Protocol for the Treatment of Patients With Previously Untreated Chronic Lymphocytic Leukemia

This study has been completed.
Sponsor:
Collaborators:
Genentech
Biogen Idec
Information provided by (Responsible Party):
University of Pittsburgh
ClinicalTrials.gov Identifier:
NCT00280241
First received: January 19, 2006
Last updated: August 21, 2014
Last verified: January 2013
  Purpose

This research study will look at the effects (good or bad) of administering cyclophosphamide, fludarabine, and rituximab. Clinical studies with combination therapy have shown higher response rates than using single drugs, and this study will evaluate the side effects and effectiveness of this combination.


Condition Intervention Phase
Chronic Lymphocytic Leukemia
Drug: Fludarabine
Drug: Cyclophosphamide
Drug: Rituximab
Phase 2

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Phase II Clinical Protocol for the Treatment of Patients With Previously Untreated Chronic Lymphocytic Leukemia

Resource links provided by NLM:


Further study details as provided by University of Pittsburgh:

Primary Outcome Measures:
  • This study will use a composite primary endpoint incorporating both tolerability and efficacy. [ Time Frame: 1-N/A ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Overall survival, duration of response, and the expression of ZAP-70, CD38, IgVH status, and chromosomes. [ Time Frame: 1 N/A ] [ Designated as safety issue: No ]

Enrollment: 65
Study Start Date: June 2004
Study Completion Date: January 2013
Primary Completion Date: February 2008 (Final data collection date for primary outcome measure)
Intervention Details:
    Drug: Fludarabine
    Fludarabine is usually administered by IV infusion over 30 minutes or longer.
    Other Name: Fludarabine
    Drug: Cyclophosphamide
    The dosage is a solution of 20 mg/mI. IV infusion over 1 hour.
    Other Name: Cyclophosphamide
    Drug: Rituximab
    First Infusion: The rituximab solution for infusion should be administered intravenously at an initial rate of 50 mg/hr. Subsequent rituximab infusions can be administered at an initial rate of 100 mg/hr, and increased by 100 mg/hr increments at 30-minute intervals, to a maximum of 400 mg/hr as tolerated.
    Other Name: Rituximab
Detailed Description:

This study is designed to expand on the highly successful combination of rituximab, fludarabine and cyclophosphamide for patients with previously untreated CLL. Responses in the range of 90-98% with 55% complete responses are reported. However, bone marrow toxicity has been a significant problem. This trial is designed to reduce the bone marrow toxicity by decreasing the doses of fludarabine and cyclophosphamide, but doubling the dose of rituximab with a maintenance dose of rituximab for up to two years, to maintain or even enhance efficacy.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Diagnosis of CD20 + CLL
  • Peripheral blood absolute lymphocyte count of > 5,000/mm3 obtained within 2 weeks prior to randomization.
  • The lymphocytosis must consist of small to moderate size lymphocytes, with ≤55% (no greater than 55%) prolymphocytes, atypical lymphocytes, or lymphoblasts morphologically.
  • Phenotypically characterized CD20 + CLL defined as: 1) the predominant population of cells share B-cell antigens with CD5 in the absence of other pan-T-celI markers (CD3, CD2, etc.); 2) B-cell expresses either kappa or lambda light chains; and 3) surface immunoglobulin (slg) with low-cell surface density expression.
  • Splenomegaly, hepatomegaly or lymphadenopathy are not required for the diagnosis of CLL.
  • Must require chemotherapy. Indications for chemotherapy are one or more of the following:
  • One or more of the following disease-related symptoms
  • Weight loss >10% within the previous 6 months.
  • Fevers of greater than 100.0° F for 2 weeks without evidence of infection.
  • Night sweats without evidence of infection.
  • Evidence of progressive marrow failure as manifested by the development of or worsening of anemia (< 10 g/dl) and/or thrombocytopenia (< 100,000/mm3).
  • Massive (i.e., > 6 cm below left costal margin) or progressive splenomegaly.
  • Massive nodes or clusters (i.e., > 10 cm in longest diameter) or progressive
  • adenopathy.
  • Progressive lymphocytosis with an increase of> 50% over 2 month period, or an anticipated doubling time of less than 6 months.
  • NOTE: Marked hypogammaglobulinemia or the development of a monoclonal protein in the absence of any of the above criteria for active disease are not sufficient for protocol therapy.
  • Serum creatinine <1.5 mg/dl.
  • Bilirubin must be <2 mg/dl, unless secondary to tumor, obtained within 2 weeks prior to randomization.
  • Age >18 years.
  • Not pregnant (confirmed by serum pregnancy test in females of reproductive potential) or breast feeding, because it is unknown what effect these drugs will have on children.
  • ECOG performance status 0-2.
  • AST or ATL >2x upper limit of normal unless related to CLL.
  • Subject has provided written informed consent.

Exclusion criteria:

  • Subjects with autoimmune anemia or thrombocytopenia are not eligible.
  • No prior cytotoxic chemotherapy. Patients with a history of steroid treatment for CLL, autoimmune hemolytic anemia, or autoimmune thrombocytopenia are not eligible.
  • Subjects with active infections requiring oral or intravenous antibiotics until resolution of the infection and completion of therapeutic antibiotics.
  • Women of childbearing potential and sexually active males who refuse to use an accepted and effective method of contraception.
  • Subjects with a second malignancy other than basal cell carcinoma of the skin or in situ carcinoma of the cervix are not eligible unless the tumor was treated with curative intent at least two years previously.
  • History of HIV
  • CNS disease
  • History of psychiatric disorder that would make it difficult to enroll and follow the patient on trial.
  • New York Heart Classification III or IV heart disease.
  • Hepatitis BsAg or Hepatitis C positive.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00280241

Locations
United States, Pennsylvania
Hillman Cancer Center
Pittsburgh, Pennsylvania, United States, 15232
Sponsors and Collaborators
University of Pittsburgh
Genentech
Biogen Idec
Investigators
Principal Investigator: Suzanne Lentzsch, MD, PhD University of Pittsburgh
  More Information

No publications provided

Responsible Party: University of Pittsburgh
ClinicalTrials.gov Identifier: NCT00280241     History of Changes
Other Study ID Numbers: 03-136
Study First Received: January 19, 2006
Last Updated: August 21, 2014
Health Authority: United States: Food and Drug Administration

Keywords provided by University of Pittsburgh:
Chronic
Lymphocytic
Leukemia
Fludarabine
Cyclophosphamide
Rituximab

Additional relevant MeSH terms:
Leukemia
Leukemia, Lymphocytic, Chronic, B-Cell
Leukemia, Lymphoid
Neoplasms by Histologic Type
Neoplasms
Leukemia, B-Cell
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Cyclophosphamide
Fludarabine phosphate
Rituximab
Fludarabine
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Pharmacologic Actions
Antirheumatic Agents
Therapeutic Uses
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Myeloablative Agonists
Antimetabolites, Antineoplastic
Antimetabolites

ClinicalTrials.gov processed this record on August 27, 2014