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Lenalidomide, Fludarabine & Cyclophosphamide in Advanced Chronic Lymphocytic Leukemia Not Responding to Therapy (LLC0606)

Primary Purpose

Chronic Lymphocytic Leukemia

Status
Completed
Phase
Phase 1
Locations
Italy
Study Type
Interventional
Intervention
Cyclophosphamide
Fludarabine phosphate
Lenalidomide
Sponsored by
Gruppo Italiano Malattie EMatologiche dell'Adulto
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for Chronic Lymphocytic Leukemia focused on measuring advanced or progressive chronic lymphocytic leukemia, Lenalidomide, Fludarabine

Eligibility Criteria

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

Inclusion criteria:

  • Age >=18 years.
  • Able to adhere to the study visit schedule and other protocol requirements.
  • Patients with advanced stage or progressive CLL (NCI criteria) and relapsed or refractory disease.
  • No more than 2 previous different treatment lines.
  • No treatment with Campath-1H in the previous 6 months.
  • Disease-free of prior malignancies for >=5 years, with the exception of currently treated basal cell, squamous cell carcinoma of the skin, or carcinoma "in situ" of the cervix or breast.
  • All previous cancer therapy, including chemotherapy, immunotherapy and surgery, must have been discontinued at least 4 weeks prior to treatment in this study.
  • ECOG performance status of <=2 at study entry.
  • Laboratory test results within these ranges:

    • Serum creatinine <=1.5 mg/dL and creatinine clearance ≥60mL/min
    • Total bilirubin <=1.5 mg/dL
    • AST (SGOT) and ALT (SGPT) <=1.5 x ULN
  • Able to take low molecular weight heparin or in alternative, low- fixed-dose warfarin or, in alternative, low-dose aspirin.
  • Able to understand and voluntarily sign the informed consent form.
  • Females of childbearing potential (FCBP) must have a negative serum or urine pregnancy test with a sensitivity of at least 25 mIU/mL 10 - 14 days prior to therapy and repeated within 24 hours of starting study. FCBP must agree to use two reliable forms of contraception for at least 28 days before starting study drug; while participating in the study; and for at least 4 weeks after discontinuation from the study.
  • Females must agree to abstain from breastfeeding during study participation and for at least 28 days after discontinuation from the study.
  • Males must agree to use a latex condom during sexual contact with females of childbearing potential while participating in the study and for at least 4 weeks following discontinuation.
  • (Other details regarding pregnancy tests and contraception are reported in the chapter "Eligibility Criteria" within the study protocol).

Exclusion criteria:

  • Treatment with Campath-1H during the previous 6 months.
  • Concurrent use of other anti-cancer agents.
  • Positive DAT with clinical and laboratory signs of hemolysis, autoimmune thrombocytopenia.
  • Known positivity for HIV or active infectious hepatitis.
  • Active bacterial, viral, or fungal infection requiring systemic anti-viral, antibiotic or anti-fungal therapy.
  • Any serious medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from signing the informed consent form.
  • Pregnant or breast feeding females (lactating females must agree not to breast feed while taking Lenalidomide).
  • Any condition, including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study or confounds the ability to interpret data from the study.
  • Prior history or presence of thrombosis, thromboembolism, hearth failure or arrhythmia, neurologic disease and renal insufficiency.
  • Use of any other experimental drug or therapy within 28 days of baseline.
  • Known hypersensitivity to thalidomide.
  • The development of erythema nodosum, desquamating rash while taking thalidomide or similar drugs.
  • Any prior use of Lenalidomide
  • Lactose intolerance

Sites / Locations

  • Unità Operativa Ematologia 1 - Università degli Studi di Bari
  • Istituto di Ematologia e Oncologia Medica "Lorenzo e A. Seragnoli" - Università degli Studi di Bologna - Policlinico S. Orsola - Malpighi
  • Azienda Ospedaliera Pugliese Ciaccio
  • Sez.Ematologia e Dip. scienze Biomediche Arcispedale S. Anna
  • Clinica Ematologica - Università degli Studi
  • Divisione di Ematologia Ospedale "Santa Maria Goretti"
  • Istituto Scientifico Romagnoli per lo Studio e la Cura dei Tumori- IRST
  • Divisione di Ematologia - Azienda Ospedaliera Ospedali Riuniti "Papardo Piemonte"
  • UO Centro Trapianti di Midollo - IRCCS Ospedale Maggiore Policlinico
  • (SA) U.O. di Oncoematologia di Nocera Inferiore-plesso ospedaliero "A. Tortora" di Pagani del DEA Nocera-Pagani
  • Università degli Studi di Padova - Ematologia ed Immunologia Clinica
  • U.O. Ematologia Clinica - Azienda USL di Pescara
  • Unità Operativa Ematologia e Centro Trapianti - Dipartimento di Oncologia ed Ematologia - AUSL Ospedale di Piacenza
  • Ospedale S. M. delle Croci
  • Azienda Ospedaliera Bianchi Melacrino Morelli
  • Ospedale "Infermi"
  • Università degli Studi "Sapienza" - Dip Biotecnologie Cellulari ed Ematologia - Divisione di Ematologia
  • Universita Degli Studi "La Sapeinza"
  • Policlinico A. Gemelli - Universita Cattolica del Sacro Cuore
  • U.O.C. Ematologia - Ospedale S.Eugenio
  • U.O. Ematologia, Azienda Ospedaliera Universitaria Senese
  • SS.C. di Oncoematologia - Dipartimento di Medicina Clinica e Sperimentale - Azienda Ospedaliera - S. Maria Di Terni
  • Clinica Ematologica - Policlinico Universitario

