Hyper-CVAD With Liposomal Vincristine in Acute Lymphoblastic Leukemia
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ClinicalTrials.gov Identifier: NCT01319981 |
Recruitment Status :
Completed
First Posted : March 22, 2011
Results First Posted : September 27, 2022
Last Update Posted : September 27, 2022
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The goal of this clinical research study is to learn if intensive chemotherapy (hyper-CVAD therapy) given in combination with liposomal vincristine (Marqibo), in addition to rituximab for patients who are CD20 positive and/or imatinib, dasatinib, or ruxolitinib for patients with the Philadelphia (Ph) chromosome, can help to control ALL or lymphoblastic lymphoma. The safety of this treatment will also be studied. CD20 is a protein "marker" that is found in leukemia or lymphoma cells.
This is an investigational study. Liposomal vincristine is FDA approved for the treatment of patients with CLL who have relapsed at least 2 times. All of the other study drugs used in this study are FDA approved and commercially available. The combination of liposomal vincristine with the other study drugs is also being used in research only.
Up to 65 patients will take part in this study. All will be enrolled at MD Anderson.
Condition or disease | Intervention/treatment | Phase |
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Leukemia | Drug: Rituximab Drug: Imatinib Drug: Cyclophosphamide Drug: Doxorubicin Drug: Mesna Drug: VSLI Drug: Solu-Medrol Drug: Methotrexate Drug: Ara-C Drug: G-CSF Drug: Pegfilgrastim Drug: Dexamethasone | Phase 2 |

Study Type : | Interventional (Clinical Trial) |
Actual Enrollment : | 31 participants |
Allocation: | Non-Randomized |
Intervention Model: | Parallel Assignment |
Masking: | None (Open Label) |
Primary Purpose: | Treatment |
Official Title: | Hyper-CVAD With Liposomal Vincristine (Hyper-CMAD) in Acute Lymphoblastic Leukemia |
Actual Study Start Date : | March 5, 2013 |
Actual Primary Completion Date : | November 11, 2020 |
Actual Study Completion Date : | November 11, 2020 |

Arm | Intervention/treatment |
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Experimental: Hyper-CMAD + Rituximab
Odd Courses 1, 3, 5, 7: Rituximab 375 mg/m2 IV Day 1 & 8 Courses 1 & 3; Imatinib oral 600 mg days 1-14 Course 1 then continuously; Cyclophosphamide 300 mg/m2 IV every; 12 hours for 6 doses; Mesna 600 mg/m2/day IV Days 1-3; Doxorubicin 50 mg/m2 IV CVC Day 4; VSLI 2.25 mg/M2 IV Day 1 & 8; Pegfilgrastim 6 mg/kg after chemotherapy + G-CSF 10 µg/kg/day; Dexamethasone 40 mg IV or P.O. daily days 1-4 and days 11-14 +/- 3 days.
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Drug: Rituximab
In CD20-positive patients, 375 mg/m2 by vein on day 1 and 8 for Courses 1 and 3; and day 1 and 8 of Courses 2 and 4.
Other Name: Rituxan Drug: Imatinib 600 mg by mouth daily days 1-14 for course 1 and continuously on all other courses for patients who are Philadelphia chromosome positive (Ph+).
Other Names:
Drug: Cyclophosphamide 300 mg/m2 by vein over 3 hours every 12 hours x 6 doses days 1, 2, 3 (total dose 1800 mg/m2) for courses 1, 3, 5, 7
Other Names:
Drug: Doxorubicin 50 mg/m2 by vein over 24 hours on day 4 after last dose of Cyclophosphamide for courses 1, 3, 5, 7
Other Names:
Drug: Mesna 600 mg/m2 by vein continuous infusion daily for 24 hours days 1-3 for courses 1, 3, 5, 7
Other Name: Mesnex Drug: VSLI 2.0 mg/m2 by vein on day 1 and day 8 for courses 1, 3, 5, 7
Other Names:
Drug: G-CSF 10 µg/kg/day (rounded) given subcutaneously until neutrophil recovery to 1 x 10^9/L or higher can be substituted or can be added if neutrophils have not recovered to 1 x 10^9/L by day 21.
Other Names:
Drug: Pegfilgrastim 6 mg/kg (rounded) within 72 hrs after completion of chemotherapy.
Other Name: Neulasta Drug: Dexamethasone 40 mg by vein or by mouth daily days 1-4 and days 11-14 for courses 1, 3, 5, 7
Other Name: Decadron |
Experimental: Hyper-CMAD
Courses 2, 4, 6, 8: Rituximab 375 mg/m2 IV Day 1 & 8 Courses 2 & 4; Imatinib oral 600 mg; Methotrexate 200 mg/m2 IV over 2 hours followed by 8-0- mg/m2 over 22 hours on Day 1; Solu-Medrol 40 mg IV hours approximately every 12 hours +/- 2 hours for 6 doses days 1-3 +/- 3 days; Decadron 40 mg IV or orally 4 times Days 1-4; Ara-C 3 gm/m2 IV every 2 hours, 4 doses on Days 2-3; Pegfilgrastim 6 mg/kg after chemotherapy + G-CSF 10 mg/kg/day.
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Drug: Rituximab
In CD20-positive patients, 375 mg/m2 by vein on day 1 and 8 for Courses 1 and 3; and day 1 and 8 of Courses 2 and 4.
Other Name: Rituxan Drug: Imatinib 600 mg by mouth daily days 1-14 for course 1 and continuously on all other courses for patients who are Philadelphia chromosome positive (Ph+).
Other Names:
Drug: VSLI 2.0 mg/m2 by vein on day 1 and day 8 for courses 1, 3, 5, 7
Other Names:
Drug: Solu-Medrol 40 mg by vein every 12 hours for 6 doses days 1-3 for courses 2, 4, 6, 8.
Other Names:
Drug: Methotrexate 200 mg/m2 IV over 2 hrs followed by 800 mg/m2 over 22 hrs on day 1 beginning after the completion of rituximab for Courses 2, 4, 6, and 8. Drug: Ara-C 3 gm/m2 by vein over 2 hours every 12 hours for 4 doses on days 2, 3 for Courses 2, 4, 6, and 8.
Other Names:
Drug: G-CSF 10 µg/kg/day (rounded) given subcutaneously until neutrophil recovery to 1 x 10^9/L or higher can be substituted or can be added if neutrophils have not recovered to 1 x 10^9/L by day 21.
Other Names:
Drug: Pegfilgrastim 6 mg/kg (rounded) within 72 hrs after completion of chemotherapy.
Other Name: Neulasta |
- Number of Patients With Complete Remission at One Year [ Time Frame: 1 year ]The complete remission (CR) is the total number of patients who are in CR at one year divided by the total number of patients who received at least one dose of HCVAD with liposomal vincristine. CR was defined as the presence of </=5% blasts in the bone marrow, with >1x10^9/L neutrophils, >100x10^9/L platelets in the perpherial blood, and no extramedullary disease.
- Overall Survival [ Time Frame: Up to 7 years, 8 months ]Time from date of treatment start until date of death due to any cause or last Follow-up. Survival will be measured by the estimated median survival computed by Kaplan-Meier (K-M) analysis, which is the time point at which the cumulative survival drops below 50%, if present. If not present then the median Overall Survival is not reached and not available (NA) as there are an insufficient number of participants with events. In either case ranges are provided for observed survival intervals used in the K-M analysis.
- Complete Response Duration [ Time Frame: Up to 7 years, 8 months ]The complete remission (CR) is the total number of patients who are in CR at one year divided by the total number of patients who received at least one dose of HCVAD with liposomal vincristine. CR was defined as the presence of </=5% blasts in the bone marrow, with >1x10^9/L neutrophils, >100x10^9/L platelets in the perpherial blood, and no extramedullary disease. Response date to loss of response or last follow up. Remission duration will be measured by the estimated median remission duration computed by Kaplan-Meier (K-M) analysis, which is the time point at which the cumulative remission duration drops below 50%, if present. If not present then median remission duration is not reached and not available (NA) as there are an insufficient number of participants with events. In either case ranges are provided for observed survival intervals used in the K-M analysis..

