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Leukemia, Lymphocytic, Chronic, B-CellPhase 2NCT00545714

A Study to Assess the Efficacy of Rituximab (MabThera) in First Line Treatment of Chronic Lymphocytic Leukemia (CLL)

A Phase 2 study testing Cyclophosphamide, Fludarabine and Rituximab in people with Leukemia, Lymphocytic, Chronic, B-Cell, run by Hoffmann-La Roche at 33 sites in Spain.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This single arm study will assess the efficacy and safety of rituximab in combination with fludarabine and cyclophosphamide, followed by rituximab maintenance therapy, as first line treatment of participants with CLL. Read more about this study

Who is it for?
Ages 18 to 70 years
Conditions the study is for
Leukemia, Lymphocytic, Chronic, B-Cell
What is being tested?
Cyclophosphamide, Fludarabine and Rituximab
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
86 participants
Where
33 sitesSpain
Study dates
21 Nov 2007to 20 May 2016
Phase
Phase 2
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 70 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • CLL according to World Health Organization diagnostic criteria
  • Active disease
  • No previous treatment
  • Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2

Who cannot join

  • Transformation to aggressive B-cell malignancy (prolymphocytic leukemia, large-cell lymphoma, Hodgkin's lymphoma)
  • Other malignancies except for localized skin cancer
  • Continuous systemic corticosteroid treatment
  • Known infection with hepatitis B or C

Trial locations and contacts

33 sites in 1 country.

33 sites in 1 country

Spain33 sites
  • Complejo Hospitalario Universitario A Coruña (CHUAC); Servicio de Hematologia

