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NCT02003222 · CITED IN SOURCE DOCUMENTS

Combination Chemotherapy With or Without Blinatumomab in Treating Patients With Newly Diagnosed BCR-ABL-Negative B Lineage Acute Lymphoblastic Leukemia

An NCI or FDA source cites this study. A citation does not establish that it applies to an individual diagnosis.

Phase
PHASE3
Status at capture
ACTIVE NOT RECRUITING
Registry last update
2026-08-04

This randomized phase III trial studies combination chemotherapy with blinatumomab to see how well it works compared to induction chemotherapy alone in treating patients with newly diagnosed breakpoint cluster region (BCR)-c-abl oncogene 1, non-receptor tyrosine kinase (ABL)-negative B lineage acute lymphoblastic leukemia. Drugs used in chemotherapy work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Immunotherapy with monoclonal antibodies, such as blinatumomab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. It is not yet known whether combination chemotherapy is more effective with or without blinatumomab in treating newly diagnosed acute lymphoblastic leukemia.

Open the original ClinicalTrials.gov record → · Download preserved record

What did the study report?

Outcomes, safety and baseline populations are separate source sections. Quality-of-life measures appear under their original outcome titles.

flow

Participant flow

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baseline

Baseline characteristics

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outcome · POSTED

Overall Survival (OS) Among Patients Who Were MRD Negative After Induction and Intensification Chemotherapy

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outcome · POSTED

Relapse-free Survival (RFS) Among Patients Who Were MRD Negative After Induction and Intensification Chemotherapy

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outcome · POSTED

RFS Among of Those Who Are MRD+ at Randomization and Then Convert to MRD- After 2 Cycles of Blinatumomab to Those Patients Who Are MRD- at Randomization and Remain MRD- After 2 Cycles of Blinatumomab or Consolidation Chemotherapy

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outcome · POSTED

OS Among of Those Who Are MRD+ at Randomization and Then Convert to MRD- After 2 Cycles of Blinatumomab to Those Patients Who Are MRD- at Randomization and Remain MRD- After 2 Cycles of Blinatumomab or Consolidation Chemotherapy

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outcome · POSTED

OS Among MRD Negative Patients Who Proceed to Allogeneic Transplant on Study

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outcome · NOT POSTED

To Determine Differences in MRD Kinetics Among Patients With the BCR/ABL1-like B-lineage ALL, and to Compare the OS (and RFS) of Patients With BCR-ABL-like Phenotype With Those Without BCR-ABLlike Phenotype

