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LCH-IV, International Collaborative Treatment Protocol for Children and Adolescents With Langerhans Cell Histiocytosis
Study Purpose
The LCH-IV is an international, multicenter, prospective clinical study for pediatric Langerhans Cell Histiocytosis LCH (age < 18 years).
Recruitment Criteria
Accepts Healthy Volunteers
Healthy volunteers are participants who do not have a disease or condition, or related conditions or symptoms |
No |
Study Type
An interventional clinical study is where participants are assigned to receive one or more interventions (or no intervention) so that researchers can evaluate the effects of the interventions on biomedical or health-related outcomes. An observational clinical study is where participants identified as belonging to study groups are assessed for biomedical or health outcomes. Searching Both is inclusive of interventional and observational studies. |
Interventional |
Eligible Ages | N/A - 18 Years |
Gender | All |
Inclusion Criteria:
- - Stratum I.
- - Patients must be less than 18 years of age at the time of diagnosis.
- - Patients must have histological verification of the diagnosis of Langerhans cell histiocytosis according to the criteria described in Section 6.1.
- - Signed informed consent form.
- - Stratum II.
- - Patients of Stratum I who have: - Progressive disease (AD worse) in non-risk organs after 6 weeks (Initial Course.
- - AD intermediate or worse in non-risk organs or AD better in risk organs after 12 weeks (Initial Course 2) - Disease progression (AD worse) in non-risk organs at any time during continuation treatment.
- - Active disease at the end of Stratum I treatment.
- - Disease reactivation in non-risk organs at any time after completion of Stratum I treatment.
- - Stratum III.
- - Patients from Stratum I who fulfill the following criteria: - AD worse in risk organs after week 6 (after Initial Course 1), or AD worse or AD intermediate in risk organs after week 12 (after Initial Course 2).
- - Presence of unequivocally severe organ dysfunction at the above mentioned evaluation points (hematological dysfunction, liver dysfunction, or both of them) as.
- - Hb <70 g/L (<7.0 g/dl) and/or transfusion dependency.
- - PLT <20 x109/L (20,000/μL) and/or transfusion dependency (both criteria have to be fulfilled) AND/OR.
- - Liver dysfunction (or digestive involvement with protein loss) - Total protein <55 g/L or substitution dependency.
- - Albumin <25 g/L or substitution dependency (at least one of the two criteria to be fulfilled) - Stratum IV.
- - Patients from Stratum I or Stratum III who fulfill the following criteria: - AD worse in risk organs after week 6 (after Initial Course 1), or AD worse or AD intermediate in risk organs after week 12 (after Initial Course 2) of Stratum I OR.
- - AD worse after the 2nd and 3rd 2-CdA/Ara-C course, and those AD worse or AD intermediate after the 4th 2-CdA/Ara-C course of Stratum III AND.
- - Presence of unequivocally severe organ dysfunction at the above mentioned evaluation points (hematological dysfunction, liver dysfunction, or both of them) as defined in Table XI (see Section 10.3.
- - Informed consent: All patients or their legal guardians (if the patient is <18 years of age) must sign an Ethics or institutional Review Board approved consent form indicating their awareness of the investigational nature and the risks of this study.
- - Adequate organ function: Patients should have adequate hepatic, renal, cardiac and pulmonary function to undergo reduced intensity HCT based upon local institutional guidelines, or at a minimum meet requirements noted in eligibility checklist Appendix A-VIII_1.
- - Stratum V.
- - All patients with verified diagnosis of LCH and MRI findings consistent with ND-CNSLCH irrespective of previous treatments (also those not registered to other Strata ofLCH-IV).
- - Patients with isolated tumorous CNS-LCH (including isolated DI with mass lesion in the hypothalamus-pituitary axis).
- - Stratum VI.
- - Stratum VII -- All patients registered in LCH IV (regardless of treatment) as long as consent for longterm follow-up has not been withheld.
