Study Comparing Blinatumomab Alternating With Low-intensity Chemotherapy Versus Standard of Care Chemotherapy for Older Adults With Newly Diagnosed Philadelphia-negative B-cell Precursor Acute Lymphoblastic Leukemia
Newly Diagnosed Philadelphia (Ph)-Negative B-cell Precursor Acute Lymphoblastic Leukemia (ALL)
About this trial
This is an interventional treatment trial for Newly Diagnosed Philadelphia (Ph)-Negative B-cell Precursor Acute Lymphoblastic Leukemia (ALL) focused on measuring Newly Diagnosed Philadelphia (Ph)-negative B-cell Precursor Acute Lymphoblastic Leukemia (ALL), Blinatumomab, Low-intensity Chemotherapy, GMALL HyperCVAD
Eligibility Criteria
Inclusion Criteria:
- Age ≥ 55 years at the time of informed consent. OR
Age 40 to < 55 years of age if at least 1 of the following comorbidities at the time of informed consent:
- history of grades 3 and 4 pancreatitis
- diabetes mellitus with end-organ damage
- severe liver disease such as cirrhosis stage 2 with portal hypertension or history of esophageal variceal bleeding and aspartate transaminase (AST)/alanine aminotransferase (ALT) > 10 x upper limit of normal (ULN) (liver cirrhosis must be confirmed by biopsy)
- body mass index (BMI) ≥ 40 combined with relevant comorbidities such as metabolic syndrome
Any further combination of documented severe comorbidities that the investigator judges to be incompatible with administering an intensive pediatric based, adult adapted standard chemotherapy regimen but still compatible with the suggested protocol for older participants in both the experimental and the SOC arm. The participant history will be reviewed by the medical monitor during screening to determine enrollment acceptability based on a standard list with types of comorbidities allowed. A medical advisory board is available to the investigators for questions/advice and includes experts in the field of adult leukemia with experience with the use of blinatumomab, the global development lead for blinatumomab and the medical monitor of the study.
- Participants with newly diagnosed Philadelphia (Ph)-negative B-cell precursor acute lymphoblastic leukemia (ALL)
- Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2, higher ECOG score allowed if due to underlying leukemia
- All participants must have adequate organ function as defined below:
- renal: estimated glomerular filtration rate based on MDRD calculation ≥ 50 mL/min/1.73 m^2
- liver function: total bilirubin ≤ 2x upper limit of normal (ULN; unless Gilbert's Disease or if liver involvement with leukemia); exception for participants 40 to < 55 years of age if they have a comorbidity listed above: severe liver disease such as cirrhosis stage 2 with portal hypertension or history of esophageal variceal bleeding and AST/ALT > 10 x ULN (liver cirrhosis must be confirmed by biopsy)
- cardiac: left ventricular ejection fraction (LVEF) ≥ 50%
Exclusion Criteria:
- Active central nervous system (CNS) leukemia not resolved with IT chemotherapy during screening.
- Clinically relevant CNS pathology requiring treatment (eg, unstable epilepsy).
- Current autoimmune disease or history of autoimmune disease with potential CNS involvement
- Known infection with human immunodeficiency virus (HIV)
- Known infection with chronic or active infection with hepatitis B (eg, hepatitis b surface [HBs] antigen reactive or quantifiable hepatitis b virus [HBV] viral load) or hepatitis C virus (HCV) (eg, HCV RNA [qualitative] is detected).
Active hepatitis B and C based on the following results:
- positive for hepatitis B surface antigen (HepBsAg) (indicative of chronic hepatitis B or recent acute hepatitis B)
- negative HepBsAg and positive for hepatitis B core antibody: negative HBV DNA by PCR result is necessary to enroll.
positive Hepatitis C virus antibody (HepCAb): negative hepatitis C virus RNA by PCR result is necessary to enroll.
- Participant with symptoms and/or clinical signs and/or radiographic and/or sonographic signs that indicate an acute or uncontrolled chronic infection.
- Cancer chemotherapy for this newly diagnosed B cell ALL before the start of protocol-required therapy with the exception of IT chemotherapy or pre-phase chemotherapy. Radiation to a spot lesion such as chloroma or lytic lesion of bone or vertebrae for pain or vertebral stabilization is allowed.
