Overview
Phase II Study of High-Dose Rituximab in High-Risk Chronic Lymphocytic Leukemia Patients in Suboptimal Response After Induction Immunochemotherapy
Status:
Terminated
Terminated
Trial end date:
2015-05-01
2015-05-01
Target enrollment:
0
0
Participant gender:
All
All
Summary
This study explores the potential to improve the quality of response obtained after induction treatment in Chronic Lymphocytic Leukemia (CLL), by giving a short and intense consolidation schema using high-dose rituximab. Patients in suboptimal response (Minimal Residual Disease persistence) after induction will be selected, as well as those who have a Minimal Residual Disease (MRD) relapse after having achieved MRD negativity.Phase:
Phase 2Accepts Healthy Volunteers?
NoDetails
Lead Sponsor:
Cliniques universitaires Saint-Luc- Université Catholique de LouvainTreatments:
Rituximab
Criteria
Inclusion Criteria:- B-cell Chronic Lymphocytic Leukemia defined by standard NCI criteria in first line or
in relapse
- > 18 years-old
- Presence of Minimal Residual Disease (MRD positivity) by Flow Cytometry criteria in
these two clinical situations :
1. Patients in Complete Remission (defined by standard criteria including Bone
Marrow examination) after rituximab-containing immunochemotherapy (ICT), who show
persisting MRD either in the Peripheral Blood at least 6 months after the last
dose of rituximab-containing immunochemotherapy or in the Bone Marrow at least 3
months after the last dose of rituximab-containing ICT
2. Patients in continuous CR who show MRD relapse in PB or BM without clinical
progression (as defined by NCI) at any time after ICT
- ICT should have comprised:
1. Rituximab combined with fludarabine, with or without an alkylating drug, with or
without an anthracycline (ex: Fludarabine-Rituximab,
Fluda-Cyclophsphamide-Rituximab, FCR-Mitoxantrone, R-bendamustine…)
2. At least 4 cycles
- Patients should have recovered from the toxicities of ICT
- POOR PROGNOSTIC FEATURES (before induction ICT) defined by at least one of the
following markers: stage C Binet, unmutated IgVH genes, 17p deletion, 11q deletion,
Zap-70 positivity, high CD38, mutated IgVH genes if VH3-21 usage
- In addition, in patients with 11q deletion and/or presence of bulky lymph nodes prior
to induction therapy, absence of profound lymph nodes at response evaluation should
have been confirmed by CT scan
- CIRS ≤6
- Absence of significant geriatric syndromes and/or significant limitations in
instrumental activities of daily living (IADL)
- Performance status (ECOG) < 2
- Neutrophils > 1000/microL, platelets > 100,000/microL
- Creatinine clearance > 50 ml/min (clearance can be reevaluated after adequate
hydration of the patient)
- Patient's written informed consent
Exclusion Criteria:
- Less than CR defined by standard criteria response after ICT
- Ongoing active infections (bacterial, viral or fungal)
- Known infection with HIV
- Subjects with any serological evidence of current or past hepatitis B or hepatitis C
exposure are excluded unless the serological findings are clearly due to vaccination.
- Concomitant treatment with steroids, or any immunosuppressive drug
- Uncontrolled autoimmune hemolytic anemia or thrombocytopenia
- Transformation into an aggressive B-cell malignancy (eg. diffuse large B-cell
lymphoma, Hodgkin lymphoma)
- Pregnancy, breast feeding, female patients with childbearing potential or male
patients who are unwilling to use adequate contraception
- Intolerance to rituximab
- Concomitant severe disease (uncompensated cardiac insufficiency, severe respiratory
insufficiency…)
- Severe hypogammaglobulinemia with recurrent infections, unless the patient is
receiving substitutive IV immunoglobulins
- Transaminases (AST, ALT) > 3 xULN
- Conjugated bilirubin > 2 xULN
- Prior autologous stem cell transplantation less than 12 months
- Prior allogeneic stem cell transplantation
- Central Nervous System involvement
- Any coexisting medical or psychological condition that would preclude participation to
the required study procedures
- Prior history of malignancies, other than CLL, unless subject has been free of the
disease for > 4 years. Exceptions include the following: basal cell carcinoma of the
skin, squamous cell carcinoma of the skin, carcinoma in situ of the cervix, carcinoma
in situ of the breast, incidental histologic finding prostate cancer (TNM stage of T1a
or T1b)
- Participation in any clinical study or having taken any investigational therapy which
would interfere with the study drug for a disease other than CLL, within 28 days prior
to initiating the maintenance therapy.