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Immunotoxin in Treating Patients With Leukemia or Lymphoma

Primary Purpose

Leukemia, Lymphoma

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
LMB-2 immunotoxin
Sponsored by
National Cancer Institute (NCI)
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for Leukemia focused on measuring recurrent adult Hodgkin lymphoma, stage IV cutaneous T-cell non-Hodgkin lymphoma, recurrent cutaneous T-cell non-Hodgkin lymphoma, Waldenström macroglobulinemia, recurrent adult acute myeloid leukemia, recurrent adult acute lymphoblastic leukemia, relapsing chronic myelogenous leukemia, refractory chronic lymphocytic leukemia, refractory hairy cell leukemia, recurrent small lymphocytic lymphoma, recurrent grade 1 follicular lymphoma, recurrent grade 2 follicular lymphoma, recurrent grade 3 follicular lymphoma, recurrent adult diffuse small cleaved cell lymphoma, recurrent adult diffuse mixed cell lymphoma, recurrent adult diffuse large cell lymphoma, recurrent adult immunoblastic large cell lymphoma, recurrent adult lymphoblastic lymphoma, recurrent adult Burkitt lymphoma, stage I adult T-cell leukemia/lymphoma, stage II adult T-cell leukemia/lymphoma, stage III adult T-cell leukemia/lymphoma, stage IV adult T-cell leukemia/lymphoma, recurrent adult T-cell leukemia/lymphoma, prolymphocytic leukemia, recurrent mantle cell lymphoma, stage IV mycosis fungoides/Sezary syndrome, recurrent mycosis fungoides/Sezary syndrome, recurrent marginal zone lymphoma, extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue, nodal marginal zone B-cell lymphoma, splenic marginal zone lymphoma

Eligibility Criteria

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

DISEASE CHARACTERISTICS: Histologically confirmed Hodgkin's disease, non-Hodgkin's lymphoma, or leukemia in one of the following categories: Adult T-cell leukemia or lymphoma (ATL) No smoldering ATL No limitation on prior therapy Cutaneous T-cell lymphoma (CTCL) Stages IB-III and failed at least 1 standard therapy Stage IV regardless of prior therapy Stages I-IV peripheral T-cell lymphoma Relapsed after standard chemotherapy Ineligible for or refused salvage chemotherapy or bone marrow transplantation (BMT) B-cell non-Hodgkin's lymphoma (NHL) of any histology Indolent stages II-IV NHL Failed at least 1 standard therapy Disease symptomatic and requiring treatment Aggressive NHL Relapsed after standard chemotherapy Ineligible for or refused salvage chemotherapy or BMT Chronic lymphocytic leukemia (CLL) Rai stages III and IV or Binet stage C Failed standard therapy and at least 1 salvage chemotherapy Primary B-cell prolymphocytic leukemia or prolymphocytic transformation of CLL Failed standard therapy and at least 1 salvage chemotherapy Hairy cell leukemia Failed standard and salvage chemotherapy Ineligible for or refused further salvage chemotherapy or BMT Acute myelogenous leukemia Failed standard chemotherapy Ineligible for or refused salvage chemotherapy or BMT Stages II-IV Hodgkin's disease Failed standard chemotherapy Ineligible for curative salvage radiotherapy or chemotherapy Ineligible for or refused BMT Patients with leukemias or lymphomas not easily classified in above categories who have failed standard therapy and are ineligible for or have refused bone marrow transplant Evidence of interleukin-2 receptor-alpha (IL2Ra) expression by one of the following: Greater than 10% of malignant cells reactive with anti-Tac by immunohistochemistry Greater than 10% of malignant cells from a particular site positive by FACS Greater than 400 IL2Ra sites per malignant cell by radiolabeled anti-Tac binding Soluble IL2Ra level greater than 1,000 U/mL (normal geometric mean 235, with 95% confidence levels of 112-502 U) Hodgkin's disease with measurable disease not amenable to biopsy No CNS disease requiring treatment Malignant cells in CSF allowed if judged not to represent clinically significant leukemic or lymphomatous meningitis (as in CSF contamination by blood) PATIENT CHARACTERISTICS: Age: 18 and over Performance status: Karnofsky 50-100% Life expectancy: Greater than 2 months Hematopoietic: Absolute neutrophil count greater than 1,000/mm3* Platelet count greater than 50,000/mm3* NOTE: *nonleukemic patients Hepatic: AST and ALT less than 5 times normal Renal: Creatinine less than 2.0 mg/dL OR Creatinine clearance greater than 50 mL/min Pulmonary: FEV1, TLC, and DLCO greater than 50% of predicted if pulmonary or mediastinal involvement with tumor greater than one third of total thoracic diameter Other: HIV negative Not pregnant Fertile patients must use effective contraception Serum must neutralize no more than 75% LMB-2 in tissue culture PRIOR CONCURRENT THERAPY: Biologic therapy: See Disease Characteristics At least 3 weeks since prior interferon Chemotherapy: See Disease Characteristics At least 3 weeks since prior cytotoxic chemotherapy At least 3 weeks since prior retinoids No concurrent chemotherapy Endocrine therapy: No concurrent corticosteroids unless begun at least 3 weeks prior to entry and dose not increased during 3 weeks prior to entry Radiotherapy: See Disease Characteristics At least 3 weeks since prior whole-body electron beam radiotherapy Other radiotherapy allowed within 3 weeks of entry provided less than 10% of marrow irradiated and measurable disease exists outside radiation port Surgery: Not specified Other: See Disease Characteristics At least 3 weeks since any prior systemic therapy No other concurrent investigational agents