Exclusion Criteria:
- - Stratum I.
- - Pregnancy (patients of child-bearing age must be appropriately tested before chemotherapy) - LCH-related permanent consequences (e.g. vertebra plana, sclerosing cholangitis, lung fibrosis, etc.) in the absence of active disease.
- - Prior systemic therapy.
- - Stratum II.
- - Patients with progressive disease in risk organs.
- - Permanent consequences (e.g. sclerosing cholangitis, lung fibrosis, etc.) without evidence of active LCH in the same organ or in any other locations.
- - No written consent of the patient or his/her parents or legal guardian.
- - Stratum III.
- - The presence of any of the following criteria will exclude the patient from the study: - Isolated sclerosing cholangitis without evidence of active hepatic LCH as the only evidence of risk organ involvement.
- - Inadequate renal function as defined by serum creatinine > 3x normal for age.
- - Stratum IV.
- - Pulmonary failure (requiring mechanical ventilation) not due to active LCH.
- - Isolated liver sclerosis or pulmonary fibrosis, without active LCH.
- - Uncontrolled active life-threatening infection.
- - Decreased renal function with a GFR of less than 50ml/1.73m2/min.
- - Pregnancy or active breast feeding.
- - Failure to provide signed informed consent.
- - Stratum VI.
Trial Details
Trial ID:
This trial id was obtained from ClinicalTrials.gov, a service of the U.S. National Institutes of Health, providing information on publicly and privately supported clinical studies of human participants with locations in all 50 States and in 196 countries. |
NCT02205762 |
Phase
Phase 1: Studies that emphasize safety and how the drug is metabolized and excreted in humans. Phase 2: Studies that gather preliminary data on effectiveness (whether the drug works in people who have a certain disease or condition) and additional safety data. Phase 3: Studies that gather more information about safety and effectiveness by studying different populations and different dosages and by using the drug in combination with other drugs. Phase 4: Studies occurring after FDA has approved a drug for marketing, efficacy, or optimal use. |
Phase 2/Phase 3 |
Lead Sponsor
The sponsor is the organization or person who oversees the clinical study and is responsible for analyzing the study data. |
North American Consortium for Histiocytosis |
Principal Investigator
The person who is responsible for the scientific and technical direction of the entire clinical study. |
Milen Minkov, MD, Ph.DCarlos Rodriguez-Galindo, MD |
Principal Investigator Affiliation | Children's Cancer Research Institute / St. Anna Children's HospitalNorth American Consortium for Histiocytosis |
Agency Class
Category of organization(s) involved as sponsor (and collaborator) supporting the trial. |
Other |
Overall Status | Recruiting |
Countries | United States |
Conditions
The disease, disorder, syndrome, illness, or injury that is being studied. |
Langerhans Cell Histiocytosis |
The international efforts of the past 20 years have shown that combination therapy with vinblastine and prednisone is an effective therapy for Multi-system (MS)-LCH. The previous prospective trial LCH-III confirmed this regimen as a standard regimen for MS-LCH in patients with and without risk organ involvement. It also showed that prolonged treatment in the latter group (treatment duration of 12 vs.#46; 6 months) is superior in preventing disease reactivations. The results of this trial are encouraging and serve as a basis for the LCH-IV study design.Due to the complexity of the disease presentations and outcomes, the LCH-IV study seeks to tailor treatment based on features at presentation and on response to treatment, leading to seven strata:
- - Stratum I: First-line treatment for MS-LCH patients (Group 1) and patients with Single system (SS)-LCH with multifocal bone or "Central Nervous System (CNS)-risk" lesions (Group 2) - Stratum II: Second-line treatment for non-risk patients (patients without risk organ involvement who fail first-line therapy or have a reactivation after completion of first-line therapy) - Stratum III: Salvage treatment for risk LCH (patients with dysfunction of risk organs who fail first-line therapy) - Stratum IV: Stem cell transplantation for risk LCH (patients with dysfunction of risk organs who fail first-line therapy) - Stratum V: Monitoring and treatment of isolated tumorous and neurodegenerative CNS-LCH.