    A Coruña, LA Coruña, 15006

  • Fundacion Hospital de Alcorcon; Servicio de Hematologia

    Alcorcón, Madrid, 28922

  • Hospital Universitario Infanta Cristina; Servicio de Hematologia

    Badajoz, 06080

  • Hospital Duran i Reynals; Servicio de Hematologia

    Barcelona, 08907

  • Hospital de Basurto; Servicio de Hematologia

    Bilbao, Vizcaya, 48013

  • Hospital San Pedro De Alcantara; Servicio de Hematologia

    Cáceres, 10003

  • Hospital Universitario Puerta del Mar; Servicio de Hematologia

    Cadiz, Cadiz, 11009

  • Hospital General de Castellon; Servicio de Hematologia

    Castellon, Castellon, 12004

  • Hospital Francesc de Borja; Servicio de Hematologia

    Gandia, Valencia, 46702

  • Hospital Universitario Virgen de las Nieves; Servicio de Hematologia

    Granada, 18014

  • Hospital de Jerez de la Frontera; Servicio de Hematologia

    Jerez de la Frontera, Cadiz, 11407

  • Hospital General Universitario Gregorio Marañon; Servicio de Hematología

    Madrid, 28007

  • Hospital Ramon y Cajal; Servicio de Hematologia

    Madrid, 28034

  • Hospital Universitario Clínico San Carlos; Servicio de Hematología

    Madrid, 28040

  • Hospital Univ. 12 de Octubre; Servicio de Hematologia

    Madrid, 28041

  • Hospital Universitario la Paz; Servicio de Hematologia

    Madrid, 28046

  • HOSPITAL DE MADRID NORTE SANCHINARRO- CENTRO INTEGRAL ONCOLOGICO CLARA CAMPAL; Servicio Hematologia

    Madrid, 28050

  • Hospital Universitario Puerta de Hierro; Servicio de Hematologia

    Madrid, 28222

  • Hospital Universitario Principe de Asturias; Servicio de Hematología

    Madrid, 28805

  • Hospital Universitario de Getafe; Servico de Hematologia

    Madrid, 28905

  • Hospital Clinico Universitario Virgen de la Victoria; Servicio de Hematologia

    Málaga, 29010

  • Hosital Universitario de Mostoles;Servicio de Hematologia

    Móstoles, Madrid, 28935

  • Hospital General Universitario J.M Morales Meseguer; Servicio de Hematología

    Murcia, 30008

  • Hospital de Sagunto; Servicio de Hematologia

    Sagunto, Valencia, 46520

  • Hospital Clinico Universitario de Salamanca;Servicio de Hematologia

    Salamanca, 37007

  • Hospital Universitario Marques de Valdecilla; Servicio de Hematologia

    Santander, Cantabria, 39008

  • Hospital General Universitario de Valencia; Servicio de Hematologia

    Valencia, 46014

  • Hospital Arnau de Vilanova (Valencia) Servicio de Hematologia

    Valencia, 46015

  • Hospital Universitario Dr. Peset; Servicio de Hematologia

    Valencia, 46017

  • Hospital Universitario la Fe; Servicio de Hematologia

    Valencia, 46026

  • Hospital De Txagorritxu; Servicio de Hematologia

    Vitoria-Gasteiz, Alava, 01009

  • Hospital Clinico Universitario Lozano Blesa; Servicio de Hematologia

    Zaragoza, 50009

  • Hospital Universitario Miguel Servet; Servicio Hematologia

    Zaragoza, 50009

Other trials in Spain

About this study

Official title: Multicentre, Non-Randomised, Open-Label Phase II Study to Evaluate the Efficacy and Safety of Induction Treatment With Rituximab, Fludarabine, Cyclophosphamide, Followed by Rituximab Maintenance Therapy (R-Fc-Rm) in the First Line Treatment of Chronic Lymphocytic Leukaemia

This single arm study will assess the efficacy and safety of rituximab in combination with fludarabine and cyclophosphamide, followed by rituximab maintenance therapy, as first line treatment of participants with CLL.

Medical subject headings
Leukemia, Lymphocytic, Chronic, B-Cell

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • CyclophosphamideDrug

    Cyclophosphamide 250 mg/m^2 as IV infusion will be administered on Days 1-3 of first six 28-day cycles.

  • FludarabineDrug

    Fludarabine 25 mg/m^2 as IV infusion will be administered on Days 1-3 of first six 28-day cycles.

  • RituximabDrug

    Also called MabThera, Rituxan

    Rituximab 375 mg/m^2 as IV infusion will be administered on Day 0 of Cycle 1; 500 mg/m^2 as IV infusion will be administered on Day 1 of Cycle 2-6; and 375 mg/m^2 as IV infusion every 2 months from 3 months after Day 1 Cycle 6 up to a total of 18 doses or up to 3 years after Cycle 6.

Study groups in NCT00545714
Study groupRoleWhat they receive
Rituximab + Fludarabine + CyclophosphamideExperimentalParticipants will receive 6 cycles (cycle length = 28 days) of treatment with rituximab (375 milligrams per square meter [mg/m^2] as intravenous [IV] infusion on Day 0 of Cycle 1 and 500 mg/m^2 as IV infusion on Day 1 of Cycles 2-6); fludarabine (25 mg/m^2 on Days 1-3) and cyclophosphamide (250 mg/m^2 on Days 1-3). Participants with a partial or complete response and appropriate neutrophil conditions will receive maintenance treatment with rituximab (375 mg/m^2 as IV infusion every 2 months) from 3 months after Day 1 Cycle 6 up to a total of 18 doses or up to 3 years after Cycle 6.
Receives: Drug: Cyclophosphamide; Drug: Fludarabine; Drug: Rituximab

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Percentage of Participants With CR Achieved After the Rituximab, Fludarabine, and Cyclophosphamide Regimen

    CR was defined as no adenopathies (ADPs) and visceromegalies (VSMs) in physical examination (PE); no general symptoms (Sx); lymphocytes (Lymph) in peripheral blood less than (<) 4000 per cubic millimeter (mm^3); normalization of peripheral blood parameters: neutrophils (Neut) greater than (>) 1500/mm^3, platelets (Plt) >100,000/mm^3, hemoglobin (Hb) >11 grams per deciliter (g/dL) without transfusion; normocellular bone marrow (BM) with <30% Lymph; BM aspirate/biopsy with no evidence of infiltration of lymphoid nodules.

