Blinatumomab in Treating Younger Patients With Relapsed B-cell Acute Lymphoblastic Leukemia

Not Recruiting

Trial ID: NCT02101853


This randomized phase III trial studies how well blinatumomab works compared with standard combination chemotherapy in treating patients with B-cell acute lymphoblastic leukemia that has returned after a period of improvement (relapsed). Immunotherapy with blinatumomab may allow the body's immune system to attack and destroy some types of leukemia cells. It is not yet known whether blinatumomab is more effective than standard combination chemotherapy in treating relapsed B-cell acute lymphoblastic leukemia.

Official Title

Risk-Stratified Randomized Phase III Testing of Blinatumomab (NSC#765986) in First Relapse of Childhood B-Lymphoblastic Leukemia (B-ALL)


Inclusion Criteria:

   - Patients >= 1 year and < 31 years of age at the time of relapse will be eligible

   - First relapse of B-ALL, allowable sites of disease include isolated bone marrow,
   combined bone marrow and CNS and/or testicular, and isolated CNS and/or testicular;
   extramedullary sites are limited to the CNS and testicles

   - No waiting period for patients who relapse while receiving standard maintenance

   - Patients who relapse on frontline therapy in phases other than maintenance must have
   fully recovered from the acute toxic effects of all prior chemotherapy, immunotherapy,
   or radiotherapy prior to entering this study

   - Cytotoxic therapy: at least 14 days since the completion of cytotoxic therapy with the
   exception of hydroxyurea, which is permitted up to 24 hours prior to the start of
   protocol therapy, or maintenance chemotherapy, or intrathecal chemotherapy
   (methotrexate strongly preferred) administered at the time of the required diagnostic
   lumbar puncture to establish baseline CNS status

   - Biologic (anti-neoplastic) agent: at least 7 days since the completion of therapy with
   a biologic agent; for agents that have known adverse events occurring beyond 7 days
   after administration, this period must be extended beyond the time during which
   adverse events are known to occur

   - Stem cell transplant or rescue: patient has not had a prior stem cell transplant or

   - Patient has not had prior treatment with blinatumomab

   - With the exception of intrathecal chemotherapy (methotrexate strongly preferred;
   cytarabine is permissible) administered at the time of the required diagnostic lumbar
   puncture to establish baseline CNS status, patient has not received prior
   relapse-directed therapy (i.e., this protocol is intended as the INITIAL treatment of
   first relapse)

   - Patients must have a performance status corresponding to Eastern Cooperative Oncology
   Group (ECOG) scores of 0, 1, or 2; use Karnofsky for patients > 16 years of age and
   Lansky for patients =< 16 years of age

   - Creatinine clearance or radioisotope glomerular filtration rate (GFR) >= 70
   mL/min/1.73 m^2 or a serum creatinine based on age/gender as follows:

      - 1 to < 2 years: =< 0.6 mg/dL

      - 2 to < 6 years: =< 0.8 mg/dL

      - 6 to < 10 years: =< 1 mg/dL

      - 10 to < 13 years: =< 1.2 mg/dL

      - 13 to < 16 years: =< 1.5 mg/dL (males) and =< 1.4 mg/dL (females)

      - >= 16 years: =< 1.7 mg/dL (males) and =< 1.4 mg/dL (females)

   - Direct bilirubin < 3.0 mg/dL

   - Shortening fraction of >= 27% by echocardiogram, or

   - Ejection fraction of >= 50% by radionuclide angiogram

   - All patients and/or their parent or legal guardian must sign a written informed

   - All institutional, Food and Drug Administration (FDA), and National Cancer Institute
   (NCI) requirements for human studies must be met

Exclusion Criteria:

   - Patients with Philadelphia chromosome positive/breakpoint cluster region protein
   (BCR)-Abelson murine leukemia viral oncogene homolog 1 (ABL1)+ ALL are not eligible

   - Patients with Burkitt leukemia/lymphoma or mature B-cell leukemia are not eligible

   - Patients with T-lymphoblastic leukemia (T-ALL)/lymphoblastic lymphoma (T-LL) are not

   - Patients with B-lymphoblastic lymphoma (B-LL) are not eligible

   - Patients with known optic nerve and/or retinal involvement are not eligible; patients
   who are presenting with visual disturbances should have an ophthalmologic exam and, if
   indicated, a magnetic resonance imaging (MRI) to determine optic nerve or retinal

   - Patients known to have one of the following concomitant genetic syndromes: Down
   syndrome, Bloom syndrome, ataxia-telangiectasia, Fanconi anemia, Kostmann syndrome,
   Shwachman syndrome or any other known bone marrow failure syndrome

   - Patients with known human immunodeficiency virus (HIV) infection

   - Patients with known allergy to mitoxantrone, cytarabine, or both etoposide and
   etoposide phosphate (Etopophos)

   - Lactating females who plan to breastfeed

   - Patients who are pregnant since fetal toxicities and teratogenic effects have been
   noted for several of the study drugs; a pregnancy test is required for female patients
   of childbearing potential

   - Sexually active patients of reproductive potential who have not agreed to use an
   effective contraceptive method for the duration of their study participation

   - Patients with pre-existing significant central nervous system pathology that would
   preclude treatment with blinatumomab, including: history of severe brain injury,
   dementia, cerebellar disease, organic brain syndrome, psychosis, coordination/movement
   disorder, or autoimmune disease with CNS involvement are not eligible; patients with a
   history of cerebrovascular ischemia/hemorrhage with residual deficits are not
   eligible; (patients with a history of cerebrovascular ischemia/hemorrhage remain
   eligible provided all neurologic deficits have resolved)

   - Patients with uncontrolled seizure disorder are not eligible; (patients with seizure
   disorders that do not require antiepileptic drugs, or are well controlled with stable
   doses of antiepileptic drugs remain eligible)


procedure: Allogeneic Hematopoietic Stem Cell Transplantation

drug: Asparaginase

biological: Blinatumomab

drug: Cyclophosphamide

drug: Cytarabine

drug: Dexamethasone

drug: Etoposide

drug: Leucovorin Calcium

drug: Mercaptopurine

drug: Methotrexate

drug: Mitoxantrone Hydrochloride

drug: Pegaspargase

other: Pharmacological Study

drug: Therapeutic Hydrocortisone

drug: Thioguanine

drug: Vincristine Sulfate

drug: Mitoxantrone

radiation: Radiation Therapy

drug: Vincristine

Not Recruiting

Contact Information

Stanford University
School of Medicine
300 Pasteur Drive
Stanford, CA 94305
Christina Baggott

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