Patients who have relapsed/refractory CLL and require therapy as per iwCLL guidelines will be eligible. Subjects will receive a treatment with ofatumumab and HDMP for three consecutive 4 week cycles. The primary endpoint is to determine the complete response (CR) to therapy and the secondary endpoints will assess the safety and tolerability of the regimen, the impact of the treatment on progression free, treatment free, overall survival, and pharmacokinetics of ofatumumab. Patients will receive allopurinol for tumor-lysis prophylaxis and antimicrobial prophylaxis.
Patients who have relapsed/refractory CLL and require therapy as per iwCLL guidelines will be eligible. Subjects will receive a treatment with ofatumumab and HDMP for three consecutive 4 week cycles. The primary endpoint is to determine the complete response (CR) to therapy and the secondary endpoints will assess the safety and tolerability of the regimen, the impact of the treatment on progression free, treatment free, overall survival, and pharmacokinetics of ofatumumab. Cycles 1-3 will be administered without scheduled interruption every 28 days for a total of 12 weeks of therapy. Patients will receive allopurinol for tumor-lysis prophylaxis and antimicrobial prophylaxis. Blood glucose levels will be monitored immediately after HDMP infusion by finger stick glucometry. Two months following completion of treatment a response assessment will occur per iwCLL guidelines. The treatment will be administered as outpatient, and each cycle will be four weeks in duration.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
21
High dose methylprednisolone sodium succinate (HDMP) at 1gm/m2 daily as infusion for 3 consecutive days every cycle. Ofatumumab 300mg administered Day1 of cycle 1 followed by 12 doses of 1000mg administered based on specific schedule. Each patient will receive a maximum of 3 cycles (one cycle is 28 days)
UC San Diego Moores Cancer Center
La Jolla, California, United States
University of California San Diego, Moores Cancer Center
La Jolla, California, United States
IwCLL-WG Defined Complete Response (CR)
Responses were assessed two months after completion of therapy. Criteria for complete remission is assessed with: a bone marrow biopsy and repeat CT scan (abdominal, chest and pelvis if initial was abnormal) to confirm iwCLL-WG defined CR. iwCLL-WG Complete Response is defined as: * Peripheral blood lymphocytes (evaluated by blood and differential count) below 4 x 109/L (4000/L). * Absence of lymphadenopathy (\>1.5 cm)of physical exam; AND * No hepatomegaly and splenomegaly on physical exam; AND * Absence of constitutional symptoms; AND * Normal complete blood count as exhibited by neutrophils ≥ 1,500/μl, platelets \> 100,000/μl, hemoglobin \> 11.0g/dL (non-transfused), and lymphocyte count \< 5,000/μl; AND * Bone marrow aspirate and biopsy must be normocellular for age with \<30% of nucleated cells being lymphocytes. Lymphoid nodules must be absent
Time frame: 2 months
IwCLL-WG Defined Overall Response Rate (ORR)
Responses were assessed two months after completion of therapy. Overall Response Rate (ORR) = CR + PR
Time frame: 2 months
IwCLL-WG Defined Nodular Partial Response (PR)
Responses were assessed two months after completion of therapy. Partial Response is defined as: * Greater than or equal to 50% decrease in blood absolute lymphocyte count from pre-treatment value; AND * Greater than or equal to 50% reduction in lymphadenopathy from pre-treatment value; AND * Greater than or equal to 50% reduction in splenomegaly/hepatomegaly from pre-treatment value. In addition, patients need to have at least ONE of the following: * Neutrophils ≥ 1,500/μl or ≥ 50% improvement from pre-treatment value; AND / OR * Platelets \> 100,000/μl or 50% improvement from pre-treatment value; AND / OR * Hemoglobin \> 11.0 gm/dl (non-transfused) or 50% improvement from pre-treatment value.
Time frame: 2 months
IwCLL-WG Defined Partial Response (PR)
Responses were assessed two months after completion of therapy
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Time frame: 2 months
IwCLL-WG Defined Stable Disease (SD)
Responses were assessed two months after completion of therapy. Subjects who do not fulfill the criteria for complete or partial response as defined above but do not exhibit progressive disease will be considered as having stable disease.
Time frame: 2 months
IwCLL-WG Defined Progressive Disease (PD)
Responses were assessed two months after completion of therapy Progressive Disease is defined as: * Greater than or equal to 50% increase in the products of at least two lymph nodes on two consecutive determinations two weeks apart (at least one lymph node must be ≥ 2 cm; or the appearance of a new palpable lymph node; OR * Greater than or equal to 50% increase in the size of the liver and/or spleen as determined by measurement below the respective costal margins; or appearance of palpable hepatomegaly or splenomegaly, which was not previously present; OR * Greater than or equal to 50% increase in the absolute number of circulating lymphocytes to at least 5,000μl; OR * Transformation to a more aggressive histology (i.e., Richter's syndrome or prolymphocytic leukemia with ≥ 56% prolymphocytes);
Time frame: 2 months
Progression-free Survival (PFS)
Time frame: 2 years
Treatment-Free Survival
Time frame: 2 years
Safety and Tolerability Measured Via Adverse Events
Please see Adverse Event module for additional details.
Time frame: 2 years
Detectable Minimal Residual Disease (MRD)
The patient who achieved a CR did not have detectable MRD in the bone marrow by four-color flow cytometry (\<0.1% of cells).
Time frame: 2 years