Blinatumomab Consolidation Post Autologous Stem Cell Transplantation in Patients With Diffuse Large B-Cell Lymphoma (DLBCL)

Study Overview
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Brief Summary
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Based on the further need to improve progression-free survival (PFS) and overall survival (OS) post autologous stem cell transplant (SCT) for DLBCL, the hematopoietic profile of patients following auto-SCT, the activity of blinatumomab in DLBCL and its favorable toxicity profile, the investigators propose a pilot study to test blinatumomab as consolidation therapy post auto-SCT for patients with DLBCL. The investigators hypothesize the blinatumomab consolidation will optimize the effector to target (E-T) ratio and aid in the eradication of remaining tumor cells, leading to decreased relapse and increased overall survival. In addition, since tumor burden will be at a minimum, infusional toxicities including neurologic toxicities may also be limited. The purpose of this pilot study is to study the feasibility and tolerability of blinatumomab consolidation post auto-SCT for patients with chemo-sensitive DLBCL undergoing auto-SCT.

Official Title
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A Pilot Trial of Blinatumomab Consolidation Post Autologous Stem Cell Transplantation in Patients With DLBCL

Conditions
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Diffuse Large B Cell Lymphoma

Intervention / Treatment
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* Drug: Blinatumomab
* Procedure: Autologous stem cell transplant
* Drug: Carmustine
* Drug: Etoposide
* Drug: Cytarabine
* Drug: Melphalan
* Procedure: Peripheral blood draws


Participation Criteria
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Eligibility Criteria
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Pre-ASCT Inclusion Criteria At least 18 years of age Histologically confirmed diagnosis of CD19 positive diffuse large B-cell lymphoma (DLBCL) or transformed large cell lymphoma from low grade lymphoma. Chemo-sensitive (defined by complete remission (CR) or partial remission (PR) to most recent chemo regimen) based on pre-transplant positron emission tomography (PET) within 2 months of autologous transplant Patients with bulky disease are eligible for study provided that the patient not undergo radiation therapy until 30 days after the end of blinatumomab administration. Available representative tissue (from fresh or formalin fixed paraffin embedded tissue) from the most recent biopsy or archival tumor tissue for Clonotype evaluation for minimal residual disease (MRD) testing. Pre-ASCT Exclusion Criteria Chemo-resistant (defined by stable disease (SD) or progressive disease (PD) to most recent chemo regimen) Pregnant or breastfeeding Active central nervous system (CNS) involvement of Non-Hodgkin's Lymphoma (NHL) Clinically relevant CNS pathology such as epilepsy, childhood or adult seizure, paresis, aphasia, stroke, severe brain injuries, dementia, Parkinson's disease, cerebellar disease, organic brain syndrome, or psychosis Prior stem cell transplant Concurrent hematologic or non-hematologic malignancy requiring treatment HIV seropositive, or active Hepatitis A, B, or C infection. Uncontrolled congestive heart failure (CHF) or other comorbid systemic illnesses or severe concurrent disease which, in the judgment of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with the proper assessment of safety and toxicity of the prescribed regimens. Eligibility Criteria to Begin Consolidation Therapy A participant must meet all of the following criteria on Day +42 visit in order to continue on the study to begin consolidation therapy with blinatumomab. Performance status of Eastern Cooperative Oncology Group (ECOG) ≤ 2 or Karnofsky ≥ 60 % Absence of clinically relevant CNS pathology such as epilepsy, paresis, aphasia, stroke, sever brain injuries, dementia, or psychosis Required clinical laboratory values: Absolute neutrophil count (ANC) ≥ 1,000 Platelets ≥ 75,000 Hemoglobin ≥ 8 g/dL Total bilirubin ≤ 1.5 x upper limit of normal (ULN) (unless related to Gilbert's or Meulengracht's syndrome) Alkaline phosphatase ≤ 5 x ULN ALT and AST ≤ 5 x ULN Calculated or measured creatinine clearance ≥ 50ml/min

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: ASCT + BEAM + Blinatumomab<br>Standard of care ASCT with BEAM conditioning (carmustine/etoposide/cytarabine/melphalan) - guidelines below, other conditionings are allowed: carmustine is typically given intravenously (IV) at a dose of 300 mg/m^2 on Day -7 etoposide is typically given IV at a dose of 100 mg/m^2 twice per day (BID) on Days -6, -5, -4, and -3 (8 doses) cytarabine is typically given IV at a dose of 100 mg/m^2 BID on Days -6, -5, -4, and -3 (8 doses) melphalan is typically given IV at a dose of 140 mg/m*2 on Day -2 Auto-SCT will take place on Day 0 as per institutional guidelines Consolidation with blinatumomab will start 6 weeks following auto-SCT. Patients with CR or PR based on pre-transplant PET/CT will receive blinatumomab as a continuous IV infusion (CIVI) at 9μg/day for 1 week, then 28μg/day for 3 weeks (total of 4 weeks). | Drug: Blinatumomab<br>* -Blinatumomab is a bispecific T cell engaging antibody<br>* Other names: Blincyto;Procedure: Autologous stem cell transplant<br>* -Standard of care<br>* Other names: auto-SCT;Drug: Carmustine<br>* -Carmustine is an alkylating agent. It will be sourced from commercial supply. Institutional guidelines will be followed for storage, preparation, and administration of carmustine.<br>* Other names: BiCNU®;Drug: Etoposide<br>* -Etoposide is a semi-synthetic podophyllotoxin derivative. It will be sourced from commercial supply. Institutional guidelines will be followed for storage, preparation, and administration of etoposide.<br>* Other names: VP16;Drug: Cytarabine<br>* -Cytarabine, commonly known as Ara-C, is a synthetic nucleoside. It will be sourced from commercial supply. Institutional guidelines will be followed for storage, preparation, and administration of cytarabine.<br>* Other names: Cytosine arabinoside;Drug: Melphalan<br>* -Melphalan is an alkylating agent. It will be sourced from commercial supply. Institutional guidelines will be followed for storage, preparation, and administration of melphalan.<br>* Other names: Phenylalanine mustard;Procedure: Peripheral blood draws<br>* -Day +42, Day + 43, Day +56, and Day +100<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Feasibility and tolerability of blinatumomab consolidation post auto-SCT as measured by percentage of patients who can finish a full course of blinatumomab post-auto-SCT | -The primary endpoint is calculated by the proportion of patients who complete a full course of blinatumomab to the total number of patients started blinatumomab after auto-SCT. | Up to Day 70 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Progression-free survival (PFS) | -PFS is defined as from the date of Day 0 to date of progression or death, which occurs first. They are censored at the last follow-up otherwise. | 1 year post-auto-SCT | 
| Progression-free survival (PFS) | -PFS is defined as from the date of Day 0 to date of progression or death, which occurs first. They are censored at the last follow-up otherwise. | 3 years post-auto-SCT | 
| Overall survival | -OS is defined as from the date of Day 0 to date of death. They are censored at the last follow-up otherwise. | 1 year post-auto-SCT | 
| Overall survival | -OS is defined as from the date of Day 0 to date of death. They are censored at the last follow-up otherwise. | 3 years post-auto-SCT | 
| Complete remission rate in patients with residual disease after auto-SCT | -Complete remission=disappearance of all evidence of disease | Up to Day 100 |