Sites / Locations

  • Laboratory of Molecular Biology
  • Medicine Branch

Outcomes

Primary Outcome Measures

Secondary Outcome Measures

Full Information

First Posted
November 1, 1999
Last Updated
April 28, 2015
Sponsor
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00002765
Brief Title
Immunotoxin in Treating Patients With Leukemia or Lymphoma
Official Title
PHASE I STUDY OF ANTI-TAC(Fv)-PE38 (LMB-2), A RECOMBINANT SINGLE-CHAIN IMMUNOTOXIN FOR TREATMENT OF TAC-EXPRESSING MALIGNANCIES
Study Type
Interventional

2. Study Status

Record Verification Date
March 2003
Overall Recruitment Status
Completed
Study Start Date
April 1996 (undefined)
Primary Completion Date
undefined (undefined)
Study Completion Date
undefined (undefined)

3. Sponsor/Collaborators

Name of the Sponsor
National Cancer Institute (NCI)

4. Oversight

5. Study Description

Brief Summary
RATIONALE: Immunotoxins can locate cancer cells and either kill them or deliver cancer-killing substances to them without harming normal cells. PURPOSE: Phase I trial to study the effectiveness of LMB-2 immunotoxin in treating patients who have leukemia or lymphoma.
Detailed Description
OBJECTIVES: Assess the therapeutic efficacy and toxicity of the recombinant immunotoxin LMB-2, an anti-Tac murine monoclonal antibody fragment conjugated to a truncated portion of Pseudomonas exotoxin, in patients with Tac-expressing leukemias and lymphomas. Define the pharmacokinetics of LMB-2, including the terminal elimination serum half-life, area under the curve, and volume of distribution. Evaluate, in a preliminary manner, the immunogenicity of LMB-2 in these patients. Determine the effect of LMB-2 on various components of the circulating cellular immune system. OUTLINE: This is a dose escalation study. Patients receive LMB-2 immunotoxin IV over 30 minutes on days 1, 3, and 5. Treatment repeats every 15-21 days for up to 10 courses in the absence of disease progression, neutralizing antibodies, or unacceptable toxicity. Cohorts of 3-6 patients each receive escalating doses of LMB-2 immunotoxin until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose at which no more than 1 patient experiences dose limiting toxicity. PROJECTED ACCRUAL: A maximum of 40 patients will be accrued for this study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Leukemia, Lymphoma
Keywords
recurrent adult Hodgkin lymphoma, stage IV cutaneous T-cell non-Hodgkin lymphoma, recurrent cutaneous T-cell non-Hodgkin lymphoma, Waldenström macroglobulinemia, recurrent adult acute myeloid leukemia, recurrent adult acute lymphoblastic leukemia, relapsing chronic myelogenous leukemia, refractory chronic lymphocytic leukemia, refractory hairy cell leukemia, recurrent small lymphocytic lymphoma, recurrent grade 1 follicular lymphoma, recurrent grade 2 follicular lymphoma, recurrent grade 3 follicular lymphoma, recurrent adult diffuse small cleaved cell lymphoma, recurrent adult diffuse mixed cell lymphoma, recurrent adult diffuse large cell lymphoma, recurrent adult immunoblastic large cell lymphoma, recurrent adult lymphoblastic lymphoma, recurrent adult Burkitt lymphoma, stage I adult T-cell leukemia/lymphoma, stage II adult T-cell leukemia/lymphoma, stage III adult T-cell leukemia/lymphoma, stage IV adult T-cell leukemia/lymphoma, recurrent adult T-cell leukemia/lymphoma, prolymphocytic leukemia, recurrent mantle cell lymphoma, stage IV mycosis fungoides/Sezary syndrome, recurrent mycosis fungoides/Sezary syndrome, recurrent marginal zone lymphoma, extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue, nodal marginal zone B-cell lymphoma, splenic marginal zone lymphoma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1