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outcome · NOT POSTED

Incidence of Anti-blinatumomab Antibody Formation

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adverse events

Adverse events

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more info

Limitations, agreements, and source contact

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Who could take part
eligibility Criteria
Inclusion Criteria: * PRE-REGISTRATION * Diagnostic bone marrow and/or peripheral blood specimens must be submitted for immunophenotyping and selected molecular testing, and the establishment of BCR/ABL status; testing will be performed by the Eastern Cooperative Oncology Group (ECOG)-American College of Radiation Imaging Network (ACRIN) Leukemia Translational Research Laboratory (LTRL) and reported to the institution * NOTE: IT IS ESSENTIAL THAT A SAMPLE CONTAINING SUFFICIENT BLAST CELLS BE SUBMITTED TO THE ECOG-ACRIN LTRL AT BASELINE SO THAT SUBSEQUENT BONE MARROW ASSESSMENTS OF MRD CAN BE DONE; IN ADDITION TO ALLOWING THE LTRL TO CONFIRM ELIGIBILITY BASED ON BLAST CELL IMMUNOPHENOTYPE AND BCR/ABL STATUS, IT IS ALSO IMPERATIVE THAT AN ADEQUATE NUMBER OF BLASTS BE BANKED FOR ANALYSIS BY DRS MULLIGHAN/WILLMAN. WITHOUT ADEQUATE BASELINE SAMPLES, PATIENTS WILL NOT BE ABLE TO BE TREATED AND RANDOMIZED ON THIS PROTOCOL; IF A BONE MARROW ASPIRATE IS NOT AVAILABLE FOR LTRL SUBMISSION AT BASELINE, IT IS IMPERATIVE THAT DR PAIETTA FROM THE LTRL IS CALLED TO DISCUSS THE PERIPHERAL BLOOD WHITE BLOOD CELL (WBC) AND BLAST COUNT BEFORE BLOOD ONLY IS SUBMITTED * NOTE: Hydroxyurea can be given for up to 5 days prior to initiation of protocol therapy for control of leukocyte count and/or other symptoms or signs; corticosteroids can be given after pre-registration to the protocol and submission of baseline marrow and blood samples for control of leukocyte count and/or other symptoms or signs prior to initiation of protocol therapy if needed; if corticosteroids are given prior to pre-registration, contact the study chair as the patient may still be eligible to participate * INDUCTION ELIGIBILITY CRITERIA-STEP 1 * Age \>= 30 years and =\< 70 years * New diagnosis of B lineage ALL must be made upon bone marrow or peripheral blood immunophenotyping; cases with myeloid antigen expression, but unequivocal lymphoid immunophenotype, are eligible * Negativity for the Philadelphia chromosome must be established by conventional cytogenetics, fluorescence in situ hybridization (FISH) and/or polymerase chain reaction (PCR); patients who are negative for the Philadelphia chromosome by conventional cytogenetics must have FISH or PCR performed for BCR/ABL to exclude occult translocations * Cytogenetic analysis must be performed from diagnostic bone marrow (preferred) or if adequate number of circulating blasts from peripheral blood; FISH testing for common B-lineage ALL abnormalities including t(9;22) (BCR/ABL1), t(12;21) (ETS-variant gene 6 \[ETV6\]/runt-related transcription factor 1 \[RUNX1\]), t(1;19) (pre-B-cell leukemia homeobox 1 \[PBX1\]/transcription factor 3 \[TCF3\]), +4,+10,+17, (centromeric \[Cen\]4/Cen10/Cen17), t(11q23;var), (myeloid/lymphoid or mixed lineage leukemia \[MLL\]), deletion (del)(9p) (cyclin-dependent kinase inhibitor 2A \[CDKN2A\]/Cen9), and t(14;var) (immunoglobulin heavy chain \[IGH\] is encouraged); if there are few or no circulating blasts and an adequate marrow sample cannot be obtained for cytogenetic analysis, the patient may still enroll on the trial * Serum direct bilirubin \< 2 mg/dl or serum total bilirubin =\< 3 (obtained =\< 48 hours prior to registration); NOTE: the above stipulation for normal hepatic function does not apply if liver dysfunction is due to leukemia infiltration * Serum creatinine \< 2 mg/dl (obtained =\< 48 hours prior to registration); NOTE: the above stipulation for normal hepatic function does not apply if liver dysfunction is due to leukemia infiltration * Patient should be human leukocyte antigen (HLA) typed (A, B, C, DR and DQ) during induction therapy phase or a written explanation for not undergoing HLA typing on the flow sheet * Patients with known human immunodeficiency virus (HIV) infection are eligible if they meet all of the following criteria: * No history of acquired immune deficiency syndrome (AIDS)-related complications other than a history of low CD4+ T-cell count (\< 200/mm\^3) prior to initiation of combination