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Sirolimus in Treating Young Patients With Relapsed or Refractory Acute Leukemia or Non-Hodgkin's Lymphoma

Primary Purpose

Leukemia, Lymphoma

Status
Terminated
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
sirolimus
Sponsored by
Children's Hospital of Philadelphia
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Leukemia focused on measuring recurrent childhood lymphoblastic lymphoma, recurrent childhood small noncleaved cell lymphoma, recurrent childhood large cell lymphoma, recurrent childhood acute myeloid leukemia, recurrent childhood acute lymphoblastic leukemia

Eligibility Criteria

undefined - 21 Years (Child, Adult)All SexesDoes not accept healthy volunteers

DISEASE CHARACTERISTICS: Histologically confirmed diagnosis of 1 of the following: Acute lymphoblastic leukemia (ALL) OR acute myeloid leukemia (AML) At least 25% blasts in the bone marrow Recurrent or refractory disease Non-Hodgkin's lymphoma (NHL) Second or greater relapse as determined by physical or radiological evidence Disease for which there is no known curative therapy PATIENT CHARACTERISTICS: Age 21 and under Performance status Karnofsky 50-100% (patients over 10 years of age) Lansky 50-100% (patients 10 years of age and under) Life expectancy At least 4 weeks Hematopoietic Absolute neutrophil count at least 1,000/mm^3* Platelet count at least 75,000/mm^3 (transfusion independent)* Hemoglobin at least 8.0 g/dL (may receive red blood cells (RBC) transfusions)* NOTE: *Patients with ALL, AML, and NHL with tumor metastatic to bone marrow, with granulocytopenia, anemia, and/or thrombocytopenia are eligible, but will not be evaluable for hematological toxicity Hepatic Bilirubin no greater than 1.5 times normal alanine aminotransferase (ALT) no greater than 5 times normal Albumin at least 2 g/dL Renal Creatinine based on age, as follows: No greater than 0.8 mg/dL (5 years of age and under) No greater than 1.0 mg/dL (6 to 10 years of age) No greater than 1.2 mg/dL (11 to 15 years of age) No greater than 1.5 mg/dL (over 15 years of age) OR Creatinine clearance or radioisotope glomerular filtration rate at least 70 mL/min Cardiovascular Shortening fraction at least 28% by echocardiogram OR Ejection fraction at least 50% by gated radionuclide Other Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception Able to ingest oral medication No known allergy to sirolimus, tacrolimus, or other mammalian target of rapamycin (mTOR) inhibitors No uncontrolled active infection Fungal disease must be stable for at least 2 weeks prior to study entry Documented negative blood cultures prior to study entry for patients with bacteremia No active graft-versus-host disease PRIOR CONCURRENT THERAPY: Biologic therapy Recovered from prior immunotherapy More than 1 week since prior hematopoietic growth factors except for epoetin alfa At least 7 days since prior biologic antineoplastic agents At least 3 months since prior bone marrow or stem cell transplantation Chemotherapy Recovered from all prior chemotherapy More than 2 weeks since prior myelosuppressive chemotherapy (4 weeks for nitrosoureas) Prior hydroxyurea within the past 2 weeks is allowed provided peripheral blast count has been stable or rising for at least 3 days Endocrine therapy Prior corticosteroids within the past 2 weeks are allowed provided peripheral blast count has been stable or rising for at least 3 days Radiotherapy Recovered from prior radiotherapy At least 2 weeks since prior local palliative radiotherapy At least 4 weeks since prior craniospinal radiotherapy or radiation to the pelvis of 50% or more At least 4 weeks since prior substantial bone marrow radiotherapy No concurrent radiotherapy, except for emergent situations or persistent extramedullary disease with resolution of bone marrow disease Surgery Not specified Other No other concurrent investigational antineoplastic drugs No concurrent administration of any of the following: Ketoconazole Tacrolimus Cyclosporine Rifampin Diltiazem

Sites / Locations

  • Children's Hospital of Philadelphia

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Sirolimus

Arm Description

This is a dose escalation study including 4-dose levels. Subjects will receive a one-time loading dose of sirolimus on day 0, time 0. Subsequent dosing at the assigned dose level will start 24 hours following the initial loading dose

Outcomes

Primary Outcome Measures

Toxicity as assessed by Common Toxicity Criteria (CTC) toxicity criteria after the first course of treatment
Subjects will be assessed for toxicity on days 3, 7 and 21

Secondary Outcome Measures

Response as assessed by radiologic scans after each course of treatment
Response will be assessed on day 21 of cycle 1

Full Information

First Posted
September 10, 2003
Last Updated
March 11, 2015
Sponsor
Children's Hospital of Philadelphia
Collaborators
National Childhood Cancer Foundation, The Leukemia and Lymphoma Society
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1. Study Identification

Unique Protocol Identification Number
NCT00068302
Brief Title
Sirolimus in Treating Young Patients With Relapsed or Refractory Acute Leukemia or Non-Hodgkin's Lymphoma
Official Title
A Phase I Trial Of Sirolimus In Relapsed/Refractory Leukemia And Non-Hodgkin's Lymphoma
Study Type
Interventional

2. Study Status

Record Verification Date
July 2013
Overall Recruitment Status
Terminated
Why Stopped
Recruiting/enrolling participants halted prematurely but potentially will resume
Study Start Date
January 2003 (undefined)
Primary Completion Date
April 2009 (Actual)
Study Completion Date
July 2013 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Children's Hospital of Philadelphia
Collaborators
National Childhood Cancer Foundation, The Leukemia and Lymphoma Society

