ 100,000/mcL; and < 5% marrow leukemia blast cells with complete disappearance of all measurable disease as confirmed by physical examination, CT scan and/or FDG-PET (Deauville criteria score of 1, 2, or 3) Morphologic complete remission with incomplete blood count recovery (CRi)=Defined as CR with the exception of neutropenia < 1,000/mcL or thrombocytopenia <100,000/mcL Partial remission (PR)=A PR requires all of the CR criteria except that marrow may still contain 5-25% leukemia blast cells. An absolute neutrophil count (segs and bands) ≥ 1000/mcL, no circulating blasts, and platelets > 100,000/mcL are requires as for a CR. For patients with measurable disease, a reduction of 50% or more in the sum of the products of the perpendicular diameters of all measurable lesions compared with pretreatment measurements and with no new or enlarging lesions
Time to response
Time to response
Duration of response
Defined as the interval from the date CR/CRi is documented to the date of recurrence.
Disease-free survival
For patients achieving a complete remission, defined as the interval from the date of first documentation of CR/CRi to the date of recurrence or death due to any cause.
Event-free survival
Defined as the interval from the date of first dose of study drug to date of treatment failure, recurrence, or death due to any cause.
Overall survival
Defined as the date of first dose of study drug to the date of death from any cause.
Estimate rate of patients who proceed to alloHCT after treatment
Estimate rate of patients who proceed to alloHCT after treatment
Interaction of pretreatment disease and morphology on clinical outcome
Interaction of pretreatment disease and morphology on clinical outcome
Interaction of pretreatment disease and CXCR4 expression on lymphoblasts on clinical outcome
Interaction of pretreatment disease and CXCR4 expression on lymphoblasts on clinical outcome
Interaction of pretreatment disease and cytogenetics on clinical outcome
Interaction of pretreatment disease and cytogenetics on clinical outcome
Interaction of pretreatment disease and immunophenotype on clinical outcome
Interaction of pretreatment disease and immunophenotype on clinical outcome
Interaction of pretreatment disease and white blood cell count on clinical outcome
Interaction of pretreatment disease and white blood cell count on clinical outcome
Interaction of pretreatment disease and performance status on clinical outcome
Interaction of pretreatment disease and performance status on clinical outcome

Full Information

First Posted
May 3, 2016
Last Updated
January 18, 2023
Sponsor
Washington University School of Medicine
Collaborators
The Leukemia and Lymphoma Society, National Institutes of Health (NIH), National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT02763384
Brief Title
BL-8040 and Nelarabine for Relapsed or Refractory T-Acute Lymphoblastic Leukemia/ Lymphoblastic Lymphoma
Official Title
A Phase IIa Study of BL-8040 in Combination With Nelarabine for Relapsed or Refractory T-Acute Lymphoblastic Leukemia/ Lymphoblastic Lymphoma
Study Type
Interventional

2. Study Status

Record Verification Date
January 2023
Overall Recruitment Status
Terminated
Why Stopped
Low accrual
Study Start Date
December 2, 2016 (Actual)
Primary Completion Date
February 11, 2022 (Actual)
Study Completion Date
May 22, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Washington University School of Medicine
Collaborators
The Leukemia and Lymphoma Society, National Institutes of Health (NIH), National Cancer Institute (NCI)