    Measured: Month 9

Secondary outcomes (13)
  1. Percentage of Participants With Clinical Response of CR or PR as Assessed by Multiparameter Flow Cytometry

    CR was defined as no ADPs and VSMs in PE; no general Sx; Lymph in peripheral blood <4000/mm^3; normalization of peripheral blood parameters: Neut >1500/mm^3, Plt >100,000/mm^3, Hb >11 g/dL without transfusion; normocellular BM with <30% Lymph; BM aspirate/biopsy with no evidence of infiltration of lymphoid nodules. PR was defined as decrease >50% in Lymph in peripheral blood; reduction in ADPs >50% in total sum of up to 6 ADPs or in the baseline ADP of largest diameter (LD), no new ADP or enlargement of a prior ADP; >50% decrease in VSM; Neut >1500/mm^3 or >50% increase from Baseline; Plt >100,000/mm^3 or >50% increase from Baseline; Hb >11.0 g/dL or >50% increase from Baseline value without transfusion. Participants who met all CR criteria but had persistent anemia or thrombocytopenia were considered as PR.

    Measured: Post-Induction Phase (IP): at 6 months; during Maintenance Phase (MP): at Cycles 9, 12, 15, 18 (cycle length = 2 months); during Follow-Up (FU): at Follow-Up Months 6, 12, 18, 24, 30, 36

  2. Percentage of Participants With Clinical Response of CR or PR Among Participants With Negative Minimal Residual Disease (MRD) as Assessed by Multiparameter Flow Cytometry

    CR: no ADPs and VSMs in PE; no general Sx; Lymph in peripheral blood <4000/mm^3; normalization of peripheral blood parameters: Neut >1500/mm^3, Plt >100,000/mm^3, Hb >11 g/dL without transfusion; normocellular BM with <30% Lymph; BM aspirate/biopsy with no evidence of infiltration of lymphoid nodules. PR: decrease >50% in Lymph in peripheral blood; reduction in ADPs >50% in total sum of up to 6 ADPs or in the baseline ADP of largest diameter (LD), no new ADP or enlargement of a prior ADP; >50% decrease in VSM; Neut >1500/mm^3 or >50% increase from Baseline; Plt >100,000/mm^3 or >50% increase from Baseline; Hb >11.0 g/dL or >50% increase from Baseline value without transfusion. Participants who met all CR criteria but had persistent anemia or thrombocytopenia were considered as PR. Negative MRD: Lymph <0.01% of all white blood cells (WBCs) in blood or BM after two consecutive measurements. Analysis performed only in blood during the Maintenance Phase and Follow-Up.

    Measured: Post-Induction Phase: at 6 months; during Maintenance Phase: at Cycles 9, 12, 15, 18 (cycle length = 2 months); during Follow-Up: at Follow-Up Months 6, 12, 18, 24, 36

  3. Percentage of Participants With CR With Incomplete Bone Marrow Recovery (CRi)

    Participants with CRi were those who met all CR criteria (including BM examinations) but had persistent anemia, thrombocytopenia, or neutropenia apparently unrelated to chronic lymphocytic leukemia (CLL) but related to drug toxicity. CR: no ADPs and VSMs in PE; no general Sx; Lymph in peripheral blood <4000/mm^3; normalization of peripheral blood parameters: Neut >1500/mm^3, Plt >100,000/mm^3, Hb >11 g/dL without transfusion; normocellular BM with <30% Lymph; BM aspirate/biopsy with no evidence of infiltration of lymphoid nodules.

    Measured: Baseline up to progressive disease (PD) or death due to any cause, whichever occurred first (up to 92 months)

  4. Percentage of Participants Who Died

    Measured: Baseline up to death due to any cause (up to 92 months)

  5. Overall Survival (OS)

    OS was defined as time from treatment start to death of the participant. For all other participants, the last follow-up available was taken as the last control. If the participant had not completed the study, the date of the last visit available was considered. OS was estimated using Kaplan-Meier (KM) methodology.

