Skip to content

Pentostatin, Cyclophosphamide, and Rituximab With or Without Bevacizumab in Treating Patients With B-Cell Chronic Lymphocytic Leukemia or Small Lymphocytic Lymphoma

Randomized Phase II Trial of Pentostatin, Cyclophosphamide, and Rituximab With or Without Concurrent Avastin® for Previously Untreated B-Chronic Lymphocytic Leukemia (CLL)

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00816595
Enrollment
68
Registered
2009-01-01
Start date
2009-02-28
Completion date
2016-11-29
Last updated
2017-06-15

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Leukemia, Lymphoma

Keywords

B-cell chronic lymphocytic leukemia, stage 0 chronic lymphocytic leukemia, stage I chronic lymphocytic leukemia, stage II chronic lymphocytic leukemia, stage III chronic lymphocytic leukemia, stage IV chronic lymphocytic leukemia, stage I small lymphocytic lymphoma, stage III small lymphocytic lymphoma, stage IV small lymphocytic lymphoma, contiguous stage II small lymphocytic lymphoma, noncontiguous stage II small lymphocytic lymphoma

Brief summary

RATIONALE: Drugs used in chemotherapy, such as pentostatin and cyclophosphamide, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Monoclonal antibodies, such as rituximab and bevacizumab, can block cancer growth in different ways. Some block the ability of cancer cells to grow and spread. Others find cancer cells and help kill them or carry cancer-killing substances to them. It is not yet known whether giving pentostatin and cyclophosphamide together with rituximab is more effective with or without bevacizumab in treating patients with B-cell chronic lymphocytic leukemia or small lymphocytic lymphoma. PURPOSE: This randomized phase II trial is studying the side effects of giving pentostatin and cyclophosphamide together with rituximab with or without bevacizumab and to see how well it works in treating patients with B-cell chronic lymphocytic leukemia or small lymphocytic lymphoma.

Detailed description

OBJECTIVES: Primary * To assess the rate of complete and overall response in patients with B-cell chronic lymphocytic leukemia or small lymphocytic lymphoma treated with pentostatin, cyclophosphamide, and rituximab with or without bevacizumab. * To assess the proportion of patients who achieve a negative minimal residual disease state after treatment with these regimens. * To monitor and assess the adverse events of these regimens. Secondary * To determine if molecular prognostic parameters (ZAP-70, CD38, cytogenetic abnormalities identified by FISH, and IgVH mutation status) relate to response in these patients. * To determine the progression-free survival of patients treated with these regimens. * To complete additional correlative studies to gain insight into disease biology and how it influences drug sensitivity. OUTLINE: Patients are stratified according to Rai risk group (high \[Rai stage III or IV\] vs low \[Rai stage 0\] or intermediate \[Rai stage I or II\]) and FISH prognosis group (favorable \[normal, +12, 13q-, or other\] vs unfavorable \[17p- or 11q-\]). Patients are randomized to 1 of 2 treatment arms. * Arm I: Patients receive bevacizumab IV over 30-90 minutes on day 1 of courses 1-5 and on days 1, 22, and 43 of course 6; rituximab IV over 2-4 hours on days 2 and 3 of course 1 and on day 1 of courses 2-6; and pentostatin IV over 30 minutes and cyclophosphamide IV over 30 minutes on day 2 of course 1 and on day 1 of courses 2-6. Patients also receive pegfilgrastim subcutaneously (SC) on day 3 of course 1 and on day 2 of courses 2-6. Treatment repeats every 21 days\* for 6 courses in the absence of disease progression or unacceptable toxicity. NOTE: \*Course 6 is 56 days in duration * Arm II: Patients receive rituximab IV over 2-4 hours on days 1 and 2 of course 1 and on day 1 of courses 2-6 and pentostatin IV over 30 minutes and cyclophosphamide IV over 30 minutes on day 1. Patients also receive pegfilgrastim SC on day 2. Treatment repeats every 21 days\* for 6 courses in the absence of disease progression or unacceptable toxicity. NOTE: \*Course 6 is 56 days in duration Patients undergo blood sample collection and bone marrow biopsy/aspiration periodically for translational research studies. Samples are analyzed by flow cytometry for assessment of minimal residual disease. Molecular prognostic markers (including CD38, ZAP-70, IgVH gene mutation status, and cytogenetic abnormalities by FISH), Tcl-1 and CD49d protein expression, and immunoglobulin heavy chain D and J family gene usage are also analyzed. Plasma samples are stored for future studies evaluating levels of VEGF, bFGF, and thrombospondin by ELISA. After completion of study therapy, patients are followed periodically for up to 5 years.

