Acalabrutinib for GVHD Prophylaxis in Allogeneic Hematopoietic Stem Cell Transplantation in Lymphomas and Leukemia
Primary Purpose
Lymphoma, Leukemia
Status
Withdrawn
Phase
Phase 1
Locations
Study Type
Interventional
Intervention
Acalabrutinib, tacrolimus, methotrexate
Sponsored by
About this trial
This is an interventional treatment trial for Lymphoma focused on measuring Graft-Versus-Host Disease Prophylaxis
Eligibility Criteria
Inclusion Criteria:
- Willingness and ability to sign the study-specific informed consent form
- Willingness to comply with all study procedures and attend all study visits.
- Participant with (a) B-cell malignancies or (b) AML (CD117 positive) who are undergoing allogeneic SCT at Penn State Cancer Institute from an 8/8 matched unrelated donor. Donor selection and screening criteria are to comply with 21 CRF Part 1271.
- Male or female participant, age ≥ 18 and ≤ 75 years.
- Ability to swallow oral medication.
- Women of childbearing potential (WOCP) as defined as not surgically sterile or not postmenopausal must have a negative serum pregnancy test at screening and a negative urine pregnancy test within 7 days of beginning the condition regimen.
- Men and WOCP must agree to use 2 medically accepted method of contraception and must agree to continue use this method while on the trial and through at least one week after the last dose of study drug. Acceptable methods of contraception include abstinence, barrier method with spermicide, intrauterine device (IUD) known to have a failure rate of less than 1% per year, or steroidal contraceptive (oral, transdermal, implanted, or injected) in conjunction with a barrier method. Periodic abstinence (e.g., calendar, ovulation, symptothermal, post ovulation methods) withdrawal, spermicides only, or lactational amenorrhea are not acceptable methods of contraception. WOCP must use a medically accepted method of contraception and must agree to continue use this method from the time of signing the informed consent through at least one week after the last dose of study drug.
- Karnofsky Performance Scale (KPS) equal to or greater than 70%.
Exclusion Criteria:
- Renal dysfunction with eGFR <30/mL/minute/1.73 m2 by Cockroft-Gault formula.
- Participant requires warfarin or vitamin K antagonist within one week of acalabrutinib administration.
- Participant requires treatment with a strong cytochrome P450 3A inducer or inhibitor.
- Treatment with post-transplant cyclophosphamide
- Treatment with any other investigational products within 21 days of conditioning regimen.
- Known hypersensitivity to acalabrutinib, tacrolimus and methotrexate and their excipients.
- Active uncontrolled infections
- Human immunodeficiency virus (HIV) positivity.
- Hepatitis B or C serologic status: subjects who are hepatitis B core antibody (anti-HBc) positive and who are hepatitis B surface antigen (HBsAg) negative will need to have a negative polymerase chain reaction (PCR) and must be willing to undergo DNA PCR testing during the study to be eligible. Those who are HBsAg positive or hepatitis B PCR positive will be excluded. Subjects who are hepatitis C antibody positive will need to have a negative PCR result to be eligible. Those who are hepatitis C PCR positive will be excluded.
- Any serious medical or psychiatric illness that could, in the investigator's opinion, potentially interfere with the completion of study procedures.
- Diagnosed or treated for another malignancy within 2 years before study registration or previously diagnosed with another malignancy and have any evidence of residual disease. Participant with non-melanoma skin cancer or carcinoma in situ of any type are not excluded if they have undergone resection.
- Participant with coagulopathy or bleeding disorder.
- Known hepatic cirrhosis or severe pre-existing hepatic impairment (ALT and/or AST more than 3x greater than upper limit of normal, Total Bilirubin more than 2x greater than upper limit of normal)
- Uncontrolled high blood pressure (i.e., systolic blood pressure > 180 mm Hg, diastolic blood pressure > 95 mm Hg).
- Uncontrolled or symptomatic cardiac arrhythmia
- Left ventricular ejection fraction (LVEF) < 40% as assessed by echocardiogram or radionuclide angiography, or NYHA class 3 or 4 heart failure
- Myocardial infarction within 6 months of signing consent.
- History of stroke or intracranial hemorrhage within 6 months of signing consent.
- Breastfeeding or pregnant.
- Has difficulty with or is unable to swallow oral medication, or has significant gastrointestinal disease that would limit absorption of oral medication.
- Suspected or confirmed PML(Progressive Multifocal Leukoencephalopathy)
- Requires treatment with proton-pump inhibitors. (Participants receiving proton-pump inhibitors who switch to H2-receptor antagonists or antacids are eligible for enrollment.)
