SWOG-1318 A Phase II Study of Blinatumomab (NSC-765986) and POMP (Prednisone, Vincristine, Methotrexate, 6-Mercaptopurine) for Patients >/= 65 Years of Age with Newly Diagnosed Philadelphia-Chromosome Negative (Ph-) Acute Lymphoblastic Leukemia (ALL) and of Dasatinib (NSC-732517), Prednisone and Blinatumomab for Patients >/= 65 Years of Age with Newly Diagnosed Philadelphia-Chromosome Positive (Ph+) ALL
I. To evaluate the 3-year survival rate in elderly patients with newly diagnosed
Philadelphia (Ph)-negative acute lymphoblastic leukemia (ALL) treated with blinatumomab
followed by POMP (prednisone, vincristine sulfate, methotrexate, and mercaptopurine)
II. To evaluate in a preliminary manner (feasibility study) the safety of dasatinib-steroid
based induction followed by blinatumomab treatment in combination with dasatinib followed by
dasatinib-based maintenance in patients with newly diagnosed Ph-positive ALL,
relapsed/refractory Ph-positive ALL, and Ph-like dasatinib-sensitive mutations or kinase
fusions (DSMKF) ALL (newly-diagnosed relapsed or refractory).
I. To evaluate toxicities in these patient populations treated with these regimens.
II. To estimate the rates of complete response (CR), complete remission with incomplete
count recovery (CRi) and disease-free survival in Ph-negative patients.
III. To estimate disease-free and overall survival in Ph-positive ALL and Ph-like DSMKF ALL.
IV. To estimate in each cohort the rate of minimal residual disease (MRD) negativity, and
the time to achieve MRD negativity (exploratory analysis).
V. To determine whether anti-idiotype antibodies directed against blinatumomab develop with
blinatumomab treatment in this study.
OUTLINE: Patients are assigned to 1 of 2 treatment cohorts according to Philadelphia
COHORT I (PHILADELPHIA CHROMOSOME NEGATIVE PATIENTS):
INDUCTION: Patients receive blinatumomab intravenously (IV) continuously over 24 hours on
days 1-28. Treatment repeats every 42 days for 2 courses in the absence of disease
progression or unacceptable toxicity.
RE-INDUCTION: Patients not achieving CR or CRi after Induction, receive blinatumomab IV
continuously over 24 hours on days 1-28 in the absence of disease progression or
POST-REMISSION: Patients receive blinatumomab IV continuously over 24 hours on days 1-28.
Treatment repeats every 42 days for 3 courses in the absence of disease progression or
MAINTENANCE: Patients receive prednisone orally (PO) on days 1-5, vincristine sulfate IV on
day 1, mercaptopurine PO on days 1-28, and methotrexate PO on days 1, 8, 15, and 22.
Treatment repeats every 28 days for 18 courses in the absence of disease progression or
COHORT II (PHILADELPHIA CHROMOSOME POSITIVE PATIENTS):
INDUCTION: Patients receive dasatinib PO twice daily (BID) on days 1-84 and prednisone PO on
days 1-24 with tapering on days 25-32 in the absence of disease progression or unacceptable
RE-INDUCTION: Patients receive blinatumomab IV continuously over 24 hours on days 1-28.
Treatment repeats every 42 days for 2 courses in the absence of disease progression or
POST-REMISSION: Patients receive blinatumomab IV continuously over 24 hours on days 1-28 and
dasatinib PO once daily (QD) on days 1-42. Treatment repeats every 42 days for 3 courses in
the absence of disease progression or unacceptable toxicity.
MAINTENANCE: Patients receive dasatinib PO BID on days 1-28 and prednisone PO on days 1-5.
Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up every 3 months for 2 years,
every 6 months for 2 years, and then annually until 10 years from initial registration.