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
The outcome of patients with relapsed or refractory adult T-acute lymphoblastic leukemia (T-ALL) and the related disease T-lymphoblastic lymphoma (T-LBL) is extremely poor with 30% of the patients responding to first salvage therapy and long-term survival of only 10%. Therefore, novel therapies for patients with relapsed/refractory T-ALL/LBL represent an unmet clinical need. Recent data provide strong evidence that CXCR4 signaling plays a major role in T-cell leukemia cell maintenance and leukemia initiating activity, and targeting CXCR4 signaling in T-ALL cells reduces tumor growth in an animal model. In this study, the investigators propose that the addition of BL-8040 to nelarabine as a salvage therapy for patients with relapsed/refractory T-ALL/LBL will result in a higher complete remission (CR) rate than nelarabine alone without an increase in toxicity and will allow patients to proceed to a potentially curative allogeneic hematopoietic cell transplant.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
T-Acute Lymphoblastic Leukemia, Adult T 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
12 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Arm 1: BL-8040 and Nelarabine
Arm Type
Experimental
Arm Description
Cycle 1: BL-8040 subcutaneous daily from Day 1 to Day 6 and nelarabine intravenously over 2 hours on Days 2, 4, and 6 Cycles 2-4: BL-8040 subcutaneous daily from Day 1 to Day 5 and nelarabine intravenously over 2 hours on Days 1, 3, and 5 Treatment may be repeated every 21 days for up to 4 cycles
Intervention Type
Drug
Intervention Name(s)
BL-8040
Intervention Type
Drug
Intervention Name(s)
Nelarabine
Other Intervention Name(s)
Arranon
Primary Outcome Measure Information:
Title
Safety and tolerability of regimen as measured by frequency and grade of adverse events
Description
The descriptions and grading scales found in the revised NCI Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 will be utilized for all adverse event reporting.
Time Frame
Up to 30 days after completion of treatment (approximately 16 weeks)
Secondary Outcome Measure Information:
Title
Pharmacodynamic effects of BL-8040 on T-lymphoblasts as measured by inhibition of CXCR4 signaling on lymphoblasts
Description
Pharmacodynamic effects of BL-8040 on T-lymphoblasts as measured by inhibition of CXCR4 signaling on lymphoblasts
Time Frame
Completion of treatment (approximately 12 weeks)
Title
Pharmacodynamic effects of BL-8040 on T-lymphoblasts as measured by mobilization of lymphoblasts into the peripheral circulation
Description
Pharmacodynamic effects of BL-8040 on T-lymphoblasts as measured by mobilization of lymphoblasts into the peripheral circulation
Time Frame
Completion of treatment (approximately 12 weeks)
Title
Pharmacodynamic effects of BL-8040 on T-lymphoblasts as measured by induction of apoptosis in lymphoblasts
Description
Pharmacodynamic effects of BL-8040 on T-lymphoblasts as measured by induction of apoptosis in lymphoblasts
Time Frame
Completion of treatment (approximately 12 weeks)
Title
Pharmacodynamic effects of BL-8040 on T-lymphoblasts as measured by alterations in lymphoblast cell cycle status
Description
Pharmacodynamic effects of BL-8040 on T-lymphoblasts as measured by alterations in lymphoblast cell cycle status
Time Frame
Completion of treatment (approximately 12 weeks)
Title
Estimate composite complete remission rate (CRc=CR+CRi)
Description
Complete remission (CR) = an absolute neutrophil count (segs and bands) > 1,000/mcL, no circulating lymphoblasts, platelets ≥ 100,000/mcL; and < 5% marrow leukemia blast cells with complete disappearance of all measurable disease as confirmed by physical examination, CT scan and/or FDG-PET (Deauville criteria score of 1, 2, or 3) -Morphologic complete remission with incomplete blood count recovery (CRi)=Defined as CR with the exception of neutropenia < 1,000/mcL or thrombocytopenia <100,000/mcL
Time Frame
Completion of treatment (approximately 12 weeks)
Title
Estimate overall response rate (CR, CRi + PR)
Description
Complete remission (CR) = an absolute neutrophil count (segs and bands) > 1,000/mcL, no circulating lymphoblasts, platelets ≥ 100,000/mcL; and < 5% marrow leukemia blast cells with complete disappearance of all measurable disease as confirmed by physical examination, CT scan and/or FDG-PET (Deauville criteria score of 1, 2, or 3) Morphologic complete remission with incomplete blood count recovery (CRi)=Defined as CR with the exception of neutropenia < 1,000/mcL or thrombocytopenia <100,000/mcL Partial remission (PR)=A PR requires all of the CR criteria except that marrow may still contain 5-25% leukemia blast cells. An absolute neutrophil count (segs and bands) ≥ 1000/mcL, no circulating blasts, and platelets > 100,000/mcL are requires as for a CR. For patients with measurable disease, a reduction of 50% or more in the sum of the products of the perpendicular diameters of all measurable lesions compared with pretreatment measurements and with no new or enlarging lesions
Time Frame
Completion of treatment (approximately 12 weeks)
Title
Time to response
Description
Time to response
Time Frame
Up to 2 years after completion of treatment (approximately 116 weeks)
Title
Duration of response
Description
Defined as the interval from the date CR/CRi is documented to the date of recurrence.
Time Frame
Up to 2 years after completion of treatment (approximately 116 weeks)
Title
Disease-free survival
Description
For patients achieving a complete remission, defined as the interval from the date of first documentation of CR/CRi to the date of recurrence or death due to any cause.