8. Arms, Groups, and Interventions

Intervention Type
Biological
Intervention Name(s)
LMB-2 immunotoxin

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically confirmed Hodgkin's disease, non-Hodgkin's lymphoma, or leukemia in one of the following categories: Adult T-cell leukemia or lymphoma (ATL) No smoldering ATL No limitation on prior therapy Cutaneous T-cell lymphoma (CTCL) Stages IB-III and failed at least 1 standard therapy Stage IV regardless of prior therapy Stages I-IV peripheral T-cell lymphoma Relapsed after standard chemotherapy Ineligible for or refused salvage chemotherapy or bone marrow transplantation (BMT) B-cell non-Hodgkin's lymphoma (NHL) of any histology Indolent stages II-IV NHL Failed at least 1 standard therapy Disease symptomatic and requiring treatment Aggressive NHL Relapsed after standard chemotherapy Ineligible for or refused salvage chemotherapy or BMT Chronic lymphocytic leukemia (CLL) Rai stages III and IV or Binet stage C Failed standard therapy and at least 1 salvage chemotherapy Primary B-cell prolymphocytic leukemia or prolymphocytic transformation of CLL Failed standard therapy and at least 1 salvage chemotherapy Hairy cell leukemia Failed standard and salvage chemotherapy Ineligible for or refused further salvage chemotherapy or BMT Acute myelogenous leukemia Failed standard chemotherapy Ineligible for or refused salvage chemotherapy or BMT Stages II-IV Hodgkin's disease Failed standard chemotherapy Ineligible for curative salvage radiotherapy or chemotherapy Ineligible for or refused BMT Patients with leukemias or lymphomas not easily classified in above categories who have failed standard therapy and are ineligible for or have refused bone marrow transplant Evidence of interleukin-2 receptor-alpha (IL2Ra) expression by one of the following: Greater than 10% of malignant cells reactive with anti-Tac by immunohistochemistry Greater than 10% of malignant cells from a particular site positive by FACS Greater than 400 IL2Ra sites per malignant cell by radiolabeled anti-Tac binding Soluble IL2Ra level greater than 1,000 U/mL (normal geometric mean 235, with 95% confidence levels of 112-502 U) Hodgkin's disease with measurable disease not amenable to biopsy No CNS disease requiring treatment Malignant cells in CSF allowed if judged not to represent clinically significant leukemic or lymphomatous meningitis (as in CSF contamination by blood) PATIENT CHARACTERISTICS: Age: 18 and over Performance status: Karnofsky 50-100% Life expectancy: Greater than 2 months Hematopoietic: Absolute neutrophil count greater than 1,000/mm3* Platelet count greater than 50,000/mm3* NOTE: *nonleukemic patients Hepatic: AST and ALT less than 5 times normal Renal: Creatinine less than 2.0 mg/dL OR Creatinine clearance greater than 50 mL/min Pulmonary: FEV1, TLC, and DLCO greater than 50% of predicted if pulmonary or mediastinal involvement with tumor greater than one third of total thoracic diameter Other: HIV negative Not pregnant Fertile patients must use