High Risk Myelodysplasia Treated by Azacytidine : Genetic and Epigenetic (MYRAGE) (MYRAGE)
Myelodysplastic syndromes (MDS) are the most frequent myeloid neoplasms in Western Countries.They mainly affect patients aged 65 years or older. This is a very heterogenous group of diseases, which prognosis is evaluated with International Prognosis Scoring System. High risk MDS present with high frequency of transformation into acute myeloid leukemia. Treatment of high risk MDS often is based on hypomethylating agents, such as 5'-azacytidine (Azacytidine), with a complete response in approximativel 20% of cases..
This treatment is based on 4-week cycles, with daily injection during the first week and rest during the 3 next weeks of the cycle.
Azacytidine efficacy is commonly evaluated with clinical and biological parameters determined by the International Working Group 2006. These parameters are usually evaluated after at least 6 cycles of treatments.
There is a response with Azacytidine treatment in 60% of cases, including 40% of partial responses and 20% of complete responses. In 40% of patients, there is no response, which means that the disases is stable or in progression under therapy.
In this regard, early evaluation of treatment response is an issue. We want to improve our knowledge about early response criteria in Azacytidine-treated high-risk MDS, focusing on SMD with excess blasts, which represent 30 to 40% of total MDS.
Then, the investigator team want to compare DNA methylation profile at diagnosis and after 3 cycles of Azacytidine treatment.
Main objective :
Identify DNA methylation profiles related to response to Azacytidine therapy, after only 3 cycles of treatment, in high risk MDS with excess blasts.
Secondary objective :
Identify at diagnosis DNA methylation profiles that are predicitive of response to Azacytidin, in high risk MDS with excess blasts.
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Study Type
Study Type
Enrollment (Anticipated)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Contact
Study Contact
- Name: Julien BROSÉUS, MD, PhD
- Phone Number: (+ 33) 3 83 15 49 14
- Email: j.broseus@chru-nancy.fr
Study Contact Backup
- Name: Aurore PERROT, MD, PhD
- Phone Number: (+33) 3 83 15 51 66
- Email: au.perrot@chru-nancy.fr
Study Locations
-
-
-
Nancy, France, 54035
- Not yet recruiting
- CHRU de NANCY
-
Contact:
- Julien BROSEUS, MCU-PH
-
Vandoeuvre les Nancy, France
- Recruiting
- BROSEUS
-
Contact:
- Julien BROSEUS
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Pre-inclusion Criteria:
- patient benefiting from social welfcare
- patient followed at the University Hospital of Nancy
- patient aged 18 years or older
- patient informed on research organization and having signed an informed pre-inclusion consent
- No personal history of myelodysplastic syndrome
- clinical exam adapted to research
- one or more blood cytopenia
Inclusion Criteria:
- patient benefiting from social welfcare
- patient followed at the University Hospital of Nancy
- patient aged 18 years or older
- patient informed on research organization and having signed an informed inclusion consent
- definitive diagnosis of high risk myelodysplastic syndrome with excess blasts
- eligibility to an Azacytidine therapy as first-line treatment
Exclusion Criteria:
- personal history or current other cancer
- immediate acute myeloid leukemia
- personal history of demethylation treatment
- pregnant or breast feeding women
- life-theatening condition
- guardianship
- imprisoned patients
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Screening
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Patients with High-risk MDS With Excess Blasts
|
Bone marrow aspiration after 3 cycles of Azacytidine treatment
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Time Frame |
|---|---|
|
Methylation level of the Differentially Methylated Regions (DMR)
Time Frame: 3 months (after 3 cycles of treatment)
|
3 months (after 3 cycles of treatment)
|
|
Overall response by IWG 2006 response criteria (complete remission / partial remission / non response)
Time Frame: At the treatment response assessment (After 6-12 cycles of treatment up to 52 weeks)
|
At the treatment response assessment (After 6-12 cycles of treatment up to 52 weeks)
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Time Frame |
|---|---|
|
Methylation level of the Differentially Methylated Regions (DMR)
Time Frame: At diagnosis
|
At diagnosis
|
|
Cytogenetic response by IWG 2006 response criteria (major / minor / no response)
Time Frame: At the treatment response assessment (After 6-12 cycles of treatment up to 52 weeks)
|
At the treatment response assessment (After 6-12 cycles of treatment up to 52 weeks)
|
|
Hematologic improvement by IWG 2006 response criteria (major / minor / no response)
Time Frame: At the treatment response assessment (After 6-12 cycles of treatment up to 52 weeks)
|
At the treatment response assessment (After 6-12 cycles of treatment up to 52 weeks)
|
|
Transfusion independence (yes/no)
Time Frame: At the treatment response assessment (After 6-12 cycles of treatment up to 52 weeks)
|
At the treatment response assessment (After 6-12 cycles of treatment up to 52 weeks)
|
|
General condition improvement (yes/no)
Time Frame: At the treatment response assessment (After 6-12 cycles of treatment up to 52 weeks)
|
At the treatment response assessment (After 6-12 cycles of treatment up to 52 weeks)
|
Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Publications and helpful links
General Publications
- Cheson BD, Greenberg PL, Bennett JM, Lowenberg B, Wijermans PW, Nimer SD, Pinto A, Beran M, de Witte TM, Stone RM, Mittelman M, Sanz GF, Gore SD, Schiffer CA, Kantarjian H. Clinical application and proposal for modification of the International Working Group (IWG) response criteria in myelodysplasia. Blood. 2006 Jul 15;108(2):419-25. doi: 10.1182/blood-2005-10-4149. Epub 2006 Apr 11.
