Chronic Lymphocytic Leukemia Clinical Trial
Early Clonal Dynamics During Venetoclax Treatment for Relapsed or Refractory Chronic Lymphocytic Leukemia (CLL)
The drug venetoclax treats leukemia-cll/" >chronic lymphocytic leukemia (CLL). Researchers want to find better treatments for CLL. To do that, they need to learn how the drug affects CLL cancer cells and the immune system.
To learn about genetic changes that happen during treatment of CLL with venetoclax.
Adults ages 18 and older with relapsed or refractory CLL after at least 1 prior therapy
Participants will be screened under a separate protocol.
In Phase 1, participants will get venetoclax free of charge through the NIH. Venetoclax is started at a low dose. The dose will be increased every week until participants reach their maximum tolerable dose. This usually take about 5 weeks. Participants will visit the NIH at least once per week. Visits will be about 4 hours. They may have to stay in the hospital to be observed.
In Phase 2, participants will continue to get the drug through their local cancer doctor and their health insurance. Patients will also visit the NIH every 6 months, or if their disease progresses.
At the NIH participants will have regular health assessments. These will include physical exams and a review of the medicines they are taking. They will talk about how they are feeling.
The study included the following tests:
CT scans: Participants will lie in a machine that takes pictures of the body (maximum 3 per year)
Bone marrow biopsies: A small amount of marrow will be taken out of the participant s hip bone with a needle.
Optional lymph node biopsies: A small piece of the participant s tissue will be taken out with a needle.
The study will last at least 2 years.
This study aims to study the clonal dynamics and kinetics of response during the ramp-up phase of venetoclax in chronic lymphocytic leukemia (CLL).
Key Eligibility Criteria:
Diagnosis of CLL/SLL (treatment naive or relapsed/refractory)
Must have designated hematologist/oncologist who has agreed to assume care and continue venetoclax after the ramp-up phase is complete
Age greater than or equal to 18 years
Patients with CLL/SLL will enroll on the study. Subjects will be treated at the NIH Clinical Center for the duration of the ramp-up phase of venetoclax. After the ramp-up phase is complete, subjects will be transitioned to the care of their local hematologist/oncologist and receive venetoclax monotherapy or in combination with other agent(s) at the discretion of the treating oncologist. Subjects will have the option to follow-up at the NIH every 6 months (from initiation of venetoclax) and at (suspected) progression.
-Determine the proportion of subjects with clonal shift during the ramp-up phase of venetoclax
-Determine response kinetics of venetoclax therapy in the peripheral blood, lymph nodes and bone marrow
Assess relationship between clonal shifts and minimal residual disease (MRD) status, progression free survival (PFS) and overall survival (OS)
Assess immunologic changes in the peripheral blood and bone marrow during venetoclax treatment
Assess circulating-tumor DNA in response to treatment during venetoclax treatment
Diagnosis of CLL/SLL which is made according to the updated criteria of the NCI Working Group16.
Active disease as defined by at least one of the following (iwCLL consensus criteria):
Weight loss greater than or equal to 10% within the previous 6 months
Fevers of greater than 100.5 F for greater than or equal to 2 weeks without evidence of infection
Night sweats for more than one month without evidence of infection
Evidence of progressive marrow failure as manifested by the development of, or worsening of
Anemia and/or thrombocytopenia
Massive or progressive splenomegaly
Massive nodes or clusters or progressive lymphadenopathy
Progressive lymphocytosis with an increase of >50% over a 2-month period, or an anticipated doubling time of less than 6 months
Must have designated hematologist/oncologist will assume care and provide venetoclax after the ramp-up phase is complete
Must have G6PD testing performed to determine whether rasburicase can be given
Must have HLA-testing performed to determine whether allopurinol hypersensitivity exists
Age greater than or equal to 18 years
Agreement to use acceptable methods of contraception for the duration of venetoclax treatment if sexually active and able to bear or beget children
Willing and able to participate in all required evaluations and procedures in this study protocol including swallowing capsules without difficulty
Able to comprehend the investigational nature of the protocol and provide informed consent
Female patients who are currently pregnant or nursing
Any uncontrolled active systemic infection
Any life-threatening illness, medical condition, or organ system dysfunction that, in the investigator s opinion, could compromise the subject s safety or put the study outcomes at undue risk
Known additional malignancy that is progressing or requires active treatment.
--Note: Exceptions include basal cell carcinoma of skin, squamous cell carcinoma of skin, and in situ cervical cancer that has undergone potentially curative therapy. Further exceptions include other cancers from which the subject has been diseasefree for > 2 years, cancers which will not limit survival to < 2 years or cancers in remission receiving endocrine therapy.
Richter s Transformation
Any prior therapy with BCL-2 inhibitors
Concomitant use of strong CYP3A4 inhibitors
Disease significantly affecting gastrointestinal function or absorption
Uncontrolled autoimmune hemolytic anemia or autoimmune thrombocytopenia
Concomitant systemic cancer directed therapy (e.g. immunotherapy, chemotherapy, radiotherapy)
Absolute neutrophil count (ANC) <1000/microL, platelets (Plt) <30,000/ microL
Serum bilirubin >3 times upper limit of normal (ULN)
Severe psychiatric illness/social situations or cognitive impairment that would limit the patient s ability to tolerate and/or comply with study requirements
If the PI assesses the decreased ANC and/or Plt to be related to CLL involvement, patients may still be enrolled in the study, as cytopenias as expected to improve with treatment of CLL. Patients may receive supportive measures (e.g. transfusions, IVIG, growth factor support, etc.) to avoid severe cytopenias prior to and during therapy with venetoclax.
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