A Phase 3 interventional study of Insulin Glargine and Insulin Aspart in Leukemia and Lymphoma, sponsored by M.D. Anderson Cancer Center. Terminated at 1 site in United States. Open to participants aged 15 Years and older. Per ClinicalTrials.gov, last updated 2015-06-03.
Sponsored by M.D. Anderson Cancer Center · Phase 3, Interventional, and Treatment
The goal of this clinical research study is to learn if intense management and control of blood sugar levels during treatment for acute lymphocytic leukemia, Burkitts lymphoma, or lymphoblastic lymphoma will result in decreased risk of relapse, fewer complications, and/or longer survival.
High blood sugar is a common side effect of treatment for certain types of cancer.
You will be randomly assigned (as in the toss of a coin) to one of two treatment groups. Participants in one group will receive blood sugar management with regular human insulin. Participants in the other group will receive more intense management with two newer forms of human insulin - insulin aspart, for rapid lowering of the blood glucose and insulin glargine for the slow decrease of blood sugar level over 24 hours.
You will receive additional blood tests (about 1 tablespoon each) at the time of entry on the study and after about every 2 to 4 courses of chemotherapy while on the study. These blood tests help better define the severity of your high blood sugar and your body's ability to metabolize sugar. Any bone marrow and blood samples that were collected before your therapy for your leukemia may be used for lab tests to measure markers of glucose metabolism in the blood. You will not be required to have a bone marrow biopsy after enrollment on study.
While in the hospital receiving chemotherapy, you will have your blood sugar checked 3 to 4 times a day. To check your blood sugar level, you, your nurse, or a laboratory technician will prick your finger with a small needle and place a small drop of blood on a test strip. If your blood sugar is high, you will be given the appropriate amount of insulin.
Before you begin out-patient insulin treatment, a research nurse, doctor, or diabetes educator will watch how you and/or your caregiver administer your insulin shots, to make sure that it is done correctly and safely. Once you leave the hospital, you will be required to check your own blood sugar 3 times a day and take insulin (either yourself or with the help of a health provider) up to 4 times a day while on steroid therapy and for 2 days after receiving steroids. On all other days you will be required to check your blood glucose once or twice a day and administer insulin 1 - 3 times daily. You will also need to speak with a nurse by phone every 1-3 days for review of blood sugar measurements and possible adjustment of the dose of insulin you must take.
You will remain on the study from the time you are found to have high blood sugar levels until completion of your chemotherapy (about 8 months for most patients). You may be taken off this study at any time if you find that you are unable or unwilling to monitor your glucose or receive insulin shots at home.
You will be followed for high blood sugar levels while you are receiving treatment with Hyper-CVAD chemotherapy regimen (fractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating cycles with methotrexate, cytarabine, methylprednisolone). If you continue to have high blood sugar after completion of this treatment, you will have continued follow-up either with your primary physician at home or if you choose, in the Internal Medicine Clinic at M. D. Anderson.
This is an investigational study. All of the insulin used in this study is FDA approved for the treatment of high blood sugar and commercially available. A total of up to 114 patients will take part in this study. All will be enrolled at M. D. Anderson.
5,578 studies on the registry are indexed under Lymphoma; 825 are open to participants now.
This study's enrollment of 52 is above the median of 40 across 4,508 interventional studies indexed under Lymphoma.
Browse Lymphoma studies →M.D. Anderson Cancer Center is the lead sponsor of 2,999 studies on the registry; 581 are open to participants now.
Of its 599 completed or terminated interventional studies of FDA-regulated products, 402 (67%) have results posted.
Counted across the registry records on this site, refreshed daily.
Exclusion Criteria:
Control Group: Conventional care using blood sugar management with regular human insulin.
Intervention Group: Intense blood sugar management with Insulin Aspart + Insulin Glargine
Drug: Insulin Glargine · Drug: Insulin Aspart
Use of human insulin glargine for slow decrease of blood sugar level over 24 hours.
