S0530 Cytarabine and Clofarabine in Treating Patients With Relapsed or Refractory Acute Lymphoblastic Leukemia

This study has been completed.
Sponsor:
Collaborator:
Information provided by (Responsible Party):
Southwest Oncology Group
ClinicalTrials.gov Identifier:
NCT00337168
First received: June 13, 2006
Last updated: November 13, 2013
Last verified: November 2013
  Purpose

RATIONALE: Drugs used in chemotherapy, such as cytarabine and clofarabine, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Giving more than one drug (combination chemotherapy) may kill more cancer cells.

PURPOSE: This phase II trial is studying how well giving cytarabine together with clofarabine works in treating patients with relapsed or refractory acute lymphoblastic leukemia.


Condition Intervention Phase
Leukemia
Drug: clofarabine
Drug: cytarabine
Phase 2

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase II Trial of Cytarabine and Clofarabine in Patients With Relapsed or Refractory Acute Lymphoblastic Leukemia (ALL)

Resource links provided by NLM:


Further study details as provided by Southwest Oncology Group:

Primary Outcome Measures:
  • Number of Patients With Complete Remission [ Time Frame: Between day 28 and day 35 inclusive ] [ Designated as safety issue: No ]
    Complete remission is defined as: less than 5% bone marrow blasts, neutrophils greater or equal to 1,000 per microliter, platelets greater than 100,000 per microliter, no blasts in the peripheral blood, and no extramedullary disease


Secondary Outcome Measures:
  • Expression of Nucleoside Transporters [ Time Frame: On average, two weeks before treatment started ] [ Designated as safety issue: No ]
    Expression was examined in paraffin-embedded tissue by immunohistochemistry. Intensities were scored on a 0-2+ scale. High expression was a score of 2+.

  • Number of Patients With Very Poor Risk Cytogenetics [ Time Frame: On average, 2 weeks before treatment started ] [ Designated as safety issue: No ]
  • Toxicity [ Time Frame: Patients were assess for adverse events after each induction cycle (up to two cycles) and after the one consolidation cycle ] [ Designated as safety issue: Yes ]
    Number of patients with Grade 3-5 adverse events that are related to study drug by given type of adverse event


Enrollment: 36
Study Start Date: October 2006
Study Completion Date: January 2013
Primary Completion Date: December 2008 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Induc, ReInduc, Consol, clofarabine, cytarabine
Induction: 40mg/m2/d; IV over 1 hr; days 1-5 Re-induction (if necessary): 40mg/m2/d; IV over 1 hr; days 1-5 Consolidation: 40mg/m2/d; IV over 1 hr; days 1-4
Drug: clofarabine
Induction: 40mg/m2/d; IV over 1 hr; days 1-5 Re-induction (if necessary): 40mg/m2/d; IV over 1 hr; days 1-5 Consolidation: 40mg/m2/d; IV over 1 hr; days 1-4
Drug: cytarabine
Induction: 1g/m2/d; IV over 2 hrs; days 1-5 Re-induction (if necessary): 1g/m2/d; IV over 2 hrs; days 1-5 Consolidation: 1g/m2/d; IV over 2 hrs; days 1-4

Detailed Description:

Primary objective:

  • Determine whether the complete remission rate in adult patients with relapsed or refractory acute lymphoblastic leukemia (ALL) is sufficiently high after treatment with cytarabine and clofarabine to warrant further investigation.

Secondary objectives:

  • Estimate the frequency and severity of toxicities associated with this dosing schedule of cytarabine and clofarabine.
  • Investigate, preliminarily, the prognostic effects of cytogenetic features on response to treatment in these patients.

Other objectives (if funding allows):

  • Investigate, preliminarily, the prognostic effects of laboratory correlates (expression of nucleoside transporters, expression of other pertinent genes by tissue microarray) and FISH features on response to treatment in these patients

OUTLINE: This is an open-label, multicenter study.

  • Induction therapy (1 or 2 courses): Patients receive induction therapy comprising clofarabine IV over 1 hour followed 4 hours later by cytarabine IV over 2 hours on days 1-5 (course 1). Patients who achieve a response (5-25% blasts in the bone marrow with a ≥ 50% reduction in blasts from initial bone marrow aspirate) receive 1 more course of induction therapy beginning no later than day 45. Patients who achieve complete remission (< 5% blasts in the bone marrow) after 1 or 2 courses of induction therapy may proceed to consolidation therapy.
  • Consolidation therapy (1 course): Beginning within 60 days after the first day of the last induction therapy, patients may receive consolidation therapy comprising clofarabine IV over 1 hour followed 4 hours later by cytarabine IV over 2 hours on days 1-4.

