Randomized Phase II Trial of Pentostatin, Cyclophosphamide, and Rituximab With or Without Concurrent Avastin® for Previously Untreated B-Chronic Lymphocytic Leukemia (CLL)
OBJECTIVES:
Primary
- To assess the rate of complete and overall response in patients with B-cell chronic
lymphocytic leukemia or small lymphocytic lymphoma treated with pentostatin,
cyclophosphamide, and rituximab with or without bevacizumab.
- To assess the proportion of patients who achieve a negative minimal residual disease
state after treatment with these regimens.
- To monitor and assess the adverse events of these regimens.
Secondary
- To determine if molecular prognostic parameters (ZAP-70, CD38, cytogenetic
abnormalities identified by FISH, and IgVH mutation status) relate to response in these
patients.
- To determine the progression-free survival of patients treated with these regimens.
- To complete additional correlative studies to gain insight into disease biology and how
it influences drug sensitivity.
OUTLINE: Patients are stratified according to Rai risk group (high [Rai stage III or IV] vs
low [Rai stage 0] or intermediate [Rai stage I or II]) and FISH prognosis group (favorable
[normal, +12, 13q-, or other] vs unfavorable [17p- or 11q-]). Patients are randomized to 1
of 2 treatment arms.
- Arm I: Patients receive bevacizumab IV over 30-90 minutes on day 1 of courses 1-5 and
on days 1, 22, and 43 of course 6; rituximab IV over 2-4 hours on days 2 and 3 of
course 1 and on day 1 of courses 2-6; and pentostatin IV over 30 minutes and
cyclophosphamide IV over 30 minutes on day 2 of course 1 and on day 1 of courses 2-6.
Patients also receive pegfilgrastim subcutaneously (SC) on day 3 of course 1 and on day
2 of courses 2-6. Treatment repeats every 21 days* for 6 courses in the absence of
disease progression or unacceptable toxicity.
NOTE: *Course 6 is 56 days in duration
- Arm II: Patients receive rituximab IV over 2-4 hours on days 1 and 2 of course 1 and on
day 1 of courses 2-6 and pentostatin IV over 30 minutes and cyclophosphamide IV over 30
minutes on day 1. Patients also receive pegfilgrastim SC on day 2. Treatment repeats
every 21 days* for 6 courses in the absence of disease progression or unacceptable
toxicity.
NOTE: *Course 6 is 56 days in duration
Patients undergo blood sample collection and bone marrow biopsy/aspiration periodically for
translational research studies. Samples are analyzed by flow cytometry for assessment of
minimal residual disease. Molecular prognostic markers (including CD38, ZAP-70, IgVH gene
mutation status, and cytogenetic abnormalities by FISH), Tcl-1 and CD49d protein expression,
and immunoglobulin heavy chain D and J family gene usage are also analyzed. Plasma samples
are stored for future studies evaluating levels of VEGF, bFGF, and thrombospondin by ELISA.
After completion of study therapy, patients are followed periodically for up to 5 years.
Interventional
Allocation: Randomized, Primary Purpose: Treatment
Complete response rate
No
Tait D. Shanafelt, MD
Study Chair
Mayo Clinic
United States: Food and Drug Administration
CDR0000630491
NCT00816595
June 2009
Name | Location |
---|---|
Mayo Clinic | Rochester, Minnesota 55905 |
Mayo Clinic in Arizona | Scottsdale, Arizona 85259-5404 |