This phase I/II studies the side effects of pembrolizumab and blinatumomab and to see how well they work in treating participants with acute lymphoblastic leukemia that has come back or has not responded to the treatment. Monoclonal antibodies, such as pembrolizumab and blinatumomab, may interfere with the ability of tumor cells to grow and spread.
PRIMARY OBJECTIVES: I. Assess the safety and tolerability of combination immunotherapy with blinatumomab and pembrolizumab by evaluation of toxicities including: type, frequency, severity, attribution, time course and duration. (Phase 1) II. Determine the recommended phase 2 schedule of combination immunotherapy with pembrolizumab and blinatumomab. (Phase 1) III. Evaluate the anti-leukemia activity of combination immunotherapy blinatumomab and pembrolizumab as assessed by overall response rate (complete response \[CR\] or CR with incomplete recovery \[CRi\]). (Phase 2) SECONDARY OBJECTIVES: I. Estimate time to response (CR or CRi) and response duration. (Phase 2) II. Estimate overall survival and event-free survival. (Phase 2) III. Determine the number and proportion of patients who underwent hematopoietic stem cell transplantation (HSCT) after treatment of pembrolizumab and blinatumomab. (Phase 2) IV. Determine the number and proportion of patients who receive pembrolizumab maintenance and the proportion continuing for up to 1 year. (Phase 2) V. Estimate the minimal residual disease rate. (Phase 2) CORRELATIVE OBJECTIVES: I. Explore evolution of T cell subsets at various points in treatment (T naive, T effector, T effector memory, T central memory, CD4, CD8). (Phase 2) II. Evaluate PD-L1 expression levels on acute lymphoblastic leukemia (ALL) blasts and blasts counts overtime. (Phase 2) III. Evaluate PD-1/PD-L1 expression on subsets of T cells. (Phase 2) IV. Evaluate the clonal evolution of leukemic blasts in response to treatment. (Phase 2) OUTLINE: Participants receive pembrolizumab intravenously (IV) over 30 minutes on day 15 of cycle 1 and days 1 and 22 of cycles 2 -5, and blinatumomab IV on days 1-28. Treatment repeats every 35-42 days for up to 5 cycles in the absence of disease progression or unacceptable toxicity. Patients who achieve complete response have the option to receive blinatumomab IV for up to 4 additional cycles. After completion of study treatment, participants are followed up at 30 days and then every 3 months for 1 year.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
36
City of Hope Medical Center
Duarte, California, United States
Incidence of toxicity (Phase 1)
Will be graded according to the National Cancer Institute-Common Terminology Criteria for Adverse Events version 5
Time frame: Up to 42 days
Response (Phase 2)
Response will be defined as complete response (CR)/CR with incomplete hematologic recovery (CRi) based on the National Comprehensive Cancer Network guidelines on acute lymphoblastic leukemia version 1 2017 response criteria. Evaluated using Simon two-stage optimal design
Time frame: Up to 1 year
Incidence of adverse events
Observed toxicities will be summarized in terms of type (organ affected or laboratory determination), severity, attribution, time of onset, duration, probable association with the study treatment and reversibility or outcome. Baseline information (e.g. the extent/type of prior therapy).
Time frame: Up to 1 year
Duration of remission
Time frame: From the date of first documented response (CR/CRi) up to 1 year
Time to response
Will be estimated using the product-limit method of Kaplan and Meier.
Time frame: From date of first dose of study drug up to 1 year
Overall survival
Will be estimated using the product-limit method of Kaplan and Meier.
Time frame: From date of first dose of study drug up to 1 year
Event-free survival
Will be estimated using the product-limit method of Kaplan and Meier.
Time frame: From date of first dose of study drug up to 1 year
Allogeneic stem cell transplantation (SCT) realization rate
Will be measured by number and proportion of patients who underwent SCT after treatment of pembrolizumab and blinatumomab
Time frame: Up to 1 year
Number and proportion of patients who start pembrolizumab maintenance
Time frame: Up to 1 year
Number and proportion of patients who complete pembrolizumab maintenance
Time frame: Up to 1 year
Minimal residual disease rate confirmed minimal residual disease
Will be measured by number and proportion of patients with CR who have confirmed minimal residual disease.
Time frame: Up to 1 year
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