After completion of study treatment, patients are followed periodically for up to 5 years.

PROJECTED ACCRUAL: A total of 35 patients will be accrued for this study.

  Eligibility

Ages Eligible for Study:   16 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Prior morphologic diagnosis of acute lymphoblastic leukemia (ALL)

    • No M0, mixed lineage, or L3 (Burkitt's) ALL
  • Refractory to a standard induction regimen OR relapsed after successful prior induction therapy

    • Standard induction regimen is defined as any program of treatment that includes vincristine and prednisone or high-dose cytarabine/mitoxantrone
    • Any number of inductions or remissions allowed
  • Must have evidence of ALL in bone marrow or peripheral blood

    • Immunophenotyping of the blood or bone marrow lymphoblasts must be performed to determine lineage (B cell, T cell, or mixed B/T cell)
    • No extramedullary only disease in the absence of bone marrow or blood involvement
    • Co-expression of myeloid antigens (CD13 and CD33) allowed
  • Patients with Philadelphia chromosome-positive (Ph+) ALL or bcr/abl-positive ALL who were previously eligible for imatinib mesylate treatment must have received imatinib mesylate either alone or in combination with chemotherapy for ALL and must have either failed treatment or been unable to tolerate treatment
  • No CNS involvement as determined by lumbar puncture (for previous CNS history or clinical signs or symptoms of CNS) or by clinical exam (if no previous history or signs/symptoms)
  • Must be registered on SWOG-S9910 and SWOG-9007

PATIENT CHARACTERISTICS:

  • Zubrod performance status 0-2
  • Creatinine ≤ 1.5 times upper limit of normal (ULN)
  • AST or ALT ≤ 1.5 times ULN
  • Bilirubin ≤ 1.5 times ULN
  • No psychiatric disorders that would interfere with study compliance
  • No uncontrolled systemic fungal, bacterial, viral, or other infection
  • No other severe concurrent disease
  • No other serious or poorly controlled medical condition that would preclude study participation
  • No history of serious organ dysfunction or disease involving the heart, kidney, liver, or other organ system that would preclude study participation
  • HIV negative
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception
  • No pre-existing motor or sensory neuropathy ≥ grade 2
  • No other prior malignancies, except for the following:

    • Adequately treated basal cell or squamous cell skin cancer
    • In situ cervical cancer
    • Adequately treated stage I or II cancer in complete remission
    • Any other prior cancer for which the patient has been disease free for ≥ 5 years

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • Recovered from prior therapy
  • No prior clofarabine
  • More than 2 weeks since prior chemotherapy, major surgery, or other investigational agents
  • More than 6 weeks since prior monoclonal antibodies
  • Prior allogeneic or autologous bone marrow transplant allowed provided the following criteria are met:

    • More than 90 days since transplant
    • No acute graft-versus-host disease (GVHD) ≥ grade 2 OR moderate or severe limited chronic GVHD OR extensive chronic GVHD of any severity
  • Prior maintenance therapy with steroids, vincristine, and/or anti-metabolite agents, such as, but not limited to, mercaptopurine, thioguanine, or methotrexate allowed
  • Concurrent hydroxyurea allowed
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00337168

  Show 91 Study Locations
Sponsors and Collaborators
Southwest Oncology Group
Investigators
Study Chair: Anjali Advani, MD The Cleveland Clinic
Principal Investigator: Jerry Radich, MD Fred Hutchinson Cancer Research Center
  More Information

Additional Information:
No publications provided

Responsible Party: Southwest Oncology Group
ClinicalTrials.gov Identifier: NCT00337168     History of Changes
Other Study ID Numbers: CDR0000481340, U10CA032102, SWOG-S0530
Study First Received: June 13, 2006
Results First Received: June 5, 2012
Last Updated: November 13, 2013
Health Authority: United States: Federal Government
United States: Food and Drug Administration

Keywords provided by Southwest Oncology Group:
recurrent adult acute lymphoblastic leukemia
L1 adult acute lymphoblastic leukemia
L2 adult acute lymphoblastic leukemia
B-cell adult acute lymphoblastic leukemia
T-cell adult acute lymphoblastic leukemia

Additional relevant MeSH terms:
Leukemia
Leukemia, Lymphoid
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Neoplasms by Histologic Type
Neoplasms
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Cytarabine
Clofarabine
Antimetabolites, Antineoplastic
Antimetabolites
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Antineoplastic Agents
Therapeutic Uses
Antiviral Agents
Anti-Infective Agents
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs

ClinicalTrials.gov processed this record on April 23, 2014