Arms
Experimental: Stratum I
Stratum I The combination of Prednisone and vinblastine is the standard first-line combination for patients needing systemic therapy (Stratum I). Patients with MS-LCH and involvement of risk organs, who do not respond to 6-12 weeks of standard therapy, will be immediately switched to alternative treatment approaches (Stratum III or Stratum IV). Further therapy prolongation (12 vs. 24 months) and intensification (± mercaptopurine) will further reduce the reactivation rate and the permanent consequences.
Experimental: Stratum II
A uniform "intensive" 24-week course consisting of prednisolone, vincristine and cytosine-arabinoside will be introduced in Stratum II for eligible patients. It will be followed by a continuation therapy to total treatment duration of 24 months. Participants who after SL-IT (week 24) have a response (NAD or AD better) are eligible for randomization between the continuation arms "INDOMETHACIN" and "6-MP/MTX" (mercaptopurine and Methotrexate).
Experimental: Stratum III
Salvage treatment for risk LCH To assess the efficacy of the combination 2-CdA/Ara-C (Cytosine Arabinoside and 2-chlorodeoxyadenosine) in MS-LCH (patients with risk organ involvement, who fail to respond to front-line (Stratum I) therapy. The initial therapy consists of 2 courses of 2-CdA/Ara-C. Continuation of outlined treatment to be assessed at assigned intervals in each stratum.
Experimental: Stratum IV
To determine the overall and disease free survival at 1 and 3 years after reduced intensity conditioning hematopoietic stem cell transplantation (RIC-HSCT). Salvage treatment option for MS-LCH patients with risk organ involvement, who fail to respond to front-line therapy (Stratum I) OR to the salvage 2- CdA/Ara-C regimen (Stratum III).
Experimental: Stratum V
Stratum V Monitoring and Treatment of isolated tumorous and neurodegenerative CNS-LCH - Special regimens will be offered to patients with isolated tumorous CNS-LCH (repeated 2-CdA courses) and to patients with clinically manifested ND-CNS-LCH (+/- extracranial LCH manifestations). For the last group monotherapy with Ara-C courses or (Intravenous immunoglobulin)IVIG will be offered depending on physician's choice.
Experimental: Stratum VI
Natural history and management of "other" SS-LCH not eligible for stratum I group 2. Treatment Options- Management (mostly "wait & see" and topical treatment) is left to the discretion of the treating physician. All treatments and disease responses must be reported in the database. In the case of uncertainties please contact your National Coordinator. Patients being followed on Stratum VI who have progression of disease to MSLCH, multifocal bone disease or CNS-risk bone lesions should be enrolled on Stratum I therapy. Patients being followed on Stratum VI who develop isolated tumorous or neurodegenerative CNS-LCH should be enrolled on Stratum V.
Interventions
Drug: - Prednisone
Stratum I
Drug: - Vinblastine
Stratum I
Drug: - mercaptopurine
Stratum I
Drug: - INDOMETHACIN
Indomethacin fixed dose given daily orally in two divided doses with gastric protection for total treatment duration of 24 months.
Drug: - Methotrexate
fixed dose weekly orally for total treatment duration of 24 months.
Drug: - Cytosine Arabinoside
Drug: - 2-chlorodeoxyadenosine
Procedure: - hematopoietic stem cell transplantation (RIC-HSCT)
Biological: - Intravenous immunoglobulin
Contact a Trial Team
If you are interested in learning more about this trial, find the trial site nearest to your location and contact the site coordinator via email or phone. We also strongly recommend that you consult with your healthcare provider about the trials that may interest you and refer to our terms of service below.