- Arber DA, Orazi A, Hasserjian R, Thiele J, Borowitz MJ, Le Beau MM, Bloomfield CD, Cazzola M, Vardiman JW. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood. 2016 May 19;127(20):2391-405. doi: 10.1182/blood-2016-03-643544. Epub 2016 Apr 11.
- Bejar R, Stevenson K, Abdel-Wahab O, Galili N, Nilsson B, Garcia-Manero G, Kantarjian H, Raza A, Levine RL, Neuberg D, Ebert BL. Clinical effect of point mutations in myelodysplastic syndromes. N Engl J Med. 2011 Jun 30;364(26):2496-506. doi: 10.1056/NEJMoa1013343.
- Chen G, Broseus J, Hergalant S, Donnart A, Chevalier C, Bolanos-Jimenez F, Gueant JL, Houlgatte R. Identification of master genes involved in liver key functions through transcriptomics and epigenomics of methyl donor deficiency in rat: relevance to nonalcoholic liver disease. Mol Nutr Food Res. 2015 Feb;59(2):293-302. doi: 10.1002/mnfr.201400483. Epub 2014 Dec 9.
- Delhommeau F, Dupont S, Della Valle V, James C, Trannoy S, Masse A, Kosmider O, Le Couedic JP, Robert F, Alberdi A, Lecluse Y, Plo I, Dreyfus FJ, Marzac C, Casadevall N, Lacombe C, Romana SP, Dessen P, Soulier J, Viguie F, Fontenay M, Vainchenker W, Bernard OA. Mutation in TET2 in myeloid cancers. N Engl J Med. 2009 May 28;360(22):2289-301. doi: 10.1056/NEJMoa0810069.
- Fandy TE, Herman JG, Kerns P, Jiemjit A, Sugar EA, Choi SH, Yang AS, Aucott T, Dauses T, Odchimar-Reissig R, Licht J, McConnell MJ, Nasrallah C, Kim MK, Zhang W, Sun Y, Murgo A, Espinoza-Delgado I, Oteiza K, Owoeye I, Silverman LR, Gore SD, Carraway HE. Early epigenetic changes and DNA damage do not predict clinical response in an overlapping schedule of 5-azacytidine and entinostat in patients with myeloid malignancies. Blood. 2009 Sep 24;114(13):2764-73. doi: 10.1182/blood-2009-02-203547. Epub 2009 Jun 22.
- Greenberg PL, Tuechler H, Schanz J, Sanz G, Garcia-Manero G, Sole F, Bennett JM, Bowen D, Fenaux P, Dreyfus F, Kantarjian H, Kuendgen A, Levis A, Malcovati L, Cazzola M, Cermak J, Fonatsch C, Le Beau MM, Slovak ML, Krieger O, Luebbert M, Maciejewski J, Magalhaes SM, Miyazaki Y, Pfeilstocker M, Sekeres M, Sperr WR, Stauder R, Tauro S, Valent P, Vallespi T, van de Loosdrecht AA, Germing U, Haase D. Revised international prognostic scoring system for myelodysplastic syndromes. Blood. 2012 Sep 20;120(12):2454-65. doi: 10.1182/blood-2012-03-420489. Epub 2012 Jun 27.
- Itzykson R, Kosmider O, Cluzeau T, Mansat-De Mas V, Dreyfus F, Beyne-Rauzy O, Quesnel B, Vey N, Gelsi-Boyer V, Raynaud S, Preudhomme C, Ades L, Fenaux P, Fontenay M; Groupe Francophone des Myelodysplasies (GFM). Impact of TET2 mutations on response rate to azacitidine in myelodysplastic syndromes and low blast count acute myeloid leukemias. Leukemia. 2011 Jul;25(7):1147-52. doi: 10.1038/leu.2011.71. Epub 2011 Apr 15.
- Meldi K, Qin T, Buchi F, Droin N, Sotzen J, Micol JB, Selimoglu-Buet D, Masala E, Allione B, Gioia D, Poloni A, Lunghi M, Solary E, Abdel-Wahab O, Santini V, Figueroa ME. Specific molecular signatures predict decitabine response in chronic myelomonocytic leukemia. J Clin Invest. 2015 May;125(5):1857-72. doi: 10.1172/JCI78752. Epub 2015 Mar 30.
