Combined Immunochemotherapy in Patients With T-Prolymphocytic Leukemia (T-PLL) - Full Text View

Purpose

Study hypothesis: Simultaneous FMC-Alemtuzumab administration followed by Alemtuzumab maintenance therapy in patients with T-PLL is feasible, safe and efficient.

Condition	Intervention	Phase
T-cell-prolymphocytic Leukemia	Drug: Fludarabine, Mitoxantrone, Cyclophosphamide and Alemtuzumab Drug: Alemtuzumab	Phase 2


Study Type:	Interventional
Study Design:	Endpoint Classification: Safety/Efficacy Study Intervention Model: Single Group Assignment Masking: Open Label Primary Purpose: Treatment
Official Title:	Phase II Trial of Combined Immunochemotherapy With Fludarabine, Mitoxantrone, Cyclophosphamide and Alemtuzumab (FMC-Alemtuzumab) in Patients With Previously Treated or Untreated T-Prolymphocytic Leukemia

Resource links provided by NLM:

MedlinePlus related topics: Leukemia

Drug Information available for: Cyclophosphamide Fludarabine Mitoxantrone Mitoxantrone hydrochloride Fludarabine phosphate Alemtuzumab

Genetic and Rare Diseases Information Center resources: Blastic Plasmacytoid Dendritic Cell Leukemia, T-cell, Chronic

U.S. FDA Resources

Further study details as provided by German CLL Study Group:

Primary Outcome Measures:

Remission Rate [ Time Frame: 2 years after trial started ] [ Designated as safety issue: No ]
Efficacy of the FMC therapy and Alemtuzumab Percentage and 95%-confidence-interval of response rates (CR, CRi, nPR, PR, SD and PD) will be provided.

Secondary Outcome Measures:

Overall Survival Time [ Time Frame: 4 years after start of trial ] [ Designated as safety issue: No ]
OS will be calculated from the patient´s time of recruitment to death from any cause.


Estimated Enrollment:	16
Study Start Date:	December 2009
Estimated Study Completion Date:	December 2015
Estimated Primary Completion Date:	August 2015 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: FCM-A followed by A-maintenance First treatment phase: Chemoimmunotherapy A-FMC maximum 4 cycles. Second treatment phase: Maintenance-treatment with 30mg Alemtuzumab s.c.	Drug: Fludarabine, Mitoxantrone, Cyclophosphamide and Alemtuzumab I. First treatment phase: Chemoimmunotherapy A-FMC Alemtuzumab: Cycle 1+2: 10 mg s.c., days 1-3 Cycle 3+4: CR: 10 mg s.c., days 1-3 PR/SD: 30 mg s.c., days 1-3 Fludarabine: 20 mg/m2 i.v., days 1-3 Mitoxantrone: 6 mg/m2 i.v., day 1 Cyclophosphamide: 200 mg/m2 i.v., days 1-3 Repeat day 29, maximum 4 cycles. II. Second treatment phase: Maintenance-treatment with 30mg Alemtuzumab s.c. The maintenance therapy will start one month after the Final Staging and will be administered monthly during the first six months plus once in month 10 and 13. Other Names: Mabcampath Fludarabine Endoxan Novantron Drug: Alemtuzumab maintenance with Alemtuzumab following a induction with combined immunochemotherapy consisting of Fludarabine, cyclophosphamide, mitoxantrone and alemtuzumab Other Name: Mabcampath

Arms

Assigned Interventions

Experimental: FCM-A followed by A-maintenance

First treatment phase: Chemoimmunotherapy A-FMC maximum 4 cycles. Second treatment phase: Maintenance-treatment with 30mg Alemtuzumab s.c.

Drug: Fludarabine, Mitoxantrone, Cyclophosphamide and Alemtuzumab

I. First treatment phase: Chemoimmunotherapy A-FMC

Alemtuzumab:

Cycle 1+2:

10 mg s.c., days 1-3

Cycle 3+4:

CR: 10 mg s.c., days 1-3 PR/SD: 30 mg s.c., days 1-3 Fludarabine: 20 mg/m2 i.v., days 1-3 Mitoxantrone: 6 mg/m2 i.v., day 1 Cyclophosphamide: 200 mg/m2 i.v., days 1-3 Repeat day 29, maximum 4 cycles. II. Second treatment phase: Maintenance-treatment with 30mg Alemtuzumab s.c. The maintenance therapy will start one month after the Final Staging and will be administered monthly during the first six months plus once in month 10 and 13.

Other Names:

Mabcampath
Fludarabine
Endoxan
Novantron

Drug: Alemtuzumab

maintenance with Alemtuzumab following a induction with combined immunochemotherapy consisting of Fludarabine, cyclophosphamide, mitoxantrone and alemtuzumab

Other Name: Mabcampath

Detailed Description:

As the median survival time of patients with T-PLL is less than 12 months, the treatment of T-PLL is a special challenge.

