A Multicenter Phase II Study of Subcutaneous Blinatumomab for Treatment of Adult Patients With CD19-Positive Mixed Phenotype Acute Leukemia (MPAL)
Summary
This is a multicenter, non-randomized, open-label, phase II study evaluating blinatumomab administered subcutaneously in adult subjects with CD19+ MPAL. This trial consists of three cohorts of patients with CD19-positive MPAL, categorized as follows: 1. Cohort A: Newly diagnosed CD19+ MPAL in untreated patients who are either ≥ 75 years of age or have at least one coexisting condition precluding intensive chemotherapy. 2. Cohort B: Patients with CD19+ MPAL who have achieved complete remission (CR, CRh, or CRi) following at least one line of treatment but have detectable measurable residual disease (MRD) at a level of ≥ 0.1%, assessed using an assay with a minimum sensitivity of 0.01%. 3. Cohort C: Patients with CD19+ MPAL with morphologic relapsed or refractory (R/R) disease following at least one prior line of treatment. The Primary Objectives for each cohort are for Cohort A: to evaluate the efficacy of SC-blinatumomab in treatment; for Cohort B: to assess the ability of SC-blinatumomab to achieve MRD-negative CR; for Cohort C: to determine the efficacy of SC-blinatumomab in inducing CR, CRh, or CRi in patients. At specified time points, subjects will undergo the following procedures: collection of informed consent, medical history, demographics, ECOG performance, and physical exam including vital signs as well as neurological examination including examination of writing ability. Subjects will provide samples for complete blood count with differential and blood chemistry profile, have a bone marrow aspiration and biopsy and lumbar puncture will be performed per protocol or if clinically indicated, and/or ECG, Echocardiography, pulmonary function test will be performed only if medically indicated. The subcutaneous treatment will be given in both the inpatient and outpatient setting. For an individual subject the length of participation includes up to a 3-week screening period, up to a 13-month treatment period, and a safety follow-up visit (30 days after the last dose of study treatment), and a follow-up period.
Arms & interventions
- DrugSubcutaneous Blinatumomab
Blinatumomab will be administered as a subcutaneous (SC) injection.
Outcome measures
Primary
Cohort A - Overall Survival
The Overall Survival (OS) is the time from treatment initiation to death from any cause.
Time frame: Up to 3 years
Cohort B - Rate of Complete Remission (CR), Complete Remission with Partial Hematological Recovery (CRh), or Complete Remission with Incomplete Hematological Recovery (CRi) with Minimal Residual Disease (MRD) negativity
The rate of achievement of complete remission (CR/CRh/CRi) with MRD-negativity (\<0.01%) after the first two cycles of therapy with blinatumomab. CR: Bone marrow blasts \<5%; absence of circulating blasts; absence of extramedullary disease; absolute neutrophil count (ANC) ≥1000/µL and platelets ≥100,000/µL; MRD+ or unknown. CR +CRh: Bone marrow blasts \<5%; absence of circulating blasts; absence of extramedullary disease; ANC ≥500/µL AND platelet count ≥50,000/µL. CR +CRi: Bone marrow blasts \<5%; absence of circulating blasts; absence of extramedullary disease; with residual thrombocytopenia (platelet count of \<100,000/µL) OR residual neutropenia (ANC \<1000/µL); not fulfilling criteria for CRh. MRD Negativity: No detectable cancer cells using sensitive tests, with less than 0.01% cancer cells. MRD positivity indicates a higher risk of relapse, while MRD negativity is linked to long-term remission and survival benefits.
Time frame: At completion of 2 cycles (each cycle is 34 days)
Cohort C - Rate of Complete Remission (CR) or Complete Remission with Partial Hematological Recovery (CRh)
The rate of achievement of complete remission (CR/CRh) after the first two cycles of therapy with blinatumomab. Complete Remission (CR): No detectable cancer cells in the bone marrow (less than 5% blast cells) and normal blood counts. CRh: No detectable cancer cells, with partial recovery of blood counts (ANC 500-1,000/µL, platelets 50,000-100,000/µL). The rate of achieving these states is calculated by the proportion of patients who reach CR/CRh within a set time. Higher rates of achievement indicate that a larger proportion of participants are responding positively to the treatment, with no detectable cancer cells in their bone marrow and recovery of blood counts.
Time frame: At completion of 2 cycles (each cycle is 34 days)
Secondary
Cohort A - MRD-negative CR + CRh rate
Time frame: At completion of 2 cycles (each cycle is 34 days)
Cohort A - Event-Free Survival (EFS)
Time frame: Up to approximately 3 years
Cohort A - Incidence and Severity of Adverse Events (AEs)
Time frame: Up to approximately 1 year
Cohort B - Overall Survival
Time frame: Up to approximately 3 years
Cohort B - Rate of MRD-negativity (<0.01%)
Time frame: At completion of 1 cycle (cycle is 34 days)
Cohort B - Event-Free Survival (EFS)
Time frame: Up to approximately 1 year
Cohort B - Incidence and Severity of Adverse Events (AEs)
Time frame: Up to approximately 1 year
Cohort C - Overall Survival
Time frame: Up to approximately 3 years
Cohort C - Event-Free Survival (EFS)
Time frame: Up to approximately 1 year
Cohort C - Incidence and Severity of Adverse Events (AEs)
Time frame: Up to approximately 1 year
Overall - Incidence and Severity of Adverse Events (AEs)
Time frame: Up to approximately 1 year
Eligibility criteria
Study locations (1)
West Virginia University Cancer Institute
Morgantown, West Virginia, 26506