Maintenance Therapy With Ceplene® (Histamine) and IL-2 on Immune Response and MRD in Acute Myeloid Leukemia

This study has been completed.
Sponsor:
Collaborator:
EpiCept Corporation
Information provided by (Responsible Party):
MEDA Pharma GmbH & Co. KG
ClinicalTrials.gov Identifier:
NCT01347996
First received: May 2, 2011
Last updated: June 12, 2014
Last verified: June 2014
  Purpose

Ceplene/IL-2 remission maintenance therapy has been shown to significantly prolong Leukemia Free Survival in patients with Acute Myeloid Leukemia (AML) in first complete remission. This is an international, multicenter, open-label study to evaluate the effects of remission maintenance therapy with Ceplene/IL-2 in adult patients with AML in CR1 on specific immune system cells (T and NK cells) and prospectively defined markers of immune response that are known to reflect T and NK cell ability to combat AML.


Condition Intervention Phase
Acute Myeloid Leukemia
Drug: histamine dihydrochloride and IL-2
Phase 4

Study Type: Interventional
Study Design: Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Open-Label, Multicenter, Effects of Remission Maintenance Therapy With Ceplene® , Given in Conjunction With Low-Dose Interleukin-2, on Immune Response and Minimal Residual Disease in Adult Patients With AML in First Complete Remission

Resource links provided by NLM:


Further study details as provided by MEDA Pharma GmbH & Co. KG:

Primary Outcome Measures:
  • Minimal residual disease (MRD) in AML patients receiving Ceplene/IL-2 [ Time Frame: Comparison at baseline and various time points up to 2 years ] [ Designated as safety issue: No ]
    A second primary objective of this study is to evaluate MRD in patients who are receiving remission maintenance therapy with Ceplene/IL-2. MRD will be evaluated using RQ-PCR for molecular detection of genetic markers of AML. Patients' MRD status will be quantified at the time of enrollment (baseline) and within ten days after completion of Cycles 3, 5, 6, 7, 9 and 10 of Ceplene/IL-2 therapy, corresponding to approximately every 3 months during this immunotherapy.

  • Pharmacodynamic effects of Ceplene plus low dose IL-2 (Ceplene/IL-2) by monitoring T and NK cell phenotypes and their functionality after the first and third cycles of treatment [ Time Frame: Baseline vs Cycle 1 and 3 ] [ Designated as safety issue: No ]

    The quantitative and qualitative pharmacodynamic effects of Ceplene/IL-2 on the immune responses of T and NK cells will be assessed as follows:

    1. Changes in T and NK cell phenotypes (CD56, CD3, CD4, CD8) in peripheral blood from Day 1 (baseline) to Day 21‡ of Cycle 1 and from Day 1 (pre-treatment Cycle 3) to Day 21‡ of Cycle 3.
    2. Changes in immune response markers (CD3, NKp46 [and other NCRs], CD25, CD69, and IFN-γ) in peripheral blood from Day 1 (baseline) to Day 21‡ of Cycle 1 and from Day 1 (pre-treatment Cycle 3) to Day 21‡ of Cycle 3


Secondary Outcome Measures:
  • Duration of LFS [ Time Frame: up to 2 years ] [ Designated as safety issue: No ]
    Duration of LFS: LFS will be defined as the time from achieving CR after successful induction therapy until relapse of AML (defined as 5% or more blast cells in the bone marrow).


Enrollment: 84
Study Start Date: July 2009
Study Completion Date: June 2014
Primary Completion Date: June 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: histamine dihydrochloride and IL-2
histamine and IL-2 subcutaneous injections
Drug: histamine dihydrochloride and IL-2
Ceplene 0.5 mg subcutaneously twice daily and IL-2 1 µg/kg [16,400 IU/kg] body weight twice daily for 10, 21 day cycles
Other Names:
  • Ceplene
  • Proleukin
  • IL-2
  • interleukin-2
  • histamine

Detailed Description:

Outcome Measures:

Primary:

  1. To assess the quantitative and qualitative pharmacodynamic effects of Ceplene plus low-dose IL-2 (Ceplene/IL-2) by monitoring T and natural killer (NK) cell phenotypes and their functionality after the first and third treatment cycles in adult patients with acute myeloid leukemia (AML) in first complete remission (CR1).
  2. To evaluate minimal residual disease (MRD) in AML patients receiving Ceplene/IL-2.

