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BL22 Immunotoxin in Treating Patients With Refractory Chronic Lymphocytic Leukemia, Prolymphocytic Leukemia, or Non-Hodgkin's Lymphoma

Primary Purpose

Leukemia, Lymphoma

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
BL22 immunotoxin
antibody-drug conjugate therapy
immunotoxin therapy
Sponsored by
MedImmune LLC
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for Leukemia focused on measuring B-cell chronic lymphocytic leukemia, refractory chronic lymphocytic leukemia, recurrent grade 1 follicular lymphoma, recurrent grade 2 follicular lymphoma, stage III grade 1 follicular lymphoma, stage III grade 2 follicular lymphoma, stage IV grade 1 follicular lymphoma, stage IV grade 2 follicular lymphoma, extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue, nodal marginal zone B-cell lymphoma, recurrent marginal zone lymphoma, splenic marginal zone lymphoma, stage III marginal zone lymphoma, stage IV marginal zone lymphoma, recurrent mantle cell lymphoma, stage III mantle cell lymphoma, stage IV mantle cell lymphoma, recurrent small lymphocytic lymphoma, stage III small lymphocytic lymphoma, stage IV small lymphocytic lymphoma, recurrent adult diffuse small cleaved cell lymphoma, stage III adult diffuse small cleaved cell lymphoma, stage IV adult diffuse small cleaved cell lymphoma, Waldenstrom macroglobulinemia, prolymphocytic leukemia

Eligibility Criteria

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

DISEASE CHARACTERISTICS: Diagnosis of B-cell leukemia or lymphoma of 1 of the following types: Chronic lymphocytic leukemia Failed standard chemotherapy Prolymphocytic leukemia Failed standard chemotherapy Indolent non-Hodgkin's lymphoma, including mantle cell lymphoma Stage III or IV disease Failed ≥ 1 prior doxorubicin- or fludarabine-containing standard therapy CD22-positive disease, as evidenced by 1 of the following: More than 15% malignant cells react with anti-CD22 by immunohistochemistry More than 30% malignant cells are CD22-positive by fluorescence-activated cell sorting analysis More than 400 CD22 sites per malignant cell (average) by radiolabeled anti-CD22 binding Treatment is medically indicated, as evidenced by any of the following: Progressive disease-related symptoms Progressive cytopenias due to marrow involvement Progressive or painful splenomegaly or adenopathy Rapidly increasing lymphocytosis Autoimmune hemolytic anemia or thrombocytopenia Increased frequency of infections No neutralizing anti-toxin or anti-mouse immunoglobulin G (IgG) antibodies to BL22 or PE38 No serum neutralization of > 75% of the activity of 1 μg/mL of BL22 No CNS disease requiring treatment No hairy cell leukemia PATIENT CHARACTERISTICS: Age 18 and over Performance status ECOG 0-2 Life expectancy More than 6 months Hematopoietic Absolute neutrophil count > 1,000/mm^3* Platelet count > 40,000/mm^3 NOTE: *Patients with leukemia are eligible regardless of absolute neutrophil count; Grade III-IV pancytopenia or growth factor dependence allowed if due to disease Hepatic Bilirubin < 1.5 times upper limit of normal (ULN) ALT and AST < 2.5 times ULN Renal Creatinine ≤ 1.5 mg/dL Pulmonary FEV1 ≥ 60% of predicted DLCO ≥ 55% of predicted Other Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception HIV negative PRIOR CONCURRENT THERAPY: Biologic therapy Prior bone marrow transplantation allowed More than 3 weeks since prior biologic therapy, including interferon, denileukin diftitox, or LMB-2 immunotoxin More than 3 months since prior monoclonal antibody therapy (e.g., rituximab) Chemotherapy See Disease Characteristics More than 3 weeks since prior cytotoxic chemotherapy Endocrine therapy More than 1 week since prior steriods Less than 5 doses for non-treatment reasons (e.g., allergy prophylaxis) No evidence of disease response Radiotherapy More than 3 weeks since prior whole-body electron beam radiotherapy Radiotherapy within the past 3 weeks allowed provided the volume of bone marrow treated is < 10% AND the patient has measurable disease located outside the radiation port Surgery Not specified Other More than 3 weeks since prior retinoids More than 3 weeks since other prior systemic therapy for this malignancy