Use of human insulin aspart for rapid lowering of the blood glucose level over 24 hours.
1-Year Overall Survival Rate
The overall survival rate defined as percentage of participants in each treatment group who are still alive at 12 months.
Time frame: 1 year
Overall Survival
Overall survival (OS) defined as the interval between the date of randomization and the date of death. Calculation of period was from baseline (date of randomization) to the death or last follow-up.
Time frame: Baseline (date of randomization) to date of death or last follow-up (weekly during treatment then every 2 months post study treatment) up to 6 years
Progression Free Survival (PFS)
PFS was defined as the time interval between the date of complete remission and the date of relapse detection or death. Complete Remission (CR) defined as granulocyte count \>1.0 × 10\^9/L, platelet count \>100 × 10\^9/L, no abnormal peripheral blasts, and \<5% blasts in normocellular or hypercellular bone marrow.
Time frame: Date of complete remission to disease progression, assessed for approximately 6 years
Recruitment Period: 04/27/2004 through 7/1/2008. All participants recruited at the University of Texas (UT) MD Anderson Cancer Center.
| Milestone | Conventional Care | Intensive Insulin |
|---|---|---|
| Started | 25 | 26 |
| Completed | 25 | 26 |
| Not completed | 0 | 0 |
The overall survival rate defined as percentage of participants in each treatment group who are still alive at 12 months.
| percentage of participants | Conventional Care | Intensive Insulin |
|---|---|---|
| 1-Year Overall Survival Rate | 80.8 (67 to 97.4) | 63.5 (47 to 85.8) |
Overall survival (OS) defined as the interval between the date of randomization and the date of death. Calculation of period was from baseline (date of randomization) to the death or last follow-up.
| Months | Conventional Care | Intervention Group |
|---|---|---|
| Overall Survival | 44 (2 to 66) | 62.2 (0.5 to 62.2) |
PFS was defined as the time interval between the date of complete remission and the date of relapse detection or death. Complete Remission (CR) defined as granulocyte count \>1.0 × 10\^9/L, platelet count \>100 × 10\^9/L, no abnormal peripheral blasts, and \<5% blasts in normocellular or hypercellular bone marrow.
| Months | Conventional Care | Intensive Insulin |
|---|---|---|
| Progression Free Survival (PFS) | 38.8 (1 to 66) | 24 (1 to 62) |
Collected over Adverse event (AE) collection from identification of high blood sugar levels until completion of chemotherapy (about 8 months). Study period was from enrollment beginning on 4/27/2004 and follow up ending on 1/20/2010.. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Conventional Care | — | 9/25 (36%) | 0/25 (0%) |
| Intensive Insulin | — | 10/26 (38.5%) | 0/26 (0%) |
| Event | Conventional Care | Intensive Insulin |
|---|---|---|
| DeathGeneral disorders | 8/25 | 10/26 |
| PainGeneral disorders | 0/25 | 2/26 |
| Neutropenic FeverInfections and infestations | 0/25 | 2/26 |
| HypoglycemiaMetabolism and nutrition disorders | 0/25 | 2/26 |
| Acute PancreatitisHepatobiliary disorders | 1/25 | 0/26 |
| Age, Continuous(years) | Conventional Care | Intensive Insulin | Total |
|---|---|---|---|
| Median | 46 (17 to 70) | 57.5 (18 to 85) | 52 (17 to 85) |
| Sex: Female, Male(Participants) | Conventional Care | Intensive Insulin | Total |
|---|---|---|---|
| Female | 9 | 12 | 21 |
| Male | 16 | 14 | 30 |
| Region of Enrollment(participants) | Conventional Care | Intensive Insulin | Total |
|---|---|---|---|
| United States | 25 | 26 | 51 |
This study is terminated, as verified in Jun 2015. You cannot join it, but the record below documents what was studied.
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