Pediatric Phase I Trial of BL22 for Refractory CD22-Positive Leukemias and Lymphomas
BL22 immunotoxin
+ antibody-drug conjugate therapy
+ immunotoxin therapy
Enfermedades Hematológicas+6
+ Enfermedades del sistema inmunitario
+ Trastornos Inmunoproliferativos
Estudio de Tratamiento
Resumen
Fecha de inicio: 1 de enero de 2004
Fecha en la que se inscribió al primer participante.OBJECTIVES: Primary * Determine the toxic effects of BL22 immunotoxin in pediatric patients with relapsed or refractory CD22-positive acute lymphoblastic leukemia or non-Hodgkin's lymphoma. * Determine the maximum tolerated dose of this drug in these patients. * Determine the immunogenicity of this drug in these patients. * Determine the pharmacokinetics of this drug in these patients. Secondary * Determine the in vitro cytotoxicity of this drug against lymphoblasts from patients with acute lymphoblastic leukemia. * Determine the therapeutic efficacy of this drug in inducing remissions in these patients. * Determine changes in lymphocyte subsets, immunoglobulin levels, serum cytokines, and soluble cytokine receptor levels in patients treated with this drug. OUTLINE: This is a non-randomized, dose-escalation study. Patients receive BL22 immunotoxin IV over 30 minutes on days 1, 3, and 5 OR on days 1, 3, 5, 7, 9, and 11. Treatment repeats every 21 days for up to 6 courses in the absence of disease progression or unacceptable toxicity. Patients who achieve a complete response (CR) or unconfirmed CR (CRu) receive 2 additional courses beyond CR or CRu for a maximum of 6 courses. Cohorts of 3-6 patients receive escalating doses of BL22 immunotoxin until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. Once the MTD is determined, the cohort is expanded and a total of 12 patients are treated at that dose. Patients are followed weekly for at least 1 month and then every 1-3 months thereafter. PROJECTED ACCRUAL: A total of 95 patients will be accrued for this study.
Protocolo
Esta sección proporciona detalles del plan del estudio, incluyendo cómo está diseñado y qué se está evaluando.Se reclutarán 95 pacientes
Número total de participantes que el ensayo clínico espera reclutar.Estudio de Tratamiento
Elegibilidad
Los investigadores buscan pacientes que cumplan ciertos criterios, conocidos como criterios de elegibilidad: estado general de salud o tratamientos previos.Cualquier sexo
Sexo biológico de los participantes elegibles para inscribirse.De 6 meses a 24 años
Rango de edades de los participantes que pueden unirse al estudio.Voluntarios sanos no permitidos
Indica si personas sanas, sin la condición que se estudia, pueden participar.Condiciones
Patología
Criterios
DISEASE CHARACTERISTICS: * Histologically confirmed acute lymphoblastic leukemia (ALL) or non-Hodgkin's lymphoma (including lymphoblastic lymphoma, Burkitt's lymphoma, and large cell lymphoma) * Not amenable to available curative therapies * Relapsed or refractory disease after at least 1 standard chemotherapy and 1 salvage regimen * CD22 positive according to at least 1 of the following criteria: * More than 15% CD22-positive malignant cells by immunohistochemistry * More than 30% CD22-positive malignant cells by fluorescent-activated cell sorter analysis * Measurable or evaluable disease * Prior CNS involvement allowed provided there is no current evidence of CNS malignancy * No CNS leukemia or lymphoma as manifested by any of the following: * Cerebrospinal fluid (CSF) WBC ≥ 5/mm\^3 and confirmation of CSF blasts * Cranial neuropathies secondary to underlying malignancy * Radiologically detected CNS lymphoma * No isolated testicular ALL * Ineligible for or refused hematopoietic stem cell transplantation OR has disease activity that prohibits the time required to identify a suitable stem cell donor PATIENT CHARACTERISTICS: Age * 6 months to 24 years Performance status * ECOG 0-3 (12 to 24 years of age) * Lansky 40-100% (under 12 years of age) Life expectancy * Not specified Hematopoietic * See Disease Characteristics * Absolute neutrophil count \> 1,000/mm\^3 \* * Platelet count \> 50,000/mm\^3 \* NOTE: \*Non-leukemic patients only Hepatic * Bilirubin ≤ 2.0 mg/dL * AST and ALT ≤ 5 times upper limit of normal * No active hepatitis B or C infection Renal * Creatinine normal for age OR * Creatinine clearance ≥ 60 mL/min Immunologic * No serum neutralization of more than 75% of the activity of 1 µg/mL of study drug * HIV negative Other * Not pregnant or nursing * Negative pregnancy test * Fertile patients must use effective contraception * No clinically significant unrelated systemic illness that would preclude study participation * No other significant organ dysfunction that would preclude study participation * No psychiatric illness or social situation that would preclude study compliance PRIOR CONCURRENT THERAPY: Biologic therapy * See Disease Characteristics * At least 1 week since prior colony-stimulating factors (e.g., filgrastim \[G-CSF\], sargramostim \[GM-CSF\], or epoetin alfa) * Prior autologous or allogeneic hematopoietic stem cell transplantation (HSCT) allowed * More than 100 days since prior allogeneic HSCT Chemotherapy * See Disease Characteristics * At least 2 weeks since prior chemotherapy (6 weeks for nitrosoureas) Endocrine therapy * Concurrent corticosteroids allowed provided there has been no increase in the dose 1 week prior to and after study entry * Steroid taper allowed Radiotherapy * At least 3 weeks since prior radiotherapy * Allowed in the past 3 weeks provided the volume of the bone marrow treated is \< 10% AND the patients has measurable disease outside of the radiation port Surgery * Not specified Other * Recovered from prior therapy * At least 30 days since prior investigational drugs * No other concurrent investigational drugs
Plan de Estudio
Conoce todos los tratamientos administrados en este estudio, su descripción detallada y en qué consisten.4 grupos de intervención están designados en este estudio
0% de probabilidad de ser asignado al grupo placebo
Grupos de Tratamiento
Grupo I
Comparador ActivoGrupo II
Comparador ActivoGrupo III
Comparador ActivoGrupo IV
Comparador ActivoObjetivos del Estudio
Objetivos Primarios
Objetivos Secundarios
Centros del Estudio
Estos son los hospitales, clínicas o centros de investigación donde se lleva a cabo el estudio. Puedes encontrar la ubicación más cercana a ti y su estado de reclutamiento.Este estudio tiene una ubicación
Warren Grant Magnuson Clinical Center - NCI Clinical Trials Referral Office
Bethesda, United StatesVer ubicación