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BL22 Immunotoxin In Treating Young Patients With Relapsed or Refractory Acute Lymphoblastic Leukemia or Non-Hodgkin's Lymphoma

This study has been suspended.
Information provided by MedImmune LLC

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Descriptive Information Fields
Brief Title  BL22 Immunotoxin In Treating Young Patients With Relapsed or Refractory Acute Lymphoblastic Leukemia or Non-Hodgkin's Lymphoma
Official Title  Pediatric Phase I Trial of BL22 for Refractory CD22-Positive Leukemias and Lymphomas
Brief Summary

RATIONALE: BL22 immunotoxin can locate tumor cells and kill them without harming normal cells. BL22 immunotoxin may be effective in treating relapsed or refractory acute lymphoblastic leukemia and non-Hodgkin's lymphoma.

PURPOSE: This phase I trial is studying the side effects and best dose of BL22 immunotoxin in treating young patients with relapsed or refractory acute lymphoblastic leukemia or non-Hodgkin's lymphoma.

Detailed Description

OBJECTIVES:

Primary

  • Determine the toxic effects of BL22 immunotoxin in pediatric patients with relapsed or refractory CD22-positive acute lymphoblastic leukemia or non-Hodgkin's lymphoma.
  • Determine the maximum tolerated dose of this drug in these patients.
  • Determine the immunogenicity of this drug in these patients.
  • Determine the pharmacokinetics of this drug in these patients.

Secondary

  • Determine the in vitro cytotoxicity of this drug against lymphoblasts from patients with acute lymphoblastic leukemia.
  • Determine the therapeutic efficacy of this drug in inducing remissions in these patients.
  • Determine changes in lymphocyte subsets, immunoglobulin levels, serum cytokines, and soluble cytokine receptor levels in patients treated with this drug.

OUTLINE: This is a non-randomized, dose-escalation study.

Patients receive BL22 immunotoxin IV over 30 minutes on days 1, 3, and 5 OR on days 1, 3, 5, 7, 9, and 11. Treatment repeats every 21 days for up to 6 courses in the absence of disease progression or unacceptable toxicity. Patients who achieve a complete response (CR) or unconfirmed CR (CRu) receive 2 additional courses beyond CR or CRu for a maximum of 6 courses.

Cohorts of 3-6 patients receive escalating doses of BL22 immunotoxin 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. Once the MTD is determined, the cohort is expanded and a total of 12 patients are treated at that dose.

Patients are followed weekly for at least 1 month and then every 1-3 months thereafter.

PROJECTED ACCRUAL: A total of 95 patients will be accrued for this study.

Study Phase Phase I
Study Type  Interventional
Study Design  Treatment, Non-Randomized, Open Label, Active Control, Single Group Assignment, Safety Study
Primary Outcome Measure  assessment of efficacy, safety, pharmacokinetics, immunogenicity. [ Time Frame: end of study ] [ Designated as safety issue: Yes ]
Secondary Outcome Measure  Expansion of MTD [ Time Frame: end of study ] [ Designated as safety issue: Yes ]
Condition  Leukemia
Lymphoma
Intervention  Drug: BL22 immunotoxin
Procedure: antibody-drug conjugate therapy
Procedure: immunotoxin therapy
Procedure: monoclonal antibody therapy
MEDLINE PMIDs
Links Clinical trial summary from the National Cancer Institute's PDQ® database This link exits the ClinicalTrials.gov site
Recruitment Information Fields
Recruitment Status  Suspended
Enrollment  95
Start Date  January 2004
Completion Date October 2008
Eligibility Criteria 

DISEASE CHARACTERISTICS:

  • Histologically confirmed acute lymphoblastic leukemia (ALL) or non-Hodgkin's lymphoma (including lymphoblastic lymphoma, Burkitt's lymphoma, and large cell lymphoma)

    • Not amenable to available curative therapies
  • Relapsed or refractory disease after at least 1 standard chemotherapy and 1 salvage regimen
  • CD22 positive according to at least 1 of the following criteria:

    • More than 15% CD22-positive malignant cells by immunohistochemistry
    • More than 30% CD22-positive malignant cells by fluorescent-activated cell sorter analysis
  • Measurable or evaluable disease
  • Prior CNS involvement allowed provided there is no current evidence of CNS malignancy
  • No CNS leukemia or lymphoma as manifested by any of the following:

    • Cerebrospinal fluid (CSF) WBC ≥ 5/mm^3 and confirmation of CSF blasts
    • Cranial neuropathies secondary to underlying malignancy
    • Radiologically detected CNS lymphoma
  • No isolated testicular ALL
  • Ineligible for or refused hematopoietic stem cell transplantation OR has disease activity that prohibits the time required to identify a suitable stem cell donor

PATIENT CHARACTERISTICS:

Age

  • 6 months to 24 years

Performance status

  • ECOG 0-3 (12 to 24 years of age)
  • Lansky 40-100% (under 12 years of age)

Life expectancy

  • Not specified

Hematopoietic

  • See Disease Characteristics
  • Absolute neutrophil count > 1,000/mm^3 *
  • Platelet count > 50,000/mm^3 * NOTE: *Non-leukemic patients only

Hepatic

  • Bilirubin ≤ 2.0 mg/dL
  • AST and ALT ≤ 5 times upper limit of normal
  • No active hepatitis B or C infection

Renal

  • Creatinine normal for age OR
  • Creatinine clearance ≥ 60 mL/min

Immunologic

  • No serum neutralization of more than 75% of the activity of 1 µg/mL of study drug
  • HIV negative

Other

  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception
  • No clinically significant unrelated systemic illness that would preclude study participation
  • No other significant organ dysfunction that would preclude study participation
  • No psychiatric illness or social situation that would preclude study compliance

PRIOR CONCURRENT THERAPY:

Biologic therapy

  • See Disease Characteristics
  • At least 1 week since prior colony-stimulating factors (e.g., filgrastim [G-CSF], sargramostim [GM-CSF], or epoetin alfa)
  • Prior autologous or allogeneic hematopoietic stem cell transplantation (HSCT) allowed
  • More than 100 days since prior allogeneic HSCT

Chemotherapy

  • See Disease Characteristics
  • At least 2 weeks since prior chemotherapy (6 weeks for nitrosoureas)

Endocrine therapy

  • Concurrent corticosteroids allowed provided there has been no increase in the dose 1 week prior to and after study entry

    • Steroid taper allowed

Radiotherapy

  • At least 3 weeks since prior radiotherapy

    • Allowed in the past 3 weeks provided the volume of the bone marrow treated is < 10% AND the patients has measurable disease outside of the radiation port

Surgery

  • Not specified

Other

  • Recovered from prior therapy
  • At least 30 days since prior investigational drugs
  • No other concurrent investigational drugs
Gender Both
Ages 6 Months to 24 Years
Accepts Healthy Volunteers No
Contacts ††
Location Countries  United States
Administrative Information Fields
NCT ID  NCT00077493
Organization ID CDR0000352020
Secondary IDs †† NCI-04-C-0079H, NCI-5643
Study Sponsor  MedImmune LLC
Collaborators †† Cambridge Antibody Technology
Investigators 
Principal Investigator:     Alan S. Wayne, MD     NCI - Pediatric Oncology Branch    
Information Provided By MedImmune LLC
Verification Date December 2007
First Received Date  February 10, 2004
Last Updated Date December 21, 2007

 †    Required WHO trial registration data element.
††   WHO trial registration data element that is required only if it exists.




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