The overall response rates with conventional chemotherapy or Deoxycoformycin were low (about 30% and 40%), with the monoclonal antibody Alemtuzumab response rates of 50% to 70% were achieved, but the duration of the response was short.

In the previous trial (T PLL 1), the efficacy of the FMC regimen (FMC = Fludarabine, Mitoxantrone and Cyclophosphamide) was tested, a preliminary analysis of 16 patients revealed a response rate of more than 60% after FMC-polychemotherapy and 83% after the subsequent administration of Alemtuzumab.

The goal of the T-PLL2-protocol is to assess if the simultaneous administration of FMC-polychemotherapy and Alemtuzumab with a subsequent Alemtuzumab maintenance therapy is capable of improving the remission rate and the disease-free survival time in patients with T-PLL.

Eligibility


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

Criteria

Inclusion Criteria:

Untreated patients with T-prolymphocytic leukemia (T-PLL) according to WHO criteria or pretreated patients (max. one previous treatment) with T-PLL
Age ≥ 18 years
WHO performance status of 0-2
Life expectancy > 6 months
CIRS score >= 6
Left ventricular ejection fraction ≥50% confirmed by echo-cardiogram performed < 6 months before inclusion to the trial and after the end of a possible anthracycline containing pretreatment
Adequate liver function as indicated by a total bilirubin, AST and ALT >= 2 the institutional ULN value, unless directly attributable to the T-PLL
Creatinine clearance >= 70 ml/min calculated according to the formula of Cockcroft and Gault
Seronegativity for HIV, HBV or HCV confirmed by serological testing within 6 weeks prior to registration
Willingness of fertile male and female patients to use a highly effective contraceptive method with a Pearl-Index < 1 during and at least six months after the end of the study treatment (e.g. implants, injectables, oral contraceptives in combination with another contraceptive method, some IUDs, sexual abstinence or vasectomised partner)
Negative serum pregnancy test one week prior to treatment (required for female patients before and <2 years after onset of menopause)
Patient's written informed consent

Exclusion Criteria:

Clinically significant auto-immune cytopenia or clinically significant hemolytic anaemia with suspicion of immune origin, even if Coombs test is negative
Active secondary malignancy requiring treatment (except basal cell carcinoma or tumour curatively treated by surgery)
Medical condition requiring prolonged use of oral corticosteroids (> 1 month)
Cerebral dysfunction, legal incapacity
Any circumstance at the time of study entry that would preclude completion of the study and required follow-up
Active infection or severe infection (WHO 4th degree) within the last three months before inclusion to the study
Participation in any other clinical trial during this study
Known hypersensitivity to any of the study medications (Fludarabine, Cyclophosphamide, Mitoxantrone or Alemtuzumab)
Patients who have already received more than 60% of the recommended maximum cumulative dose of an anthracycline (Epirubicine, Adriamycine or Mitoxantrone).

This maximum cumulative dose is defined for the individual substances as follows:

Epirubicin 900 mg/m²
Daunorubicin 550 mg/m², (or 400 mg/m² if the patient received mediastinal irradiation)
Adriamycine (Doxorubicine) 550 mg/m²
Mitoxantrone 200 mg/m²
- Patients who already received Fludarabine in combination with Cyclophosphamide or Mitoxantrone
- Patients who received prior treatment with Alemtuzumab alone or in combination with a purine analogue and who did not achieve a PR that lasted at least 6 months
- Patients who are employees of the Sponsor (University of Cologne) or the study sites.

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: NCT01186640

Locations


Germany
University Hospital Cologne
Cologne, Germany, 50924

Sponsors and Collaborators

German CLL Study Group

Genzyme, a Sanofi Company

University of Cologne

More Information

Additional Information:

Related Info This link exits the ClinicalTrials.gov site

No publications provided


Responsible Party:	German CLL Study Group
ClinicalTrials.gov Identifier:	NCT01186640 History of Changes
Other Study ID Numbers:	TPLL2, 2008-001421-34
Study First Received:	August 20, 2010
Last Updated:	February 5, 2014
Health Authority:	Germany: Paul-Ehrlich-Institut

Keywords provided by German CLL Study Group:


T-PLL Polychemotherapy Alemtuzumab Efficacy

Additional relevant MeSH terms:


Leukemia Leukemia, Prolymphocytic Leukemia, Prolymphocytic, T-Cell Immune System Diseases Immunoproliferative Disorders Leukemia, Lymphoid Leukemia, T-Cell Lymphatic Diseases Lymphoproliferative Disorders Neoplasms Neoplasms by Histologic Type Alemtuzumab Cyclophosphamide Fludarabine Fludarabine phosphate	Mitoxantrone Alkylating Agents Analgesics Antimetabolites Antimetabolites, Antineoplastic Antineoplastic Agents Antineoplastic Agents, Alkylating Antirheumatic Agents Central Nervous System Agents Enzyme Inhibitors Immunologic Factors Immunosuppressive Agents Molecular Mechanisms of Pharmacological Action Myeloablative Agonists Peripheral Nervous System Agents

ClinicalTrials.gov processed this record on March 02, 2015