Phase2 Trial of High Dose Intravenous Ascorbic Acid as an Adjunct to Salvage Chemotherapy in Relapsed/ Refractory Lymphoma, Patients With Clonal Cytopenia of Undetermined Significance, and Chronic Myelomonocytic Leukemia

Who is this study for? Adult patients with diffuse large B-cell lymphoma and other lumphomas
Status: Recruiting
Location: See all (4) locations...
Intervention Type: Procedure, Drug, Biological, Other, Dietary supplement
Study Type: Interventional
Study Phase: Phase 2
SUMMARY

This phase II trial studies the effect of ascorbic acid and combination chemotherapy in treating patients with lymphoma that has come back (recurrent) or does not respond to therapy (refractory), clonal cytopenia of undetermined significance and chronic myelomonocytic leukemia (CMML). Ascorbic acid may make cancer cells more sensitive to chemotherapy. Drugs used in chemotherapy, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving ascorbic acid and combination chemotherapy may kill more cancer cells.

Eligibility
Participation Requirements
Sex: All
Minimum Age: 18
Healthy Volunteers: f
View:

• Age \>= 18 years

• Biopsy-proven relapsed or refractory lymphomas; relapsed is defined as a relapse that occurred after having a response to the last therapy that lasted \> 6 months; refractory is no response or relapse within 6 months; previous biopsies \< 6 months prior to treatment on this protocol will be acceptable

‣ NOTE: Arms A/B - relapsed or refractory DLBCL within 24 months from the end of anthracycline-based therapy; no prior salvage therapy; patients can have received radiation therapy as part of initial treatment but not specifically for relapse

⁃ NOTE: Arm C patients include relapsed or refractory lymphoma patients of any type for which the recommended treatment includes one of the platinum-based regimens; of note, relapsed or refractory double-hit high grade lymphoma patients and relapsed or refractory Hodgkin lymphoma patients will be enrolled in Arm C; there is no limit on the number of prior therapies for Arm C patients; the patient must be eligible for a platinum-based regimen and must not have received the same regimen in the past without responding

• Measurable or assessable disease: measurable disease is defined as measurable by computed tomography (CT) \[dedicated CT or the CT portion of a positron emission tomography (PET)/CT\] or magnetic resonance imaging (MRI): to be considered measurable, there must be at least one lesion that has a single diameter of \>= 1.5 cm

‣ NOTE: Skin lesions can be used if the area is \>= 1.5 cm in at least one diameter and photographed with a ruler; patients with assessable disease by PET are also eligible as long as the assessable disease is biopsy proven lymphoma

• Arms A/B - eligible for treatment with ifosfamide, carboplatin, and etoposide (+/- rituximab)

• Arm C eligible for treatment with one of the following standard, every 3 week, platinum-based salvage regimens (with or without monoclonal antibody as appropriate for the disease):

‣ Ifosfamide/carboplatin/etoposide (ICE) or rituximab/ifosfamide/carboplatin/etoposide (RICE);

⁃ Cisplatin, cytarabine (cytosine arabinoside), dexamethasone (DHAP) or RDHAP;

⁃ Gemcitabine hydrochloride (gemcitabine), dexamethasone, cisplatin (GDP) or rituximab, gemcitabine, dexamethasone, cisplatin (RGDP);

⁃ Gemcitabine and oxaliplatin (GemOx) or rituximab, gemcitabine and oxaliplatin (RGemOx);

⁃ Oxaliplatin, cytosine arabinoside, dexamethasone (OAD) or rituximab, oxaliplatin, cytosine arabinoside, dexamethasone (ROAD)

• Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0, 1 or 2

• Hemoglobin \>= 8.0 g/dL (may transfuse to meet this requirement), obtained =\< 14 days prior to registration

• Absolute neutrophil count (ANC) \>= 1500/mm\^3, obtained =\< 14 days prior to registration

• Platelet count \>= 75000/mm\^3, obtained =\< 14 days prior to registration

• Total bilirubin =\< 2 x upper limit of normal (ULN) (if \> 2 x ULN direct bilirubin is required and should be =\< 1.5 x ULN), obtained =\< 14 days prior to registration

• Alanine aminotransferase (ALT) and aspartate transaminase (AST) =\< 3 x ULN (=\< 5 x ULN for patients with liver involvement), obtained =\< 14 days prior to registration

• Creatinine =\< 1.6 mg/dL; if over 1.6 then the calculated creatinine clearance must be \>= 55 ml/min using the Cockcroft-Gault formula, obtained =\< 7 days prior to registration

• Negative pregnancy test done =\< 7 days prior to registration, for persons of childbearing potential only

‣ NOTE: If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required

• Human immunodeficiency virus (HIV) test done =\< 14 days prior to registration

‣ If positive, the CD4 count must be \> 400

• Provide written informed consent

• Willingness to have a central venous line \[peripherally inserted central catheter (PICC) or PORT\]

• Willingness to provide mandatory blood specimens for correlative research

• Willingness to provide mandatory tissue specimens for correlative research

• Willingness to return to enrolling institution for follow-up (during the active monitoring phase of the study)

• Willingness to follow the requirements of the intravenous ascorbic acid program schedule

