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A Phase II Study of Initial Treatment With Methotrexate in Large Granular Lymphocytic (LGL) Leukemia


Phase 2
18 Years
N/A
Not Enrolling
Both
Leukemia

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Trial Information

A Phase II Study of Initial Treatment With Methotrexate in Large Granular Lymphocytic (LGL) Leukemia


LGL leukemia is characterized by clonal expansion of cytotoxic T cells. Prominent clinical
features include neutropenia, anemia, and rheumatoid arthritis. The terminal effector memory
phenotype (CD3+/CD8+/CD57+/CD45RA+/CD62L-) of leukemic LGL suggest a pivotal chronic antigen
driven immune response. LGL survival is then promoted by PDGF and IL-15, resulting in global
dysregulation of apoptosis and resistance to normal pathways of activation-induced death.
These pathogenic features explain why treatment of LGL leukemia is based on
immunosuppression therapy. However, no standard therapy has been established due to the
absence of large prospective trials.

Oral low dose MTX has been shown to be efficacious in the treatment of neutropenia. However,
response to MTX is slow, requiring several months for the neutrophil count to increase above
500/mm3. Also, complete clinical remission may not be achieved until after one year of MTX
therapy. Oral Cy has been the primary drug used for the treatment of severe
transfusion-dependent anemia. Beneficial clinical effects are seen despite this treatment
having no apparent effect on the abnormal LGL clone. Normal hematocrits are maintained after
cessation of Cy and these results contrast the effects seen with MTX, in which clinical
remissions are often associated with the disappearance of the clone.

This phase II trial undertaken by the Eastern Cooperative Group (ECOG) was initiated to
investigate the mechanism of treatment response in patients with LGL leukemia, who need
treatment for anemia or neutropenia.

Inclusion Criteria


Inclusion:

- Phenotypic studies from peripheral blood showing CD3+, CD57+ cells greater than
400/mm3 or CD8+ cells greater than 650/mm3 within eight weeks prior to registration

- Evidence for clonal T-cell receptor gene rearrangement within one year prior to
registration

- At least one of the following: Severe neutropenia less than 500/mm3, neutropenia
associated with recurrent infections, symptomatic anemia, or transfusion-dependent
anemia

- Bilirubin ≤ 2.0 mg/dl, SGOT(AST) ≤ 1.5 times normal, and Creatinine ≤ 2.0 mg/dl
within 4 weeks prior to registration

- ECOG performance status of 0-2

- At least 18 years of age

- Written informed consent

Exclusion:

- Prior therapy with oral MTX or oral Cy

- Previous or concurrent malignancies except inactive non-melanoma skin cancer, in situ
carcinoma of the cervix, or other cancer if the patient has been disease free for
over 5 years

- Pregnant or breast-feeding for female patients

- Serious medical illness, other than that treated by the study, which would limit
survival to less than 2 years, or psychiatric condition which would prevent informed
consent

Note: to be eligible for step 2 of this study, patients were required to have no response
after at least 4 months of methotrexate treatment.

Type of Study:

Interventional

Study Design:

Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Complete, Partial, and Overall Response Rates of Treatment With MTX, and Also With CY for Patients Failing to Respond to MTX

Outcome Description:

We will report the overall response rate below. Complete remission requires that all of the following be present for at least four weeks: The patient must have a normal CBC including neutrophil count > 1500/mm3, lymphocyte count< 4000/mm3, hemoglobin > 11 g/dl, and platelet count > 100,000/mm3. In addition, the patient must have a normal LGL count. A complete response will be attained if CD8+ cells were less than 760/mm³. A partial response will be defined as achievement of any one of the following in the absence of CR. The response must last for at least four weeks:In patients being treated for severe neutropenia (less than 500 neutrophils/mm3) an improvement to over 500 neutrophils/mm3 will be considered a partial response, as long as that improvement represents at least a 50% impr

Outcome Time Frame:

Assessed during the first 4 months, then at least every three months for two years. Then every six months until five years after study entry, and every 12 months thereafter until full study stop date.

Safety Issue:

No

Principal Investigator

Thomas P. Loughran, MD

Investigator Role:

Study Chair

Investigator Affiliation:

Milton S. Hershey Medical Center

Authority:

United States: Federal Government

Study ID:

CDR0000067089

NCT ID:

NCT00003910

Start Date:

July 1999

Completion Date:

March 2012

Related Keywords:

  • Leukemia
  • stage I chronic lymphocytic leukemia
  • stage II chronic lymphocytic leukemia
  • stage III chronic lymphocytic leukemia
  • stage IV chronic lymphocytic leukemia
  • T-cell large granular lymphocyte leukemia
  • LGL clone
  • Leukemia
  • Leukemia, Lymphoid

