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Trial details imported from ClinicalTrials.gov

For full trial details, please see the original record at https://clinicaltrials.gov/ct2/show/NCT01142011




Registration number
NCT01142011
Ethics application status
Date submitted
10/06/2010
Date registered
11/06/2010
Date last updated
10/02/2012

Titles & IDs
Public title
A Study of Belimumab in Treating Symptomatic Waldenstroms Macroglobulinaemia
Scientific title
A Single Arm, Phase II Study of the Anti-Blys Monoclonal Antibody, Belimumab in Symptomatic Waldenstroms Macroglobulinaemia
Secondary ID [1] 0 0
HGSI Belimumab in WM
Universal Trial Number (UTN)
Trial acronym
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Symptomatic Waldenstroms Macroglobulinaemia 0 0
Condition category
Condition code
Cancer 0 0 0 0
Lymphoma (non Hodgkin's lymphoma) - High grade lymphoma
Cancer 0 0 0 0
Lymphoma (non Hodgkin's lymphoma) - Low grade lymphoma
Cancer 0 0 0 0
Children's - Leukaemia & Lymphoma

Intervention/exposure
Study type
Interventional
Description of intervention(s) / exposure
Treatment: Drugs - Belimumab

Experimental: Belimumab - The first cycle of Belimumab is a loading cycle of 3 doses over 28 days (days 1, 15, 29).
After the first cycle, additional cycles of belimumab will be administered every 28 ± 1 days (cycle 2 and all subsequent cycles).


Treatment: Drugs: Belimumab
The first cycle of Belimumab (10mg/kg by intravenous (IV) infusion) is a loading cycle of 3 doses over 28 days (days 1, 15, 29). After the first cycle, additional cycles of belimumab (10mg/kg by intravenous (IV) infusion) will be administered every 28 ± 1 days (cycle 2 and all subsequent cycles).
The infusion will be administered over a minimum period of 1 hour.
Intervention code [1] 0 0
Treatment: Drugs
Comparator / control treatment
Control group

Outcomes
Primary outcome [1] 0 0
Safety of Belimumab infusions in symptomatic WM
Timepoint [1] 0 0
Patients are assessed every 28 days while on treatment
Secondary outcome [1] 0 0
Reduction of IgM paraprotein
Timepoint [1] 0 0
Serum Immunoglobulins will be tested every 28 days
Secondary outcome [2] 0 0
Reduction of splenomegaly and/or lymphadenopathy
Timepoint [2] 0 0
This will be tested every 28 days
Secondary outcome [3] 0 0
Improvement in anaemia
Timepoint [3] 0 0
Patients will be assessed every 28 days while on treatment
Secondary outcome [4] 0 0
Correlate the degree of response with Belimumab levels
Timepoint [4] 0 0
Pharmacokinetics will be performed on days 1, 15, 56, 168, 364

Eligibility
Key inclusion criteria
- At least 18 years of age.

- Diagnosis of WM histologically confirmed on bone marrow biopsy.

- Detectable IgM paraprotein >5 g/L

- Less than 3 lines of prior therapy for WM

- Full blood count within 4 weeks prior to screening shows ANC >1.0 x109/l AND platelet
count >50 x109/l

- Therapy indicated due to development of one or more of the following:

1. symptomatic anaemia

2. hyperviscosity symptoms

3. rapidly rising paraprotein of >25% or >5g/l over 3 months

4. splenomegaly

5. bulky lymphadenopathy

6. B symptoms or paraneoplastic phenomena, which, in the opinion of the investigator
are the result of progressive WM.

- Life expectancy >12 months

- ECOG < 3

- Able to provide informed consent

- Ability to understand the requirements of the study, provide written informed consent,
including consent for the use and disclosure of research-related health information,
and comply with the protocol procedures, including required study visits.

- Subjects of child bearing potential must agree to use effective contraception
throughout the study and for 3 months after the last dose of belimumab
Minimum age
18 Years
Maximum age
No limit
Sex
Both males and females
Can healthy volunteers participate?
No
Key exclusion criteria
- Prior therapy with belimumab.

