S1312, Inotuzumab Ozogamicin and Combination Chemotherapy in Treating Patients With Relapsed or Refractory Acute Leukemia
Condition: Acute Leukemias of Ambiguous Lineage; B-cell Adult Acute Lymphoblastic Leukemia; Philadelphia Chromosome Positive Adult Precursor Acute Lymphoblastic Leukemia; Recurrent Adult Acute Lymphoblastic Leukemia; Recurrent Adult Burkitt Lymphoma
MeSH terms: Burkitt Lymphoma; Leukemia; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Leukemia, Lymphoid; Recurrence; Acute Disease; Philadelphia Chromosome
Intervention: cyclophosphamide; vincristine sulfate; prednisone; inotuzumab ozogamicin; laboratory biomarker analysis
Intervention description: Given IV; Given IV; Given PO; Given IV; Correlative studies
Intervention MeSH terms: Prednisone; Cyclophosphamide; Vincristine; Inotuzumab Ozogamicin
Phase: Phase 1
Study type: Interventional
Primary purpose: Treatment
Allocation: Non-Randomized
Intervention model: Sequential Assignment
Masking: None (Open Label)
Enrollment: 50.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No

Summary:

      This phase I trial studies the side effects and best dose of inotuzumab ozogamicin when given
      together with combination chemotherapy in treating patients with relapsed or refractory acute
      leukemia. Immunotoxins, such as inotuzumab ozogamicin, can find cancer cells that express
      cluster of differentiation (CD)22 and kill them without harming normal cells. Drugs used in
      chemotherapy, such as cyclophosphamide, vincristine sulfate, and prednisone, work in
      different ways to stop the growth of cancer cells, either by killing the cells or by stopping
      them from dividing. Giving inotuzumab ozogamicin together with combination chemotherapy may
      kill more cancer cells.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Patients must have a diagnosis of relapsed or refractory CD22-positive acute leukemia
             including B-ALL, mixed phenotype leukemia (biphenotypic), or Burkitt's leukemia based
             on World Health Organization (WHO) classification; patients with bilineal leukemia are
             excluded

          -  Patients must have evidence of acute leukemia in their peripheral blood or bone
             marrow; patients must have >= 5% blasts in the peripheral blood or bone marrow within
             14 days prior to registration; at least >= 20% of those blasts must be CD22-positive
             (surface) based on local immunophenotyping and histopathology

          -  Patients must be refractory or have relapsed following prior induction therapy; a
             standard induction regimen is defined as any program of treatment that includes
             vincristine and prednisone or dexamethasone, cytarabine/anthracycline, or high dose
             cytarabine

          -  For sites with the B1931022 pharmaceutical trial open, precursor B-cell ALL patients
             from that site may be eligible for S1312 providing they meet the following criteria:

               -  Patient is in second salvage or more; OR

               -  Patient was treated on the standard of care arm of B1931022 and failed therapy

          -  Patients may have received prior allogeneic transplant or autologous transplant;
             however, patients with prior allogeneic bone marrow transplant will be eligible only
             if both of the following conditions are met:

               -  The transplant must have been performed >= 90 days prior to registration

               -  The patient must not have >= grade 2 acute graft versus host disease (GvHD) or
                  either moderate or severe limited chronic GvHD within 14 days prior to
                  registration

          -  Patients known to have Philadelphia chromosome positive (Ph+) ALL must have either
             failed treatment or been intolerant to treatment with at least two second or third
             generation tyrosine kinase inhibitors

          -  Patients must not have received prior treatment with inotuzumab ozogamicin; previous
             treatment with other anti-CD22 antibodies must have been completed at least 90 days
             prior to registration

          -  Patients must have Zubrod performance status 0-2

          -  Patients must not have received any chemotherapy, investigational agents, or undergone
             major surgery within 14 days prior to registration with the following exceptions:

               -  Monoclonal antibodies must not have been received for 1 week prior to
                  registration

               -  Chimeric antigen receptor (CAR) T-cells must not have been received for 28 days
                  prior to registration.

               -  Steroids, hydroxyurea, vincristine, 6-mercaptopurine, methotrexate, thioguanine
                  and intrathecal chemotherapy are permitted within any time frame prior to
                  registration. FDA-approved TKIs may also be administered until 1 day prior to
                  start of study therapy (C1, D1).

