RATIONALE: Monoclonal antibodies, such as alemtuzumab, can block cancer growth in different ways. Some block the ability of cancer cells to grow and spread. Others find cancer cells and help kill them or carry cancer-killing substances to them. PURPOSE: This phase I/II trial is studying the side effects and best dose of alemtuzumab in treating patients with B-cell chronic lymphocytic leukemia.
OBJECTIVES: * To determine the safest dose of alemtuzumab as consolidation therapy in patients in second remission after fludarabine phosphate alone; fludarabine phosphate and cyclophosphamide; fludarabine phosphate, cyclophosphamide, and rituximab; bendamustine hydrochloride alone; or bendamustine hydrochloride and rituximab. * To determine the frequency of cytomegalovirus reactivations or infections during or after alemtuzumab treatment. * To determine which dose of alemtuzumab is efficient to eliminate minimal residual disease in peripheral blood and bone marrow (i.e., to turn a clinical partial remission into a clinical complete remission \[CR\], to turn a flow cytometry-positive CR into a flow cytometry-negative CR, or to turn a PCR-positive CR into a PCR-negative CR). * To determine the pharmacokinetic profile of alemtuzumab. * To compare the pharmacokinetic profile between intravenous versus subcutaneous administration of alemtuzumab. OUTLINE: This is a multicenter, dose-escalation study of alemtuzumab. * Group 1: Patients receive escalating doses of alemtuzumab IV over 2 hours once weekly for 8 weeks until the maximum tolerated dose (MTD) is determined. * Group 2: Patients receive escalating doses of alemtuzumab subcutaneously once weekly for 8 weeks, beginning with the MTD determined in group 1 until a second MTD is determined. Patients undergo bone marrow and blood sample collection periodically for laboratory and pharmacokinetic studies. Samples are analyzed for minimal residual disease and T-cell subsets (i.e., CD4 and CD8) via quantitative-PCR analysis and flow cytometry and cytomegalovirus antigens via PCR. After completion of study treatment, patients are followed at 3, 6, 9, 12, 18, and 24 months.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
13
Alemtuzumab will be administered once per week as a 2 h infusion * Dose level I: 10mg once weekly (start with dose escalation : 3 mg on day 1, 10mg on day 2) Duration * Dose level II: 20mg once weekly (start with dose escalation: 3mg on day 1, 10mg on day 2, 20mg on day 3) * Dose level III: 30mg once weekly (start with dose escalation: 3mg on day 1, 10mg on day 2, 30mg on day 3)
Alemtuzumab will be administered once per week subcutaneously * Dose level I: 10mg once weekly (start with dose escalation : 3 mg on day 1, 10mg on day 2) Duration * Dose level II: 20mg once weekly (start with dose escalation: 3mg on day 1, 10mg on day 2, 20mg on day 3) * Dose level III: 30mg once weekly (start with dose escalation: 3mg on day 1, 10mg on day 2, 30mg on day 3)
Medizinische Universitaetsklinik I at the University of Cologne
Cologne, Germany
Klinikum Barnim GmbH, Werner Forssmann Krankenhaus
Eberswalde, Germany
Universitatsklinikum Heidelberg
Heidelberg, Germany
Klinikum Lippe - Lemgo
Lemgo, Germany
Dose-limiting toxicity
• Dose-limiting toxicity (DLT) and maximal tolerable dose (MTD) DLT is defined as a) all grade III/IV non-hematologic toxicity and b) all grade IV hematologic toxicity lasting for more than 2 weeks (excluding lymphopenia) occuring during or within 4 weeks after end of consolidation therapy.
Time frame: 28 days after the last dose of study medication
Maximum tolerated dose
• Dose-limiting toxicity (DLT) and maximal tolerable dose (MTD) DLT is defined as a) all grade III/IV non-hematologic toxicity and b) all grade IV hematologic toxicity lasting for more than 2 weeks (excluding lymphopenia) occuring during or within 4 weeks after end of consolidation therapy.
Time frame: 28 days after the last dose of study medication
Rate of complete minimal residual disease response
• Rate of molecular responses (defined by negativity of 4- colour- cytometry in BOTH peripheral blood AND bone marrow in patients in clinical CR) The approved laboratory diagnostics for detection of MRD response is 4-colour flow cytometry. Collaterally, it is possible to take samples for potential PCR- analysis for confirmation if available.
Time frame: will be tested repeatedly, first time 3 months after the last dose of study medication, last time point 24 months after last dose of study medication
Rate of immunophenotypic remission using 4-color flow cytometry
Time frame: will be tested repeatedly, first time 3 months after the last dose of study medication,
Rate of infections (especially CMV infections and reactivations)
Time frame: upt to 24 months after last dose of study medication (end of study)
Rate of severe hematologic and non-hematologic side effects
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III Medizinische Klinik Mannheim
Mannheim, Germany
Krankenhaus Barmherzige Brueder Regensburg
Regensburg, Germany
Time frame: 28 days after the last dose of study medication
Pharmacokinetics of alemtuzumab (after IV and subcutaneous administration)
Pharmacokinetic samples will be taken at week 4 and 8 during alemtuzumab treatment at the following time points: 0, 4, 8, 24, 48, 96, 168 h
Time frame: up to 8 weeks during the alemtuzumab treatment
Progression-free survival
Time frame: upt to 24 months after last dose of study medication (end of study)
Overall survival
Time frame: upt to 24 months after last dose of study medication (end of study)
Complete remission rate
Time frame: 28 days after the last dose of study medication