Secondary:

To document, in adult AML patients in CR1 treated with Ceplene/IL-2:

  1. Leukemia-free survival (LFS) after a follow-up period of up to two years.
  2. The safety of Ceplene/IL-2 therapy.
  3. The potential relationship of Ceplene/IL-2 effects on T and NK cell phenotypes and their functionality to MRD.
  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • AML patients in CR1 whose AML subtype has been well-characterized using conventional karyotyping and molecular genetic techniques (eg, RQ-PCR) at diagnosis. Patients may be considered eligible if they have not had this assessment performed at diagnosis provided that stored samples of diagnostic genetic material (DNA/RNA) from blood and BM are available that can be assayed for the presence of markers such as WT1 and/or AML-specific genetic markers.
  • Bone marrow examination confirming CR (defined as less than 5% blasts in a normocellular bone marrow).
  • Eighteen years of age or older.
  • Patients have received any form of induction and consolidation therapy as per standard practice at the institution, including autologous stem cell transplantation (ASCT).
  • Within 8 weeks following the date of the last dose of consolidation or conditioning chemotherapy for AML, or following ASCT.
  • Patients not undergoing consolidation therapy must have been in CR1 for at least one month prior to enrollment.
  • Platelet count recovered after chemotherapy to ≥75 x 109/L, and Partial Thromboplastin Time (PTT) within normal limits.
  • WBC ≥1.5 x 109/L and LFTs (to include SGPT [ALAT] or SGOT [AST] and bilirubin) should not exceed twice the upper limit of normal.
  • Serum creatinine less than or equal to 1.5 times the upper normal limit.
  • Able to function without significant decrease in daily activities (WHO Performance Status 0 - 1 or Karnofsky ≥70).
  • Life expectancy of more than three months and able to undergo routine outpatient evaluations for efficacy, safety, and/or compliance.
  • Women of childbearing potential must be practicing barrier or oral contraception, for the duration of the treatment, or documented as surgically sterile or one year post-menopausal.
  • If female, be non-nursing, non-pregnant and have a negative pregnancy test within two weeks of starting study drug.
  • The patient must be informed of the investigational nature of the study and written informed consent obtained.

Exclusion Criteria:

  • Patients who have undergone or are planned for allogeneic stem cell transplantation.
  • Patients with M3 as an AML subtype.
  • Class III or IV cardiac disease, hypotension or severe hypertension, vasomotor instability, serious or uncontrolled cardiac dysrhythmias (including ventricular arrhythmias) at any time, acute myocardial infarction within the past 12 months, active uncontrolled angina pectoris or symptomatic arteriosclerotic blood vessel disease.
  • Other active malignancies except in situ carcinoma of the cervix, localized squamous or basal cell carcinoma of the skin.
  • Serious concurrent or recent non-malignant medical conditions which, in the opinion of the Investigator, makes the patient unsuitable for participation in this study.
  • History of seizures, central nervous system disorders, stroke within the last 12 months, or psychiatric disability thought to be clinically significant in the opinion of the Investigator and adversely affecting compliance to protocol.
  • Patients unable to undergo repeat treatments, clinical evaluations and other diagnostic procedures required by the protocol.
  • Active autoimmune disease (including but not limited to systemic lupus, inflammatory bowel disease, and psoriasis).
  • Patients with active peptic or esophageal ulcer disease or with past peptic ulcer or esophageal disease with a history or bleeding.
  • Patients requiring active treatment for hypotension.
  • Medical, sociologic, or psychological impediment to probable compliance with the protocol.
  • Patients continuing systemic treatment with clonidine, steroids, and/or H2 receptor blocking agents.
  • Patients with a history of histamine hypersensitivity, severe allergies to food or contrast media requiring treatment within the last five years.
  • Patients unable to provide written consent.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01347996

Locations
Sweden
Sahlgrenska Academy, University of Gothenburg
Gothenburg, Sweden
Sponsors and Collaborators
MEDA Pharma GmbH & Co. KG
EpiCept Corporation
Investigators
Study Chair: Robin FOA, MD, PhD Università degli Studi di Roma "La Sapienza" Dipartimento di Biotecnologie Cellulari ed Ematolgia
Principal Investigator: Mats L Brune, MD, PhD Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden
  More Information

No publications provided

Responsible Party: MEDA Pharma GmbH & Co. KG
ClinicalTrials.gov Identifier: NCT01347996     History of Changes
Other Study ID Numbers: EPC2008-02
Study First Received: May 2, 2011
Last Updated: June 12, 2014
Health Authority: Sweden: Medical Products Agency
United Kingdom: National Health Service
France: Afssaps - Agence française de sécurité sanitaire des produits de santé (Saint-Denis)
Belgium: Federal Agency for Medicines and Health Products, FAMHP
Spain: Ministry of Health
Italy: National Monitoring Centre for Clinical Trials - Ministry of Health

Keywords provided by MEDA Pharma GmbH & Co. KG:
AML
Leukemia
Acute Myeloid Leukemia
Minimal Residual Disease
Ceplene
Histamine
interleukin 2

Additional relevant MeSH terms:
Leukemia
Leukemia, Myeloid, Acute
Leukemia, Myeloid
Neoplasm, Residual
Neoplasms by Histologic Type
Neoplasms
Neoplastic Processes
Pathologic Processes
Histamine
Histamine phosphate
Interleukin-2
Histamine Agonists
Histamine Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Physiological Effects of Drugs
Antineoplastic Agents
Therapeutic Uses
Analgesics, Non-Narcotic
Analgesics
Sensory System Agents
Peripheral Nervous System Agents
Central Nervous System Agents

ClinicalTrials.gov processed this record on August 21, 2014