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
RATIONALE: Drugs used in chemotherapy such as sirolimus use different ways to stop cancer cells from dividing so they stop growing or die. PURPOSE: This phase I trial is studying the side effects and best dose of sirolimus in treating young patients with relapsed or refractory acute leukemia or non-Hodgkin's lymphoma.
Detailed Description
OBJECTIVES: Determine the maximum tolerated dose of sirolimus in pediatric patients with refractory or relapsed acute leukemia or non-Hodgkin's lymphoma. Determine the dose-limiting toxic effects of this drug in these patients. Determine the trough levels produced by this drug in these patients. Determine the anti-leukemia/lymphoma activity of this drug in these patients. OUTLINE: This is an open-label, dose-escalation study. Patients receive oral sirolimus once daily on days 1-21. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of sirolimus 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. Patients are followed for survival. PROJECTED ACCRUAL: A total of 3-30 patients will be accrued for this study within 2 years.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Leukemia, Lymphoma
Keywords
recurrent childhood lymphoblastic lymphoma, recurrent childhood small noncleaved cell lymphoma, recurrent childhood large cell lymphoma, recurrent childhood acute myeloid leukemia, recurrent childhood acute lymphoblastic leukemia

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Sirolimus
Arm Type
Experimental
Arm Description
This is a dose escalation study including 4-dose levels. Subjects will receive a one-time loading dose of sirolimus on day 0, time 0. Subsequent dosing at the assigned dose level will start 24 hours following the initial loading dose
Intervention Type
Drug
Intervention Name(s)
sirolimus
Other Intervention Name(s)
rapamycin, Rapamune
Intervention Description
3-6 subjects will be enrolled into each dose level
Primary Outcome Measure Information:
Title
Toxicity as assessed by Common Toxicity Criteria (CTC) toxicity criteria after the first course of treatment
Description
Subjects will be assessed for toxicity on days 3, 7 and 21
Time Frame
within 21 days following administration of sirolimus
Secondary Outcome Measure Information:
Title
Response as assessed by radiologic scans after each course of treatment
Description
Response will be assessed on day 21 of cycle 1
Time Frame
day 21

10. Eligibility

Sex
All
Maximum Age & Unit of Time
21 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically confirmed diagnosis of 1 of the following: Acute lymphoblastic leukemia (ALL) OR acute myeloid leukemia (AML) At least 25% blasts in the bone marrow Recurrent or refractory disease Non-Hodgkin's lymphoma (NHL) Second or greater relapse as determined by physical or radiological evidence Disease for which there is no known curative therapy PATIENT CHARACTERISTICS: Age 21 and under Performance status Karnofsky 50-100% (patients over 10 years of age) Lansky 50-100% (patients 10 years of age and under) Life expectancy At least 4 weeks Hematopoietic Absolute neutrophil count at least 1,000/mm^3* Platelet count at least 75,000/mm^3 (transfusion independent)* Hemoglobin at least 8.0 g/dL (may receive red blood cells (RBC) transfusions)* NOTE: *Patients with ALL, AML, and NHL with tumor metastatic to bone marrow, with granulocytopenia, anemia, and/or thrombocytopenia are eligible, but will not be evaluable for hematological toxicity Hepatic Bilirubin no greater than 1.5 times normal alanine aminotransferase (ALT) no greater than 5 times normal Albumin at least 2 g/dL Renal Creatinine based on age, as follows: No greater than 0.8 mg/dL (5 years of age and under) No greater than 1.0 mg/dL (6 to 10 years of age) No greater than 1.2 mg/dL (11 to 15 years of age) No greater than 1.5 mg/dL (over 15 years of age) OR Creatinine clearance or radioisotope glomerular filtration rate at least 70 mL/min Cardiovascular Shortening fraction at least 28% by echocardiogram OR Ejection fraction at least 50% by gated radionuclide Other Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception Able to ingest oral medication No known allergy to sirolimus, tacrolimus, or other mammalian target of rapamycin (mTOR) inhibitors No uncontrolled active infection Fungal disease must be stable for at least 2 weeks prior to study entry Documented negative blood cultures prior to study entry for patients with bacteremia No active graft-versus-host disease PRIOR CONCURRENT THERAPY: Biologic therapy Recovered from prior immunotherapy More than 1 week since prior hematopoietic growth factors except for epoetin alfa At least 7 days since prior biologic antineoplastic agents At least 3 months since prior bone marrow or stem cell transplantation Chemotherapy Recovered from all prior chemotherapy More than 2 weeks since prior myelosuppressive chemotherapy (4 weeks for nitrosoureas) Prior hydroxyurea within the past 2 weeks is allowed provided peripheral blast count has been stable or rising for at least 3 days Endocrine therapy Prior corticosteroids within the past 2 weeks are allowed provided peripheral blast count has been stable or rising for at least 3 days Radiotherapy Recovered from prior radiotherapy At least 2 weeks since prior local palliative radiotherapy At least 4 weeks since prior craniospinal radiotherapy or radiation to the pelvis of 50% or more At least 4 weeks since prior substantial bone marrow radiotherapy No concurrent radiotherapy, except for emergent situations or persistent extramedullary disease with resolution of bone marrow disease Surgery Not specified Other No other concurrent investigational antineoplastic drugs No concurrent administration of any of the following: Ketoconazole Tacrolimus Cyclosporine Rifampin Diltiazem
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Susan Rheingold, MD
Organizational Affiliation
Children's Hospital of Philadelphia
Official's Role
Study Chair
Facility Information:
Facility Name
Children's Hospital of Philadelphia
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States

12. IPD Sharing Statement

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Sirolimus in Treating Young Patients With Relapsed or Refractory Acute Leukemia or Non-Hodgkin's Lymphoma

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