Low Dose CdA Combined With Valproic Acid (VPA) in Previously Treated B-cell Chronic Lymphocytic Leukemia(B-CLL)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01295593
Recruitment Status : Unknown
Verified June 2012 by Cliniques universitaires Saint-Luc- Université Catholique de Louvain.
Recruitment status was:  Recruiting
First Posted : February 14, 2011
Last Update Posted : June 7, 2012
Information provided by (Responsible Party):
Cliniques universitaires Saint-Luc- Université Catholique de Louvain

Brief Summary:

Rationale New chemotherapeutic agents are needed in relapsing B-Cell Chronic Lymphocytic Leukemia (B-CLL) to overcome resistance of CLL cells. Valproic acid (VPA) is an inhibitor of histone deacetylase (HDAC) used as an anticonvulsant and mood-stabilizing drug for decades. VPA mediates apoptosis in CLL cells through caspase activation. VPA shows toxicity toward CLL cells displaying alterations in the p53 pathway. The combination of VPA with fludarabine or 2-Chlorodeoxyadenosine (CdA, Cladribine) results in synergistic loss of B-CLL cell viability, and significant increase in apoptosis. The highest index of synergism is observed between VPA and CdA, a purine nucleoside analog active in B-CLL.

Study design Overall, the study will be proposed to previously treated patients with advanced B-CLL, who are not eligible for aggressive approaches, and who exhibit progressive disease. A total of 33 patients will be included. Estimated enrolment time is 2 years.

  • First part: It is planned to start therapy with single VPA during 2 months, targeting plasma levels that have been reported to be active in vitro toward CLL cells (but that do not exceed therapeutic levels in seizure prevention), and in parallel, to verify whether cellular targets of VPA have been actually inhibited in leukemic B-lymphocytes.
  • Second part: After the VPA preloading period (2 months), patients will be evaluated to receive CdA. CdA will be given at 5.6 mg/m²/day intravenously during 3 days, a reduced-dose schedule which is less toxic - at no obvious cost of loss of efficacy - as compared to the standard dosage of 5 days. CdA was chosen because it displays the highest level of in vitro synergism with VPA. Four monthly courses of CdA will be given. Patients will then be evaluated. VPA will be stopped at the time of response evaluation (scheduled 28 days after the last course of CdA).

Condition or disease Intervention/treatment Phase
Chronic Lymphocytic Leukemia Drug: valproic acid and 2-chlorodeoxyadenosine Phase 1 Phase 2

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 33 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase I-II Study of Low Dose CdA Combined With Valproic Acid (VPA) in Previously Treated B-cell Chronic Lymphocytic Leukemia (CLL) Patients
Study Start Date : December 2010
Estimated Primary Completion Date : April 2013
Estimated Study Completion Date : April 2013

Arm Intervention/treatment
Experimental: valproic acid combined with CdA
valproic acid, oral daily intake, combined with 2-chlorodeoxyadenosine administered intravenously for 4 cycles
Drug: valproic acid and 2-chlorodeoxyadenosine
VPA : daily, oral, starting dose 10mg/kg/day total dose, taken in 2 separate administrations of around 5 mg/kg/day each, for a maximum of 6 months CdA : 5.6 mg/m²/day IV during 3 days, every 28 days, for a maximum of 4 cycles

Primary Outcome Measures :
  1. To determine the tolerability of VPA in combination with low dose CdA in patients with advanced B-CLL [ Time Frame: 6 months on average ]

Secondary Outcome Measures :
  1. minimal dose of VPA able to achieve adequate plasma levels of VPA and effective inhibition of VPA cellular targets, therapeutic response and survival , VPA pharmacokinetics [ Time Frame: 6 months on average ]

Information from the National Library of Medicine

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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:

  • B-cell Chronic Lymphocytic Leukemia (CLL)
  • Patients must have intermediate or high-risk categories of the modified 3-stage Rai and Binet staging
  • Patient MUST have progressive or symptomatic disease as defined by any of the following conditions:

    • Progressive lymphocytosis with a lymphocyte count increased > 50% over the last 2 months period or an anticipation of the doubling time in less than 6 months
    • Progressive or symptomatic splenomegaly or hepatomegaly
    • Progressive or symptomatic lymphadenopathy
    • Evidence of progressive marrow failure as manifested by development or worsening of anemia and/or thrombocytopenia
    • Presence of any B-symptoms: weight loss ≥ 10% within the previous 6 months, fever > 38.0°C for ≥ 2 weeks without evidence of infection, or night sweats without evidence of infection
  • Patient must have received one or more prior therapies for Chronic Lymphocytic Leukemia. Patients may have received any of the following prior treatment regimens: fludarabine-containing combinations, alemtuzumab single agent or combination, rituximab combinations, chlorambucil, cyclophosphamide +/- prednisone, or other forms of immunotherapy…
  • Patients must have adequate organ function:

    • Neutrophils > 500/mm³
    • Platelets > 50.000/mm³
    • Creatinine clearance (measured or calculated) > 40 ml/min
  • Age > 18 years
  • Patient's ECOG performance status must be 0-2
  • Patient's written informed consent
  • Life expectancy > 6 months

Exclusion Criteria:

