Testing the Combination of Inotuzumab Ozogamicin and Lower Dose Chemotherapy Compared to Usual Chemotherapy for Adults With B-Cell Acute Lymphoblastic Leukemia or B-Cell Lymphoblastic Lymphoma
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ClinicalTrials.gov Identifier: NCT05303792 |
Recruitment Status :
Recruiting
First Posted : March 31, 2022
Last Update Posted : November 1, 2023
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Condition or disease | Intervention/treatment | Phase |
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B Acute Lymphoblastic Leukemia B Lymphoblastic Lymphoma | Drug: Cyclophosphamide Drug: Vincristine Drug: Dexamethasone Biological: Inotuzumab Ozogamicin Drug: Methotrexate Drug: Cytarabine Drug: Methylprednisolone Biological: Rituximab Drug: Prednisone Drug: Mercaptopurine Drug: Doxorubicin | Phase 2 |

Study Type : | Interventional (Clinical Trial) |
Estimated Enrollment : | 66 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Masking: | None (Open Label) |
Primary Purpose: | Treatment |
Official Title: | A Randomized Phase II Study Comparing Inotuzumab Plus Chemotherapy Versus Standard Chemotherapy in Older Adults With Philadelphia-Chromosome-Negative B-Cell Acute Lymphoblastic Leukemia |
Actual Study Start Date : | February 27, 2023 |
Estimated Primary Completion Date : | May 2028 |
Estimated Study Completion Date : | May 2028 |

Arm | Intervention/treatment |
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Experimental: Arm A (inotuzumab ozogamicin, chemotherapy)
Induction: For cycles 1-4 on days 2 and 8, patients receive inotuzumab ozogamicin IV and IT chemotherapy consisting of alternating Cytarabine and Methotrexate. Patients with leukemic blasts expressing CD20 also receive rituximab IV on days 2 and 8 of cycles 1-4. For cycles 1,3,5,7, patients receive cyclophosphamide intravenously (IV) on days 1-3, mesna IV, vincristine IV on days 1 and 8, and dexamethasone IV or orally (PO) on days 1-4 and 11-14. For cycles 2,4,6,8, patients receive methotrexate on day 1, cytarabine IV on days 2-3, and methylprednisolone on days 1-3. Patients >= 70 years of age receive either 2 or 4 cycles of treatment. Patients < 70 years of age receive up to 8 cycles of treatment. Maintenance: Patients receive vincristine IV on day 1, prednisone PO on days 1-5, mercaptopurine PO on days 1-28, and methotrexate PO weekly. Treatment occurs for up to 24 cycles or 2 years, whichever comes first, in the absence of disease progression or unacceptable toxicity. |
Drug: Cyclophosphamide
Given IV Drug: Vincristine Given IV Drug: Dexamethasone Given IV or PO Biological: Inotuzumab Ozogamicin Given IV Drug: Methotrexate Given IV or PO Drug: Cytarabine Given IV Drug: Methylprednisolone Given IV Biological: Rituximab Given IV Drug: Prednisone Given PO Drug: Mercaptopurine Given PO |
Active Comparator: Arm B (chemotherapy)
Induction: For cycles 1-4 on days 2 and 8, patients receive IT chemotherapy consisting of alternating Cytarabine and Methotrexate. Patients with leukemic blasts expressing CD20 also receive rituximab IV on days 2 and 8 of cycles 1-4. For cycles 1,3,5,7, patients receive cyclophosphamide intravenously (IV) on days 1-3, mesna IV, doxorubicin IV on day 4, vincristine IV on days 1 and 8, and dexamethasone IV or orally (PO) on days 1-4 and 11-14. For cycles 2,4,6,8, patients receive methotrexate on day 1, cytarabine IV on days 2-3, and methylprednisolone on days 1-3. Patients >= 70 years of age receive either 2 or 4 cycles of treatment. Patients < 70 years of age receive up to 8 cycles of treatment. Maintenance: Patients receive vincristine IV on day 1, prednisone PO on days 1-5, mercaptopurine PO on days 1-28, and methotrexate PO weekly. Treatment occurs for up to 24 cycles or 2 years, whichever comes first, in the absence of disease progression or unacceptable toxicity. |
Drug: Cyclophosphamide
Given IV Drug: Vincristine Given IV Drug: Dexamethasone Given IV or PO Drug: Methotrexate Given IV or PO Drug: Cytarabine Given IV Drug: Methylprednisolone Given IV Biological: Rituximab Given IV Drug: Prednisone Given PO Drug: Mercaptopurine Given PO Drug: Doxorubicin Given IV |
- Event-free survival [ Time Frame: From randomization to failure to achieve measurable residual disease (MRD)-negative complete response (CR) after two cycles of chemotherapy, relapse, or death from any causes, assessed at 2 months (after 2 cycles of treatment) ]Will be evaluated using the methods of Kaplan-Meier as well as Cox regression models.
- Disease-free survival [ Time Frame: Time from achieving a CR/ complete remission with incomplete blood count recovery (CRi) to the time of relapse and/or death, assessed up to 5 years ]Will be evaluated using the methods of Kaplan-Meier as well as Cox regression models.
- Overall survival [ Time Frame: From randomization to the time of death due to any cause, assessed up to 5 years ]Will be evaluated using the methods of Kaplan-Meier as well as Cox regression models.
- Complete remission rate [ Time Frame: Up to 5 years ]The proportion of patients who achieve complete remission or any response to induction therapy will be summarized as the proportion of patients who achieve any type of response to induction therapy divided by the number of all evaluable patients registered to this trial and who received at least one dose of induction therapy. Corresponding 95% binomial confidence intervals will also be calculated. In a similar manner, the investigators will also evaluate the overall induction response rates. All evaluable patients will be used for this analysis.
- Overall response rate [ Time Frame: Up to 5 years ]Overall response rate (CR/CRi, CR/complete remission with incomplete platelet counts [CRp], CR/complete remission with partial hematologic recovery [CRh]). The proportion of patients who achieve complete remission or any response to induction therapy will be summarized as the proportion of patients who achieve any type of response to induction therapy divided by the number of all evaluable patients registered to this trial and who received at least one dose of induction therapy. Corresponding 95% binomial confidence intervals will also be calculated. In a similar manner, the investigators will also evaluate the overall induction response rates. All evaluable patients will be used for this analysis.
- MRD-negativity rate [ Time Frame: Up to end of cycle 8 (1 cycle = 28 days) ]MRD-negativity by flow cytometry will be evaluated at designated time point (after cycle 1, after cycle 2, end of intensive phase). Will also compare MRD assessment by centralized aspirate flow cytometry (Wood lab) to next generation sequencing (clonoSEQ, Adaptive) of blood and bone marrow at designated time points; and determine association with outcome.
- Event-free survival [ Time Frame: Up to 5 years ]Event defined as failure to achieve Complete Response (CR)/Complete Remission with Incomplete Blood Count Recovery (CRi)/Complete Remission with Partial Hematological Recovery (CRh)/Complete Remission with Incomplete Platelet Counts (CRp), relapse, death.
- Rate of grade 3-5 adverse events [ Time Frame: Up to 5 years ]The proportion of patients experiencing a grade 3+ adverse events or toxicities will be described for each treatment arm, but will also be compared between the arms using Fisher's exact tests.