- FVC, FEV1, or DLCO (corrected with hemoglobin) less than 40% of expected value.
- Prothrombin time (PT)/INR or aPTT (in the absence of lupus anticoagulant) >2x ULN.
- Major surgical procedure within 28 days of first dose of study drug. Note: If a subject had major surgery, they must have recovered adequately from any toxicity and/or complications from the intervention before the first dose of study drug.
- Concurrent participation in another therapeutic clinical trial.
Sites / Locations
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Acalabrutinib in combination with tacrolimus and methotrexate
Arm Description
Phase I: To determine the maximum tolerated dose (MTD) of Acalabrutinib in combination with tacrolimus and methotrexate for Phase II. Phase II: To determine if acalabrutinib in combination with tacrolimus and methotrexate is safe and effective in reducing acute GVHD rate.
Outcomes
Primary Outcome Measures
Dose-limiting toxicity
Dose-limiting toxicity of acalabrutinib in combination with tacrolimus and methotrexate in early SCT for Phase I part of the study
Maximum tolerated dose (MTD)
Maximum tolerated dose (MTD) of acalabrutinib in combination with tacrolimus and methotrexate in early SCT for Phase I part of the study
acute GVHD grade II-IV
Incidence of acute GVHD grade II-IV by day 180 for Phase II part of the study
Secondary Outcome Measures
Full Information
NCT ID
NCT04961801
First Posted
June 16, 2021
Last Updated
February 20, 2022
Sponsor
Shin Mineishi
Collaborators
Milton S. Hershey Medical Center
1. Study Identification
Unique Protocol Identification Number
NCT04961801
Brief Title
Acalabrutinib for GVHD Prophylaxis in Allogeneic Hematopoietic Stem Cell Transplantation in Lymphomas and Leukemia
Official Title
Acalabrutinib for GVHD Prophylaxis in Allogeneic Hematopoietic Stem Cell Transplantation in Lymphomas and Leukemia
Study Type
Interventional
2. Study Status
Record Verification Date
February 2022
Overall Recruitment Status
Withdrawn
Why Stopped
Manufacturer AstraZeneca withdrew the study due to lack of funding
Study Start Date
March 2022 (Anticipated)
Primary Completion Date
January 2026 (Anticipated)
Study Completion Date
January 2030 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Shin Mineishi
Collaborators
Milton S. Hershey Medical Center
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
GVHD remains a major cause of morbidity and mortality following SCT. The current standard of care for prophylaxis against GVHD includes tacrolimus and methotrexate.
This study proposes to utilize acalabrutinib, a Bruton tyrosine kinase (BTK) inhibitor, for GVHD prophylaxis following allogeneic SCT.
The hypothesis is that the addition of acalabrutinib to our institutional standard GVHD prophylaxis (tacrolimus and methotrexate) is safe, feasible, and effective in reducing both the incidence and severity of acute GVHD.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Lymphoma, Leukemia
Keywords
Graft-Versus-Host Disease Prophylaxis
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Sequential Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
0 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Acalabrutinib in combination with tacrolimus and methotrexate
Arm Type
Experimental
Arm Description
Phase I: To determine the maximum tolerated dose (MTD) of Acalabrutinib in combination with tacrolimus and methotrexate for Phase II.
Phase II: To determine if acalabrutinib in combination with tacrolimus and methotrexate is safe and effective in reducing acute GVHD rate.
Intervention Type
Drug
Intervention Name(s)
Acalabrutinib, tacrolimus, methotrexate
Intervention Description
For Graft-Versus-Host Disease Prophylaxis in Allogeneic Hematopoietic Stem Cell Transplantation in Lymphomas and Leukemia
Primary Outcome Measure Information:
Title
Dose-limiting toxicity
Description
Dose-limiting toxicity of acalabrutinib in combination with tacrolimus and methotrexate in early SCT for Phase I part of the study
Time Frame
30 days
Title
Maximum tolerated dose (MTD)
Description
Maximum tolerated dose (MTD) of acalabrutinib in combination with tacrolimus and methotrexate in early SCT for Phase I part of the study
Time Frame
30 days
Title
acute GVHD grade II-IV
Description
Incidence of acute GVHD grade II-IV by day 180 for Phase II part of the study
Time Frame
180 days
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Willingness and ability to sign the study-specific informed consent form
Willingness to comply with all study procedures and attend all study visits.