Interventions

DRUGpentostatin

Given IV

BIOLOGICALpegfilgrastim

Given subcutaneously

BIOLOGICALrituximab

Given IV

DRUGcyclophosphamide

Given IV

BIOLOGICALbevacizumab

Given IV

Sponsors

National Cancer Institute (NCI)
CollaboratorNIH
Mayo Clinic
Lead SponsorOTHER

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to 120 Years
Healthy volunteers
No

Inclusion criteria

DISEASE CHARACTERISTICS: * Diagnosis of 1 of the following: * Biopsy proven small lymphocytic lymphoma (SLL) * Chronic lymphocytic leukemia (CLL)\* as evidenced by the following criteria: * Peripheral blood lymphocyte count \> 5,000/mm³ consisting of small to moderate size lymphocytes * Immunophenotyping consistent with CLL, defined by the following: * The predominant population of lymphocytes share both B-cell antigens (CD19, CD20, or CD23) as well as CD-5 in the absence of other pan-T-cell markers (CD-3 or CD-2) * Dim surface immunoglobulin expression * Exclusively kappa and lambda light chains * Negative FISH analysis for t(11;14)(IgH/CCND1) on peripheral blood or tissue biopsy samples NOTE: \*Splenomegaly, hepatomegaly, or lymphadenopathy are not required for the diagnosis of CLL * Has ≥ 1 of the following indications\*\* for chemotherapy: * Evidence of progressive marrow failure as manifested by the development of or worsening anemia (hemoglobin ≤ 11 g/dL) and/or thrombocytopenia (platelet count ≤ 100,000/mm³) * Symptomatic or progressive lymphadenopathy, splenomegaly or hepatomegaly * Has ≥ 1 of the following disease-related symptoms: * Weight loss \> 10% within the past 6 months * Extreme fatigue attributed to CLL * Fevers \> 100.5\^oF for 2 weeks without evidence of infection * Night sweats without evidence of infection * Progressive lymphocytosis (not due to the effects of corticosteroids) with an increase of \> 50% over a 2-month period or an anticipated doubling time of \< 6 months NOTE: \*\*Marked hypogammaglobulinemia or the development of a monoclonal protein in the absence of any of the above criteria for active disease are not sufficient indications for study treatment PATIENT CHARACTERISTICS: * Eastern Cooperative Oncology Group performance status 0-3 * Life expectancy ≥ 12 months * Total bilirubin ≤ 3.0 times upper limit of normal (ULN) (unless due to Gilbert's disease) * Direct bilirubin \< 1.5 mg/dL (in patients with Gilbert's disease) * Serum glutamate oxaloacetate transaminase ≤ 3.0 times ULN (unless due to hepatic involvement by CLL) * Creatinine ≤ 1.5 times ULN * Urine protein:creatinine ratio \< 1.0 OR \< 1 g of protein by 24-hour urine collection * Not pregnant or nursing * Negative pregnancy test * Fertile patients must use effective contraception during and for 12 months after completion of study treatment * Willing to provide mandatory blood and tissue samples * None of the following cardiovascular conditions: * NYHA class III-IV heart disease * Myocardial infarction within the past 6 months * Unstable angina * Stroke, cerebrovascular accident, or transient ischemic attack within the past 6 months * Arterial thromboembolic events within the past 12 months * Clinically significant peripheral vascular disease * Uncontrolled hypertension, defined as systolic BP \> 150 mm Hg or diastolic BP \> 100 mm Hg * Hypertension allowed provided it is controlled with a stable anti-hypertensive regimen * History of hypertensive crises or hypertensive encephalopathy * Deep venous thromboses or pulmonary embolism within the past 12 months * No evidence of bleeding diathesis or coagulopathy * No uncontrolled or active hemolytic anemia requiring immunosuppressive therapy or other pharmacologic treatment * No active or recent history (within the past 30 days) of hemoptysis (≥ ½ teaspoon of bright red blood per episode) * No abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within the past 6 months * No active peptic ulcer disease * No serious non-healing wound, ulcer, or bone fracture * No significant traumatic injury within the past 28 days * No uncontrolled infection * No active HIV infection * No other active primary malignancy (except nonmelanoma skin cancer or carcinoma in situ of the cervix) requiring treatment or limiting survival to ≤ 2 years * No psychiatric or addictive disorders or other conditions that, in the opinion of the investigator, would preclude study participation PRIOR CONCURRENT THERAPY: * Prior corticosteroids allowed * More than 4 weeks since prior radiotherapy * More than 28 days since prior and no concurrent major surgical procedure or open biopsy * More than 7 days since prior minor surgical procedure, fine needle aspiration, or core biopsy (other than bone marrow biopsy) * No concurrent therapeutic doses of coumadin-derivative anticoagulants (e.g., warfarin) * Doses of ≤ 2 mg daily allowed for prophylaxis of thrombosis * Prophylactic doses of low molecular weight heparin allowed * No other concurrent investigational agents for treatment of CLL or SLL * No other concurrent specific anticancer treatment except hormonal therapy