effective contraception Serum must neutralize no more than 75% LMB-2 in tissue culture PRIOR CONCURRENT THERAPY: Biologic therapy: See Disease Characteristics At least 3 weeks since prior interferon Chemotherapy: See Disease Characteristics At least 3 weeks since prior cytotoxic chemotherapy At least 3 weeks since prior retinoids No concurrent chemotherapy Endocrine therapy: No concurrent corticosteroids unless begun at least 3 weeks prior to entry and dose not increased during 3 weeks prior to entry Radiotherapy: See Disease Characteristics At least 3 weeks since prior whole-body electron beam radiotherapy Other radiotherapy allowed within 3 weeks of entry provided less than 10% of marrow irradiated and measurable disease exists outside radiation port Surgery: Not specified Other: See Disease Characteristics At least 3 weeks since any prior systemic therapy No other concurrent investigational agents
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Robert Kreitman, MD
Organizational Affiliation
National Cancer Institute (NCI)
Official's Role
Study Chair
Facility Information:
Facility Name
Laboratory of Molecular Biology
City
Bethesda
State/Province
Maryland
ZIP/Postal Code
20892
Country
United States
Facility Name
Medicine Branch
City
Bethesda
State/Province
Maryland
ZIP/Postal Code
20892
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
18596230
Citation
Matsushita K, Margulies I, Onda M, Nagata S, Stetler-Stevenson M, Kreitman RJ. Soluble CD22 as a tumor marker for hairy cell leukemia. Blood. 2008 Sep 15;112(6):2272-7. doi: 10.1182/blood-2008-01-131987. Epub 2008 Jul 2.
Results Reference
background
PubMed Identifier
10778980
Citation
Kreitman RJ, Margulies I, Stetler-Stevenson M, Wang QC, FitzGerald DJ, Pastan I. Cytotoxic activity of disulfide-stabilized recombinant immunotoxin RFB4(dsFv)-PE38 (BL22) toward fresh malignant cells from patients with B-cell leukemias. Clin Cancer Res. 2000 Apr;6(4):1476-87.
Results Reference
background
PubMed Identifier
10690555
Citation
Robbins DH, Margulies I, Stetler-Stevenson M, Kreitman RJ. Hairy cell leukemia, a B-cell neoplasm that is particularly sensitive to the cytotoxic effect of anti-Tac(Fv)-PE38 (LMB-2). Clin Cancer Res. 2000 Feb;6(2):693-700.
Results Reference
background
PubMed Identifier
10764422
Citation
Kreitman RJ, Wilson WH, White JD, Stetler-Stevenson M, Jaffe ES, Giardina S, Waldmann TA, Pastan I. Phase I trial of recombinant immunotoxin anti-Tac(Fv)-PE38 (LMB-2) in patients with hematologic malignancies. J Clin Oncol. 2000 Apr;18(8):1622-36. doi: 10.1200/JCO.2000.18.8.1622.
Results Reference
result
PubMed Identifier
10552943
Citation
Kreitman RJ, Wilson WH, Robbins D, Margulies I, Stetler-Stevenson M, Waldmann TA, Pastan I. Responses in refractory hairy cell leukemia to a recombinant immunotoxin. Blood. 1999 Nov 15;94(10):3340-8.
Results Reference
result

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Immunotoxin in Treating Patients With Leukemia or Lymphoma

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