This is a prospective, single-center phase I clinical study aimed at determining the maximum-tolerated dose, recommended phase 2 dose and safety of Lintuzumab-Ac225 in combination with CLAG-M chemotherapy in the management of relapsed/refractory acute myeloid leukemia. This study uses a 3+3 design with a five-patient cohort at the recommended phase 2 dose.
Relapsed/refractory acute myeloid leukemia (RR-AML) in adults is an important therapeutic challenge. Nearly 60% of AML patients ultimately relapse or have refractory disease, and failure to achieve remission in this population is almost universally fatal. Therefore, a critical need exists for the development of novel therapies. Currently, for RR-AML, many institutions utilize the chemotherapy regimen of CLAG-M (cladribine, cytarabine, G-CSF, mitoxantrone) based on a reported morphological complete remission (CR) rate of 58% in prospective clinical trials. Because of this, and its favorable performance when compared with outcomes reported for other regimens utilized in RR-AML, we believe enhancing the efficacy of CLAG-M is a rational approach to improve therapy in RR-AML. A promising approach that could enhance the clearance of leukemic blasts when added to CLAG-M chemotherapy is a monoclonal antibody radioconjugate directed against markers expressed in leukemic cells. Radiation has known cytotoxic properties in chemo-resistant AML. The benefit of an antibody radioconjugate would be leukemic specific delivery of potent radiotherapy with potentially minimal systemic off-target side-effects. One such antibody radioconjugate is Lintuzumab-Ac225, a highly cytotoxic alpha radiation emitter that targets the cluster of differentiation 33 (CD33) cell surface antigen, which is expressed on leukemic cells. In this novel study, we aim to add the radioconjugated antibody Lintuzumab-Ac225 to salvage CLAG-M chemotherapy in order to improve the treatment response for patients with RR-AML.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
26
Lintuzumab-Ac225 is an immunoconjugate \[antibody: anti-CD 33 antibody and radioactive isotope: Actinium (225Ac)\] for the treatment of relapsed/refractory acute myeloid leukemia.
Cladribine is a purine antimetabolite.
Cytarabine is an antineoplastic anti-metabolite.
Froedtert Hospital and the Medical College of Wisconsin
Milwuakee, Wisconsin, United States
The number of subjects with dose-limiting toxicities.
Dose-escalation will be conducted according to a 3+3 design with a five-patient expansion cohort at the recommended phase 2 dose. The initial dose of Lintuzumab-Ac225 will be 0.25 micro-Curie (μCi)/kg (Dose level 1), and the highest dose administered will be 1.25 μCi/kg. * if 0/3 pts have no dose-limiting toxicity (DLT), new patients enter next dose level. * if 1/3 pts has DLT, 3 pts treated at same dose level. * if 0/3 pts at that dose level has DLT, new pts enter higher level. * if 1 or more of the additional 3 pts has a DLT, no further pts started at dose level, preceding dose is the MTD. * if 2/3 of initially dosed patients have a DLT on first dose, study terminated. * if 0/3 have DLT at highest dose, additional 3 enrolled.
Time frame: 28 Days
Maximum-tolerated dose.
Defined as the dosage with the highest level at which no more than one subject experiences a DLT.
Time frame: 28 Days
The number of subjects who have at least one serious adverse event related to the study.
All subjects who receive study drug will be closely monitored for serious adverse events (SAEs). The NCI's CTCAE (Common Toxicity Criteria for Adverse Effects) v4.03 will be used.
Time frame: 60 days
Overall survival
The number of subjects alive at two years from the first day of salvage therapy.
Time frame: 2 years
The number of subjects with a complete response (CR).
A complete response will be defined as bone marrow blasts \<5% with absolute neutrophil count ≥1000/μL and platelet ≥100,000/μL.
Time frame: Up to Day 60
The number of subjects with CR with incomplete hematologic recovery (CRi)
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Mitoxantrone is an anthracenedione antineoplastic agent.
G-CSF is a glycoprotein that stimulates the bone marrow to produce granulocytes and stem cells.
CRi is defined as CR without platelet recovery or neutrophil recovery. This will be defined as bone marrow blasts \<5% with absolute neutrophil count \<1000/L and platelet \<100,000/L.
Time frame: Up to Day 60
The number of subjects in a morphologic leukemia-free state (MLFS).
MLFS is bone marrow blasts \<5% with absolute neutrophil count \<1000/μL AND platelet \<100,000/μL.
Time frame: Up to Day 60
The number of subjects experiencing partial remission.
Partial remission (PR) is defined by a decrease of at 50% or more in the percentage of blasts to less than 25% in the bone marrow. and normalized blood counts ( ANC\>1000, Platelets\>100,000/ml).
Time frame: Up to Day 60
Progression-free Survival
The number of subjects, who from the first day of remission until one year, do not relapse or progress.
Time frame: 1 Year