- Pregnant or breast feeding

- Chemotherapy, immunotherapy or biological therapy within 4 weeks of enrolment.
Therapeutic plasma exchange can continue- see section 3.1.4.

- Creatinine clearance (calculated by Cockcroft-Gault) < 60ml/min

- Bilirubin >2x ULN, ALT >2x ULN.

- History of an allergic or anaphylactic reaction to parenteral administration of
contrast agents, human or murine proteins or monoclonal antibodies, a history of
severe allergic reaction to drugs, food, or insects requiring medical intervention, or
a history of hypersensitive triad (having all 3 features of allergic rhinitis with
nasal polyps, asthma, and aspirin sensitivity).

- Prior opportunistic infection including tuberculosis or atypical mycobacterial
infection, multi-dermatome Herpes Zoster or Pneumocystis pneumonia or invasive fungal
infection (not including oral or vaginal candidiasis or superficial dermatophytes) .

- Active infection with hepatitis B, hepatitis C or HIV or historically positive test or
test positive at screening for HIV antibody, hepatitis B surface antigen, or hepatitis
C antibody.

- History of organ transplant (eg, heart, lung, kidney, liver) or hematopoietic stem
cell/marrow transplant.

- Planned surgical procedure during the treatment period of this study or a history of
any other medical disease (eg, cardiopulmonary), laboratory abnormality, or condition
that, in the opinion of the principal investigator, makes the subject unsuitable for
the study.

- Hospitalization for treatment of infection within 60 days of Day 1.

- Use of parenteral (IV or IM) antibiotics (antibacterials, antivirals, anti-fungals, or
anti parasitic agents) within 60 days of Day 1.

- Current drug or alcohol abuse or dependence, or a history of drug or alcohol abuse or
dependence within 364 days prior to Day 1.

Study design
Purpose of the study
Treatment
Allocation to intervention
N/A
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Masking / blinding
Open (masking not used)
Who is / are masked / blinded?



Intervention assignment
Single group
Other design features
Phase
Phase 2
Type of endpoint/s
Statistical methods / analysis

Recruitment
Recruitment status
Unknown status
Data analysis
Reason for early stopping/withdrawal
Other reasons
Date of first participant enrolment
Anticipated
Actual
1/11/2009
Date of last participant enrolment
Anticipated
Actual
Date of last data collection
Anticipated
1/01/2013
Actual
Sample size
Target
15
Accrual to date
Final
Recruitment in Australia
Recruitment state(s)
VIC
Recruitment hospital [1] 0 0
The Peter MacCallum Cancer Centre - Melbourne
Recruitment hospital [2] 0 0
Alfred Health - Melbourne
Recruitment postcode(s) [1] 0 0
3002 - Melbourne
Recruitment postcode(s) [2] 0 0
3181 - Melbourne

Funding & Sponsors
Primary sponsor type
Other
Name
Cancer Trials Australia
Address
Country
Other collaborator category [1] 0 0
Commercial sector/Industry
Name [1] 0 0
Human Genome Sciences Inc.
Address [1] 0 0
Country [1] 0 0