9L-13-1: Correlative Biomarker Study for MPD-RC Treatment Studies in the Philadelphia Chromosome Negative Myeloproliferative Neoplasms (MPN)
The Philadelphia chromosome negative myeloproliferative neoplasms (MPN) polycythemia vera (PV), essential thrombocythemia (ET) and primary myelofibrosis (PMF) are clonal hematopoietic malignancies originating at the level of the pluripotent hematopoietic stem cell. MPNs have the potential to undergo clonal evolution and a stepwise progression that terminates in bone marrow failure due to myelofibrosis, ineffective hematopoiesis, or in transformation to acute leukemia. Recently it has been learned that a point mutation in the tyrosine kinase, Jak2, accounts for the characteristic growth factor hypersensitivity observed in MPNs, however, the molecular mechanisms that result in the etiology and progression of these neoplasms have not been fully characterized. Because of the long evolution of these neoplasms, identifying biomarkers of disease progression and the development of molecularly targeted translational therapies has been difficult.The principal objective of this study is to collect and store tissue samples from patients with myeloproliferative neoplasms (PV, PMF, and ET). Tissue samples will be used to perform a variety of biomarker studies to monitor the effects of a particular therapeutic intervention. The specimens will be obtained from study participants either at the time of diagnosis, remission, or at relapse, or other specific time points as specified by the individual treatment/research protocols.Study participants qualify to take part in this research study because they have agreed to participate in an MPD-RC treatment study for which this biomarker study is a mandatory component. Participants will be asked to participate in this study that allows for the storage of a small portion of the participants blood and bone marrow and toenail clippings for research. This study is being conducted by the Myeloproliferative Disorders Research Consortium (MPD-RC) through a grant provided by the National Cancer Institute (NCI). These samples will be frozen and securely stored at the MPD-RC Research Laboratory at the New York Blood Center in New York, New York. Participation in this study is expected to last from 2 to 4 years.
9L-15-3: A Pivotal Multicenter Trial of Moxetumomab Pasudotox in Relapsed/Refractory Hairy Cell Leukemia
- Hairy cell leukemia is an indolent B-cell leukemia comprising 2% of all leukemias, or
approximately 900 of the 44,000 new cases of leukemia/year in the US
- Over the last two decades, immunotoxin research has accumulated to support a role for
CD22-targeted therapy in the treatment of HCL.
- Moxetumomab pasudotox is a recombinant immunotoxin containing an Fv fragment of an
anti-CD22 monoclonal antibody and truncated Pseudomonas exotoxin.
- Moxetumomab pasudotox has demonstrated a high complete response (CR) rate in patients
with chemoresistant hairy cell leukemia (HCL) and has shown activity in pediatric acute
lymphoblastic leukemia as well.
- Modification of the structure of moxetumomab pasudotox has greatly improved binding and
cytotoxicity toward CD22 expressing malignant cells compared to the precursor molecule.
Preclinical and clinical studies have demonstrated that this increase in binding
affinity results in improved antitumor activity and tolerability
- Currently there are no approved agents with significant efficacy for HCL patients after
failure of standard therapy
- This is a multicenter, single-arm study of moxetumomab pasudotox in patients with
relapsed/refractory hairy cell leukemia.
- 77 patients will be enrolled to receive moxetumomab pasudotox IV on days 1, 3 and 5 of
each 28 day cycle for a maximum of 6 cycles or until disease progression, unacceptable
toxicity occurs, the subject begins alternate therapy, or documented CR (for subjects
who have no assessable minimal residual disease and not to exceed 6 cycles). If less
than or equal to 2 of the first 25 patients do not achieve durable CR, no additional
patients will be accrued.
- The overall IRB accrual ceiling is currently set at 80 to allow for a small number of
patients that cannot be assessed for response.
SWOG-S1117: A Randomized Phase II Study of Azacitidine in Combination with Lenalidomide (NSC-703813) vs. Azacitidine Alone vs. Azacitidine in Combination with Vorinostat (NSC-701852) for Higher-Risk Myelodysplastic Syndromes (MDS) and Chronic Myelomonocytic Leukemia (CMML)
I. To select based on response rate (complete remission, partial remission, or hematologic
improvement) either the combination of lenalidomide and azacitidine or the combination of
vorinostat and azacitidine for further testing against single-agent azacitidine among
patients with higher-risk myelodysplastic syndromes (MDS) or chronic myelomonocytic leukemia
(CMML). (Phase II) II. To compare overall survival between the combination arm selected in
the Phase II portion of the trial to single-agent azacitidine among patients with
higher-risk myelodysplastic syndromes (MDS) or chronic myelomonocytic leukemia (CMML).
I. To estimate relapse-free survival, overall survival and cytogenetic response rate of
patients treated on each regimen.
II. To estimate the frequency and severity of toxicities of the three regimens in this
III. To investigate in a preliminary manner the frequency of subgroups from pre-study
cytogenetic studies and correlate these subgroups with clinical outcomes in this patient
IV. To collect specimens for banking for use in future research studies.
OUTLINE: Patients are randomized to 1 of 3 treatment arms. In Phase III, patients are
randomized to 1 of 2 treatment arms (the combination arm selected in Phase II or the
single-agent azacitidine arm).
ARM I: Patients receive azacitidine subcutaneously (SC) or intravenously (IV) on days 1-7 or
days 1-5 and 8-9, and lenalidomide orally (PO) once daily (QD) on days 1-21.