  • Patients having received Valproic Acid (VPA) within 3 months
  • Previous, suspected or known hypersensitivity to VPA, or any of its derivatives
  • Liver porphyria
  • Epilepsy due to mitochondrial diseases
  • Ongoing treatment with VPA-interacting drugs
  • Cumulative Illness rating Scale (CIRS) > 6
  • Prior allogenic or autologous bone marrow transplantation less than 12 months
  • Patient having received any anticancer agents (chemotherapy, immunotherapy or targeted agents) within 4 weeks
  • Central Nervous System involvement
  • Concomitant disease requiring prolonged use of corticosteroids (> 1 month)
  • Transformation into an aggressive B-cell malignancy (e.g. diffuse large cell lymphoma, Hodgkin lymphoma)
  • Creatinine clearance < 40 ml/min calculated according to the formula of Cockcroft and Gault. Patients with a calculated creatinine clearance below 40 ml/min may be eligible if (1) a measured creatinine clearance (based on 24 hours urine collection or other reliable method) is > 40 ml/min, or (2) a new calculation conducted after adequate hydration is > 40 ml/min.
  • Any coexisting medical or psychological condition that would preclude participation to the required study procedures
  • Patient with mental deficiency preventing proper understanding of the requirements of treatment
  • Pregnancy, lactating woman, females of childbearing potential or male patient who are unwilling to use adequate contraception
  • Clinically significant auto-immune cytopenia, Coombs-positive hemolytic anemia as judged by the treating physician
  • Patients with a history of another malignancy in complete remission less than 2 years, except basal cell skin cancer, stage 0 (in situ) cervical carcinoma or tumor treated curatively by surgery
  • Any severe co-morbidities such as New York Heart Association Class III or IV heart failure, myocardial infarction within 6 months, unstable angina, ventricular tachyarrhythmias requiring ongoing treatment, or severe uncontrolled myocardiopathy, uncontrolled hypertension, severe chronic obstructive pulmonary disease with hypoxemia or uncontrolled diabetes mellitus
  • Active bacterial, viral or fungal infection
  • Seropositivity for: Human Immunodeficiency Virus, hepatitis C or hepatitis B (unless clearly due to vaccination)
  • Liver insufficiency
  • Total bilirubin > 2 x the upper limit of normal (ULN)
  • Prior history of severe hepatic or pancreatic disorder
  • Alkaline phosphatases and aminotransferases (AST, ALT) > 2 x ULN

Information from the National Library of Medicine

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 identifier (NCT number): NCT01295593

Contact: Eric Van Den Neste, MD, PhD +32 27 64 18 00
Contact: Sabrina Costantini +32 27 64 18 09

Clinique Sud Luxembourg Recruiting
Arlon, Belgium, 6700
Contact: Pascal Pierre, MD         
Institut Jules Bordet Recruiting
Brussels, Belgium, 1000
Contact: Dominique Bron, MD, PhD         
ULB Erasme Recruiting
Brussels, Belgium, 1070
Contact: Alain Kentos, MD         
Cliniques universitaires Saint Luc Recruiting
Brussels, Belgium, 1200
Principal Investigator: Eric Van Den Neste, MD, PhD         
Grand Hôpital de Charleori - Site notre Dame Recruiting
Charleroi, Belgium, 6000
Contact: Marc André, MD         
Clinique Notre-Dame de Grâce Recruiting
Gosselies, Belgium, 6041
Contact: Marie Maerevoet, MD         
Hôpital de Jolimont Recruiting
Haine-St-Paul, Belgium, 7100
Contact: Valérie Delrieu, MD         
CHU ULg Recruiting
Liège, Belgium, 4000
Contact: Bernard De Prijck, MD         
Clinique Saint Pierre Recruiting
Ottignies, Belgium, 1340
Contact: Thierry Connerotte, MD, PhD         
Heilig-Hartziekenhuis Recruiting
Roeselaere, Belgium, 8800
Contact: Hilde Demuynck, MD         
Cliniques de Mont Godinne Recruiting
Yvoir, Belgium, 5530
Contact: Christian Chatelain, MD, PhD         
Sponsors and Collaborators
Cliniques universitaires Saint-Luc- Université Catholique de Louvain
Principal Investigator: Eric Van Den Neste, MD, PhD Cliniques universitaires Saint-Luc

Responsible Party: Cliniques universitaires Saint-Luc- Université Catholique de Louvain Identifier: NCT01295593     History of Changes
Other Study ID Numbers: VPA-CdA
First Posted: February 14, 2011    Key Record Dates
Last Update Posted: June 7, 2012
Last Verified: June 2012

Keywords provided by Cliniques universitaires Saint-Luc- Université Catholique de Louvain:
CLL previously treated

Additional relevant MeSH terms:
Leukemia, Lymphoid
Leukemia, Lymphocytic, Chronic, B-Cell
Neoplasms by Histologic Type
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Leukemia, B-Cell
Valproic Acid
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
GABA Agents
Neurotransmitter Agents
Physiological Effects of Drugs
Antimanic Agents
Tranquilizing Agents
Central Nervous System Depressants
Psychotropic Drugs
Antineoplastic Agents
Immunosuppressive Agents
Immunologic Factors