Ethics approval
Ethics application status

Summary
Brief summary
Hypothesis; That inhibition of plasma Blys by the monoclonal antibody Belimumab will reduce
both the survival of the lymphoplasmacytoid cells of Waldenstrom Macroglobulinaemia (WM), and
their production of monoclonal IgM, resulting in a reduction of IgM paraprotein.
Trial website
https://clinicaltrials.gov/ct2/show/NCT01142011
Trial related presentations / publications
Cheema GS, Roschke V, Hilbert DM, Stohl W. Elevated serum B lymphocyte stimulator levels in patients with systemic immune-based rheumatic diseases. Arthritis Rheum. 2001 Jun;44(6):1313-9. doi: 10.1002/1529-0131(200106)44:63.0.CO;2-S.
Elsawa SF, Novak AJ, Grote DM, Ziesmer SC, Witzig TE, Kyle RA, Dillon SR, Harder B, Gross JA, Ansell SM. B-lymphocyte stimulator (BLyS) stimulates immunoglobulin production and malignant B-cell growth in Waldenstrom macroglobulinemia. Blood. 2006 Apr 1;107(7):2882-8. doi: 10.1182/blood-2005-09-3552. Epub 2005 Nov 22.
Furie R, Stohl W, Ginzler EM, Becker M, Mishra N, Chatham W, Merrill JT, Weinstein A, McCune WJ, Zhong J, Cai W, Freimuth W; Belimumab Study Group. Biologic activity and safety of belimumab, a neutralizing anti-B-lymphocyte stimulator (BLyS) monoclonal antibody: a phase I trial in patients with systemic lupus erythematosus. Arthritis Res Ther. 2008;10(5):R109. doi: 10.1186/ar2506. Epub 2008 Sep 11.
Gross JA, Dillon SR, Mudri S, Johnston J, Littau A, Roque R, Rixon M, Schou O, Foley KP, Haugen H, McMillen S, Waggie K, Schreckhise RW, Shoemaker K, Vu T, Moore M, Grossman A, Clegg CH. TACI-Ig neutralizes molecules critical for B cell development and autoimmune disease. impaired B cell maturation in mice lacking BLyS. Immunity. 2001 Aug;15(2):289-302. doi: 10.1016/s1074-7613(01)00183-2.
Gross JA, Johnston J, Mudri S, Enselman R, Dillon SR, Madden K, Xu W, Parrish-Novak J, Foster D, Lofton-Day C, Moore M, Littau A, Grossman A, Haugen H, Foley K, Blumberg H, Harrison K, Kindsvogel W, Clegg CH. TACI and BCMA are receptors for a TNF homologue implicated in B-cell autoimmune disease. Nature. 2000 Apr 27;404(6781):995-9. doi: 10.1038/35010115.
Halpern WG, Lappin P, Zanardi T, Cai W, Corcoran M, Zhong J, Baker KP. Chronic administration of belimumab, a BLyS antagonist, decreases tissue and peripheral blood B-lymphocyte populations in cynomolgus monkeys: pharmacokinetic, pharmacodynamic, and toxicologic effects. Toxicol Sci. 2006 Jun;91(2):586-99. doi: 10.1093/toxsci/kfj148. Epub 2006 Mar 3.
Kimby E, Treon SP, Anagnostopoulos A, Dimopoulos M, Garcia-Sanz R, Gertz MA, Johnson S, LeBlond V, Fermand JP, Maloney DG, Merlini G, Morel P, Morra E, Nichols G, Ocio EM, Owen R, Stone M, Blade J. Update on recommendations for assessing response from the Third International Workshop on Waldenstrom's Macroglobulinemia. Clin Lymphoma Myeloma. 2006 Mar;6(5):380-3. doi: 10.3816/CLM.2006.n.013.
Mackay F, Woodcock SA, Lawton P, Ambrose C, Baetscher M, Schneider P, Tschopp J, Browning JL. Mice transgenic for BAFF develop lymphocytic disorders along with autoimmune manifestations. J Exp Med. 1999 Dec 6;190(11):1697-710. doi: 10.1084/jem.190.11.1697.
Petri M, Stohl W, Chatham W, McCune WJ, Chevrier M, Ryel J, Recta V, Zhong J, Freimuth W. Association of plasma B lymphocyte stimulator levels and disease activity in systemic lupus erythematosus. Arthritis Rheum. 2008 Aug;58(8):2453-9. doi: 10.1002/art.23678.