Sites / Locations

  • Warren Grant Magnuson Clinical Center - NCI Clinical Trials Referral Office

Outcomes

Primary Outcome Measures

Secondary Outcome Measures

Full Information

First Posted
August 2, 2005
Last Updated
June 17, 2010
Sponsor
MedImmune LLC
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1. Study Identification

Unique Protocol Identification Number
NCT00126646
Brief Title
BL22 Immunotoxin in Treating Patients With Refractory Chronic Lymphocytic Leukemia, Prolymphocytic Leukemia, or Non-Hodgkin's Lymphoma
Official Title
Phase I Study of BL22, A Recombinant Immunotoxin for Chronic Lymphocytic Leukemia and CD22+ Lymphomas
Study Type
Interventional

2. Study Status

Record Verification Date
June 2010
Overall Recruitment Status
Completed
Study Start Date
June 2005 (undefined)
Primary Completion Date
March 2009 (Actual)
Study Completion Date
June 2009 (Actual)

3. Sponsor/Collaborators

Name of the Sponsor
MedImmune LLC

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
RATIONALE: BL22 immunotoxin can find tumor cells and kill them without harming normal cells. PURPOSE: This phase I trial is studying the side effects and best dose of BL22 immunotoxin in treating patients with refractory B-cell chronic lymphocytic leukemia, prolymphocytic leukemia, or non-Hodgkin's lymphoma.
Detailed Description
OBJECTIVES: Determine the maximum tolerated dose of recombinant BL22 immunotoxin in patients with CD22-positive refractory B-cell chronic lymphocytic leukemia, prolymphocytic leukemia, or indolent non-Hodgkin's lymphoma. Determine the safety and efficacy of this drug in these patients. Determine the pharmacokinetics of this drug in these patients. Determine the immunogenicity of this drug in these patients. Determine the effect of this drug on various components of the circulating cellular immune system in these patients. OUTLINE: This is a nonrandomized, dose-escalation study. Patients are stratified according to disease type (chronic lymphocytic leukemia vs non-Hodgkin's lymphoma). Patients receive recombinant BL22 immunotoxin IV over 30 minutes on days 1, 3, and 5. Treatment repeats ≥ every 27 days for up to 6 courses in the absence of neutralizing antibodies to BL22 or PE38, disease progression, or unacceptable toxicity. Patients achieving a complete response (CR) receive 2 additional courses beyond CR. Patients who relapse from a CR lasting ≥ 6 months may receive additional courses. Cohorts of 3-6 patients per stratum receive escalating doses of recombinant BL22 immunotoxin until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. PROJECTED ACCRUAL: A total of 24 patients (12 per stratum) will be accrued for this study within 1-2 years.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Leukemia, Lymphoma
Keywords
B-cell chronic lymphocytic leukemia, refractory chronic lymphocytic leukemia, recurrent grade 1 follicular lymphoma, recurrent grade 2 follicular lymphoma, stage III grade 1 follicular lymphoma, stage III grade 2 follicular lymphoma, stage IV grade 1 follicular lymphoma, stage IV grade 2 follicular lymphoma, extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue, nodal marginal zone B-cell lymphoma, recurrent marginal zone lymphoma, splenic marginal zone lymphoma, stage III marginal zone lymphoma, stage IV marginal zone lymphoma, recurrent mantle cell lymphoma, stage III mantle cell lymphoma, stage IV mantle cell lymphoma, recurrent small lymphocytic lymphoma, stage III small lymphocytic lymphoma, stage IV small lymphocytic lymphoma, recurrent adult diffuse small cleaved cell lymphoma, stage III adult diffuse small cleaved cell lymphoma, stage IV adult diffuse small cleaved cell lymphoma, Waldenstrom macroglobulinemia, prolymphocytic leukemia

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
24 (Anticipated)