Design outcomes

Primary

MeasureTime frameDescription
Complete and Overall Response RateEvaluated after 6 cycles (up to 196 days)A Complete Response (CR) requires all of the following for 2 months: * Absence of lymphadenopathy by physical examination (PE) * No hepato- or splenomegaly by PE * Neutrophils \>1500/ul, Platelets \>100,000/ul. Hemoglobin \>11.0 gm/dl, Peripheral blood lymphocytes \<4000/uL Nodular Partial Response (nPR) is defined as a patient qualified for a CR, but regenerative nodules are histologically present on bone marrow samples. A Clinical Complete Response (CCR) is defined as a patient qualified for a CR, but bone marrow samples are not available. A Partial Response (PR) requires 50% reduction in 2 of the following: peripheral blood lymphocytes, or the sum of the products of the maximal perpendicular diameters, or the size of liver and/or spleen; and a 50% increase in neutrophils, platelets, or hemoglobin. Overall response rate is calculated as the number of patients receiving CR, CCR, nPR, or PR as their objective status divided by the total number of evaluable patients.

Secondary

MeasureTime frameDescription
Overall SurvivalAssessed up to 5 years from registrationThe Kaplan-Meier method will be used to estimate overall survival distributions Overall survival is measured as the time from registration to the time of death due to any cause.
Progression-free SurvivalAssessed up to 5 years from registrationThe Kaplan-Meier method will be used to estimate progression-free survival distribution. Progression-free survival is defined as the time from registration to the time of progression or death, whichever occurs first.

Countries

United States

Participant flow

Participants by arm

ArmCount
Arm A: Pentostatin, Cyclophosphamide, Rituximab, and Avastin
Patients receive 15 mg/kg bevacizumab IV over 30-90 minutes on day 1 of courses 1-5 and on days 1, 22, and 43 of course 6; 375 mg/m\^2 rituximab IV over 2-4 hours on days 2 and 3 of course 1 and on day 1 of courses 2-6; and 2 mg/m\^3 pentostatin IV over 30 minutes and 600 mg/m\^2 cyclophosphamide IV over 30 minutes on day 2 of course 1 and on day 1 of courses 2-6. Patients also receive 6 mg pegfilgrastim subcutaneously (SC) on day 3 of course 1 and on day 2 of courses 2-6. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity.
33
Arm B: Pentostatin, Cyclophosphamide, and Rituximab
Patients receive 100 mg rituximab IV over 2-4 hours on day 1 and 375 mg/m\^2 on day 2 of course 1 and 375 mg/m\^2 on day 1 of courses 2-6. They receive 2 mg/m\^2 pentostatin IV over 30 minutes and 600 mg/m\^2 cyclophosphamide IV over 30 minutes on day 1. Patients also receive 6 mg pegfilgrastim SC on day 2. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity.
33
Total66