• ARM D: Patients who had a diagnosis of CCUS with one or more TET2 mutations or TET2 mutations with concurrent splicing genes mutations (SRSF2, U2AF1, SF3B1, and ZRSR2) or epigenetic regulator mutations (DNMT3A, EZH2, IDH1, IDH2). CCUS diagnosis being defined based on the absence of definitive morphologic evidence of hematologic neoplasms from bone marrow biopsy evaluation combined with evidence of pathogenic myeloid somatic mutation with a variant allele frequency (VAF) of at least 2% using our institution's next generation sequencing (NGS) panel (OncoHeme, Mayo Clinic)

• ARM D: ECOG performance status (PS) 0, 1 or 2

• ARM D: Patients must meet at least 1 of these 3 laboratory criteria to be enrolled:

‣ Hemoglobin =\< 10g/dL (obtained =\< 7 days prior to registration)

⁃ Absolute neutrophil count (ANC) =\< 1000/mm\^3 (obtained =\< 7 days prior to registration)

⁃ Platelet count =\< 100,000/mm\^ 3 (obtained =\< 7 days prior to registration)

• ARM D: Total bilirubin =\< 2 x ULN (if \> 2 x ULN direct bilirubin is required and should be =\< 1.5 x ULN) (obtained =\<7 days prior to registration)

• ARM D: Alanine aminotransferase (ALT) and aspartate transaminase (AST) =\< 3 x ULN (=\< 5 x ULN for patients with liver involvement) (obtained =\<7 days prior to registration)

• ARM D: Creatinine =\< 1.6 mg/dL (obtained =\<7 days prior to registration). If \> 1.6, then the Calculated creatinine clearance must be \>= 55 ml/min using the Cockcroft-Gault formula

• ARM D: Negative pregnancy test, for persons of childbearing potential only (obtained =\< 7 days prior to registration). NOTE: If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required.

• ARM D: Provide written informed consent

• ARM D: Willingness to have a central venous line (PICC or PORT)

• ARM D: Willingness to provide mandatory blood specimens for correlative research

• ARM D: Willingness to return to enrolling institution (MCR) for follow-up (during the active monitoring phase of the study)

• ARM D: Willingness to follow the requirements of the intravenous ascorbic acid program schedule

• ARM E PRE-REGISTRATION: Age ≥ 18 years

• ARM E PRE-REGISTRATION: New or an established diagnosis of 2016 World Health Organization (WHO) defined chronic myelomonocytic leukemia with a somatic TET2, IDH1, or IDH2 mutation requiring treatment with DNA methyltransferase inhibitors/hypomethylating agents

• ARM E PRE-REGISTRATION: No prior CMML directed therapy.

‣ Exception: Received ≤ 1 cycle of azacitidine, decitabine, erythropoiesis stimulating agent therapy (ESA), or oral decitabine and cedazuridine. NOTE: Prior exposure to hydroxyurea is allowed. Continuation beyond the first cycle must be discussed with the principal investigator (PI)

• ARM E PRE-REGISTRATION: Creatinine ≤ 1.6 mg/dL. If \> 1.6, then the Calculated creatinine clearance must be ≥ 55 ml/min using the Cockcroft-Gault formula

• ARM E PRE-REGISTRATION: Willingness to provide mandatory research bone marrow sample for correlative research

• ARM E PRE-REGISTRATION: ECOG performance status (PS) 0, 1, or 2

• ARM E PRE-REGISTRATION: Provide written informed consent

• ARM E REGISTRATION: Willingness to provide mandatory blood specimens for correlative research

• ARM E REGISTRATION: Willingness to return to enrolling institution (MCR) for follow-up (during the active monitoring phase of the study)

• ARM E REGISTRATION: Recovered to grade 1 or baseline or established as sequelae from all toxic effects of previous therapy except alopecia

• ARM E REGISTRATION: Absolute neutrophil count (ANC) ≥ 500/mm\^3 (obtained ≤ 7 days prior to registration)

• ARM E REGISTRATION: Platelet count ≥ 20,000/mm\^3 (obtained ≤ 7 days prior to registration)

• ARM E REGISTRATION: Total bilirubin ≤ 1.5 x ULN ( ≤ 3 x ULN for patients with Gilbert's syndrome) (obtained ≤ 7 days prior to registration)

• ARM E REGISTRATION: Alanine aminotransferase (ALT) and aspartate transaminase (AST) ≤ 3 x ULN (obtained ≤ 7 days prior to registration)

• ARM E REGISTRATION: Ability to complete questionnaire by themselves or with assistance

• ARM E REGISTRATION: For a person of child-bearing potential (WOCBP): Must agree to use contraception or take measures to avoid pregnancy during the study. Adequate contraception is defined as follows:

‣ Complete true abstinence

⁃ Consistent and correct use of one of the following methods of birth control:

• Male partner who is sterile prior to the female patient's entry into the study and is the sole sexual partner for that female patient

∙ Implants of levonorgestrel

∙ Injectable progestogen

∙ Intrauterine device (IUD) with a documented failure rate of less than 1% per year

∙ Oral contraceptive pill (either combined or progesterone only)

