A Trial of Rituximab Combined With Prednisone/Ifosfamide/Etoposide for Relapsed Acute Lymphoblastic Leukemia (ALL)
Rationale for study design:
The combination of etoposide and ifosfamide is a reinduction regimen used in many previous
studies for pediatric B lineage acute lymphoblastic leukemia (ALL). It does not use
anthracyclines, and therefore can be safely used in patients at risk for cardiac toxicity
due to previous anthracycline use.
Previous studies in adult patients with ALL have demonstrated safety and efficacy with the
addition of rituximab to other induction regimens. Rituximab is an anti-CD20 monoclonal
antibody. Approximately one-half of pediatric cases of B precursor ALL express the CD20
antigen on the leukemic blasts. The use of rituximab provides a potential target for CD20
positive cells, therefore improving the rates of cytotoxicity associated with the
chemotherapy. Rituximab has been previously utilized in many pediatric and adult regimens
in combination with other chemotherapeutic agents, and is expected to be safe with the
combination of etoposide and ifosfamide. However, since it has never been studied with this
combination of chemotherapy, strict stopping rules are in place to ensure that it is a safe
combination.
A recent study demonstrated upregulation of CD20 expression on leukemic blasts exposed to
one week of prednisone therapy. This increase in expression occurred in the majority of
B-ALL patient samples, regardless of whether the patient initially expressed CD20 on the
surface of the leukemic blasts. In those samples with upregulation of CD20 treated with
rituximab, cytotoxicity from rituximab was more successful than in samples with a smaller
percentage of CD20 expression.
Therefore, prednisone will be given for two weeks in combination with etoposide and
ifosfamide. It is hoped that the percentage of leukemic blasts expressing CD20 will
increase with this combination of medications, allowing the rituximab to be more effective
when given weekly starting on day 8 of therapy. To better understand this process, samples
of blood and bone marrow will be collected to quantify CD20 expression and the amount of
leukemia present at multiple time points during the month of study duration.
Interventional
Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
4 month Event Free Survival (EFS)
To estimate the 4 month EFS after therapy with rituximab and cytotoxic chemotherapy (prednisone/etoposide/ifosfamide) in patients with second relapse/refractory ALL.
one year after enrollment
No
Todd Cooper, DO
Principal Investigator
Emory University/Children's Healthcare of Atlanta
United States: Institutional Review Board
Rituximab
NCT01230788
September 2010
October 2012
Name | Location |
---|---|
Emory University | Atlanta, Georgia 30322 |
Children's Healthcare of Atlanta | Atlanta, Georgia 30342 |
The children's Mercy Hospital | Kansas City, Missouri 64108 |