Time Frame
Up to 2 years after completion of treatment (approximately 116 weeks)
Title
Event-free survival
Description
Defined as the interval from the date of first dose of study drug to date of treatment failure, recurrence, or death due to any cause.
Time Frame
Up to 2 years after completion of treatment (approximately 116 weeks)
Title
Overall survival
Description
Defined as the date of first dose of study drug to the date of death from any cause.
Time Frame
Up to 2 years after completion of treatment (approximately 116 weeks)
Title
Estimate rate of patients who proceed to alloHCT after treatment
Description
Estimate rate of patients who proceed to alloHCT after treatment
Time Frame
Completion of treatment (approximately 12 weeks)
Title
Interaction of pretreatment disease and morphology on clinical outcome
Description
Interaction of pretreatment disease and morphology on clinical outcome
Time Frame
Up to 2 years after completion of treatment (approximately 116 weeks)
Title
Interaction of pretreatment disease and CXCR4 expression on lymphoblasts on clinical outcome
Description
Interaction of pretreatment disease and CXCR4 expression on lymphoblasts on clinical outcome
Time Frame
Up to 2 years after completion of treatment (approximately 116 weeks)
Title
Interaction of pretreatment disease and cytogenetics on clinical outcome
Description
Interaction of pretreatment disease and cytogenetics on clinical outcome
Time Frame
Up to 2 years after completion of treatment (approximately 116 weeks)
Title
Interaction of pretreatment disease and immunophenotype on clinical outcome
Description
Interaction of pretreatment disease and immunophenotype on clinical outcome
Time Frame
Up to 2 years after completion of treatment (approximately 116 weeks)
Title
Interaction of pretreatment disease and white blood cell count on clinical outcome
Description
Interaction of pretreatment disease and white blood cell count on clinical outcome
Time Frame
Up to 2 years after completion of treatment (approximately 116 weeks)
Title
Interaction of pretreatment disease and performance status on clinical outcome
Description
Interaction of pretreatment disease and performance status on clinical outcome
Time Frame
Up to 2 years after completion of treatment (approximately 116 weeks)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Diagnosis of T-acute lymphoblastic leukemia/ lymphoblastic lymphoma according to WHO criteria which has relapsed or is refractory to chemotherapy. Peripheral blood lymphoblasts ≤ 50,000 mcL. Hydroxyurea and/or leukapheresis is permitted to reduce the peripheral blast count prior to enrollment and treatment. Age ≥ 18 years ECOG performance status ≤ 2. Adequate organ function defined as: Calculated creatinine clearance ≥ 50 ml/min using the Cockroft-Gault formula AST, ALT, total bilirubin ≤ 2 x institutional ULN except for Gilbert's disease or when in the opinion of treating physician elevated levels are due to direct involvement of leukemia (e.g., hepatic infiltration or biliary obstruction due to leukemia), in which case ALT and AST may be elevated up to ≤ 5 x IULN. Women of childbearing potential and men must agree to use adequate contraception with a highly effective method (hormonal or barrier method of birth control, abstinence) prior to study entry and for the duration of study participation. Abstinence is acceptable if this is the established and preferred contraception for the subject. Female subjects must have a negative urine or serum pregnancy test within 72 hours prior to start of study treatment if of childbearing potential or be of non-childbearing potential. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required. The serum pregnancy test must be negative for the subject to be eligible. Non-childbearing potential is defined as: *≥ 45 years of age and has not had menses for > 2 years Amenorrheic for > 2 years without a hysterectomy and oophorectomy and a FSH value in the postmenopausal range upon pretrial (screening) evaluation Post-hysterectomy, oophorectomy, or tubal ligation. Documented hysterectomy or oophorectomy must be confirmed with medical records of the actual procedure or confirmed by an ultrasound. Tubal ligation must be confirmed with medical records of the actual procedure. Able to understand and willing to sign an IRB-approved written informed consent document. Exclusion Criteria: Previous treatment with nelarabine for relapsed or refractory disease. Pregnant or nursing. Received any other investigational agent or systemic cytotoxic chemotherapy within the preceding 2 weeks. Active CNS involvement with leukemia Active HIV or hepatitis B or C infection. Any medical condition which, in the opinion of the clinical investigator, would interfere with the evaluation of the patient. Subjects with a clinically significant or unstable medical or surgical condition or any other condition that cannot be well-controlled by the allowed medications permitted in the study protocol that would preclude safe and complete study participation, as determined by medical history, physical examinations, laboratory tests, and according to the investigator's judgment.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Geoffrey L Uy, 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
Facility Name
The University of Texas MD Anderson Cancer Center
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
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

Learn more about this trial

BL-8040 and Nelarabine for Relapsed or Refractory T-Acute Lymphoblastic Leukemia/ Lymphoblastic Lymphoma

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