antiretroviral therapy; on study CD4+ T-cell count may not be informative due to leukemia and should not be used as an exclusion criterion if low * Patient must be healthy on the basis of HIV disease with high likelihood of near normal life span were it not for the leukemia * Patient must have serum HIV viral load of \< 200 copies/mm\^3 * Patient must be on combination antiretroviral therapy with minimal pharmacokinetic interactions with study therapy and minimal overlapping clinical toxicity with protocol therapy * Patient must not be receiving protease inhibitors or once daily formulations containing cobicistat, stavudine, or on regimens containing stavudine or zidovudine * It is recommended to utilize a regimen of the integrase inhibitor, dolutegravir, combined with either disoproxil fumarate/emtricitabine or dolutegravir combined with tenofovir alafenamide/emtricitabine * Patient must have no history of recent myocardial infarction (within three months), uncontrolled congestive heart failure, or uncontrolled cardiac arrhythmia * Patient must have a normal cardiac ejection fraction by pretreatment multigated acquisition scan (MUGA) or echocardiogram within 4 weeks prior to registration (resting ejection fraction \>= 40% or \>= 5% increase with exercise), shortening fraction by echocardiogram \>= 24%, or to within the normal range of values for the institution * Women must not be pregnant or breast-feeding due to administration of teratogenic chemotherapy and must not become pregnant or breastfeed during protocol therapy and for at least 3 months after protocol therapy; woman of childbearing potential must abstain from sexual activity or be willing to use 2 highly effective forms of contraception throughout protocol therapy and for at least an additional 3 months after the last dose of protocol-specified therapy; all females of childbearing potential must have a blood test or urine study within 2 weeks prior to registration to rule out pregnancy; a female of childbearing potential is any woman, regardless of whether they have undergone tubal ligation, who meets the following criteria: has not undergone a hysterectomy or bilateral oophorectomy; or has not been naturally postmenopausal for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months) * Men who have a female partner of childbearing potential must be willing to use 2 highly effective forms of contraception throughout protocol therapy and for at least an additional 3 months after the last dose of protocol-specified therapy; men who have a pregnant partner must be willing to use a condom during sexual activity throughout protocol therapy and for 3 months after the last dose of protocol-specified therapy * ECOG performance score 0-3 * Patient must have given written informed consent * POST-INDUCTION THERAPY ELIGIBILITY CRITERIA (PRIOR TO INTENSIFICATION-STEP 2) * ECOG performance status 0-2 * Patients must have achieved a CR or CRi * Patients who have achieved a CR or CRi must have maintained peripheral blood evidence of a CR or CRi * Patient must be CNS (cerebrospinal fluid \[CSF\]) negative for leukemia * Patients must have resolved any serious infectious complications related to induction * Any significant medical complications related to induction must have resolved * Serum creatinine =\< 2.0 mg/dl (obtained =\< 48 hours prior to registration) * Serum direct bilirubin \< 2 mg/dL or serum total bilirubin =\< 3 (obtained =\< 48 hours prior to registration) * Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) \< 3 x upper limit of normal (ULN) (obtained =\< 48 hours prior to registration) * RANDOMIZATION OR ASSIGNMENT TO BLINATUMOMAB OR NO BLINATUMOMAB-STEP 3 * Patients must have an ECOG performance status of 0-2 * Patients must have maintained peripheral blood evidence of a remission and must have a CR or CRi, confirmed on restaging bone marrow (BM) aspirate and biopsy * Patients must have resolved any serious infectious complications related to therapy * Any significant medical complications related to therapy must have resolved * Direct or total bilirubin \< 1.5 x ULN (unless related to Gilbert's or Meulengracht's syndrome); the values must be obtained within 48 hours prior to randomization * Serum creatinine \< 1.5 x ULN; the values must be obtained within 48 hours prior to randomization * Bone marrow aspirates must be submitted for centralized minimal residual disease (MRD) assessment performed by the ECOG-ACRIN