Participant with (a) B-cell malignancies or (b) AML (CD117 positive) who are undergoing allogeneic SCT at Penn State Cancer Institute from an 8/8 matched unrelated donor. Donor selection and screening criteria are to comply with 21 CRF Part 1271.
Male or female participant, age ≥ 18 and ≤ 75 years.
Ability to swallow oral medication.
Women of childbearing potential (WOCP) as defined as not surgically sterile or not postmenopausal must have a negative serum pregnancy test at screening and a negative urine pregnancy test within 7 days of beginning the condition regimen.
Men and WOCP must agree to use 2 medically accepted method of contraception and must agree to continue use this method while on the trial and through at least one week after the last dose of study drug. Acceptable methods of contraception include abstinence, barrier method with spermicide, intrauterine device (IUD) known to have a failure rate of less than 1% per year, or steroidal contraceptive (oral, transdermal, implanted, or injected) in conjunction with a barrier method. Periodic abstinence (e.g., calendar, ovulation, symptothermal, post ovulation methods) withdrawal, spermicides only, or lactational amenorrhea are not acceptable methods of contraception. WOCP must use a medically accepted method of contraception and must agree to continue use this method from the time of signing the informed consent through at least one week after the last dose of study drug.
Karnofsky Performance Scale (KPS) equal to or greater than 70%.
Exclusion Criteria:
Renal dysfunction with eGFR <30/mL/minute/1.73 m2 by Cockroft-Gault formula.
Participant requires warfarin or vitamin K antagonist within one week of acalabrutinib administration.
Participant requires treatment with a strong cytochrome P450 3A inducer or inhibitor.
Treatment with post-transplant cyclophosphamide
Treatment with any other investigational products within 21 days of conditioning regimen.
Known hypersensitivity to acalabrutinib, tacrolimus and methotrexate and their excipients.
Active uncontrolled infections
Human immunodeficiency virus (HIV) positivity.
Hepatitis B or C serologic status: subjects who are hepatitis B core antibody (anti-HBc) positive and who are hepatitis B surface antigen (HBsAg) negative will need to have a negative polymerase chain reaction (PCR) and must be willing to undergo DNA PCR testing during the study to be eligible. Those who are HBsAg positive or hepatitis B PCR positive will be excluded. Subjects who are hepatitis C antibody positive will need to have a negative PCR result to be eligible. Those who are hepatitis C PCR positive will be excluded.
Any serious medical or psychiatric illness that could, in the investigator's opinion, potentially interfere with the completion of study procedures.
Diagnosed or treated for another malignancy within 2 years before study registration or previously diagnosed with another malignancy and have any evidence of residual disease. Participant with non-melanoma skin cancer or carcinoma in situ of any type are not excluded if they have undergone resection.
Participant with coagulopathy or bleeding disorder.
Known hepatic cirrhosis or severe pre-existing hepatic impairment (ALT and/or AST more than 3x greater than upper limit of normal, Total Bilirubin more than 2x greater than upper limit of normal)
Uncontrolled high blood pressure (i.e., systolic blood pressure > 180 mm Hg, diastolic blood pressure > 95 mm Hg).
Uncontrolled or symptomatic cardiac arrhythmia
Left ventricular ejection fraction (LVEF) < 40% as assessed by echocardiogram or radionuclide angiography, or NYHA class 3 or 4 heart failure
Myocardial infarction within 6 months of signing consent.
History of stroke or intracranial hemorrhage within 6 months of signing consent.
Breastfeeding or pregnant.
Has difficulty with or is unable to swallow oral medication, or has significant gastrointestinal disease that would limit absorption of oral medication.
Suspected or confirmed PML(Progressive Multifocal Leukoencephalopathy)
Requires treatment with proton-pump inhibitors. (Participants receiving proton-pump inhibitors who switch to H2-receptor antagonists or antacids are eligible for enrollment.)
FVC, FEV1, or DLCO (corrected with hemoglobin) less than 40% of expected value.
Prothrombin time (PT)/INR or aPTT (in the absence of lupus anticoagulant) >2x ULN.
Major surgical procedure within 28 days of first dose of study drug. Note: If a subject had major surgery, they must have recovered adequately from any toxicity and/or complications from the intervention before the first dose of study drug.
Concurrent participation in another therapeutic clinical trial.
12. IPD Sharing Statement
Plan to Share IPD
No
Learn more about this trial
Acalabrutinib for GVHD Prophylaxis in Allogeneic Hematopoietic Stem Cell Transplantation in Lymphomas and Leukemia
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