- Nazha A, Narkhede M, Radivoyevitch T, Seastone DJ, Patel BJ, Gerds AT, Mukherjee S, Kalaycio M, Advani A, Przychodzen B, Carraway HE, Maciejewski JP, Sekeres MA. Incorporation of molecular data into the Revised International Prognostic Scoring System in treated patients with myelodysplastic syndromes. Leukemia. 2016 Nov;30(11):2214-2220. doi: 10.1038/leu.2016.138. Epub 2016 May 20.
- Rasmussen KD, Jia G, Johansen JV, Pedersen MT, Rapin N, Bagger FO, Porse BT, Bernard OA, Christensen J, Helin K. Loss of TET2 in hematopoietic cells leads to DNA hypermethylation of active enhancers and induction of leukemogenesis. Genes Dev. 2015 May 1;29(9):910-22. doi: 10.1101/gad.260174.115. Epub 2015 Apr 17.
- Santini V, Melnick A, Maciejewski JP, Duprez E, Nervi C, Cocco L, Ford KG, Mufti G. Epigenetics in focus: pathogenesis of myelodysplastic syndromes and the role of hypomethylating agents. Crit Rev Oncol Hematol. 2013 Nov;88(2):231-45. doi: 10.1016/j.critrevonc.2013.06.004. Epub 2013 Jul 7.
- Sperling AS, Gibson CJ, Ebert BL. The genetics of myelodysplastic syndrome: from clonal haematopoiesis to secondary leukaemia. Nat Rev Cancer. 2017 Jan;17(1):5-19. doi: 10.1038/nrc.2016.112. Epub 2016 Nov 11.
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Anticipated)
Primary Completion
Study Completion (Anticipated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- MYRAGE
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on High-risk Myelodysplastic Syndromes With Excess Blasts
-
NCT03383575RecruitingAcute Myeloid Leukemia | Chronic Myelomonocytic Leukemia | Myelodysplastic Syndrome With Excess Blasts | IDH2 Gene Mutation | Recurrent High Risk Myelodysplastic Syndrome | Refractory High Risk Myelodysplastic Syndrome | Blasts 20-30 Percent of Bone Marrow Nucleated Cells
-
NCT06247917RecruitingMyelodysplastic Syndromes | Myelodysplastic Syndrome With Excess Blasts-2 | Myelodysplastic Syndrome With Excess Blasts-1
-
NCT00104962CompletedUnspecified Childhood Solid Tumor, Protocol Specific | Childhood Myelodysplastic Syndromes | Previously Treated Myelodysplastic Syndromes | Secondary Myelodysplastic Syndromes | de Novo Myelodysplastic Syndromes | Refractory Anemia | Refractory Anemia With Excess Blasts | Refractory Cytopenia With Multilineage Dysplasia | Refractory Anemia With Ringed Sideroblasts
-
NCT04526288TerminatedAcute Myeloid Leukemia | Myelodysplastic Syndrome With Excess Blasts-2 | Myeloid Neoplasm
-
NCT00015990CompletedChronic Myelomonocytic Leukemia | Previously Treated Myelodysplastic Syndromes | Secondary Myelodysplastic Syndromes | de Novo Myelodysplastic Syndromes | Refractory Anemia | Refractory Anemia With Excess Blasts | Refractory Anemia With Excess Blasts in Transformation | Refractory Anemia With Ringed Sideroblasts
-
NCT00005845CompletedChronic Myelomonocytic Leukemia | Previously Treated Myelodysplastic Syndromes | de Novo Myelodysplastic Syndromes | Refractory Anemia | Refractory Anemia With Excess Blasts | Refractory Cytopenia With Multilineage Dysplasia | Refractory Anemia With Excess Blasts in Transformation | Refractory Anemia With Ringed Sideroblasts
-
NCT00005942CompletedChronic Myelomonocytic Leukemia | Recurrent Adult Acute Myeloid Leukemia | Previously Treated Myelodysplastic Syndromes | Refractory Anemia With Excess Blasts | Refractory Anemia With Excess Blasts in Transformation
-
NCT02562443TerminatedMyelodysplastic Syndrome | MDS | Refractory Anemia With Excess Blasts | RAEB
-
NCT04027309Active, not recruitingAcute Myeloid Leukemia | Myelodysplastic Syndrome With Excess Blasts-2
-
NCT03839771Active, not recruitingAcute Myeloid Leukemia | Myelodysplastic Syndrome With Excess Blasts-2
Clinical Trials on Myelogram
-
NCT04144387Active, not recruiting
-
NCT00231374Withdrawn
-
NCT02903082TerminatedSevere Sepsis | Inflammatory Response Syndrome, Systemic
-
NCT03681574CompletedPain, Postoperative | Vomiting | Anesthesia | Agitation States as Acute Reaction to Exceptional Stress