    Measured: Baseline up to death due to any cause (up to 92 months)

  6. Percentage of Participants With PD or Death

    PD was defined as new ADPs (1.5 centimeters [cm]), hepato-/splenomegaly (HSM), Richter syndrome (RS), or other infiltrated organs; greater than or equal to (>/=) 50% increase in size of Baseline prior ADPs or HSM in participants with PR; Lymph increase >/=50% in peripheral blood with B Lymph >/=5000/mm^3; cytopenia attributable to CLL. Progression of any cytopenia (not related to autoimmune cytopenia) reported as a 2-g/dL decrease in basal Hb, Hb <10 g/dL, >/=50% decrease in basal Plt count, or count <100,000/mm^3 at >/=3 months post-treatment was defined as PD if BM biopsy confirmed infiltration of clonal CLL cells.

    Measured: Baseline up to PD or death due to any cause, whichever occurred first (up to 92 months)

  7. Progression-Free Survival (PFS)

    PFS was defined as time from start of study treatment to PD or death, whichever occurred first. For other participants, last follow-up available was taken as last control. If participant did not complete study, date of last visit available was considered. PFS was estimated using KM methodology. PD was defined as new ADPs (1.5 cm), HSM, RS, or other infiltrated organs; >/=50% increase in size of Baseline prior ADPs or HSM in participants with PR; Lymph increase >/=50% in peripheral blood with B Lymph >/=5000/mm^3; cytopenia attributable to CLL. Progression of any cytopenia (not related to autoimmune cytopenia) reported as a 2-g/dL decrease in basal Hb, Hb <10 g/dL, >/=50% decrease in basal Plt count, or count <100,000/mm^3 at >/=3 months post-treatment was defined as PD if BM biopsy confirmed infiltration of clonal CLL cells.

    Measured: Baseline up to PD or death due to any cause, whichever occurred first (up to 92 months)

  8. Treatment-Free Survival (TFS)

    TFS was defined time from start of study treatment until participant received new chemotherapy/immunotherapy because of PD and to reduce the disease with palliative or curative intent. PD was defined as new ADPs (1.5 cm), HSM, RS, or other infiltrated organs; >/=50% increase in size of Baseline prior ADPs or HSM in participants with PR; Lymph increase >/=50% in peripheral blood with B Lymph >/=5000/mm^3; cytopenia attributable to CLL. Progression of any cytopenia (not related to autoimmune cytopenia) reported as a 2-g/dL decrease in basal Hb, Hb <10 g/dL, >/=50% decrease in basal Plt count, or count <100,000/mm^3 at >/=3 months post-treatment was defined as PD if BM biopsy confirmed infiltration of clonal CLL cells.

    Measured: Baseline up to PD or death due to any cause, whichever occurred first (up to 92 months)

  9. Duration of Response (DOR)

    DOR: time from CR/PR to MRD/PD. PD: new ADP (1.5 cm), HSM, RS, other infiltrated organs or >/=50% increase size in those with PR; blood Lymph increase >/=50% with B Lymph >/=5000/mm^3; cytopenia due to CLL. Progression of (nonautoimmune) cytopenia: 2-g/dL decrease basal Hb, Hb <10 g/dL, >/=50% decrease basal Plt or <100,000/mm^3 at >/=3 months post-treatment was PD if clonal CLL cell infiltration on BM biopsy. CR: no ADP/VSM in PE; no general Sx; blood Lymph <4000/mm^3; Neut >1500/mm^3; Plt >100,000/mm^3; Hb >11 g/dL (no transfusion); normocellular BM with <30% Lymph; BM aspirate/biopsy with no lymphoid nodule infiltration. PR: >50% decrease blood Lymph; >50% decrease in total sum up to 6 ADPs or baseline ADP of LD, no new/enlargement of prior ADP; >50% decrease VSM; Neut >1500/mm^3 or >50% increase; Plt >100,000/mm^3 or >50% increase; Hb >11.0 g/dL or >50% increase (no transfusion). All CR criteria but persistent anemia or thrombocytopenia was PR. MRD: Lymph >0.01% of blood/BM WBCs.