Name

Location

CCOP - Carle Cancer Center Urbana, Illinois  61801
CCOP - Metro-Minnesota Saint Louis Park, Minnesota  55416
Aurora Presbyterian Hospital Aurora, Colorado  80012
Boulder Community Hospital Boulder, Colorado  80301-9019
Penrose Cancer Center at Penrose Hospital Colorado Springs, Colorado  80933
CCOP - Colorado Cancer Research Program Denver, Colorado  80224-2522
Porter Adventist Hospital Denver, Colorado  80210
Presbyterian - St. Luke's Medical Center Denver, Colorado  80218
St. Joseph Hospital Denver, Colorado  80218
Rose Medical Center Denver, Colorado  80220
Swedish Medical Center Englewood, Colorado  80110
St. Mary's Regional Cancer Center at St. Mary's Hospital and Medical Center Grand Junction, Colorado  81502
Sky Ridge Medical Center Lone Tree, Colorado  80124
Hope Cancer Care Center at Longmont United Hospital Longmont, Colorado  80502
St. Mary - Corwin Regional Medical Center Pueblo, Colorado  81004
North Suburban Medical Center Thornton, Colorado  80229
Rush-Copley Cancer Care Center Aurora, Illinois  60507
Evanston Northwestern Healthcare - Evanston Hospital Evanston, Illinois  60201-1781
Joliet Oncology-Hematology Associates, Limited - West Joliet, Illinois  60435
Carle Cancer Center at Carle Foundation Hospital Urbana, Illinois  61801
Methodist Cancer Center at Methodist Hospital Indianapolis, Indiana  46202
Saint Anthony Memorial Health Centers Michigan City, Indiana  46360
Mercy Medical Center - Sioux City Sioux City, Iowa  51104
Siouxland Hematology-Oncology Associates, LLP Sioux City, Iowa  51101
St. Luke's Regional Medical Center Sioux City, Iowa  51104
Bronson Methodist Hospital Kalamazoo, Michigan  49007
West Michigan Cancer Center Kalamazoo, Michigan  49007-3731
Borgess Medical Center Kalamazooaa, Michigan  49001
Fairview Ridges Hospital Burnsville, Minnesota  55337
Mercy and Unity Cancer Center at Mercy Hospital Coon Rapids, Minnesota  55433
Fairview Southdale Hospital Edina, Minnesota  55435
Mercy and Unity Cancer Center at Unity Hospital Fridley, Minnesota  55432
Hutchinson Area Health Care Hutchinson, Minnesota  55350
Meeker County Memorial Hospital Lichfield, Minnesota  55355
Minnesota Oncology Hematology, PA - Maplewood Maplewood, Minnesota  55109
HealthEast Cancer Care at St. John's Hospital Maplewood, Minnesota  55109
Hennepin County Medical Center - Minneapolis Minneapolis, Minnesota  55415
Virginia Piper Cancer Institute at Abbott - Northwestern Hospital Minneapolis, Minnesota  55407
Hubert H. Humphrey Cancer Center at North Memorial Outpatient Center Robbinsdale, Minnesota  55422-2900
St. Francis Cancer Center at St. Francis Medical Center Shakopee, Minnesota  55379
HealthEast Cancer Care at St. Joseph's Hospital St Paul, Minnesota  55102
Park Nicollet Cancer Center St. Louis Park, Minnesota  55416
Regions Hospital Cancer Care Center St. Paul, Minnesota  55101
United Hospital St. Paul, Minnesota  55102
Ridgeview Medical Center Waconia, Minnesota  55387
Minnesota Oncology Hematology, PA - Woodbury Woodbury, Minnesota  55125
HealthEast Cancer Care at Woodwinds Health Campus Woodbury, Minnesota  55125
Aultman Cancer Center at Aultman Hospital Canton, Ohio  44710-1799
St. Rita's Medical Center Lima, Ohio  45801
Penn State Cancer Institute at Milton S. Hershey Medical Center Hershey, Pennsylvania  17033-0850
Medical College of Wisconsin Cancer Center Milwaukee, Wisconsin  53226
Froedtert Hospital and Medical College of Wisconsin Milwaukee, Wisconsin  53226-3596
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Baltimore, Maryland  21231-2410
Medical Center of Central Georgia Macon, Georgia  31201
Lewistown Hospital Lewistown, Pennsylvania  17044
Mount Nittany Medical Center State College, Pennsylvania  16803
North Colorado Medical Center Greeley, Colorado  80631
McKee Medical Center Loveland, Colorado  80539
Gundersen Lutheran Center for Cancer and Blood La Crosse, Wisconsin  54601
Robert H. Lurie Comprehensive Cancer Center at Northwestern University Chicago, Illinois  60611
Fox Chase Cancer Center - Philadelphia Philadelphia, Pennsylvania  19111-2497
North Shore Oncology and Hematology Associates, Limited - Libertyville Libertyville, Illinois  60048
St. Anthony Central Hospital Denver, Colorado  80204-1335
Exempla Lutheran Medical Center Wheat Ridge, Colorado  80033
Mercy Cancer Center at Mercy Medical Center - North Iowa Mason City, Iowa  50401
McFarland Clinic, PC Ames, Iowa  50010
McGlinn Family Regional Cancer Center at Reading Hospital and Medical Center Reading, Pennsylvania  19612-6052
Central Pennsylvania Hematology and Medical Oncology Associates, PC Lemoyne, Pennsylvania  17043