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Ages Eligible for Study: | 50 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- PRE-REGISTRATION ELIGIBILITY CRITERIA (STEP 0)
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Research bone marrow or peripheral blood submission
* This bone marrow or peripheral blood submission is mandatory prior to registration/randomization as baseline for real-time MRD analysis. The bone marrow sample should be from the first aspiration (i.e., first pull). Aspirate needle should be redirected if needed to get first pull bone marrow aspirate. It should be obtained as soon after pre-registration as possible
- REGISTRATION INCLUSION CRITERIA (STEP 1)
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Diagnosis of B-cell acute lymphoblastic leukemia (ALL) or lymphoblastic lymphoma (LBL) per World Health Organization (WHO) 2016 criteria. Patients must have >= 5% blasts in the bone marrow or blood. Patients with lymphoblastic lymphoma (LBL) without measurable marrow involvement (>= 5% blasts) are not eligible
* T-cell ALL/LBL, Philadelphia-chromosome positive B-cell (as determined by fluorescence in situ hybridization [FISH], cytogenetics, or reverse transcriptase polymerase chain reaction [RT-PCR]), and Burkitt's like leukemia/lymphoma (mature B-ALL) are not eligible
- Must be CD22 positive by local assessment (>= 20% by immunohistochemistry or flow cytometry). Patients are eligible regardless of CD20 status but CD20 expression should be assessed at diagnosis by flow cytometry or immunohistochemistry
- Patients must have >= 5% blasts in the bone marrow or blood. Patients with lymphoblastic lymphoma (LBL) without marrow involvement (>= 5% blasts) are not eligible
- No prior chemotherapy for ALL except for hydroxyurea (no limit), steroids limited to 7 days, ATRA (no limit), vincristine (single dose), and/or intra-thecal chemotherapy. Leukapheresis is permitted. Palliative radiation to doses 24 Gy or less is permitted. Patients being treated with chronic steroids for other reasons (autoimmune disorder, etc.) are eligible
- Age >= 50 years
- Eastern Cooperative Oncology Group (ECOG) performance status =< 2. ECOG 3 permitted if related to disease
- Creatinine =< 2.0 g/dL
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Total bilirubin =< 1.5 x upper limit of normal (ULN)
* Except in the event of: 1) Gilbert disease, in which case total bilirubin must be =< 2 x ULN, or 2) elevated bilirubin believed by investigator to be due to leukemic infiltration, in which case total bilirubin must be =< 2 x ULN
- AST / ALT =< 2.5 x upper limit of normal (ULN)
- Cardiac ejection fraction (as measured by multigated acquisition scan [MUGA] or echocardiogram) > 40%
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No clinically relevant liver disease (such as cirrhosis, active hepatitis, or alcohol use disorder), which in the opinion of the treating physician would make this protocol unreasonably hazardous
- Patients with known hepatitis B virus (HBV) infection are eligible if they are on effective HBV suppressive therapy with undetectable HBV viral load and there is no clinically relevant liver disease present (related or unrelated to HBV-related liver damage)
- Patients with known history of hepatitis C virus (HCV) infection are eligible if they have cleared the infection spontaneously or via eradication therapy (HCV viral load undetectable) and there is no clinically relevant liver disease present (related or unrelated to HCV-related liver damage)
- Women and men of reproductive potential should agree to use an appropriate method of birth control throughout their participation in this study due to the teratogenic potential of the therapy utilized in this trial. Include as applicable: Appropriate methods of birth control include abstinence, oral contraceptives, implantable hormonal contraceptives, or double barrier method (diaphragm plus condom)
Exclusion Criteria:
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Physicians should consider whether any of the following may render the patient inappropriate for this protocol:
- Medical condition such as uncontrolled diabetes mellitus, uncontrolled cardiac disease, and uncontrolled pulmonary disease.
- Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months are eligible for this trial.
- Patients with a "currently active" second malignancy other than non-melanoma skin cancers, early stage prostate cancer, cervical carcinoma in situ, or other cancer for which standard of care would be observation (not requiring treatment). Patients are not considered to have a "currently active" malignancy if they have completed therapy and are free of disease for >= 1 year, or if the cancer has been surgically resected and considered cured. Patients with a history of multiple myeloma with absence of serum paraprotein for >= 1 year are not considered to have a "currently active" malignancy.
- REGISTRATION EXCLUSION CRITERIA (STEP 1)
- Patients with symptomatic central nervous system (CNS) disease are not eligible. CNS assessment is not required for eligibility determination if asymptomatic

