Blinatumomab for Treatment of R/R or MRD-positive CD19-Positive MPAL
Mixed Phenotype Acute Leukemia (MPAL), Measurable Residual Disease (MRD)
About this trial
This is an interventional treatment trial for Mixed Phenotype Acute Leukemia (MPAL)
Eligibility Criteria
Inclusion Criteria:
- Subjects must have histologically or cytologically confirmed R/R CD19-positive MPAL based on the WHO criteria, OR CD19-positive MPAL in CR/CRh/CRi/CRp after at least one chemotherapy block of standard ALL or AML therapy with detectable MRD ≥ 0.1%. Primary refractory MPAL is defined by absence of CR/CRh/CRi/CRp after at least one cycle of standard AML/ALL induction therapy. A patient has relapsed MPAL if they achieved a CR/CRh/CRi/CRp after induction therapy (CR1) and has then relapsed during, or after continuation of therapy.
- Age 18 years and older
- Subjects who have undergone allo-HSCT are eligible if they are ≥ 4 weeks post stem cell infusion, have no evidence of GVHD > Grade 2, and are at least ≥ 1 week off all immunosuppressive therapy
- Previous cytotoxic chemotherapy (except for hydroxyurea) must have been completed at least 2 weeks prior to day 1 of treatment on the study. Subjects with hematologic malignancies are expected to have hematologic abnormalities at study entry.
- ECOG performance status < 3
Subjects must have organ function as below:
- Direct bilirubin ≤ 2.5 mg/dL
- AST/ALT/Alkaline phosphatase ≤ 5 X institutional upper limit of normal
- Serum creatinine ≤ 3 mg/dL
- Subjects with a history of CNS leukemia must be clinically stable with a flow cytometric clear CSF in the 2 weeks prior to day 1 of blinatumomab administration. Subjects with history of CNS leukemia in Cohort A should have received one dose of intrathecal chemotherapy in the 4 weeks prior to day 1 of blinatumomab administration. Subject can receive subsequent prophylactic intrathecal chemotherapy.
- Female subjects of childbearing potential must have a negative pregnancy test
- Ability to understand and willingness to sign a written informed consent document
- Agree to comply with the study requirements and agree to come to the clinic/hospital for required study visits
Exclusion Criteria:
- Subjects receiving any other investigational agents, or concurrent chemotherapy, radiation therapy, or immunotherapy not including corticosteroids or hydroxyurea
Subjects with acute leukemia with any of the following cytogenetic abnormalities:
t(15;17)(q24;q21) PML/RARA, t(8;21)(q22;q22) RUNX1/RUNX1T1, inv(16)(p13q22)/t(16;16)(p13;q22) CBFB-MYH11
- A history or presence of clinically relevant CNS pathology (e.g., as epilepsy, paresis, aphasia, stroke, severe brain injuries, dementia, cerebellar disease, psychosis)
- Hyperleukocytosis with > 50,000 blasts/µL. Hydroxyurea for blast count control is permitted before starting treatment and up to maximum of 10 days after starting treatment on the study. The WBC need not reach 50,000/µL to start hydroxyurea during protocol; the decision to start hydroxyurea during this time is at the discretion of the treating physician
- Active, uncontrolled infection; subjects with infection under active treatment and controlled with antimicrobials are eligible
- Pregnant women
- Uncontrolled undercurrent illness including, but not limited to, symptomatic congestive heart failure, unstable angina pectoris, uncontrolled active seizure disorder, or psychiatric illness/social situations that per site Principal Investigator's judgment would limit compliance with study requirements
Sites / Locations
- Greenebaum Cancer Center at University of Maryland Medical Center
Arms of the Study
Arm 1
Arm 2
Experimental
Experimental
Subjects with R/R CD19-positive MPAL
Subjects with CD19-positive MPAL in CR/CRh/CRi/CRp and detectable MRD
Cohort A: Evaluate the efficacy of blinatumomab to achieve the best morphologic response after the first two cycles of therapy in subjects with morphologic R/R CD19-positive MPAL The treatment of blinatumomab consists of induction, consolidation and maintenance therapy Subject will receive study drug blinatumomab by continuous IV infusion (CIV) Each treatment cycle consists of 28 days of blinatumomab CIV followed by a 14±3 days treatment-free interval for induction, 28±3 days treatment-free interval for consolidation, and 56±3 days treatment-free interval for maintenance The initial dose of blinatumomab is 9 mcg/day for 7 days. The target dose for rest of treatment is 28 mcg/day
Cohort B: Evaluate the efficacy of blinatumomab to achieve MRD-negativity in subjects with CD19-positive MPAL in CR, or CRh, or CRi or CRp after receiving at least one chemotherapy block of standard ALL or AML treatment with MRD-positivity at a level of ≥ 0.1% using an assay with a minimum sensitivity of 0.01% The treatment of blinatumomab consists of induction, consolidation and maintenance therapy Subject will receive study drug blinatumomab by continuous IV infusion (CIV) Each treatment cycle consists of 28 days of blinatumomab CIV followed by a 14±3 days treatment-free interval for induction, 28±3 days treatment-free interval for consolidation, and 56±3 days treatment-free interval for maintenance. The dose of blinatumomab is 28 mcg/day