Leukemia Translational Research Laboratory * MRD results will be reported to the submitting institution * NOTE: FOR MRD ASSESSMENTS, AN ASPIRATE FROM A SEPARATE BONE MARROW ASPIRATION SITE MUST BE SUBMITTED (THE NEEDLE CAN BE RE-DIRECTED THROUGH THE SAME SKIN PUNCTURE SITE); ONLY SUBMIT ASPIRATES FROM THE FIRST PULL OF AN ASPIRATION SITE FOR MRD TESTING; DO NOT SUBMIT SAMPLES FROM THE SECOND OR THIRD PULL OF THE SAME ASPIRATION SITE * In B-lineage ALL, MRD levels in peripheral blood or from a dilute marrow aspiration can be 300% lower, on average, than those in bone marrow at a given time point; submitting a first pull from a separate aspiration site will ensure that MRD determinations used in randomization and trial interpretation are accurate * NOTE: failure to submit bone marrow aspirates will result in a major violation at the time of an audit * CRITERIA FOR ALLOGENEIC TRANSPLANTATION * A suitable donor must be identified; there are no restrictions on donor type and can include a matched sibling, a matched or mismatched unrelated donor, a family haplotype matched donor or a cord blood donor (single or double) * Patients should meet the eligibility criteria for RANDOMIZATION OR ASSIGNMENT TO BLINATUMOMAB OR NO BLINATUMOMAB-STEP 3 * Patients must be considered reliable enough to comply with the medication regimen and follow-up, and have social support necessary to allow this compliance * CRITERIA FOR MAINTENANCE THERAPY-STEP 4: Patients must have an ECOG performance status of 0-3 * CRITERIA FOR MAINTENANCE THERAPY-STEP 4: Patients must have maintained peripheral blood evidence of a remission and must have a CR or CRi, confirmed on restaging BM aspirate and biopsy * CRITERIA FOR MAINTENANCE THERAPY-STEP 4: Patients must have resolved any serious infectious complications related to therapy * CRITERIA FOR MAINTENANCE THERAPY-STEP 4: Any significant medical complications related to therapy must have resolved Exclusion Criteria: * Mature B ALL (Burkitt's-like leukemia) is excluded from enrollment in this trial; pre-study bone marrow biopsy and aspirate must be completed =\< 1 week prior to registration * Patient must not have a concurrent active malignancy for which they are receiving treatment * Patient must not have intercurrent organ damage or medical problems that will jeopardize the outcome of therapy (i.e., psychiatric disorder, drug abuse, pregnancy) * Patient must not have an antecedent hematologic disorder * Patient must not have a history or presence of clinically relevant central nervous system (CNS) pathology such as epilepsy, seizure, paresis, aphasia, stroke, severe brain injuries, dementia; Parkinson's disease, cerebellar disease, organic brain syndrome, psychosis, or other significant CNS abnormalities * Patient must not have an active uncontrolled infection
healthy Volunteers
true
maximum Age
70 Years
minimum Age
30 Years
sex
ALL
std Ages
  1. ADULT
  2. OLDER_ADULT
Treatment arms and interventions
arm Groups
  1. description
    See Detailed Description
    intervention Names
    1. Procedure: Allogeneic Hematopoietic Stem Cell Transplantation
    2. Procedure: Biospecimen Collection
    3. Biological: Blinatumomab
    4. Procedure: Bone Marrow Aspiration
    5. Procedure: Bone Marrow Biopsy
    6. Drug: Cyclophosphamide
    7. Drug: Cytarabine
    8. Drug: Daunorubicin
    9. Drug: Daunorubicin Hydrochloride
    10. Drug: Dexamethasone
    11. Drug: Etoposide
    12. Drug: Leucovorin Calcium
    label
    Arm I (blinatumomab, chemotherapy)
    type
    EXPERIMENTAL
  2. description
    See Detailed Description
    intervention Names
    1. Procedure: Allogeneic Hematopoietic Stem Cell Transplantation
    2. Procedure: Biospecimen Collection
    3. Procedure: Bone Marrow Aspiration
    4. Procedure: Bone Marrow Biopsy
    5. Drug: Cyclophosphamide
    6. Drug: Cytarabine
    7. Drug: Daunorubicin
    8. Drug: Daunorubicin Hydrochloride
    9. Drug: Dexamethasone
    10. Drug: Etoposide
    11. Drug: Leucovorin Calcium
    12. Procedure: Lumbar Puncture
    label
    Arm II (chemotherapy)
    type
    ACTIVE_COMPARATOR
interventions
  1. arm Group Labels
    1. Arm I (blinatumomab, chemotherapy)
    2. Arm II (chemotherapy)
    description
    Undergo allogeneic hematopoietic SCT
    name
    Allogeneic Hematopoietic Stem Cell Transplantation
    other Names
    1. Allogeneic
    2. Allogeneic Hematopoietic Cell Transplantation
    3. Allogeneic Stem Cell Transplantation
