E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Primary previously untreated B or T-lineage ALL (excluding ALL with mature B-cell phenotype, but including Philadelphia positive or BCR-ABL positive ALL) or previously untreated T-LBL |
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E.1.1.1 | Medical condition in easily understood language |
acute lymphoblastic leukemia
T-cell lymphoblastic lymphoma |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 18.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10000845 |
E.1.2 | Term | Acute lymphoblastic leukemia |
E.1.2 | System Organ Class | 100000004864 |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
Phase II part
- To determine the feasibility of adding i.v. clofarabine to standard prephase therapy (followed by induction chemotherapy)
Phase III part
- To improve EFS in adult ALL patients by the addition of i.v. clofarabine to the standard prephase and consolidation therapy
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E.2.2 | Secondary objectives of the trial |
- To improve the molecular response rate of adult ALL following RI by the addition of i.v. clofarabine to standard prephasepreophase and consolidation therapy
- To improve DFS, and OS in adult ALL patients by the addition of i.v. clofarabine to the standard prephase and consolidation therapy
- To document safety and toxicity of adding clofarabine to standard prephase and consolidation therapy in adult ALL
-To assess and compare clinical outcome of patients with and without an HLA-identical sibling in a donor vs no-donor analysis
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
- Patients aged 18 to 70 years inclusive
- Primary previously untreated B or T-lineage ALL (excluding ALL with mature B-cell
phenotype, but including Philadelphia positive or BCR-ABL positive ALL) or previously untreated T-LBL (pretreatment with prednisolone for 7 days is allowed)
- WHO performance status 0 – 2
- Adequate renal and hepatic function tests as indicated by the following laboratory
values:
- Serum creatinine ≤1.0 mg/dl (≤ 88.7 micromol/L); if serum creatinine >1.0 mg/dl
(>88.7 micromol/L), then the glomerular filtration rate (GFR) must be
>60 ml/min/1.73 m2 as calculated by the Modification of Diet in Renal Disease
equation where the predicted GFR (ml/min/1.73 m2) = 186 x (Serum Creatinine in
mg/dl)-1.154 x (age in years)-0.023 x (0.742 if patient is female) x (1.212 if
patient is black)
NOTE: if serum creatinine is measured in micromol/L, recalculate it in mg/dl
according to the equation: 1 mg/dl = 88.7 micromol/L) and used above mentioned
formula.
- Serum bilirubin ≤ 1.5 × upper limit of normal (ULN)
- Aspartate transaminase (AST)/alanine transaminase (ALT) ≤ 2.5 × ULN
- Alkaline phosphatase ≤ 2.5 × ULN
- Negative pregnancy test at inclusion, if applicable
- Written informed consent
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E.4 | Principal exclusion criteria |
- Mature surface Ig positive B-cell leukemia/lymphoma
- Acute undifferentiated leukemia
- Severe cardiovascular disease (arrhythmias requiring chronic treatment, congestive
heart failure or symptomatic ischemic heart disease)
- Severe pulmonary dysfunction (CTCAE grade III-IV, see appendix D)
- Severe neurological or psychiatric disease
- History of active malignancy during the past 5 years with the exception of basal
carcinoma of the skin or stage 0 cervical carcinoma
- Active, uncontrolled infection
- Patient known to be HIV-positive
- Patient is a lactating woman
- Any psychological, familial, sociological and geographical condition potentially
hampering compliance with the study protocol and follow-up schedule
- Unwilling or not capable to use effective means of birth control
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E.5 End points |
E.5.1 | Primary end point(s) |
Phase II of the study: Feasibility (i.e. defined as less than 10% increase in DLT (e.g. from 20% to 30%) and 5% increase in TRM in arm B compared to arm A
Phase III of the study: Event free survival (i.e. time from registration until no CR on protocol treatment, relapse or death in 1st CR, whichever comes first) |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
At entry: The investigations before start of treatment should be no older than 14 days prior to randomization unless otherwise noted in the following part
During induction, consolidation, intensification, allo-SCT, interphase and maintenance therapy during follow up
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E.5.2 | Secondary end point(s) |
MRD level following induction chemotherapy
- MRD level prior start of maintenance
- Blood blast clearance (corticosteroid sensitivity)(day 8 of prephase)
- Chemosensitivity (day 15 counted from start prephase therapy)
- Hematological response
- Disease free survival (hematologically; i.e. time from CR until relapse or death, whichever comes first)
- Disease free survival (molecularly); i.e. time from molecular CR until molecular relapse or death (whichever comes first)
- Overall survival, measured from the time of registration. Patients still alive or lost to follow up are censored at the date they were last known to be alive.
- Adverse events
- Relapse as from start of maintenance
- Incidence of objectively diagnosed symptomatic thromboembolic events
- Influence of ALL (treatment) on plasma coagulation markers
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
At entry: The investigations before start of treatment should be no older than 14 days prior to randomization unless otherwise noted in the following part
During induction, consolidation, intensification, allo-SCT, interphase and maintenance therapy during follow up
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | Yes |
E.8.2.3.1 | Comparator description |
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E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 8 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 23 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Belgium |
Croatia |
France |
Netherlands |
Portugal |
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E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 6 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 6 |
E.8.9.2 | In all countries concerned by the trial months | 0 |
E.8.9.2 | In all countries concerned by the trial days | 0 |