Outcomes

Primary Outcome Measures

Maximum Tolerated Dose of Lenalidomide (Phase I)
Maximum tolerated dose of lenalidomide given in combination with fludarabine.
Overall Complete Response (CR) Rate (Phase II)
Response will be assessed by clinical examination, peripheral blood, bone marrow aspirate and biopsy, radiographic evaluation. Response will be evaluated at three different levels: clinical, cytometric and molecular.

Secondary Outcome Measures

Number of Patients Reaching Disease-free Survival (DSF) Overall
Response will be assessed by clinical examination, peripheral blood, bone marrow aspirate and biopsy, radiographic evaluation. Response will be evaluated at three different levels: clinical, cytometric and molecular.
Toxicity as Assessed by NCI CTCAE v3.0
Data from all subjects who receive any study drug will be included in the safety analyses.
Number of Patients With Severe Infections
Severe infection requiring more than 2 weeks of antibiotic therapy.
Correlation Between Complete Response (CR) and Baseline Biologic Parameters (i.e., IgHV, CD38, Etc.).

Full Information

First Posted
August 1, 2008
Last Updated
August 10, 2018
Sponsor
Gruppo Italiano Malattie EMatologiche dell'Adulto
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1. Study Identification

Unique Protocol Identification Number
NCT00727415
Brief Title
Lenalidomide, Fludarabine & Cyclophosphamide in Advanced Chronic Lymphocytic Leukemia Not Responding to Therapy
Acronym
LLC0606
Official Title
A Prospective Multicenter Pilot Trial to Evaluate the Efficacy of a Treatment With Fludarabine, Cyclophosphamide, Lenalidomide (FCL) for Advanced Relapsed/Refractory Chronic Lymphocytic Leukemia (CLL) Patients.
Study Type
Interventional

2. Study Status

Record Verification Date
August 2018
Overall Recruitment Status
Completed
Study Start Date
February 2008 (undefined)
Primary Completion Date
January 2016 (Actual)
Study Completion Date
January 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Gruppo Italiano Malattie EMatologiche dell'Adulto

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This is a phase I - II multicenter, non-comparative, open label study in patients with previously treated CLL aimed at defining the MTD of Lenalidomide given in combination with Fludarabine, Cyclophosphamide and at evaluating the (CR) rate of FC given in combination with the MTD of Lenalidomide (FCL).
Detailed Description
OBJECTIVES: Primary To define the maximum tolerated dose (MTD) of Lenalidomide given in combination with FC.(Phase I) To evaluate the complete remission (CR) rate of FC given in combination with the MTD of Lenalidomide (FCL). (Phase II) Secondary To define the toxicity and the infection rate of patients treated with FCL and the median number of delivered courses of FCL, overall response rate and the progression-free survival and the relationship between the response and the baseline biologic factors (IgVH, FISH, ZAP-70, CD38). To evaluate the overall response rate (complete and partial responses). To evaluate the progression-free survival. OUTLINE: This is a phase I - II multicenter, non-comparative, open label study in patients with previously treated CLL aimed at defining the MTD of Lenalidomide given in combination with Fludarabine, Cyclophosphamide and at evaluating the (CR) rate of FC given in combination with the MTD of Lenalidomide (FCL). All patients will receive six monthly courses of FCL schedule consisting of three days of Fludarabine and Cyclophosphamide administration (d1-d3) combined with 14 days of Lenalidomide administration (d1-d14). After completion of study treatment, patients are followed periodically for up to 18 months.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chronic Lymphocytic Leukemia
Keywords
advanced or progressive chronic lymphocytic leukemia, Lenalidomide, Fludarabine

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
42 (Actual)