    4. HSC
    5. HSCT
    6. Stem Cell Transplantation, Allogeneic
    type
    PROCEDURE
  2. arm Group Labels
    1. Arm I (blinatumomab, chemotherapy)
    2. Arm II (chemotherapy)
    description
    Undergo blood sample collection
    name
    Biospecimen Collection
    other Names
    1. Biological Sample Collection
    2. Biospecimen Collected
    3. Sample Collection
    4. Specimen Collection
    type
    PROCEDURE
  3. arm Group Labels
    1. Arm I (blinatumomab, chemotherapy)
    description
    Given IV
    name
    Blinatumomab
    other Names
    1. AMG 103
    2. AMG-103
    3. AMG103
    4. Anti-CD19 x Anti-CD3 Bispecific Monoclonal Antibody
    5. Anti-CD19/Anti-CD3 Recombinant Bispecific Monoclonal Antibody MT103
    6. Blincyto
    7. MEDI 538
    8. MEDI-538
    9. MEDI538
    10. MT 103
    11. MT-103
    12. MT103
    type
    BIOLOGICAL
  4. arm Group Labels
    1. Arm I (blinatumomab, chemotherapy)
    2. Arm II (chemotherapy)
    description
    Undergo bone marrow aspiration
    name
    Bone Marrow Aspiration
    type
    PROCEDURE
  5. arm Group Labels
    1. Arm I (blinatumomab, chemotherapy)
    2. Arm II (chemotherapy)
    description
    Undergo bone marrow biopsy
    name
    Bone Marrow Biopsy
    other Names
    1. Biopsy of Bone Marrow
    2. Biopsy, Bone Marrow
    type
    PROCEDURE
  6. arm Group Labels
    1. Arm I (blinatumomab, chemotherapy)
    2. Arm II (chemotherapy)
    description
    Given IV
    name
    Cyclophosphamide
    other Names
    1. (-)-Cyclophosphamide
    2. 2H-1,3,2-Oxazaphosphorine, 2-[bis(2-chloroethyl)amino]tetrahydro-, 2-oxide, monohydrate
    3. Asta B 518
    4. B 518
    5. B-518
    6. B518
    7. Carloxan
    8. Ciclofosfamida
    9. Ciclofosfamide
    10. Cicloxal
    11. Clafen
    12. Claphene
    type
    DRUG
  7. arm Group Labels
    1. Arm I (blinatumomab, chemotherapy)
    2. Arm II (chemotherapy)
    description
    Given IT, IV, or SC
    name
    Cytarabine
    other Names
    1. .beta.-Cytosine arabinoside
    2. 1-.beta.-D-Arabinofuranosyl-4-amino-2(1H)pyrimidinone
    3. 1-.beta.-D-Arabinofuranosylcytosine
    4. 1-Beta-D-arabinofuranosyl-4-amino-2(1H)pyrimidinone
    5. 1-Beta-D-arabinofuranosylcytosine
    6. 1.beta.-D-Arabinofuranosylcytosine
    7. 2(1H)-Pyrimidinone, 4-Amino-1-beta-D-arabinofuranosyl-
    8. 2(1H)-Pyrimidinone, 4-amino-1.beta.-D-arabinofuranosyl-
    9. Alexan
    10. Ara-C
    11. ARA-cell
    12. Arabine
    type
    DRUG
  8. arm Group Labels
    1. Arm I (blinatumomab, chemotherapy)
    2. Arm II (chemotherapy)
    description
    Given IV
    name
    Daunorubicin
    other Names
    1. Daunomycin
    2. Daunorrubicina
    3. DNR
    4. Leukaemomycin C
    5. Rubidomycin
    6. Rubomycin C
    type
    DRUG
  9. arm Group Labels
    1. Arm I (blinatumomab, chemotherapy)
    2. Arm II (chemotherapy)
    description
    Given IV
    name
    Daunorubicin Hydrochloride
    other Names
    1. Cerubidin
    2. Cerubidine
    3. Cloridrato de Daunorubicina
    4. Daunoblastin
    5. Daunoblastina
    6. Daunoblastine
    7. Daunomycin Hydrochloride
    8. Daunomycin, hydrochloride
    9. Daunorubicin.HCl
    10. Daunorubicini Hydrochloridum
    11. FI-6339
    12. Ondena
    type
    DRUG
  10. arm Group Labels
    1. Arm I (blinatumomab, chemotherapy)
    2. Arm II (chemotherapy)
    description
    Given PO
    name
    Dexamethasone
    other Names
    1. Aacidexam
    2. Adexone
    3. Aknichthol Dexa
    4. Alba-Dex
    5. Alin
    6. Alin Depot
    7. Alin Oftalmico
    8. Amplidermis
    9. Anemul mono
    10. Auricularum
    11. Auxiloson
    12. Baycadron
    type
    DRUG
  11. arm Group Labels
    1. Arm I (blinatumomab, chemotherapy)
    2. Arm II (chemotherapy)
    description
    Given IV
    name
    Etoposide
    other Names
    1. Demethyl Epipodophyllotoxin Ethylidine Glucoside
    2. EPEG
    3. Lastet
    4. Toposar
    5. Vepesid
    6. VP 16
    7. VP 16-213
    8. VP 16213
    9. VP-16
    10. VP-16-213
    11. VP-16213
    12. VP16
    type
    DRUG
  12. arm Group Labels
    1. Arm I (blinatumomab, chemotherapy)
    2. Arm II (chemotherapy)
    description
    Given IV or PO
    name
    Leucovorin Calcium
    other Names
    1. Adinepar
    2. Calcifolin
    3. Calcium (6S)-Folinate
    4. Calcium Folinate
    5. Calcium Leucovorin
    6. Calfolex
    7. Calinat
    8. Cehafolin
    9. Citofolin
    10. Citrec