    Measured: From first CR or PR up to detectable MRD or disease occurrence/PD, whichever occurred first (up to 92 months)

  10. Percentage of Participants With Cluster of Differentiation (CD) 38 Cells >/=30% in Peripheral Blood

    Percentages of participants with CD38 expression by >/=30% of CLL cells during the Induction Phase, Maintenance Phase, and Follow-Up were reported.

    Measured: Post-Induction Phase: at 6 months; during Maintenance Phase: at Cycles 9, 12, 15, 18 (cycle length = 2 months); during Follow-Up: at Follow-Up Months 6, 12, 18, 24, 30, 36

  11. Percentage of Participants With Genetic Abnormalities

    Percentages of participants with genetic abnormalities (deletion 6q, deletion 11q22-q23, deletion p53, trisomy 12, and deletion 13q14) in the course of the disease during the Induction Phase and Maintenance Phase were reported.

    Measured: Post-Induction Phase: at 6 months; during Maintenance Phase: at Cycles 9, 12, 15, 18 (cycle length = 2 months)

  12. Percentage of Participants With Positive and Negative Zeta-Chain-Associated Protein Kinase 70 (ZAP-70) Expression

    Percentages of participants with positive and negative ZAP-70 expression during the Induction Phase, Maintenance Phase, and Follow-Up were reported. Positive ZAP-70 was defined as ZAP-70 expression by >/=20% of CLL cells. Negative ZAP-70 was defined as ZAP-70 expression by <20% of CLL cells.

    Measured: Post-Induction Phase: at 6 months; during Maintenance Phase: at Cycles 9, 12, 15, 18 (cycle length = 2 months); during Follow-Up: at Follow-Up Months 6, 12, 18, 24, 30, 36

  13. Percentage of Participants With Immunoglobulin Heavy Locus (IgH) Rearrangement

    Percentages of participants with IgH rearrangement during the Induction Phase, Maintenance Phase, and Follow-Up were reported.

    Measured: Post-Induction Phase: at 6 months; during Maintenance Phase: at Cycles 9, 12, 15, 18 (cycle length = 2 months); during Follow-Up: at Follow-Up Months 6, 12, 18, 24, 30, 36

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted17 Oct 2007 (estimated)
  2. Study start21 Nov 2007
  3. Primary completion20 May 2016
  4. Study completion20 May 2016

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
86 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00545714
Sponsor's protocol ID
ML21135
Other IDs
2007-002733-36
Status last verified
Jul 2018
First submitted
16 Oct 2007
Last updated
16 Jan 2019

Publications

  • Garcia-Marco JA, Jimenez JL, Recasens V, Zarzoso MF, Gonzalez-Barca E, De Marcos NS, Ramirez MJ, Parraga FJP, Yanez L, De La Serna Torroba J, Malo MDG, Ariznavarreta GD, Persona EP, Guinaldo MAR, De Paz Arias R, Llanos EB, Jarque I, Valle MDCF, Tatay AC, De Oteyza JP, Martin EMD, Fernandez IP, Martinez RM, Costa MAA, Champ D, Suarez JG, Diaz MG, Ferrer S, Carbonell F, Garcia-Vela JA; GELLC Study Group. High prognostic value of measurable residual disease detection by flow cytometry in chronic lymphocytic leukemia patients treated with front-line fludarabine, cyclophosphamide, and rituximab, followed by three years of rituximab maintenance. Haematologica. 2019 Nov;104(11):2249-2257. doi: 10.3324/haematol.2018.204891. Epub 2019 Mar 19.

    PubMed 30890600

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Cyclophosphamide, Fludarabine and Rituximab in people with Leukemia, Lymphocytic, Chronic, B-Cell, run by Hoffmann-La Roche at 33 sites in Spain.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 16 Jan 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 33 sites in Spain. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 16 Jan 2019). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Percentage of Participants With CR Achieved After the Rituximab, Fludarabine, and Cyclophosphamide Regimen (time frame: Month 9). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00545714, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 16 Jan 2019.

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