8. Arms, Groups, and Interventions

Intervention Type
Drug
Intervention Name(s)
Cyclophosphamide
Intervention Description
All patients will receive six monthly courses of FCL schedule consisting of three days of Fludarabine and Cyclophosphamide administration (d1-d3) combined with 14 days of Lenalidomide administration (d1-d14).
Intervention Type
Drug
Intervention Name(s)
Fludarabine phosphate
Intervention Description
All patients will receive six monthly courses of FCL schedule consisting of three days of Fludarabine and Cyclophosphamide administration (d1-d3) combined with 14 days of Lenalidomide administration (d1-d14).
Intervention Type
Drug
Intervention Name(s)
Lenalidomide
Intervention Description
All patients will receive six monthly courses of FCL schedule consisting of three days of Fludarabine and Cyclophosphamide administration (d1-d3) combined with 14 days of Lenalidomide administration (d1-d14). In the first phase of the study, the dose of Lenalidomide given with FC will be gradually escalated to reach the MTD. In the second phase of the study, FC will be given in combination with the Lenalidomide escalated to the MTD or the maximum planned dose.
Primary Outcome Measure Information:
Title
Maximum Tolerated Dose of Lenalidomide (Phase I)
Description
Maximum tolerated dose of lenalidomide given in combination with fludarabine.
Time Frame
The MTD of Lenalinomide will be evaluated during the two courses given with the escalated dose of Lenalinomide defined by the respective dose level.
Title
Overall Complete Response (CR) Rate (Phase II)
Description
Response will be assessed by clinical examination, peripheral blood, bone marrow aspirate and biopsy, radiographic evaluation. Response will be evaluated at three different levels: clinical, cytometric and molecular.
Time Frame
After 6 months from study entry (end of treatment).
Secondary Outcome Measure Information:
Title
Number of Patients Reaching Disease-free Survival (DSF) Overall
Description
Response will be assessed by clinical examination, peripheral blood, bone marrow aspirate and biopsy, radiographic evaluation. Response will be evaluated at three different levels: clinical, cytometric and molecular.
Time Frame
After 6 months from study entry (end of treatment)
Title
Toxicity as Assessed by NCI CTCAE v3.0
Description
Data from all subjects who receive any study drug will be included in the safety analyses.
Time Frame
At 24 months from study entry (end of follow-up)
Title
Number of Patients With Severe Infections
Description
Severe infection requiring more than 2 weeks of antibiotic therapy.
Time Frame
At 24 months from study entry (end of follow-up)
Title
Correlation Between Complete Response (CR) and Baseline Biologic Parameters (i.e., IgHV, CD38, Etc.).
Time Frame
After 6 months from study entry (end of treatment).