    11. Citrovorum Factor
    12. Cromatonbic Folinico
    type
    DRUG
Study design
allocation
RANDOMIZED
intervention Model
PARALLEL
masking Info
masking
NONE
primary Purpose
TREATMENT
Enrollment
count
488
type
ACTUAL
Registered outcome plans (not posted results)
other Outcomes
  1. description
    To determine differences in MRD kinetics among patients with the BCR/ABL1-like B-lineage ALL, and to compare the OS (and RFS) of patients with BCR-ABL-like phenotype with those without BCR-ABLlike phenotype
    measure
    To Determine Differences in MRD Kinetics Among Patients With the BCR/ABL1-like B-lineage ALL, and to Compare the OS (and RFS) of Patients With BCR-ABL-like Phenotype With Those Without BCR-ABLlike Phenotype
    time Frame
    Assessed every 3 months for 2 years, then every 6 months for 3 years, then annually for 5 years
  2. description
    To evaluate the incidence of anti-blinatumomab antibody formation
    measure
    Incidence of Anti-blinatumomab Antibody Formation
    time Frame
    Assessed at baseline, end of 2 cycles of blinatumomab, end of 4 cycles of blinatumomab, and end of blinatumomab treatment
primary Outcomes
  1. description
    Overall survival is defined as the time from randomization to death of any cause.
    measure
    Overall Survival (OS) Among Patients Who Were MRD Negative After Induction and Intensification Chemotherapy
    time Frame
    Assessed every 3 months for 2 years, then every 6 months for 3 years, then annually for 5 years
secondary Outcomes
  1. description
    RFS was defined as time from randomization to relapse or to death without documentation of relapse. Patients without events were censored at the date of last disease assessment. Relapse/Persistent Disease Persistent disease/Relapse following complete remission (CR)/complete remission incomplete (CRi) is defined as: * Reappearance or persistence of blasts in the blood * Presence of \> 5% blasts, not attributable to another cause (e.g., bone marrow regeneration). * In the case of isolated CNS relapse such as a positive cytospin examination of CSF, please consult with Study Chair. Perform bone marrow biopsy (if not already done) to confirm presence or lack of medullary relapse.
    measure
    Relapse-free Survival (RFS) Among Patients Who Were MRD Negative After Induction and Intensification Chemotherapy
    time Frame
    Assessed every 3 months for 2 years, then every 6 months for 3 years, then annually for 5 years
  2. description
    RFS was defined as time from end of 2 cycles of blinatumomab to relapse or to death without documentation of relapse. Patients without events were censored at the date of last disease assessment. Relapse/Persistent Disease Persistent disease/Relapse following complete remission (CR)/complete remission incomplete (CRi) is defined as: * Reappearance or persistence of blasts in the blood * Presence of \> 5% blasts, not attributable to another cause (e.g., bone marrow regeneration). * In the case of isolated CNS relapse such as a positive cytospin examination of CSF, please consult with Study Chair. Perform bone marrow biopsy (if not already done) to confirm presence or lack of medullary relapse.
    measure
    RFS Among of Those Who Are MRD+ at Randomization and Then Convert to MRD- After 2 Cycles of Blinatumomab to Those Patients Who Are MRD- at Randomization and Remain MRD- After 2 Cycles of Blinatumomab or Consolidation Chemotherapy
    time Frame
    Assessed every 3 months for 2 years, then every 6 months for 3 years, then annually for 5 years
  3. description
    OS was defined as time from end of 2 cycles of blinatumomab to death of any cause
    measure
    OS Among of Those Who Are MRD+ at Randomization and Then Convert to MRD- After 2 Cycles of Blinatumomab to Those Patients Who Are MRD- at Randomization and Remain MRD- After 2 Cycles of Blinatumomab or Consolidation Chemotherapy
    time Frame
    Assessed every 3 months for 2 years, then every 6 months for 3 years, then annually for 5 years
  4. description
    OS was defined as time from allogeneic transplant to death of any cause.
    measure
    OS Among MRD Negative Patients Who Proceed to Allogeneic Transplant on Study
    time Frame
    Assessed every 3 months for 2 years, then every 6 months for 3 years, then annually for 5 years
Full study description
brief Summary