               -  All drug-related toxicities must have resolved to =< grade 2

          -  Patients must not have a systemic bacterial, fungal, or viral infection that is not
             controlled (defined as exhibiting ongoing signs/symptoms related to the infection and
             without improvement despite appropriate antibiotics or other treatment)

          -  Patients must not have any other serious concurrent disease or have a history of
             serious organ dysfunction or disease involving the heart, kidney, liver, or other
             organ system that would put the patient at undue risk of undergoing therapy

          -  Patients must not have active central nervous system (CNS) involvement (by clinical
             evaluation); patients with previous documented history of CNS involvement of acute
             leukemia, or with clinical signs or symptoms consistent with CNS involvement of acute
             leukemia, must have a lumbar puncture which is negative for CNS involvement of acute
             leukemia; the lumbar puncture must be completed within 14 days prior to registration;
             patients with no previous history of documented CNS involvement and with no clinical
             signs or symptoms consistent with CNS involvement are not required to have completed a
             lumbar puncture before registration; note that treatment with intrathecal therapy is
             recommended during protocol treatment but CNS analysis during treatment is not
             required

          -  Patients must have a peripheral blast count < 25,000/uL within 2 days prior to
             registration; (treatment with hydroxyurea and steroids is permitted to bring the
             countdown)

          -  Patients must have serum creatinine =< 2 x institutional upper limits of normal (IULN)
             within 7 days prior to registration

          -  Patients must have bilirubin =< 2 x IULN within 7 days prior to registration (unless
             the bilirubin is primarily unconjugated)

          -  Patients must have < grade 2 neuropathy (sensory/motor) within 7 days prior to
             registration

          -  Patients must have serum glutamic oxaloacetic transaminase (SGOT) and serum glutamate
             pyruvate transaminase (SGPT) =< 2.5 x IULN within 7 days prior to registration

          -  Patients with a history of a serious allergic or anaphylactic reaction to humanized
             monoclonal antibodies are not eligible

          -  Patients must not have a history of chronic or active hepatitis B or C infection;
             patients must have negative hepatitis B and C serologies performed within 28 days
             prior to registration

          -  Patients must not have evidence or history of veno-occlusive disease or sinusoidal
             obstruction syndrome

          -  Patients must not have a cardiac ejection fraction < 45% or the presence of New York
             Heart Association stage III or IV heart failure within 14 days prior to registration;
             either echocardiogram (ECHO) or multiple-gated acquisition scan (MUGA) may be used to
             determine ejection fraction

          -  Patients must not have a myocardial infarction within 6 months prior to registration

          -  Patients must not have a history of clinically significant arrhythmia, prolonged
             corrected QT (QTc) interval, or unexplained syncope not thought to be vasovagal in
             nature within 6 months prior to registration

          -  Patients must not have a screening corrected QT using Fridericia's formula (QTcF)
             interval > 500 milliseconds (by Fridericia calculation) based on the average of
             triplicate electrocardiogram (EKG) performed within 7 days prior to registration; note
             that triplicate EKG is required at other timepoints

          -  Patients must not have a history of chronic liver disease (or cirrhosis)

          -  Patients who are known to be human immunodeficiency virus (HIV)+ are eligible
             providing they meet all of the following additional criteria within 28 days prior to
             registration:

               -  CD4+ cells >= 350/mm^3 (nadir)

               -  Viral load of < 50 copies HIV messenger ribonucleic acid (mRNA)/mm^3 if on
                  combination antiretroviral therapy (cART) or < 25,000 copies HIV mRNA if not on
                  cART

               -  No zidovudine or stavudine as part of cART Patients who are HIV+ and do not meet
                  all of these criteria are not eligible for this study

          -  Patients with evidence of extramedullary disease at diagnosis will have computed
             tomography (CT) scan of the chest, abdomen and pelvis to obtain baseline values within
             28 days prior to registration

          -  Patients must have complete history and physical examination within 28 days prior to
             registration

          -  Patients must not be pregnant or nursing; women/men of reproductive potential must
             have agreed to use an effective contraceptive method; a woman is considered to be of
             "reproductive potential" if she has had menses at any time in the preceding 12
             consecutive months; in addition to routine contraceptive methods, "effective
             contraception" also includes heterosexual celibacy and surgery intended to prevent
             pregnancy (or with a side-effect of pregnancy prevention) defined as a hysterectomy,
             bilateral oophorectomy or bilateral tubal ligation; however, if at any point a
             previously celibate patient chooses to become heterosexually active during the time
             period for use of contraceptive measures outlined in the protocol, he/she is
             responsible for beginning contraceptive measures

          -  Prior malignancy other than acute leukemia is allowed, provided it is in remission and
             there is no plan to treat the malignancy at the time of registration

          -  Pretreatment cytogenetics must be performed on all patients; collection of
             pretreatment specimens must be completed within 14 days prior to registration to
             S1312; specimens must be submitted to the site's preferred Clinical Laboratory
             Improvement Amendments (CLIA)-approved cytogenetics laboratory; reports of the results
             must be submitted as described; note that cytogenetics are required at other time
             points

          -  Patients or their legally authorized representative must be informed of the
             investigational nature of this study and must sign and give written informed consent
             in accordance with institutional and federal guidelines

          -  As a part of the OPEN registration process the treating institution's identity is
             provided in order to ensure that the current (within 365 days) date of institutional
             review board approval for this study has been entered in the system

          -  Patients planning to enroll in this study must first have a slot reserved in advance
             of the registration; all site staff will use OPEN to create a slot reservation