Blinatumomab for MRD in Pre-B ALL Patients Following Stem Cell Transplant

NCT04044560 | Terminated Phase 2 DMC FDA Drug

• 2 other identifiers: H19-00893CTTC 1902
• Study Type: interventional
• Target: 8
• Locations: 1 country
• Sites: 3

Brief Summary

This is a single arm, open label, multi-centre phase II study using blinatumomab for treatment of detectable minimal residual disease (MRD) in the first year following allogeneic hematopoietic stem cell transplant (HSCT) for patients with B cell acute lymphoblastic leukemia (B-ALL). The study has 2 phases: 1. MRD testing phase and 2. blinatumomab treatment phase. Participants with B-ALL planning for HSCT meeting other eligibility criteria will be enrolled onto the MRD testing phase, which will involve centralized MRD testing of bone marrow aspirate samples on day +56, +100, +180, +270 following HSCT. Participants with detectable MRD ≥10\^-4 leukemic cells/total nucleated cells will enroll onto the treatment phase. Blinatumomab treatment will be started following detection of MRD after 7 to 42 days from enrollment onto the treatment phase to allow for initiation of taper of immunosuppressive medications.

Conditions

B-cell Adult Acute Lymphoblastic Leukemia; Stem Cell Leukemia; Minimal Residual Disease

Keywords

acute lymphoblastic leukemia, blinatumomab, minimal residual disease, stem cell transplant

Outcome Measures

Primary Outcomes (1)

• MRD Response

  To determine the proportion of patients with MRD response, defined as negative MRD as measured by flow cytometry, after 1 cycle of blinatumomab.

  Following 1st cycle of blinatumomab (each cycle is 28 days)

Secondary Outcomes (6)

• Safety and Tolerability

  During Blinatumomab treatment, an average of 24 weeks

• Survival

  Up to 5 years

• Incidence of MRD Post HSCT

  Up to day +270 following stem cell transplant

• Patient Recruitment (Number of Patients Recruited)

  Through Study Completion, an average of 2 years

• Turnaround time of centralized MRD testing (days)

  Through Study Completion, an average of 2 years

Study Arms (1)

Blinatumomab Treatment

EXPERIMENTAL

Eligible patients with detectable MRD will taper immunosuppressive medications, if applicable, and undergo treatment with blinatumomab. The duration of each cycle of blinatumomab treatment is 6 weeks. Adult and pediatric patients will be treated for 4 weeks followed by a 2-week treatment free period. Patients may receive up to 4 cycles total of blinatumomab therapy.

Biological: blinatumomab

Interventions

blinatumomab BIOLOGICAL

Continuous intravenous infusion

Blinatumomab Treatment

Eligibility Criteria

• Age: 1 Year+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Pre-B-ALL in complete remission (CR), \<5% blasts on most recent bone marrow aspirate determined by morphologic assessment, with an intention to proceed to allogeneic HSCT. Eligible participants can be in 1st CR or greater. Presence of detectable MRD by flow cytometry or other techniques in patients that are in morphologic remission prior to transplant is permitted.
• Detectable MRD measured by flow cytometry or other molecular techniques is acceptable for enrollment in patients with \<5% blasts.
• Patients with either Philadelphia chromosome positive or negative B-ALL are eligible
• Documented expression of CD19 on the lymphoblast population as measured by flow-cytometry if patient has received prior CD19-directed therapy.
• Eligibility for HSCT along with conditioning regimen and donor selection will be determined according to the treating centre's policy.
• Patients must be age ≥1 years and have a baseline performance status of ECOG ≤ 2 (adult) or Lansky ≥ 50% (pediatric).
• Patient with chronic hepatitis B (Hep B surface antigen or Hep B Core antibody reactive) are eligible if they are receiving treatment to prevent reactivation (e.g. lamivudine, tenofovir) and have undetectable serum Hepatitis B DNA
• Patients (or legally acceptable designate) must provide written consent.
• Female patients of childbearing potential should be willing to use 2 methods of birth control or be surgically sterile, or abstain from heterosexual activity for the course of the study from the time of informed consent signature date until 3 months after completion of study treatment. Patients of childbearing potential are those who have not been surgically sterilized or have not been free from menses for \> 1 year.

You may not qualify if:

• Inability to comply with study procedures.
• Active central nervous system (CNS) involvement or other extramedullary disease at the time of enrollment.
• Uncontrolled infection until resolved.
• Burkitt lymphoma/leukemia or mixed phenotype leukemia.
• Chronic infection with Hepatitis C. Previously treated Hepatitis C with undetectable Hepatitis C RNA for six months or longer is acceptable.
• HIV 1/2 Infection.
• Treatment Phase of Trial:
• Detectable MRD ≥ 10\^-4 leukemic cells/TNC on a bone marrow aspirate done on day +56, +100, +180 or day +270.
• Morphologic remission on bone marrow from same date (on day +56, +100, +180 or day +270)
• Patients must be age ≥1 years and have a baseline performance status of ECOG ≤ 2 (adult) or Lansky ≥ 50% (pediatric) documented within 7 days of enrollment.
• Patients with either Philadelphia chromosome positive or negative B-ALL are eligible
• Documented expression of CD19 on the lymphoblast population as measured by flow-cytometry if patient has received prior CD19-directed therapy.
• Patient with chronic hepatitis B (Hep B surface antigen or Hep B Core antibody reactive) are eligible if they are receiving treatment to prevent reactivation (e.g. lamivudine, tenofovir) and have undetectable serum Hepatitis B DNA
• Adequate organ, liver and renal function including: Total bilirubin ≤ 1.5 x upper limit of normal (ULN), eGFR \>30 mL/min/1.73 m, Alkaline phosphatase ≤ 2.5 x ULN, Serum lipase ≤ 1.5 x ULN
• Patients (or legally acceptable designate) must provide written consent.

Sponsors & Collaborators

• University of British Columbia: lead
• Amgen: collaborator

Study Sites (3)

Vancouver General Hospital - Leukemia/Bone Marrow Transplant Program

Vancouver, British Columbia, V5Z1M9, Canada

Location

BC Children's Hospital

Vancouver, British Columbia, V5Z4H4, Canada

Location

QEII - Health Sciences Centre

Halifax, Nova Scotia, B3H 2Y9, Canada

Location

MeSH Terms

Conditions

Leukemia, Biphenotypic, Acute; Neoplasm, Residual; Precursor Cell Lymphoblastic Leukemia-Lymphoma

Interventions

blinatumomab

Condition Hierarchy (Ancestors)

Leukemia, Lymphoid; Leukemia; Neoplasms by Histologic Type; Neoplasms; Hematologic Diseases; Hemic and Lymphatic Diseases; Lymphoproliferative Disorders; Lymphatic Diseases; Immunoproliferative Disorders; Immune System Diseases; Neoplastic Processes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• David Sanford, MD

  University of British Columbia

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 2
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SEQUENTIAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Clinical Assistant Professor

Model Details: Participants will be monitored for MRD post transplant during the testing phase of the trial. If they have detectable MRD, they will be enrolled into the blinatumomab treatment phase.

Study Record Dates

• First Submitted: July 31, 2019
• First Posted: August 5, 2019
• Study Start: September 8, 2020
• Primary Completion: February 2, 2022
• Study Completion: February 2, 2022
• Last Updated: February 21, 2022

Record last verified: 2022-02

Locations

CA (3)