This randomized phase III trial studies combination chemotherapy with blinatumomab to see how well it works compared to induction chemotherapy alone in treating patients with newly diagnosed breakpoint cluster region (BCR)-c-abl oncogene 1, non-receptor tyrosine kinase (ABL)-negative B lineage acute lymphoblastic leukemia. Drugs used in chemotherapy work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Immunotherapy with monoclonal antibodies, such as blinatumomab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. It is not yet known whether combination chemotherapy is more effective with or without blinatumomab in treating newly diagnosed acute lymphoblastic leukemia.
detailed Description
PRIMARY OBJECTIVE: I. To compare the overall survival (OS) of blinatumomab in conjunction with chemotherapy to chemotherapy alone in patients with BCR-ABL-negative B cell precursor acute lymphoblastic leukemia (ALL) who are minimal residual disease (MRD) negative after induction and intensification chemotherapy, based on multiparameter flow cytometric (MFC) assessment of residual blasts. SECONDARY OBJECTIVES: I. To compare the relapse-free survival (RFS) of blinatumomab in conjunction with chemotherapy to chemotherapy alone in MRD negative patients after induction and intensification chemotherapy. II. To compare the OS and RFS of those patients who are MRD positive (+) at step 3 randomization/registration and then convert to MRD negative (-) after 2 cycles of blinatumomab to those patients who are MRD- at randomization and remain MRD- after 2 cycles of blinatumomab or consolidation chemotherapy. III. To assess the toxicities of blinatumomab in this patient population. IV. To assess the toxicities of the modified E2993 chemotherapy regimen in this patient population. V. To describe the outcome of patients who proceed to allogeneic blood or marrow transplant after treatment with or without blinatumomab. LABORATORY OBJECTIVES: I. To determine differences in MRD kinetics among patients with the BCR/ABL1-like B-lineage ALL, and to compare the OS (and RFS) of patients with BCR-ABL-like phenotype with those without BCR-ABL-like phenotype. II. To evaluate the incidence of anti-blinatumomab antibody formation. OUTLINE: INDUCTION CHEMOTHERAPY: Patients receive cytarabine intrathecally (IT) on day 1; daunorubicin hydrochloride intravenously (IV) over 10-15 minutes on days 1, 8, 15, and 22; vincristine sulfate IV on days 1, 8, 15, and 22; dexamethasone orally (PO) daily on days 1-7 (and 15-21 for patients age \< 55 years only); methotrexate IT on day 14; pegaspargase intramuscularly (IM) or IV on day 18 (patients age \< 55 years); and CD20 positive patients may optionally receive rituximab IV on day 8 and 15. Beginning on day 29, patients with absolute neutrophil count (ANC) \>= 0.75 x 10\^9/L and platelets \> 75 x 10\^9/L (patients with delayed hematologic recovery) (patients with residual disease that is delaying count begin treatment immediately) receive cyclophosphamide IV over 30 minutes on days 1 and 29, cytarabine IV over 30 minutes or subcutaneously (SC) on days 1-4, 8-11, 29-32, and 36-39, mercaptopurine PO on days 1-14, 29-42, pegaspargase IM or IV on day 15 (patients age \< 55 years), patients receiving treatment for central nervous system (CNS) 2 or 3 leukemia in cycle 1 receive methotrexate IT on days 1, 8, 15, and 22, and CD20 positive patients may optionally receive rituximab IV on days 8 and 15. INTENSIFICATION THERAPY: Beginning 4 weeks after the completion of cycle 2 of induction therapy, patients receive intensification therapy comprising high-dose methotrexate IV over 2 hours on days 1 and 8, and pegaspargase IM or IV on day 9. Patients are then randomized to 1 of 2 treatment arms. Patients randomized to the blinatumomab group receive blinatumomab IV continuously on days 1-28. Treatment repeats every 6 weeks for 2 cycles in the absence of disease progression or unacceptable toxicity. Patients may then undergo allogeneic stem cell transplant (SCT) or proceed to consolidation therapy per investigator discretion. CONSOLIDATION THERAPY: Beginning after the second cycle of blinatumomab (patients randomized to the blinatumomab group) or after intensification therapy (patients not randomized to blinatumomab), patients receive cytarabine IV over 30 minutes or SC on days 1-5, etoposide IV over 1 hour on days 1-5, methotrexate IT on day 1, and pegaspargase IM or IV on day 5, and CD20 positive patients may optionally receive rituximab IV on day 5. Beginning 4 weeks from day 1 of cycle 