∙ Barrier method, for example: diaphragm with spermicide or condom with spermicide in combination with either implants of levonorgestrel or injectable progestogen

• ARM E REGISTRATION: WOCBP must have a negative serum or urine pregnancy test ≤ 7 days prior to registration. NOTE: WOCBP include any person who has experienced menarche and who has not undergone successful surgical sterilization (hysterectomy, bilateral tubal ligation, or bilateral oophorectomy) or is not postmenopausal (defined as amenorrhea \> 12 consecutive months); or women on hormone replacement therapy with documented serum follicle stimulating hormone (FSH) level \> 35 mIU/mL. Even women who are using oral, implanted, or injectable contraceptive hormones or mechanical products such as an IUD or barrier methods (diaphragm, condoms, spermicides) to prevent pregnancy or practicing abstinence or where partner is sterile (e.g., vasectomy), must be considered to be of child-bearing potential. NOTE: If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required

• ARM E REGISTRATION: Persons who are able to father a child must use contraception during the study and for 3 months after the last treatment dose.

‣ Complete true abstinence

⁃ Latex condom with a spermicidal agent

⁃ Diaphragm with spermicide

• ARM E REGISTRATION: Willingness to have a central venous line (PICC or PORT)

• ARM E REGISTRATION: Willingness to follow the requirements of the intravenous ascorbic acid program schedule

Locations
United States
Minnesota
Mayo Clinic Health Systems-Mankato
NOT_YET_RECRUITING
Mankato
Mayo Clinic in Rochester
RECRUITING
Rochester
Wisconsin
Mayo Clinic Health System-Eau Claire Clinic
NOT_YET_RECRUITING
Eau Claire
Mayo Clinic Health System-Franciscan Healthcare
ACTIVE_NOT_RECRUITING
La Crosse
Contact Information
Primary
Clinical Trials Referral Office
mayocliniccancerstudies@mayo.edu
855-776-0015
Time Frame
Start Date: 2018-03-23
Estimated Completion Date: 2026-03
Participants
Target number of participants: 80
Treatments
Experimental: Arm A (ascorbic acid, combination chemotherapy)
Patients receive ascorbic acid IV on days 1, 3, 5, 8, 10, 12, 15, 17, and 19, and rituximab intravenously IV, ifosfamide IV, carboplatin IV and etoposide IV on days 1-3. Patients who achieve MR or SD after 2 cycles may receive rituximab IV or PO, cisplatin IV or PO, cytarabine IV or PO, and dexamethasone IV or PO. Treatment repeats every 21 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity. Patients additionally, undergo blood sample collection, core needle biopsy, bone marrow aspiration and biopsy, ECHO, PET/CT or MRI throughout study.
Active_comparator: Arm B (placebo, combination chemotherapy)
Patients receive placebo (normal saline) IV on days 1, 3, 5, 8, 10, 12, 15, 17, and 19, and rituximab intravenously IV, ifosfamide IV, carboplatin IV and etoposide IV on days 1-3. Patients who achieve MR or SD after 2 cycles may receive rituximab IV or PO, cisplatin IV or PO, cytarabine IV or PO, and dexamethasone IV or PO. Treatment repeats every 21 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity. Patients additionally, undergo blood sample collection, core needle biopsy, bone marrow aspiration and biopsy, ECHO, PET/CT or MRI throughout study.
Experimental: Arm C (ascorbic acid and combination chemotherapy)
Patients receive ascorbic acid IV on days 1, 3, 5, 8, 10, 12, 15, 17, and 19. Patients also receive ifosfamide, carboplatin, and etoposide IV or PO, or cisplatin, cytarabine, and dexamethasone IV or PO, or gemcitabine hydrochloride, dexamethasone, and cisplatin IV or PO, or gemcitabine hydrochloride and oxaliplatin IV or PO, or oxaliplatin, cytarabine, and dexamethasone IV or PO according to standard regimen schedule. Treatment repeats every 21 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity. Patients who achieve MR or SD after 2 cycles may switch to an alternative chemotherapy regimen. Patients additionally, undergo blood sample collection, core needle biopsy, bone marrow aspiration and biopsy, ECHO, PET/CT or MRI throughout study.
Experimental: Arm D (ascorbic acid)
Patients receive ascorbic acid IV TIW. Treatments repeat every 28 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PICC or portacath placement prior to starting treatment, blood sample collection, bone marrow aspiration and biopsy throughout study.
Experimental: ARM E (ascorbic acid, decitabine)
Patients receive ascorbic acid IV on days 1, 3 and 5 and decitabine IV over 1 hour on days 1-5. Treatment repeats every 28 days for up to 12 cycles in the absence of disease progression or unacceptable toxicity. Patients with stable disease after 12 cycles may continue decitabine with or without ascorbic acid as long as clinically appropriate. Patients may also take vitamin C PO on days 6-28. Patients undergo PICC or portacath placement prior to starting treatment, blood sample collection, bone marrow aspiration and biopsy throughout study.
Sponsors
Leads: Mayo Clinic
Collaborators: National Cancer Institute (NCI)

This content was sourced from clinicaltrials.gov

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