Sites / Locations
- City of Hope National Medical CenterRecruiting
- University of California IrvineRecruiting
- University of California San Francisco Medical CenterRecruiting
- AdventHealth OrlandoRecruiting
- Saint Francis Hospital, IncRecruiting
- University of Texas MD Anderson Cancer CenterRecruiting
- FundaleuRecruiting
- Royal North Shore HospitalRecruiting
- Princess Alexandra HospitalRecruiting
- Royal Adelaide HospitalRecruiting
- Peter MacCallum Cancer CentreRecruiting
- The Alfred HospitalRecruiting
- Fiona Stanley HospitalRecruiting
- Medizinische Universitaet GrazRecruiting
- Hanusch KrankenhausRecruiting
- AZ Sint-Jan Brugge-Oostende AVRecruiting
- Universite Catholique de Louvain Cliniques Universitaires Saint LucRecruiting
- Universitair Ziekenhuis GentRecruiting
- Centre Hospitalier Universitaire de Liege - Sart TilmanRecruiting
- AZ Delta Campus RumbekeRecruiting
- Centre Hospitalier Universitaire Dinant Godinne - Universite Catholique de Louvain NamurRecruiting
- University Multiprofile Hospital for Active Treatment Sveti Georgi EADRecruiting
- Specialized Hospital for Active Treatment of Hematology Diseases EADRecruiting
- Aarhus UniversitetshospitalRecruiting
- Odense UniversitetshospitalRecruiting
- Hôpital Henri MondorRecruiting
- Centre Hospitalier Universitaire de Nantes - Hopital Hotel DieuRecruiting
- Centre Hospitalier Universitaire Archet 2Recruiting
- Hôpital Saint LouisRecruiting
- Hopital Saint AntoineRecruiting
- Centre Hospitalier Universitaire de Bordeaux - Hopital Haut LevequeRecruiting
- Hopital Lyon SudRecruiting
- Klinikum AugsburgRecruiting
- Charite - Universitaetsmedizin Berlin, Campus Benjamin FranklinRecruiting
- Universitaetsklinikum DresdenRecruiting
- Universitätsklinikum DüsseldorfRecruiting
- Universitaetsklinikum HeidelbergRecruiting
- Universitaetsklinikum JenaRecruiting
- Universitaetsklinikum Schleswig-HolsteinRecruiting
- Klinikum der LMU MuenchenRecruiting
- Evangelismos HospitalRecruiting
- Laiko General Hospital of AthensRecruiting
- Attiko General University HospitalRecruiting
- University Hospital of PatrasRecruiting
- General Hospital of Thessaloniki Georgios PapanikolaouRecruiting
- Semmelweis EgyetemRecruiting
- Del-pesti Centrumkorhaz - Orszagos Hematologiai es Infektologiai IntezetRecruiting
- Heves Varmegyei Markhot Ferenc Oktatokorhaz es RendelointezetRecruiting
- Szabolcs-Szatmar-Bereg Varmegyei Oktatokorhaz Nyiregyhazi Josa Andras TagkorhazRecruiting
- Azienda Socio Sanitaria Territoriale Papa Giovanni XXIIIRecruiting
- Azienda Ospedaliera Universitaria di Bologna Policlinico S Orsola MalpighiRecruiting
- Ospedale Policlinico San Martino IRCCSRecruiting
- Azienda Unità Locale Socio Sanitaria 3 Ospedale Dell AngeloRecruiting
- Azienda Ospedaliera di Perugia Ospedale Santa Maria della MisericordiaRecruiting
- Azienda Unita Sanitaria Locale Pescara Ospedale Civile Santo SpiritoRecruiting
- Nagoya University HospitalRecruiting
- Akita University HospitalRecruiting
- University of Fukui HospitalRecruiting
- Kyushu University HospitalRecruiting
- Kurume University HospitalRecruiting
- Fukushima Medical University HospitalRecruiting
- Sapporo Hokuyu HospitalRecruiting
- Kanazawa University HospitalRecruiting
- Tokai University HospitalRecruiting
- Yokohama City University Medical CenterRecruiting
- Nagasaki University HospitalRecruiting
- National Hospital Organization Okayama Medical CenterRecruiting
- Osaka Metropolitan University HospitalRecruiting
- Kindai University HospitalRecruiting
- Jichi Medical University HospitalRecruiting
- Yamagata University HospitalRecruiting
- Centro Hospitalar Universitario de Lisboa Central, EPE - Hospital de Santo Antonio dos CapuchosRecruiting
- Institutul Clinic FundeniRecruiting
- Institutul Oncologic Prof Dr Ion ChiricutaRecruiting
- Institutul Regional de Oncologie IasiRecruiting
- Spitalul Clinic Judetean de Urgenta SibiuRecruiting
- Hospital Universitario Reina SofiaRecruiting
- Hospital Universitario Virgen del RocioRecruiting
- Institut Catala d Oncologia Badalona Hospital Universitari Germans Trias i PujolRecruiting
- Hospital Universitari Vall d HebronRecruiting
- Institut Catala d Oncologia Hospitalet Hospital Duran i ReynalsRecruiting
- National Cheng Kung University HospitalRecruiting
- National Taiwan University HospitalRecruiting
- Hacettepe Universitesi Tip FakultesiRecruiting
- Bagcilar Medipol Mega Universite HastanesiRecruiting
- Dokuz Eylul Universitesi Onkoloji EnstitusuRecruiting
- Ondokuz Mayis Universitesi Tip FakultesiRecruiting
Arms of the Study
Arm 1
Arm 2
Arm 3
Experimental
Experimental
Active Comparator
Safety Run-in: Blinatumomab alternating with low-intensity chemotherapy
Phase 3: Blinatumomab alternating with low-intensity chemotherapy
Phase 3: Standard of care (SOC) chemotherapy
The safety run-in will be performed prior to initiating the phase 3 randomized part of the study. This safety run-in is to evaluate the safety and tolerability of blinatumomab alternating with low-intensity chemotherapy. The safety run-in also evaluates a shorter dose step interval from (4 days instead of 7 days) and a 1-week (instead of 2-week) drug free interval between blinatumomab cycles. Blinatumomab will be infused at a lower dose for 4 days and increase to a higher dose on Day 5 of the infusion for the remainder of the infusion.
Participants will receive blinatumomab alternating with low-intensity chemotherapy.
Participants will receive 1 of 2 SOC chemotherapy regimens (GMALL or HyperCVAD) per investigator's choice.