Pediatric-type Therapy With Pre-transplant Blinatumomab for HR Patients - Phase II Study

NCT ID: NCT04334993

Last Updated: 2021-05-07

Basic Information

• Recruitment Status: UNKNOWN
• Clinical Phase: PHASE2
• Total Enrollment: 110 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2021-01-01
• Study Completion Date: 2025-05-01

Brief Summary

Despite recent therapeutic advancements, the outcome of young adults with Philadelphia-negative (Ph-neg) acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL) remains unsatisfactory, especially in those patients with high-risk disease features. In young adults pediatric-based chemotherapy approaches improve outcome. Furthermore, there is evidence that pre-transplant antibody-based therapy may render patients with positive minimal residual disease (MRD+) to an MRD-negative status (MRD-) and that this may be associated with improved post-transplant outcome.

This is prospective study to evaluate the potential benefit of a modified pediatric-based approach in young adults with Ph-neg ALL. Safety and efficacy of pre-transplant antibody-based consolidation in high-risk patients with Ph-neg ALL will be performed.

Detailed Description

This is a national, multicenter, phase II clinical trial to evaluate the potential benefit of a modified pediatric-based approach in young adults with Ph-neg ALL. Safety and efficacy of pre-transplant antibody-based consolidation in high-risk patients with Ph-neg ALL will be assessed.

Young-adult patients eligible with Ph-neg ALL, LBL and mixed phenotype acute leukemia (MPAL) will undergo risk stratification and started on the pediatric Italian Association of Pediatric Hematology Oncology-Berlin-Frankfurt-Münster (AIEOP-BFM) 2009 protocol. Patients defined as having non-high-risk disease features (non-HR) as defined by MRD and/or cytogenetic criteria will complete the non-HR chemotherapy arm per protocol. Patients designated as having HR disease features after 2 induction blocks will be treated with CNS directed block followed by up to 2 cycles of blinatumomab (for B-cell ALL) followed by allogeneic stem cell transplantation. All patients will be centrally assessed for MRD and for Ph-like status.

Conditions

Philadelphia-Negative ALL; High-Risk Cancer

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Blinatumomab pre-transplant to high risk Ph-negative ALL pts.

Patients designated high risk based on protocol will receive 2 cycles of therapy followed by allogeneic transplantation. Patients ≥45 kg (fixed dose): Cycles 1 and 2: 28 mcg daily administered as a continuous infusion on days 1 to 28 of a 6-week treatment cycle.

Group Type: EXPERIMENTAL

Blinatumomab

Intervention Type: DRUG

Patients with high risk disease features after 2 induction blocks as defined per protocol will be treated with CNS directed block followed by up to 2 cycles of blinatumomab (for B-cell ALL) followed by allogeneic stem cell transplantation.

Interventions

Blinatumomab

Patients with high risk disease features after 2 induction blocks as defined per protocol will be treated with CNS directed block followed by up to 2 cycles of blinatumomab (for B-cell ALL) followed by allogeneic stem cell transplantation.

Intervention Type: DRUG

Other Intervention Names

AIEOP-BFM 2009 protocol - multiagent chemothertapy protocol backbone

Eligibility Criteria

Inclusion Criteria

1. Age ≥ 18 years and <30 years of age at the time of signing the informed consent document.

2. Have a documented diagnosis of Ph-neg ALL, LBL or MPAL according to the WHO 2016 classification (appendix I).

3. Females of childbearing potential (FCBP) may participate, providing they meet the following conditions:

Agree to use at least two effective contraceptive methods (oral, injectable, or implantable hormonal contraceptive; tubal ligation; intra-uterine device; barrier contraceptive with spermicide; or vasectomized partner) throughout the study, and for 3 months following EOT; and have a negative serum or urine pregnancy test (investigator's discretion; sensitivity at least 25 mIU/mL) at screening; and have a negative serum or urine pregnancy test (investigator's discretion) within 72 hours prior to starting study therapy in the treatment phase (note that the screening serum pregnancy test can be used as the test prior to starting study therapy in treatment phase if it is performed within the 72-hour timeframe).

4. Male subjects with a female partner of childbearing potential must agree to the use of at least two physician-approved contraceptive methods throughout the course of the study and should avoid fathering a child during the course of the study and for 3 months following the last dose of study drug.

5. Understand and voluntarily sign an informed consent document prior to any study related assessments/procedures being conducted.

6. Able to adhere to the study visit schedule and other protocol requirements.

Exclusion Criteria

1. Age <18 or over 30 years at the time of signing the informed consent document.

2. Ph-positive disease.

3. Known Human Immunodeficiency Virus (HIV).

4. Known or suspected hypersensitivity to any of the study drugs.

5. Pregnant or lactating females.

6. Any significant medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from participating in the study.

7. Any condition including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study.

8. Participation to an investigational drug trial in the last month before randomization.

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 30 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Israeli Medical Association

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Locations

Rambam Medical Center

Haifa, , Israel

Site Status: RECRUITING

Shaarei Tzedek Medical Center

Jerusalem, , Israel

Site Status: RECRUITING

Rabin Medical Center

Petah Tikva, , Israel

Site Status: RECRUITING

Tel Aviv Medical Center

Tel Aviv, , Israel

Site Status: NOT_YET_RECRUITING

Countries

Israel

Central Contacts

Ofir Wolach, MD

Role: CONTACT

ofirw@clalit.org.il

+972-3-9378116

Facility Contacts

Yishai Ofran, MD

Role: primary

y_ofran@rambam.health.gov.il

Jacob Rowe, MD

Role: primary

rowe@rambam.health.gov.il

Ofir Wolach, MD

Role: primary

ofirw@clalit.org.il

+972-3-937-8116

Miri Pinhasov, MA

Role: backup

miripi@clalit.org.il

+972-3-9378078

Yakir Moshe, MD PhD

Role: primary

yakirm@tlvmc.gov.il

Other Identifiers

AYA001

Identifier Type: -

Identifier Source: org_study_id