Bridging Study to Eliminate Presence of MRD for Acute Leukemia Before HCT

Acute Myeloid Leukemia Clinical Trial

Official title:

Bridging Study: A Phase 2 Study Investigating Clofarabine, Cyclophosphamide and Etoposide for Children, Adolescents, and Young Adults (AYA) With Acute Leukemia and Minimal Residual Disease

Clinical Trial Details — Status: Terminated

Administrative data

• NCT number: NCT02349178
• Other study ID #: Bridging
• Status: Terminated
• Phase: Phase 2
• Start date: December 8, 2014
• Est. completion date: March 16, 2017

Study information

• Verified date: February 2020
• Source: Medical College of Wisconsin
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This is a Phase 2 study designed for the purpose of estimating various parameters surrounding the efficacy of Clofarabine, Cyclophosphamide and Etoposide in eliminating minimal residual disease (MRD) in acute leukemia patients otherwise in remission and without causing significant delay of HCT due to treatment related toxicity.

A single course of "bridge" chemotherapy is given prior to the transplant procedure as an approach to improved disease-free survival in a patient group who historically has had inferior outcomes.

Description:

Study entry is open to patients regardless of gender or ethnic background.

The intent of this study design is for all patients to receive and complete one course of therapy. Patients who exhibit signs of disease progression or experience an unacceptable toxicity will be discontinued from treatment.

There will be no dose delays or dose reductions of study drugs for hematologic toxicity during Consolidation "Bridging" therapy (Day 1 through Day 30); however, prolonged hematopoietic recovery or bone marrow aplasia during the first 42 days may meet a study stopping rule.

Recruitment information / eligibility

• Status: Terminated
• Enrollment: 6
• Est. completion date: March 16, 2017
• Est. primary completion date: March 16, 2017
• Accepts healthy volunteers: No
• Gender: All
• Age group: N/A to 39 Years

Eligibility

Inclusion Criteria:

• Diagnosis of acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML) with < 5% blasts in the bone marrow (M1) by morphology and that meets one of the following criteria:

Flow cytometric evidence of MRD (= 0.01% leukemic blasts for ALL or = 0.5% leukemic blasts for AML detected in the bone marrow) OR Molecular/cytogenetic evidence of disease (FISH or PCR methodology) performed within 7 days And with the intent of going on to an allogeneic hematopoietic cell transplantation (HCT) independent of this study

• Patients must have an available donor and have intention of proceeding directly to ALL-HCT after completion of 1 cycle of Bridging therapy.

• Age 0 to 39 years

• Karnofsky Performance Status = 50% for patients 16 years and older and Lansky Play Score = 50 for patients under 16 years of age (see Appendix 2)

• Patients must have a life expectancy = 8 weeks as determined by the enrolling investigator

• Have acceptable organ function as defined within 7 days of study registration

Renal: creatinine clearance = 60 mL/min/1.73 m2 or serum creatinine based on age/gender as follows:

Hepatic: ALT < 5 x upper limit of normal (ULN) and total bilirubin = 1.5 x upper limit of normal (ULN) for age Cardiac: left ventricular ejection fraction = 40% by ECHO/MUGA

• Patients must have fully recovered from the acute toxic effects of all prior chemotherapy, immunotherapy, or radiotherapy prior to entering this study. At least 7 days must have elapsed from prior chemotherapy.

• Hematopoietic Growth Factors: At least 7 days since the completion of therapy with a growth factor and at least 14 days since pegfilgrastim (Neulasta®) administration.

• Sexually active females of child bearing potential must agree to use adequate contraception (diaphragm, birth control pills, injections, intrauterine device [IUD], surgical sterilization, subcutaneous implants, or abstinence, etc.) for the duration of treatment and for 2 months after the last dose of chemotherapy. Sexually active men must agree to use barrier contraceptive for the duration of treatment and for 2 months after the last dose of chemotherapy.

• Voluntary written consent before performance of any study-related procedure not part of normal medical care, with the understanding that consent may be withdrawn by the subject at any time without prejudice to future medical care.

Exclusion Criteria:

• Acute Promyelocytic Leukemia (APL)

• Active extramedullary disease (CNS = CNS2 and/or testicular leukemia) or presence of chloromatous disease

• Receiving concomitant chemotherapy, radiation therapy; immunotherapy or other anti-cancer therapy other than is specified in the protocol

• Systemic fungal, bacterial, viral, or other infection not controlled (defined as exhibiting ongoing signs/symptoms related to the infection and without improvement, despite appropriate antibiotics or other treatment)

• Pregnant or lactating. The agents used in this study are known to be teratogenic to a fetus and there is no information on the excretion of agents into breast milk. All females of childbearing potential must have a blood test or urine study within 2 weeks prior to registration to rule out pregnancy.

• Known allergy to any of the agents or their ingredients used in this study

• Participating in a concomitant Phase 1 or 2 study

Related Conditions & MeSH terms

• Acute Myeloid Leukemia
• Leukemia
• Leukemia, Acute Lymphoblastic
• Precursor Cell Lymphoblastic Leukemia-Lymphoma

Intervention

Drug:
• Clofarabine
Days 1-5 receive Clofarabine 20 mg/m2 IV over 2 hours
• Cyclophosphamide
Days 1-5 receive Cyclophosphamide 300 mg/m2 IV as a 30-60 minute infusion
• Etoposide
Days 1-5 receive Etoposide 100 mg/m2 IV over 2 hours

Locations

Country	Name	City	State
United States	Nationwide Children's Hospital	Columbus	Ohio
United States	American Family Children's Hospital	Madison	Wisconsin
United States	Children's Hospital of Wisconsin	Milwaukee	Wisconsin
United States	Froedtert Memorial Lutheran Hospital	Milwaukee	Wisconsin

Sponsors (3)

Lead Sponsor	Collaborator
Medical College of Wisconsin	American Family Children’s Hospital, Nationwide Children's Hospital

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Minimal Residual Disease	A bone marrow evaluation to determine study response and remission status will be performed on study Day 30 or upon adequate blood count recovery (ANC > 0.50 and platelet > 50,000), whichever occurs first. If the marrow is hypocellular and without evidence of normal tri-lineage hematopoiesis the marrow should be repeated at Day 42.	Day 30 or adequate blood recovery