Feasibility and Effectiveness of Inotuzumab Ozogamicin in B-Cell Acute Lymphoblastic Leukemia

Inclusion Criteria:

• Ph+ ALL with p190 or p210 detectable and measurable (at least 10-4 x10000 ABL) afterat least 3 months of any therapy, or the failure of at least 2 TKI.
• Ph- ALL with detectable and measurable IG specific transcript after at least 2 coursesof previous therapy.
• Age ≥ 18 years old.
• ECOG ≤ 2.

Exclusion Criteria:

• More than 5% of BM blasts.
• WHO performance status ≤ 50% (Karnofsky) or ≥ 3 (ECOG).
• Active HBV or HCV hepatitis, or AST/ALT ≥ 2.5 x ULN and bilirubine ≥ 1.5 x ULN.
• Evidence of liver fibrosis, portal hypertension or other clinically relevant liverabnormalities at screening liver ultrasonography.
• History of alcohol abuse.
• Burkitt lymphoma and active CNS leukemia. Patients with previuos neurologicaltoxicitiy as well co-morbidity will be carefully evaluated for enrolment.
• Ongoing or active infections.
• Uncontrolled hypertriglyceridemia (triglycerides >450 mg/dL). Clinically significant,uncontrolled, or active cardiovascular disease.
• Uncontrolled hypertension (diastolic blood pressure >90 mm Hg; systolic >140 mm Hg).Patients with hypertension should be under treatment on study entry to effect bloodpressure control.
• Creatinine level > 2.5mg/dl or Glomerular Filtration Rate (GFR) < 20 ml/min orproteinuria > 3.5 g/day.
• Documented inherited protrombotic disorders
• Patients who have received any investigational drug ≤ 4 weeks.
• Patients who have undergone major surgery ≤ 2 weeks prior to starting study drug orwho have not recovered from side effects of such therapy.
• Patients with a history of another primary malignancy that is currently clinicallysignificant or currently requires active intervention or with a life expectancy due toother malignancy <6 months.
• Patients that have received Inotuzumab or Anti CD22 directed therapies before
• Patients with known hereditary coagulopathy
• Patient that received during their life diagnosis of VOD or had ongoing VOD
• Patients who are pregnant or breastfeeding and adults of reproductive potential notemploying an effective method of birth control (women of childbearing potential musthave a negative serum pregnancy test within 48 hrs prior to administration ofinduction therapy). Postmenopausal women must be amenorrheic for at least 12 months tobe considered of non-childbearing potential. Male and female patients must agree toemploy an effective barrier method of birth control throughout the study and for up to 4 months following discontinuation of study drugs.
• Patients unwilling or unable to comply with the protocol.