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Investigator(s):
Robert J. Kreitman, M.D. Principal Investigator Phone: 301-496-6947 kreitmar@mail.nih.gov
Referral Contact(s):
Linda Ellison, R.N. Research Nurse Phone: 301-496-9458 Fax: 240-220-7677 ellisonl@mail.nih.gov	Elizabeth Maestri, R.N. Research Nurse Phone: 301-402-5633 Fax: 240-220-7677 maestrie@mail.nih.gov	Rita Mincemoyer, R.N. Research Nurse Phone: 301-594-1778 Fax: 240-220-7677 mincemor@mail.nih.gov

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Primary Eligibility:

• Diagnosis of acute or lymphomatous adult T-cell leukemia (ATL)
• Previously treated disease unless the patient is ineligible for, or refuses other protocols or treatment for ATL
• Neutralizing antibodies < 25% neutralization of 200 ng/mL of LMB-2 immunotoxin
• No central nervous system disease
• No prior therapy with LMB-2 immunotoxin
• No concurrent Coumadin
• ECOG performance status 0–2
• ANC ≥ 1,000/μL
• Platelet count ≥ 50,000/μL
• ALT and AST ≤ 2.5 x upper limits of normal
• Albumin ≥ 3.0 gm/dL
• Total bilirubin ≤ 1.5 mg/dL (< 5 mg/dL in patients with Gilbert syndrome)
• Creatinine < 2.0 mg/dL
• LVEF ≥ 45%
• DLCO or FEV₁ ≥ 50% of normal
• No uncontrolled infection
• No untreated or uncontrolled second malignancy
• Not pregnant or nursing; fertile patients must use effective contraception prior to, during, and for 1 month after completion of study treatment
• No HIV or hepatitis C positivity; hepatitis B surface antigen positivity allowed provided patient is receiving lamivudine

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Treatment Plan:

This is a dose-escalation study of LMB-2 immunotoxin (LMB-2).

• Patients receive fludarabine phosphate IV over 30 minutes and cyclophosphamide IV for 60 minutes on Days 1–3
• Beginning in course two, patients also receive LMB-2 IV over 30 minutes on Days 3, 5, and 7
• Treatment repeats every 21 days for 7 courses in the absence of disease progression or unacceptable toxicity
• Blood samples are collected periodically

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Additional Information:

• This trial will be conducted at the NIH Clinical Center in Bethesda, MD. It is open to patients who meet the eligibility requirements, regardless of where they live in the United States.
• There is no charge for medical care received at NIH Clinical Center.
• PDQ (Physicians Data Query) - provides additional details about this study for health care providers.

Reviewed: 
Updated: 12/15/08