Combination Chemotherapy and Alemtuzumab in Treating Patients With Relapsed or Refractory Acute Lymphoblastic Leukemia

Study Overview
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Brief Summary
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This phase II trial is studying how well giving combination chemotherapy together with alemtuzumab works in treating patients with relapsed or refractory acute lymphoblastic leukemia. Drugs used in chemotherapy work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Giving more than one drug (combination chemotherapy) may kill more cancer cells. Monoclonal antibodies, such as alemtuzumab, can block cancer growth in different ways. Some block the ability of cancer cells to grow and spread. Others find cancer cells and help kill them or carry cancer-killing substances to them. Giving combination chemotherapy together with alemtuzumab may kill more cancer cells.

Detailed Description
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OBJECTIVES: I. Determine the complete response rate in patients with relapsed or refractory acute lymphoblastic leukemia treated with methotrexate, vincristine, asparaginase, and dexamethasone (MOAB) in combination with alemtuzumab. II. Determine disease-free and/or overall survival of patients treated with this regimen. III. Determine the toxic effects of this regimen in these patients. IV. Correlate the density of cluster of differentiation 52 (CD52) molecules on the surface of leukemic lymphoblasts with response in patients treated with this regimen. V. Correlate the presence of minimal residual disease at the time of maximal response to this regimen with overall outcome in these patients. OUTLINE: This is a multicenter study. The study had two steps. Step 1: 5 mg dose of Campath (alemtuzumab); Step 2: 10 mg dose of Campath. INDUCTION THERAPY: Patients receive methotrexate intravenously (IV) on day 1; vincristine IV and asparaginase intramuscularly (IM) on day 2; oral dexamethasone on days 1-10; and alemtuzumab subcutaneously (SC) on days 1, 4, and 7. Treatment repeats every 10 days for 6 courses in the absence of disease progression or unacceptable toxicity. Patients who achieve complete remission (CR) proceed to consolidation therapy. CONSOLIDATION THERAPY: Patients receive methotrexate IV on day 1 and asparaginase IM on day 2. Treatment repeats every 10 days for 6 courses in the absence of disease progression or unacceptable toxicity. Patients who remain in CR proceed to cytoreduction therapy. CYTOREDUCTION THERAPY: Patients receive vincristine IV and methotrexate IV over 6 hours on day 1; leucovorin calcium IV continuously over 24 hours on days 1 and 2 and then orally 4 times a day on day 3; and oral dexamethasone on days 2-6. Treatment repeats every 30 days for 12 courses in the absence of disease progression or unacceptable toxicity. Patients who remain in CR proceed to maintenance therapy. MAINTENANCE THERAPY: Patients receive oral mercaptopurine on days 1-30; oral methotrexate on days 1, 8, 15, and 22; vincristine IV on day 1; and oral dexamethasone on days 1-5. Treatment repeats every 30 days for 36 courses in the absence of disease progression or unacceptable toxicity. Patients are assessed every 3 months if patient is < 2 years from study entry and every 6 months if patient is 2-5 years from study entry. PROJECTED ACCRUAL: Allowing for two dose levels, a maximum of 48 patients may be accrued approximately in 30 months.

Official Title
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A Phase II Study of MOAD (Methotrexate, Vincristine, L-asparaginase and Dexamethasone) With Subcutaneous Campath for Adults With Relapsed or Refractory Acute Leukemia (ALL)

Conditions
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Recurrent Adult Acute Lymphoblastic Leukemia

Intervention / Treatment
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* Biological: alemtuzumab
* Drug: asparaginase
* Drug: methotrexate
* Drug: dexamethasone
* Drug: leucovorin calcium
* Drug: mercaptopurine
* Drug: vincristine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Refractory or relapsed acute lymphoblastic leukemia Must be in first relapse or have failed to achieve complete remission with 1 prior regimen Prior central nervous system (CNS) leukemia allowed provided cerebrospinal fluid is normal ECOG Performance status of 0-3 Bilirubin normal Creatinine normal Human immunodeficiency virus (HIV) negative Negative pregnancy test Fertile patients must use effective contraception Exclusion criteria: Hepatitis B positivity Bacterial or fungal infection Infection requiring treatment with antibiotics Active cytomegalovirus infection by molecular detection methods Known hypersensitivity to alemtuzumab or its components Pregnant or nursing Other malignancy within the past 5 years except adequately treated basal cell skin cancer or cervical carcinoma

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: Treatment (chemotherapy, enzyme inhibitor therapy)<br>INDUCTION THERAPY: Patients receive methotrexate IV; vincristine IV and asparaginase IM ; oral dexamethasone ; and alemtuzumab SC. CONSOLIDATION THERAPY: Patients receive methotrexate IV and asparaginase IM. CYTOREDUCTION THERAPY: Patients receive vincristine IV and methotrexate IV; leucovorin calcium IV; and oral dexamethasone. MAINTENANCE THERAPY: Patients receive oral mercaptopurine; oral methotrexate; vincristine IV; and oral dexamethasone. | Biological: alemtuzumab<br>* Given subcutaneously<br>* Other names: Monoclonal Antibody CD52;Drug: asparaginase<br>* Given IM<br>* Other names: L-ASP;Drug: methotrexate<br>* Given IV or orally<br>* Other names: MTX;Drug: dexamethasone<br>* Given orally<br>* Other names: DXM;Drug: leucovorin calcium<br>* Given IV<br>* Other names: LV;Drug: mercaptopurine<br>* Given orally<br>* Other names: MP;Drug: vincristine<br>* Given IV<br>* Other names: Vincasar PFS;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Complete Response Rate | Complete response requires that all of the following be present for at least four weeks. 1. Peripheral Blood Counts: Neutrophil count >= 1.0 x 109/L, Platelet count >= 100 x 109/L, Reduced hemoglobin concentration or hematocrit has no bearing on remission status, Leukemic blasts must not be present in the peripheral blood. 2 .Bone Marrow Aspirate and Biopsy: Cellularity of bone marrow biopsy must be > 20% with maturation of all cell lines, <= 5% blasts. 3. Extramedullary leukemia, such as CNS or soft tissue involvement, must not be present. | assessed before the first consolidation cycle and first cytoreduction cycle, before the first and after the last maintenance cycle; after discontinuing treatment, assessed every 3 months if < 2 years and every 6 months if 2-5 years from study entry | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Overall Survival | Time from registration to death from any cause. Patients alive were censored at follow up. | assessed every 3 months if patient is < 2 years from study entry and every 6 months if patient is 2-5 years from study entry | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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MOAD, Methotrexate, Vincristine, L-asparaginase, Dexamethasone, Subcutaneous Campath