ARM II: Patients receive azacitidine as in Arm I.
ARM III: Patients receive azacitidine as in Arm I and vorinostat PO twice daily (BID) on
In all arms, treatment repeats every 28 days for up to 5 years in the absence of disease
progression or unacceptable toxicity.
After completion of study treatment, patients are followed up every 3 months for up to 5
9L-12-1: Phase II Study of Combined Tretinoin and Arsenic Trioxide for Patients with Newly Diagnosed Acute Promyelocytic Leukemia Followed by Risk-Adapted Postremission Therapy
Induction will consist of tretinoin 45 mg/m2 po daily (rounded up to the nearest 10mg) in
two divided doses (25 mg/m2 in patients <20 years of age) for 35 days and ATO 0.15 mg/kg IV
daily for 35 doses given 5-7 days per week. The drugs will then be discontinued, and the
patient will be followed until a clinical complete remission is achieved. Idarubicin 12
mg/m2 IV for 4 doses will be added during induction on day 2 if the presenting WBC is
>10,000/μl, or if the WBC increases to 5,000/μl on day 5, 10,000/μl on day 10, or 15,000/μl
on day 15, because of the increased risk of the APL differentiation syndrome and relapse in
these patients. Dexamethasone 10 mg twice daily with be given on days 1-14 of induction as
prophylaxis for the APL differentiation syndrome. All patients will then receive four
courses of consolidation with tretinoin 45 mg/m2 po daily (rounded up to the nearest 10mg)
(25 mg/m2 in patients <20 years of age) for 15 days and ATO 0.15 mg/kg IV for 25 doses.
Patients with high-risk disease or who received Idarubicin during Induction may receive
intrathecal cytarabine as CNS prophylaxis given by the treating physician during
consolidation, at the discretion of the site PI. High-risk patients will also receive
maintenance therapy with additional courses of tretinoin and ATO every 3 months for 2 years.
Each maintenance course will consist of tretinoin 45 mg/m2 po daily (25 mg/m2 in patients
<20 years of age) for 15 days and ATO 0.15 mg/kg IV for 10 doses. Disease status will be
monitored with serial analyses of peripheral blood samples using RT-PCR for PML-RARα mRNA.
Patients will be followed until relapse, death, loss to follow-up, or removal from study.
Induction therapy can be given as an inpatient or outpatient. Consolidation and maintenance
treatments will be given as an outpatient. Consolidation may also be given at the patient's
local institution. Intrathecal cytarabine treatments will be administered as an outpatient.
0S-11-12: PhI-67 Phase I Study of the Aurora Kinase A Inhibitor MLN8237 in Combination with the Histone Deacetylase Inhibitor Vorinostat in Lymphoid Malignancies
I. To determine the maximum-tolerated dose (MTD) of MLN8237 (alisertib) when given in
combination with vorinostat and to select a dose and schedule for further testing
(recommended Phase 2 dose: RP2D) in patients with lymphoid malignancies.
II. To describe the toxicities of MLN8237 when given in combination with vorinostat on a
III. To determine any clinical responses with MLN8237 in combination with vorinostat.
IV. To compare the plasma pharmacokinetics of MLN8237 when given alone and in combination
V. To perform immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH)
analysis to determine aurora kinase A (AURKA) expression in archival formalin-fixed
paraffin-embedded sections from the most recent available tumor specimens of patients.
VI. To perform correlative studies for apoptosis and proliferation on bone marrow and lymph
node specimens, where available, obtained from patients in the expanded cohort at RP2D.
OUTLINE: This is a dose-escalation study of alisertib.
Patients receive alisertib orally (PO) twice daily (BID) on days 1-7 or days 1-3 and 8-10,
and vorinostat PO BID on days 1-14 or days 1-5 and 8-12. Courses repeat every 21 days in the
absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up for at least 30 days.
SWOG-S0910: A Phase II Study of Epratuzumab (NSC-716711) in Combination with Cytarabine and Clofarabine for Patients with Relapsed or Refractory Ph-Negative Precursor B-cell Acute Lymphoblastic Leukemia (ALL)
- To test whether the complete remission (CR) rate (CR and incomplete CR) in adult
patients with relapsed or refractory precursor B-cell acute lymphoblastic leukemia is
sufficiently high after treatment with cytarabine, clofarabine, and epratuzumab to
warrant further investigation.
- To estimate the frequency and severity of toxicities associated with the dosing
schedule of cytarabine, clofarabine, and epratuzumab used in this study.