8. Arms, Groups, and Interventions

Intervention Type
Drug
Intervention Name(s)
BL22 immunotoxin
Intervention Type
Procedure
Intervention Name(s)
antibody-drug conjugate therapy
Intervention Type
Procedure
Intervention Name(s)
immunotoxin therapy

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Diagnosis of B-cell leukemia or lymphoma of 1 of the following types: Chronic lymphocytic leukemia Failed standard chemotherapy Prolymphocytic leukemia Failed standard chemotherapy Indolent non-Hodgkin's lymphoma, including mantle cell lymphoma Stage III or IV disease Failed ≥ 1 prior doxorubicin- or fludarabine-containing standard therapy CD22-positive disease, as evidenced by 1 of the following: More than 15% malignant cells react with anti-CD22 by immunohistochemistry More than 30% malignant cells are CD22-positive by fluorescence-activated cell sorting analysis More than 400 CD22 sites per malignant cell (average) by radiolabeled anti-CD22 binding Treatment is medically indicated, as evidenced by any of the following: Progressive disease-related symptoms Progressive cytopenias due to marrow involvement Progressive or painful splenomegaly or adenopathy Rapidly increasing lymphocytosis Autoimmune hemolytic anemia or thrombocytopenia Increased frequency of infections No neutralizing anti-toxin or anti-mouse immunoglobulin G (IgG) antibodies to BL22 or PE38 No serum neutralization of > 75% of the activity of 1 μg/mL of BL22 No CNS disease requiring treatment No hairy cell leukemia PATIENT CHARACTERISTICS: Age 18 and over Performance status ECOG 0-2 Life expectancy More than 6 months Hematopoietic Absolute neutrophil count > 1,000/mm^3* Platelet count > 40,000/mm^3 NOTE: *Patients with leukemia are eligible regardless of absolute neutrophil count; Grade III-IV pancytopenia or growth factor dependence allowed if due to disease Hepatic Bilirubin < 1.5 times upper limit of normal (ULN) ALT and AST < 2.5 times ULN Renal Creatinine ≤ 1.5 mg/dL Pulmonary FEV1 ≥ 60% of predicted DLCO ≥ 55% of predicted Other Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception HIV negative PRIOR CONCURRENT THERAPY: Biologic therapy Prior bone marrow transplantation allowed More than 3 weeks since prior biologic therapy, including interferon, denileukin diftitox, or LMB-2 immunotoxin More than 3 months since prior monoclonal antibody therapy (e.g., rituximab) Chemotherapy See Disease Characteristics More than 3 weeks since prior cytotoxic chemotherapy Endocrine therapy More than 1 week since prior steriods Less than 5 doses for non-treatment reasons (e.g., allergy prophylaxis) No evidence of disease response Radiotherapy More than 3 weeks since prior whole-body electron beam radiotherapy Radiotherapy within the past 3 weeks allowed provided the volume of bone marrow treated is < 10% AND the patient has measurable disease located outside the radiation port Surgery Not specified Other More than 3 weeks since prior retinoids More than 3 weeks since other prior systemic therapy for this malignancy
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Robert Kreitman, MD
Organizational Affiliation
National Cancer Institute (NCI)
Official's Role
Principal Investigator
Facility Information:
Facility Name
Warren Grant Magnuson Clinical Center - NCI Clinical Trials Referral Office
City
Bethesda
State/Province
Maryland
ZIP/Postal Code
20892-1182
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
16061911
Citation
Kreitman RJ, Squires DR, Stetler-Stevenson M, Noel P, FitzGerald DJ, Wilson WH, Pastan I. Phase I trial of recombinant immunotoxin RFB4(dsFv)-PE38 (BL22) in patients with B-cell malignancies. J Clin Oncol. 2005 Sep 20;23(27):6719-29. doi: 10.1200/JCO.2005.11.437. Epub 2005 Aug 1.
Results Reference
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BL22 Immunotoxin in Treating Patients With Refractory Chronic Lymphocytic Leukemia, Prolymphocytic Leukemia, or Non-Hodgkin's Lymphoma

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