A Phase I-II Study of Oxaliplatin, Fludarabine, Cytarabine, and Rituximab in Patients With Richter's Transformation, Prolymphocytic Leukemia, Aggressive, Relapsed or Refractory B-Cell Chronic Lymphocytic Leukemia
Cytarabine is designed to insert itself into DNA (the genetic material of cells) and stop
the DNA from repairing itself.
Oxaliplatin is designed to kill cancer cells by damaging their DNA.
Fludarabine is designed to make cancer cells less able to repair damaged DNA. This may
increase the likelihood of the cells dying.
Rituximab is designed to attach to lymphoma cells, which may cause them to die.
Before you can start treatment on this study, you will have "screening tests." The
following tests will help the doctor decide if you are eligible to take part in this study:
You will have a complete physical exam. Blood (about 2 teaspoons) will be drawn for routine
tests. This routine blood draw will include a pregnancy test for women who are able to have
children. To be eligible to take part in this study, the pregnancy test must be negative.
A bone marrow biopsy/aspirate will be collected. To collect a bone marrow biopsy/aspirate,
an area of the hip or chest bone is numbed with anesthetic and a small amount of bone marrow
is withdrawn through a large needle.
During the Phase I portion of the study, researchers will be testing different doses of the
study drug combination. Oxaliplatin and rituximab will be given at the same dose level.
However, fludarabine and cytarabine will be given daily for 2 days to the first 3
participants, daily for 3 days to the next 3 participants, and daily for 4 days to the next
3 participants. Although the plan is to treat 3, up to 6 participants may be treated in
each of these groups.
If participants who receive the fludarabine and cytarabine for 2 or 3 days do not experience
intolerable side effects, after the second cycle they may receive the next higher dose (an
additional day of fludarabine and cytarabine) for the following cycles.
Once the highest tolerated dose of fludarabine and cytarabine given in combination with
oxaliplatin and rituximab is found, the next group of participants entering the study will
take part in the Phase II portion of the study. Participants in the Phase II portion will
receive the study drugs at the highest tolerated dose found in the Phase I portion of the
study. The goal of this part of the study is to look at how effective the drug combination
is in treating patients with Richter's syndrome, prolymphocytic leukemia, and aggressive,
relapsed, or refractory CLL. The same dose levels for all 4 drugs will be used throughout
the Phase II portion of the study, unless intolerable side effects occur. In that case, the
dose may be lowered or the treatment may be stopped.
Each cycle will be repeated every 4-6 weeks, depending on your blood counts and your medical
You will receive oxaliplatin through a needle in your vein over about 2 hours on Days 1-4 of
every 28-day study "cycle."
You will receive rituximab by vein over about 4-6 hours on Day 3 of the first cycle and on
Day 1 on every cycle after that.
Starting on Day 2, you will receive fludarabine by vein over about 30 minutes and cytarabine
by vein over about 2 hours for 2, 3, or 4 days.
On Day 6, you will receive peg-filgrastim subcutaneously (through a needle just under your
skin) to help increase your white blood cell count.
On the days that you receive the study drugs, you will also be given fluids (such as saline)
by vein to keep you from becoming dehydrated. If you receive the treatment as an outpatient,
this means that the visit may take up to 8 hours.
Additional drugs will be given before each dose of rituximab to lower the risk of side
effects. If side effects do occur, rituximab may have to be stopped until the side effects
go away, at which point the drug may be restarted. This may make your time in the
outpatient area longer.
The first study cycle will be given at M.D. Anderson. Depending on your response, up to 5
more cycles will be given either at M.D. Anderson or at home with your regular doctor.
Every 1-2 weeks, blood samples (about 1 teaspoon each) will be drawn for routine tests.
At the end of every cycle, you will have a physical exam and blood (about 1 teaspoon) will
be drawn to determine whether you should receive another cycle.
You will have a bone marrow biopsy/aspirate at the end of the 3rd and 6th cycles. The
biopsy at the end of cycle 3 will be used to determine if you are responding to treatment
and will determine whether you should continue to receive the study drug combination.
You may remain on study for up to 6 cycles. You will be taken off-study early if the
disease gets worse or intolerable side effects occur.
Once you are no longer receiving treatment, you will have an end-of-treatment visit. At
this visit, you will have a physical exam and blood (about 1 teaspoon) will be drawn for
If you achieve remission, after your last cycle is complete, you will have blood drawn
(about 2 teaspoons each) every 3 months for routine tests. These tests will continue for as
long as you are in remission.
This is an investigational study. Fludarabine, cytarabine, oxaliplatin, and rituximab are
all FDA approved and commercially available. The use of these drugs together is
investigational. Up to 102 patients will take part in this multicenter study. Up to 90 will
be enrolled at M.D. Anderson.
Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Phase 1: Maximum tolerated dose (MTD)
Evaulation each 4 week cycle
William G. Wierda, M.D., PhD
M.D. Anderson Cancer Center
United States: Institutional Review Board
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