- To investigate, preliminarily, the effect of laboratory correlates (minimal
post-treatment residual disease) and cytogenetic factors on prognosis in this patient
population. (Not reported here due to limited MRD data)
OUTLINE: This is a multicenter study.
Patients receive cytarabine IV over 2 hours on days 1-5, clofarabine IV over 1 hour on days
2-6, and epratuzumab IV over at least 1 hour on days 7, 14, 21, and 28 in the absence of
disease progression or unacceptable toxicity*.
NOTE: * Prophylactic intrathecal methotrexate is required for patients < 22 years of age,
and is recommended (but not required) for patients ≥ 22 years of age.
Blood samples, bone marrow samples, and/or tumor tissue samples may be collected for further
Patients are followed up every 3 months for 2 years, then annually for 3 years (until 5
years after registration).
9L-15-5 A PhII-134, Randomized Phase II Study to Assess the Role of Nivolumab as Single Agent to Eliminate Minimal Residual Disease and Maintain Remission in Acute Myelogenous Leukemia (AML) Patients After Chemotherapy
I. To evaluate and compare the progression free survival rate after randomization in the two
treatment arms (nivolumab versus [vs.] observation).
I. To determine and compare the overall survival rates in the two arms. II. To determine and
compare the incidence of non-relapse mortality in the two arms.
III. To evaluate the toxicities of nivolumab as maintenance.
I. To analyze programmed cell death (PD)-ligand (L)1 expression on acute myeloid leukemia
(AML) cells from peripheral blood and/or bone marrow samples at diagnosis if available and
at the time of study enrollment.
II. To monitor AML minimal residual disease (MRD) by Wilms tumor 1 (WT1) polymerase chain
reaction (PCR) at enrollment and at subsequent defined time points in the nivolumab-treated
and control groups.
III. To perform an exploratory analysis on the frequencies, absolute numbers and subsets of
T cells (including regulatory T cells) in the nivolumab-treated and control groups with an
emphasis on activation markers.
IV. To perform deep sequencing of T cell receptor (TCR)-alpha and TCR-beta chains on
polyclonal T cells at baseline and at subsequent time points in the nivolumab and control
OUTLINE: Patients are randomized to 1 of 2 treatment arms.
ARM I: Patients receive nivolumab intravenously (IV) over 60 minutes once every 2 weeks.
Treatment repeats every 2 weeks for 46 courses in the absence of disease progression or
ARM II: Patients undergo standard of care clinical observation for up to 2 years. Upon
disease relapse, patients may cross-over to Arm I.
After completion of study treatment, patients are followed up for 2 years.
9L-15-9: A Phase 3, multicenter, open-label, Randomized study comparing the efficacy and safety of AG -221 (CC-90007) versus conventional care regimens in older subjects with late stage acute myeloid leukemia harboring an isocitrate dehydrogenase 2 mutation
Acute myeloid leukaemia (AML) is a form of cancer that is common in older patients.
Mutations in the isocitrate dehydrogenase enzyme 2 (IDH2) have been found in approximately
15% of patients with AML.
The outcome of first line chemotherapy treatment is poor and many patients fail to attain
complete remission (CR, ie refractory) or will eventually relapse. There is no single
standard of care for relapsed or refractory AML. Since the prognosis is very poor there is a
great need for new therapies.
Inhibition of IDH2 mutations may represent a promising targeted therapy for AML. AG-221 is
designed to only block the IDH2 mutations. Data from the ongoing first-in-human study has
shown AG-221 to be generally well tolerated and demonstrated CR in patients with IDH2
mutation positive relapsed or refractory AML.
The study purpose is to test the safety and efficacy of AG-221 compared with conventional
care regimens (CCR), which include best supportive care (BSC) only, azacitidine plus BSC,
low-dose cytarabine plus BSC or intermediate-dose cytarabine plus BSC, in patients with late
stage AML refractory to or relapsed after second or third line therapy and positive for the
IDH2 mutation. Patients will be randomly assigned to receive open-label tablets of AG-221 or
one of the CCR on continuous 28-day treatment cycles. The trial duration is expected to be
28 months which includes 24 months enrollment, approximately 4 months treatment and a
Study procedures include: vital signs, physical exams, ECGs, ECHO, urine/blood samples, bone
marrow aspirates and/or biopsies and peripheral blood to test for IDH2 and assess treatment
response. Bone marrow, blood, cheek swab samples will be used for genetic tests.
This study is being sponsored by Celgene Corporation. Approximately 280 participants will
take part in the study.