Status
Recruiting
Address
Children's of Alabama
Birmingham, Alabama, 35233
Status
Recruiting
Address
Phoenix Children's Hospital
Phoenix, Arizona, 85006
Status
Recruiting
Address
Arkansas Children's Hospital
Little Rock, Arkansas, 72202
Status
Recruiting
Address
Children's Hospital of Los Angeles
Los Angeles, California, 90027
Status
Recruiting
Address
Valley Children's Healthcare
Madera, California, 93636
Status
Recruiting
Address
UCSF Benioff Children's Hospital of Oakland
Oakland, California, 94609
Status
Recruiting
Address
Children's Hospital of Orange County
Orange, California, 92868
Status
Recruiting
Address
UCSF Helen Diller Family Cancer Center
San Francisco, California, 94158-0106
Status
Recruiting
Address
Connecticut Children's Medical Center
Hartford, Connecticut, 06106
Status
Recruiting
Address
Children's National Medical Center
Washington, District of Columbia, 20010
Status
Recruiting
Address
Johns Hopkins All Children's Hospital
Saint Petersburg, Florida, 33701
Status
Recruiting
Address
Children's Healthcare of Atlanta, Emory
Atlanta, Georgia, 30342
Status
Recruiting
Address
Ann & Robert H. Lurie Children's Hospital of Chicago
Chicago, Illinois, 60611-2991
Status
Recruiting
Address
Children's Mercy Hospitals
Kansas City, Kansas, 64108
Status
Recruiting
Address
University of Kentucky A.B.Chandler Medical Center
Lexington, Kentucky, 40536
Status
Recruiting
Address
University of Louisville, Norton Children's Hospital
Louisville, Kentucky, 40202
Status
Recruiting
Address
Johns Hopkins University
Baltimore, Maryland, 21287
Status
Recruiting
Address
Massachusetts General Hospital
Boston, Massachusetts, 02114
Status
Recruiting
Address
Dana Farber Cancer Institute
Boston, Massachusetts, 02115
Status
Recruiting
Address
Children's Minnesota
Minneapolis, Minnesota, 55404
Status
Recruiting
Address
Hackensack University Medical Center
Hackensack, New Jersey, 07601
Status
Recruiting
Address
Cohen Children's Medical Center
New Hyde Park, New York, 11040
Status
Recruiting
Address
Mount Sinai Hospital
New York, New York, 10029
Status
Recruiting
Address
Columbia University / Herbert Irving Cancer Center
New York, New York, 10032
Status
Recruiting
Address
Memorial Sloan Kettering Cancer Center
New York, New York,
Status
Recruiting
Address
SUNY Upstate Medical University
Syracuse, New York, 13210
Status
Recruiting
Address
Carolinas Medical Center, Levine Children's Hospital
Charlotte, North Carolina, 28203
Status
Recruiting
Address
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio, 45229
Status
Recruiting
Address
Rainbow Babies & Children's Hospital, University Hospitals
Cleveland, Ohio, 44106
Status
Recruiting
Address
The Toledo Hospital, Toledo Children's Hospital
Toledo, Ohio, 43606
Status
Recruiting
Address
UPMC Children's Hospital of Pittsburgh
Pittsburgh, Pennsylvania, 15224
Status
Recruiting
Address
Medical University of South Carolina (MUSC)
Charleston, South Carolina, 29425
Status
Recruiting
Address
Greenville Health System BI-LO Charities Children's Cancer Center
Greenville, South Carolina, 29605
Status
Recruiting
Address
St. Jude Children's Research Hospital
Memphis, Tennessee, 38105
Status
Recruiting
Address
Children's Medical Center Dallas, UT Southwestern
Dallas, Texas,
Status
Recruiting
Address
Providence Sacred Heart Children's Hospital
Spokane, Washington, 99204
Status
Recruiting
Address
Madigan Army Medical Center
Tacoma, Washington, 98431
Status
Recruiting
Address
American Family Children's Hospital University of Wisconsin
Madison, Wisconsin, 53792