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Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Newly diagnosed previously untreated ALL or lymphoblastic lymphoma >/= 18 years old. Allow urgent administration of cytarabine/hydrea/atra prior to starting treatment on protocol. Allow previous administration of up to one course of Hyper-CVAD and/or FDA approved TKI.
- Zubrod performance status </= 3.
- Adequate liver function (bilirubin </= 3.0 mg/dl unless considered due to tumor) and renal function (creatinine </= 3.0 mg/dl, unless considered due to tumor).
- No active co-existing malignancy with life expectancy less than 12 months due to that malignancy.
- All men and women of childbearing potential who are participating in the study must agree to use effective forms of birth control throughout the duration of their treatment.
- Adequate cardiac function as assessed clinically
Exclusion Criteria:
- Pregnant or lactating women. Women of childbearing potential (WOCB) must have a blood or urine pregnancy test within 7 days prior to administration of the study drug. (WOCB is defined as a woman who has not undergone hysterectomy or bilateral oophorectomy and has not been naturally postmenopausal for at least 24 consecutive months).
- Active Grade III-IV cardiac failure as defined by the New York Heart Association criteria, uncontrolled angina or MI within 6 months.
- Patients with medical conditions that compromise their ability to complete the study or confound interpretation of study results.

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01319981
United States, Texas | |
University of Texas MD Anderson Cancer Center | |
Houston, Texas, United States, 77030 |
Principal Investigator: | Elias Jabbour, MD | M.D. Anderson Cancer Center |
Documents provided by M.D. Anderson Cancer Center:
Responsible Party: | M.D. Anderson Cancer Center |
ClinicalTrials.gov Identifier: | NCT01319981 |
Other Study ID Numbers: |
2008-0598 NCI-2011-00861 ( Registry Identifier: NCI CTRP ) |
First Posted: | March 22, 2011 Key Record Dates |
Results First Posted: | September 27, 2022 |
Last Update Posted: | September 27, 2022 |
Last Verified: | August 2022 |
Studies a U.S. FDA-regulated Drug Product: | Yes |
Studies a U.S. FDA-regulated Device Product: | No |
Acute Lymphoblastic Leukemia ALL Lymphoblastic lymphoma Cytoxan Neosar Mesnex Liposomal Vincristine Vincristine Sulfate Liposomes Injection Marqibo Dexamethasone Adriamycin |
Rubex Cytarabine Cytosar DepoCyt Cytosine Arabinosine Hydrochloride Imatinib Mesylate Gleevec ST1571 NSC-716051 Filgrastim Neupogen |
Leukemia Precursor Cell Lymphoblastic Leukemia-Lymphoma Leukemia, Lymphoid Neoplasms by Histologic Type Neoplasms Lymphoproliferative Disorders Lymphatic Diseases Immunoproliferative Disorders Immune System Diseases Cytarabine Dexamethasone Methylprednisolone Methylprednisolone Acetate Methylprednisolone Hemisuccinate Prednisolone |
Prednisolone acetate Cyclophosphamide Rituximab Doxorubicin Methotrexate Vincristine Imatinib Mesylate Prednisolone hemisuccinate Prednisolone phosphate Immunosuppressive Agents Immunologic Factors Physiological Effects of Drugs Antirheumatic Agents Antineoplastic Agents, Alkylating Alkylating Agents |