9L-14-3: A Phase 4 Safety And Efficacy Study Of Bosutinib (Bosulif) In Patients With Philadelphia Chromosome Positive Chronic Myeloid Leukemia Previously Treated With One Or More Tyrosine Kinase Inhibitors
The study drug, bosutinib is a tyrosine kinase inhibitor (TKI) that has been approved for the treatment of adult patients with Philadelphia chromosome positive chronic phase chronic myelogenous leukemia (CML) previously treated with other TKI therapy. CML is the fourth most commonly occurring adult leukemia. The transformation of CML from a deadly cancer to a chronic illness that took place over the last decade has been to the development of TKIs (inhibitors of the kinase activity of BCR-ABL1). The purpose of this phase 4 study is to fulfill the post-authorization commitment made by Pfizer to the European Medicines Agency in providing additional safety and efficacy data in approximately 150 Ph+ CML patients with high unmet medical need, including 75 chronic phase (CP), accelerated phase( AP) or BP(blastic phase) participants in the 4th or later line treatment setting. The primary objectives of this study are to estimate the 1-year (Week 52) probability of cumulative Major Cytogenetic Response (MCyR) in CP Ph+ CML patients with 1 or 2 prior lines of TKI therapy or 3 or more prior lines of TKI therapy. And to estimate the 1-year (Week 52) probability of cumulative confirmed Overall Hematological Response (OHR) in AP and BP Ph+ CML patients with any prior TKI therapy.This is a single-arm, open-label, non-randomized, multi-center Phase 4 study to evaluate bosutinib (Bosulif ) in patients with CP/AP/BP Ph+ CML whose disease has failed prior treatment with commercially available TKIs due to drug resistance or intolerance, or are otherwise contraindicated for treatment with commercially available TKIs such as imatinib, dasatinib, or nilotinib.Participants will receive bosutinib for at least 4 years from the time of first dose. Participants discontinuing bosutinib before completing at least 4 years of therapy will be followed for survival until they complete at least 4 years on study. Participants completing at least 4 years of bosutinib with continued benefit may be switched to commercially available therapy at that time. During the first 3 months of study, disease assessments will be performed weekly during the first month, then approximately every 4 weeks until Week 13. Assessments will then be performed every 3 months until Week 52, then at 6 month intervals during year 2, 3, and 4 of treatment.This study does not include any formal sample size determination. All treated Ph+ participants will be included in the efficacy analyses. Analyses will be presented by disease stage and/or line of therapy. The exploratory time-to-event endpoints of OS and PFS will be summarized using the Kaplan-Meier method or by cumulative incidence, whichever is more appropriate.
9L-11-8: HLA-mismatched allogeneic cellular therapy (HMMACT) after Chemotherapy in High Risk Acute Myeloid Leukemia
There have been no major new drugs for acute leukemia in 30 years. There are approximately 12,000 new cases of Acute myeloid leukemia in the US per year, and allogeneic stem cell transplant may cure 35-50% of these cases.It is believed that HLA-mismatched allogeneic cellular therapy (HMMACT) harnesses a powerful immunologic tool for achieving complete remission in acute leukemias without fewer risks of transplantation or limitations as nearly all patients will have an available donor.The primary objective of this study is to assess the feasibility of cytarabine based chemotherapy and HLA-mismatched allogeneic cellular therapy (HMMACT) in patients with high risk AML, with feasibility measured by induction mortality (IM) and complete response rate.Eligible AML patients will receive induction chemotherapy with mitoxantrone (IV, 3 days) and cytarabine (IV, 7 days) and receive HLA-mismatched G-PBSCs on day 9 or 10. Family donors will concurrently be HLA typed and best available donor will undergo donor screening.This is a Pilot/Feasability study. The primary measures of feasibility will be (1) induction mortality (IM) and (2) complete remission (CR or CRi). Secondary assessments of feasibility will involve safety as measured by the occurrence of serious infections (Grade 4), time to recovery of absolute neutrophil counts and platelets, and incidence of graft versus host disease (GvHD). An additional assessment of feasibility will be the ability to identify a suitable donor in this elderly population. It is expected that between 60% and 80% patients will have a suitable donor; therefore it is anticipated (assuming that only 60% of patients have a donor) that 33-35 patients will be initially recruited to the trial. The number of 20 patients (who actually receive a stem cell infusion) was selected to permit preliminary estimates of toxicities, CRR, EFS and OS. Standard errors (based on 20 patients) for the proportion of patients who experience a CR or IM or GvHD will be 0.11.Follow-up for survival will be done monthly for 3 years or until death. Those no longer followed at our center would be followed by phone call follow-up by the research RN.