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion criteria: Age >=18 years. Able to adhere to the study visit schedule and other protocol requirements. Patients with advanced stage or progressive CLL (NCI criteria) and relapsed or refractory disease. No more than 2 previous different treatment lines. No treatment with Campath-1H in the previous 6 months. Disease-free of prior malignancies for >=5 years, with the exception of currently treated basal cell, squamous cell carcinoma of the skin, or carcinoma "in situ" of the cervix or breast. All previous cancer therapy, including chemotherapy, immunotherapy and surgery, must have been discontinued at least 4 weeks prior to treatment in this study. ECOG performance status of <=2 at study entry. Laboratory test results within these ranges: Serum creatinine <=1.5 mg/dL and creatinine clearance ≥60mL/min Total bilirubin <=1.5 mg/dL AST (SGOT) and ALT (SGPT) <=1.5 x ULN Able to take low molecular weight heparin or in alternative, low- fixed-dose warfarin or, in alternative, low-dose aspirin. Able to understand and voluntarily sign the informed consent form. Females of childbearing potential (FCBP) must have a negative serum or urine pregnancy test with a sensitivity of at least 25 mIU/mL 10 - 14 days prior to therapy and repeated within 24 hours of starting study. FCBP must agree to use two reliable forms of contraception for at least 28 days before starting study drug; while participating in the study; and for at least 4 weeks after discontinuation from the study. Females must agree to abstain from breastfeeding during study participation and for at least 28 days after discontinuation from the study. Males must agree to use a latex condom during sexual contact with females of childbearing potential while participating in the study and for at least 4 weeks following discontinuation. (Other details regarding pregnancy tests and contraception are reported in the chapter "Eligibility Criteria" within the study protocol). Exclusion criteria: Treatment with Campath-1H during the previous 6 months. Concurrent use of other anti-cancer agents. Positive DAT with clinical and laboratory signs of hemolysis, autoimmune thrombocytopenia. Known positivity for HIV or active infectious hepatitis. Active bacterial, viral, or fungal infection requiring systemic anti-viral, antibiotic or anti-fungal therapy. Any serious medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from signing the informed consent form. Pregnant or breast feeding females (lactating females must agree not to breast feed while taking Lenalidomide). Any condition, including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study or confounds the ability to interpret data from the study. Prior history or presence of thrombosis, thromboembolism, hearth failure or arrhythmia, neurologic disease and renal insufficiency. Use of any other experimental drug or therapy within 28 days of baseline. Known hypersensitivity to thalidomide. The development of erythema nodosum, desquamating rash while taking thalidomide or similar drugs. Any prior use of Lenalidomide Lactose intolerance
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Roberto Foa, MD
Organizational Affiliation
Universita Degli Studi "La Sapeinza"
Official's Role
Principal Investigator
Facility Information:
Facility Name
Unità Operativa Ematologia 1 - Università degli Studi di Bari
City
Bari
ZIP/Postal Code
70010
Country
Italy
Facility Name
Istituto di Ematologia e Oncologia Medica "Lorenzo e A. Seragnoli" - Università degli Studi di Bologna - Policlinico S. Orsola - Malpighi
City
Bologna
Country
Italy
Facility Name
Azienda Ospedaliera Pugliese Ciaccio
City
Catanzaro
ZIP/Postal Code
88100
Country
Italy
Facility Name
Sez.Ematologia e Dip. scienze Biomediche Arcispedale S. Anna
City
Ferrara
ZIP/Postal Code
44100
Country
Italy
Facility Name
Clinica Ematologica - Università degli Studi
City
Genova
Country
Italy
Facility Name
Divisione di Ematologia Ospedale "Santa Maria Goretti"
City
Latina
Country
Italy
Facility Name
Istituto Scientifico Romagnoli per lo Studio e la Cura dei Tumori- IRST
City
Meldola
Country
Italy
Facility Name
Divisione di Ematologia - Azienda Ospedaliera Ospedali Riuniti "Papardo Piemonte"
City
Messina
Country
Italy
Facility Name
UO Centro Trapianti di Midollo - IRCCS Ospedale Maggiore Policlinico
City
Milano
Country
Italy
Facility Name
(SA) U.O. di Oncoematologia di Nocera Inferiore-plesso ospedaliero "A. Tortora" di Pagani del DEA Nocera-Pagani
City
Nocera Inferiore
Country
Italy
Facility Name
Università degli Studi di Padova - Ematologia ed Immunologia Clinica
City
Padova
Country
Italy
Facility Name
U.O. Ematologia Clinica - Azienda USL di Pescara
City
Pescara
Country
Italy
Facility Name
Unità Operativa Ematologia e Centro Trapianti - Dipartimento di Oncologia ed Ematologia - AUSL Ospedale di Piacenza
City
Piacenza
Country
Italy
Facility Name
Ospedale S. M. delle Croci
City
Ravenna
ZIP/Postal Code
I-48100
Country
Italy
Facility Name
Azienda Ospedaliera Bianchi Melacrino Morelli
City
Reggio Calabria
ZIP/Postal Code
89100
Country
Italy
Facility Name
Ospedale "Infermi"
City
Rimini
Country
Italy
Facility Name
Università degli Studi "Sapienza" - Dip Biotecnologie Cellulari ed Ematologia - Divisione di Ematologia
City
Roma
Country
Italy
Facility Name
Universita Degli Studi "La Sapeinza"
City
Rome
ZIP/Postal Code
00161
Country
Italy
Facility Name
Policlinico A. Gemelli - Universita Cattolica del Sacro Cuore
City
Rome
ZIP/Postal Code
00168
Country
Italy
Facility Name
U.O.C. Ematologia - Ospedale S.Eugenio
City
Rome
Country
Italy
Facility Name
U.O. Ematologia, Azienda Ospedaliera Universitaria Senese
City
Siena
ZIP/Postal Code
53100
Country
Italy
Facility Name
SS.C. di Oncoematologia - Dipartimento di Medicina Clinica e Sperimentale - Azienda Ospedaliera - S. Maria Di Terni
City
Terni
Country
Italy
Facility Name
Clinica Ematologica - Policlinico Universitario
City
Udine
Country
Italy

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
27881039
Citation
Mauro FR, Carella AM, Molica S, Paoloni F, Liberati AM, Zaja F, Belsito V, Cortellezzi A, Rizzi R, Tosi P, Spriano M, Ferretti A, Nanni M, Marinelli M, De Propris MS, Orlando SM, Vignetti M, Cuneo A, Guarini AR, Foa R. Fludarabine, cyclophosphamide and lenalidomide in patients with relapsed/refractory chronic lymphocytic leukemia. A multicenter phase I-II GIMEMA trial. Leuk Lymphoma. 2017 Jul;58(7):1640-1647. doi: 10.1080/10428194.2016.1258698. Epub 2016 Nov 23.
Results Reference
derived
Links:
URL
http://www.gimema.it
Description
GIMEMA Foundation Website

Learn more about this trial

Lenalidomide, Fludarabine & Cyclophosphamide in Advanced Chronic Lymphocytic Leukemia Not Responding to Therapy

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