1, patients receive cytarabine, etoposide, methotrexate, and CD20 positive patients may receive rituximab as in cycle 1. Beginning 4 weeks from day 1 of cycle 2, patients receive daunorubicin hydrochloride IV over 10-15 minutes on day 1, 8, 15, and 22; vincristine sulfate IV on days 1, 8, 15, and 22; dexamethasone PO daily on days 1-7 (and 15-21 for patients age \< 55 years); methotrexate IT on day 2; cyclophosphamide IV over 30 minutes on day 29; cytarabine IV over 30 minutes or SC on days 30-33 and 37-40; mercaptopurine PO on days 29-42 and CD20 positive patients may receive rituximab on day 8. Beginning 8 weeks from day 1 of cycle 3, patients receive cytarabine, etoposide, methotrexate, and CD20 positive patients may optionally receive rituximab as in cycle 1. Patients randomized to blinatumomab repeat cycle 4 and then receive blinatumomab IV continuously on days 1-28. MAINTENANCE THERAPY: Within 6 weeks after beginning last cycle of consolidation therapy, patients receive mercaptopurine PO daily, methotrexate PO or IV over 2 hours once weekly for 2.5 years, vincristine sulfate IV on day 1 every 3 months, prednisone PO on days 1-5 every 3 months, and methotrexate IT on day 1 every 3 months. Treatment continues for up to 2.5 years in the absence of disease progression or unacceptable toxicity. Patients undergo x-ray imaging during screening, lumbar puncture while on study, and bone marrow aspiration, bone marrow biopsy, and blood sample collection throughout the study. After completion of study treatment, patients are followed up every 3 months for 2 years, every 6 months for 3 years, and then every 12 months for 5 years.
Source references
references
  1. citation
    Litzow MR, Sun Z, Mattison RJ, Paietta EM, Roberts KG, Zhang Y, Racevskis J, Lazarus HM, Rowe JM, Arber DA, Wieduwilt MJ, Liedtke M, Bergeron J, Wood BL, Zhao Y, Wu G, Chang TC, Zhang W, Pratz KW, Dinner SN, Frey N, Gore SD, Bhatnagar B, Atallah EL, Uy GL, Jeyakumar D, Lin TL, Willman CL, DeAngelo DJ, Patel SB, Elliott MA, Advani AS, Tzachanis D, Vachhani P, Bhave RR, Sharon E, Little RF, Erba HP, Stone RM, Luger SM, Mullighan CG, Tallman MS. Blinatumomab for MRD-Negative Acute Lymphoblastic Leukemia in Adults. N Engl J Med. 2024 Jul 25;391(4):320-333. doi: 10.1056/NEJMoa2312948.
    pmid
    39047240
    type
    DERIVED
  2. citation
    Seftel MD. Hyper-CVAD: a regimen for all seasons. Lancet Haematol. 2020 Jul;7(7):e501-e502. doi: 10.1016/S2352-3026(20)30179-4. No abstract available.
    pmid
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Source notices and limitations
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      parsed_JSON_string_unmodified
      source string sha256
      ee9813b8f71c61d363e23bfc59b27d2253842edd8917d0654ef29ed2dd764485
      source url
      https://api.fda.gov/drug/label.json?search=%28indications_and_usage%3Acancer+OR+indications_and_usage%3Acarcinoma+OR+indications_and_usage%3Acarcinomas+OR+indications_and_usage%3Alymphoma+OR+indications_and_usage%3Alymphomas+OR+indications_and_usage%3Aleukemia+OR+indications_and_usage%3Aleukaemia+OR+indications_and_usage%3Asarcoma+OR+indications_and_usage%3Asarcomas+OR+indications_and_usage%3Amelanoma+OR+indications_and_usage%3Amyeloma+OR+indications_and_usage%3Atumor+OR+indications_and_usage%3Atumors+OR+indications_and_usage%3Atumour+OR+indications_and_usage%3Atumours+OR+indications_and_usage%3Aneoplasm+OR+indications_and_usage%3Aneoplasms+OR+indications_and_usage%3Amalignant+OR+indications_and_usage%3Amalignancy+OR+indications_and_usage%3Amyelodysplastic+OR+indications_and_usage%3Amyelofibrosis+OR+indications_and_usage%3Amastocytosis+OR+indications_and_usage%3Aglioma+OR+indications_and_usage%3Aglioblastoma+OR+indications_and_usage%3Aneuroblastoma+OR+indications_and_usage%3Aretinoblastoma+OR+indications_and_usage%3Apheochromocytoma+OR+indications_and_usage%3Aparaganglioma+OR+indications_and_usage%3Amyeloproliferative+OR+indications_and_usage%3Awaldenstrom+OR+indications_and_usage%3Apolycythemia+OR+indications_and_usage%3Athrombocythemia+OR+indications_and_usage%3Adesmoid+OR+indications_and_usage%3Aneurofibromatosis+OR+indications_and_usage%3Ahistiocytosis%29+AND+%28openfda.application_number%3ANDA%2A+OR+openfda.application_number%3ABLA%2A%29&limit=100&skip=200&sort=id%3Aasc
      spl effective time
      20260414
      spl set id
      38b482a8-960b-4591-9857-5031ecb830aa

    Preserved source evidence · Not medical advice