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyWithdrawal by Subject20

Baseline characteristics

CharacteristicArm A: Pentostatin, Cyclophosphamide, Rituximab, and AvastinArm B: Pentostatin, Cyclophosphamide, and RituximabTotal
Age, Continuous65 years63 years63.5 years
Region of Enrollment
United States
33 participants33 participants66 participants
Sex: Female, Male
Female
13 Participants9 Participants22 Participants
Sex: Female, Male
Male
20 Participants24 Participants44 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
32 / 3330 / 33
serious
Total, serious adverse events
11 / 335 / 33

Outcome results

Primary

Complete and Overall Response Rate

A Complete Response (CR) requires all of the following for 2 months: * Absence of lymphadenopathy by physical examination (PE) * No hepato- or splenomegaly by PE * Neutrophils \>1500/ul, Platelets \>100,000/ul. Hemoglobin \>11.0 gm/dl, Peripheral blood lymphocytes \<4000/uL Nodular Partial Response (nPR) is defined as a patient qualified for a CR, but regenerative nodules are histologically present on bone marrow samples. A Clinical Complete Response (CCR) is defined as a patient qualified for a CR, but bone marrow samples are not available. A Partial Response (PR) requires 50% reduction in 2 of the following: peripheral blood lymphocytes, or the sum of the products of the maximal perpendicular diameters, or the size of liver and/or spleen; and a 50% increase in neutrophils, platelets, or hemoglobin. Overall response rate is calculated as the number of patients receiving CR, CCR, nPR, or PR as their objective status divided by the total number of evaluable patients.

Time frame: Evaluated after 6 cycles (up to 196 days)

Population: One patient on Arm A was treated at an incorrect dose level and was not evaluable for this endpoint. On Arm B, one patient did not have correct eligibility reported, one patient did not complete an assessment, and one patient was incorrectly treated. The primary endpoint is based on 32 Arm A and 30 Arm B patients.

ArmMeasureGroupValue (NUMBER)
Arm A: Pentostatin, Cyclophosphamide, Rituximab, and AvastinComplete and Overall Response RateComplete Response (CR) Rate50.0 percentage of patients
Arm A: Pentostatin, Cyclophosphamide, Rituximab, and AvastinComplete and Overall Response RateOverall Response Rate93.8 percentage of patients
Arm B: Pentostatin, Cyclophosphamide, and RituximabComplete and Overall Response RateComplete Response (CR) Rate33.3 percentage of patients
Arm B: Pentostatin, Cyclophosphamide, and RituximabComplete and Overall Response RateOverall Response Rate96.7 percentage of patients
Secondary

Overall Survival

The Kaplan-Meier method will be used to estimate overall survival distributions Overall survival is measured as the time from registration to the time of death due to any cause.

Time frame: Assessed up to 5 years from registration

Population: One patient on Arm A was treated at an incorrect dose level and was not evaluable for this endpoint. On Arm B, one patient did not have correct eligibility reported, one patient did not complete an assessment, and one patient was incorrectly treated. The primary endpoint is based on 32 Arm A and 30 Arm B patients.

ArmMeasureValue (MEDIAN)
Arm A: Pentostatin, Cyclophosphamide, Rituximab, and AvastinOverall SurvivalNA months
Arm B: Pentostatin, Cyclophosphamide, and RituximabOverall SurvivalNA months
Secondary

Progression-free Survival

The Kaplan-Meier method will be used to estimate progression-free survival distribution. Progression-free survival is defined as the time from registration to the time of progression or death, whichever occurs first.

Time frame: Assessed up to 5 years from registration

Population: One patient on Arm A was treated at an incorrect dose level and was not evaluable for this endpoint. On Arm B, one patient did not have correct eligibility reported, one patient did not complete an assessment, and one patient was incorrectly treated. The primary endpoint is based on 32 Arm A and 30 Arm B patients.

ArmMeasureValue (MEDIAN)
Arm A: Pentostatin, Cyclophosphamide, Rituximab, and AvastinProgression-free SurvivalNA months
Arm B: Pentostatin, Cyclophosphamide, and RituximabProgression-free Survival34.1 months

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026