Neoplasms

Blood and Lymph Conditions

Immune System Diseases

All Conditions

Infections

Nutritional and Metabolic Diseases

Rare Diseases

Lymphoma

Leukemia

Precursor Cell Lymphoblastic Leukemia-Lymphoma

Leukemia, Lymphoid

Burkitt Lymphoma

Hyperglycemia

Neoplasms by Histologic Type

Lymphoproliferative Disorders

Lymphatic Diseases

Immunoproliferative Disorders

Hematologic Diseases

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Acute Lymphoblastic Leukemia

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Acute Graft Versus Host Disease

Hypoglycemic Agents

All Drugs and Chemicals

Micronutrients

Insulin

Insulin, Globin Zinc

Insulin Aspart

Insulin Glargine

Zinc

Control Group: Conventional care using blood sugar management with regular human insulin.

Intervention Group: Intense blood sugar management with Insulin Aspart + Insulin Glargine

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.

Khanh Vu, MD

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.

Effect of Tight Control of Blood Glucose During Hyper-CVAD Chemotherapy For Acute Lymphocytic Leukemia (ALL)

Effect of Tight Control of Blood Glucose During Hyper-CVAD Chemotherapy For Acute Lymphocytic Leukemia

The overall survival rate defined as percentage of participants in each treatment group who are still alive at 12 months.

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.

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.

Novo Nordisk A/S

M.D. Anderson Cancer Center

Conventional Care

Intensive Insulin

Total

Age, Continuous

Sex: Female, Male

United States

Region of Enrollment

Study terminated early due to futility at the pre-determined interim analysis point.

Khanh D Vu, MD/ Associated Professor

Control Group - Conventional care using blood sugar management with regular human insulin.

Intervention Group - Intense blood sugar management with Insulin Aspart + Insulin Glargine

1-Year Overall Survival Rate

Control Group - Conventional care using blood sugar management with regular human insulin

Intense blood sugar management with Insulin Aspart + Insulin Glargine

Intervention Group

Overall Survival

Progression Free Survival (PFS)

Overall Study

Gland and Hormone Related Diseases

Symptoms and General Pathology

Diabetes Mellitus

Diabetes Mellitus, Type 2

Neoplasm Metastasis

Metabolic Diseases

Glucose Metabolism Disorders

Endocrine System Diseases

Neoplastic Processes

Pioglitazone

pioglitazone

subcutaneous injection, start dose 6-10 units, once daily, 26 weeks

insulin glargine

Leif Groop, Professor

Pioglitazone and insulin glargine are equally effective in achieving glycemic control in secondary drug failure of type 2 diabetes but the mechanisms of actions are different.

The present study was undertaken to assess differences in how insulin glargine vs. pioglitazone affect:

* Beta-cell function as measured by proinsulin/insulin, homeostasis model assessment for insulin secretion (HOMA β-cell) and glucagon stimulated C-peptide test
* Insulin sensitivity as measured by adiponectin, homeostasis model assessment for insulin resistance (HOMA-IR) and insulin tolerance test and
* Surrogate markers of cardiovascular disease as measured by BNP, NT-pro BNP and plasma lipid profile as add-on therapy in patients with T2D and secondary drug failure. The patients' satisfaction with each treatment was also surveyed.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Effect of Tight Control of Blood Glucose During Hyper-CVAD Chemotherapy For Acute Lymphocytic Leukemia (ALL)	NCT00500240	Leukemia Lymphoma	Insulin Glargin... Insulin Aspart	15 Years -	M.D. Anderson Cancer Center
Pioglitazone vs. Insulin Glargine in the Treatment of Secondary Drug Failure in Type 2 Diabetes	NCT00609856	Type 2 Diabetes Secondary Drug ...	pioglitazone insulin glargin...	30 Years - 75 Years	Skane University Hospital
Effect of Tight Control of Blood Glucose During Hyper-CVAD Chemotherapy For Acute Lymphocytic Leukemia (ALL)	NCT00500240	Leukemia Lymphoma	Insulin Glargin... Insulin Aspart	15 Years -	M.D. Anderson Cancer Center
Effect of Tight Control of Blood Glucose During Hyper-CVAD Chemotherapy For Acute Lymphocytic Leukemia (ALL)	NCT00500240	Leukemia Lymphoma	Insulin Glargin... Insulin Aspart	15 Years -	M.D. Anderson Cancer Center

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