Rennert P, Schneider P, Cachero TG, Thompson J, Trabach L, Hertig S, Holler N, Qian F, Mullen C, Strauch K, Browning JL, Ambrose C, Tschopp J. A soluble form of B cell maturation antigen, a receptor for the tumor necrosis factor family member APRIL, inhibits tumor cell growth. J Exp Med. 2000 Dec 4;192(11):1677-84. doi: 10.1084/jem.192.11.1677.
Scapini P, Carletto A, Nardelli B, Calzetti F, Roschke V, Merigo F, Tamassia N, Pieropan S, Biasi D, Sbarbati A, Sozzani S, Bambara L, Cassatella MA. Proinflammatory mediators elicit secretion of the intracellular B-lymphocyte stimulator pool (BLyS) that is stored in activated neutrophils: implications for inflammatory diseases. Blood. 2005 Jan 15;105(2):830-7. doi: 10.1182/blood-2004-02-0564. Epub 2004 Sep 9.
Scapini P, Nardelli B, Nadali G, Calzetti F, Pizzolo G, Montecucco C, Cassatella MA. G-CSF-stimulated neutrophils are a prominent source of functional BLyS. J Exp Med. 2003 Feb 3;197(3):297-302. doi: 10.1084/jem.20021343.
Schiemann B, Gommerman JL, Vora K, Cachero TG, Shulga-Morskaya S, Dobles M, Frew E, Scott ML. An essential role for BAFF in the normal development of B cells through a BCMA-independent pathway. Science. 2001 Sep 14;293(5537):2111-4. doi: 10.1126/science.1061964. Epub 2001 Aug 16.
Schneider P, Takatsuka H, Wilson A, Mackay F, Tardivel A, Lens S, Cachero TG, Finke D, Beermann F, Tschopp J. Maturation of marginal zone and follicular B cells requires B cell activating factor of the tumor necrosis factor family and is independent of B cell maturation antigen. J Exp Med. 2001 Dec 3;194(11):1691-7. doi: 10.1084/jem.194.11.1691.
Yan M, Marsters SA, Grewal IS, Wang H, Ashkenazi A, Dixit VM. Identification of a receptor for BLyS demonstrates a crucial role in humoral immunity. Nat Immunol. 2000 Jul;1(1):37-41. doi: 10.1038/76889.
Yu G, Boone T, Delaney J, Hawkins N, Kelley M, Ramakrishnan M, McCabe S, Qiu WR, Kornuc M, Xia XZ, Guo J, Stolina M, Boyle WJ, Sarosi I, Hsu H, Senaldi G, Theill LE. APRIL and TALL-I and receptors BCMA and TACI: system for regulating humoral immunity. Nat Immunol. 2000 Sep;1(3):252-6. doi: 10.1038/79802.
Zhang J, Roschke V, Baker KP, Wang Z, Alarcon GS, Fessler BJ, Bastian H, Kimberly RP, Zhou T. Cutting edge: a role for B lymphocyte stimulator in systemic lupus erythematosus. J Immunol. 2001 Jan 1;166(1):6-10. doi: 10.4049/jimmunol.166.1.6.
Locksley RM, Killeen N, Lenardo MJ. The TNF and TNF receptor superfamilies: integrating mammalian biology. Cell. 2001 Feb 23;104(4):487-501. doi: 10.1016/s0092-8674(01)00237-9. No abstract available.
Mackay F, Schneider P, Rennert P, Browning J. BAFF AND APRIL: a tutorial on B cell survival. Annu Rev Immunol. 2003;21:231-64. doi: 10.1146/annurev.immunol.21.120601.141152. Epub 2001 Dec 19.
Thompson JS, Bixler SA, Qian F, Vora K, Scott ML, Cachero TG, Hession C, Schneider P, Sizing ID, Mullen C, Strauch K, Zafari M, Benjamin CD, Tschopp J, Browning JL, Ambrose C. BAFF-R, a newly identified TNF receptor that specifically interacts with BAFF. Science. 2001 Sep 14;293(5537):2108-11. doi: 10.1126/science.1061965. Epub 2001 Aug 16.
Yan M, Wang H, Chan B, Roose-Girma M, Erickson S, Baker T, Tumas D, Grewal IS, Dixit VM. Activation and accumulation of B cells in TACI-deficient mice. Nat Immunol. 2001 Jul;2(7):638-43. doi: 10.1038/89790.
Public notes

Contacts
Principal investigator
Name 0 0
David Ritchie
Address 0 0
The Peter MacCallum Cancer Centre
Country 0 0
Phone 0 0
Fax 0 0
Email 0 0
Contact person for public queries
Name 0 0
David Ritchie Ritchie
Address 0 0
Country 0 0
Phone 0 0
+61396561111
Fax 0 0
Email 0 0
[email protected]
Contact person for scientific queries



Summary Results

For IPD and results data, please see https://clinicaltrials.gov/ct2/show/NCT01142011