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): NCT05303792
Contact: Marlise R. Luskin, MD, MSCE | 617-632-2168 | marlise_luskin@dfci.harvard.edu |

Study Chair: | Marlise R. Luskin, MD, MSCE | Dana-Farber Cancer Institute |
Responsible Party: | Alliance for Clinical Trials in Oncology |
ClinicalTrials.gov Identifier: | NCT05303792 |
Other Study ID Numbers: |
A042001 NCI-2022-01735 ( Registry Identifier: NCI Clinical Trial Reporting Program ) U10CA180821 ( U.S. NIH Grant/Contract ) |
First Posted: | March 31, 2022 Key Record Dates |
Last Update Posted: | November 1, 2023 |
Last Verified: | October 2023 |
Individual Participant Data (IPD) Sharing Statement: | |
Plan to Share IPD: | Undecided |
Studies a U.S. FDA-regulated Drug Product: | Yes |
Studies a U.S. FDA-regulated Device Product: | No |
Lymphoma Leukemia Precursor Cell Lymphoblastic Leukemia-Lymphoma Leukemia, Lymphoid Lymphoma, Non-Hodgkin Neoplasms by Histologic Type Neoplasms Lymphoproliferative Disorders Lymphatic Diseases Immunoproliferative Disorders Immune System Diseases Cytarabine Dexamethasone Prednisone Methylprednisolone |
Cyclophosphamide Rituximab Doxorubicin Methotrexate Vincristine Mercaptopurine Inotuzumab Ozogamicin Immunosuppressive Agents Immunologic Factors Physiological Effects of Drugs Antirheumatic Agents Antineoplastic Agents, Alkylating Alkylating Agents Molecular Mechanisms of Pharmacological Action Antineoplastic Agents |