Decitabine Maintenance for Acute Myelogenous Leukemia (AML) and Myelodysplastic Syndrome (MDS) Post Transplant (AML MDS)

February 11, 2016 updated by: Washington University School of Medicine

Maintenance Therapy With Decitabine After Allogeneic Stem Cell Transplantation for Acute Myelogenous Leukemia and High-Risk Myelodysplastic Syndrome

Primary:

To determine the maximum tolerated dose and schedule of decitabine when administered as maintenance therapy after allogeneic hematopoietic stem cell transplantation (alloHSCT) performed for AML or high-risk MDS.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Secondary:

  • To determine the safety and tolerability of decitabine as maintenance therapy after alloHSCT.
  • To determine the rates disease relapse, 1-year disease-free survival, and overall survival.
  • To assess lymphoid and myeloid chimerism while on decitabine maintenance.
  • To determine the incidence of acute and chronic GVHD.
  • To assess immunologic reconstitution after alloHSCT.
  • To assess changes in gene expression and methylation patterns following decitabine treatment
  • To assess the effects of decitabine on immune reconstitution post transplant.
  • To access the frequency of FoxP3+ CD3+/CD4+ and CD3+/CD8+ lymphocytes before and after decitabine treatment.

Study Type

Interventional

Enrollment (Actual)

24

Phase

  • Phase 1

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • Missouri
      • St. Louis, Missouri, United States, 63110
        • Washington University School of Medicine

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Patient Screening Criteria and Enrollment Process

This is a single institution study at Washington University School of Medicine in St. Louis. Study population are patients >=18 years of age, with histologically confirmed AML or MDS according to World Health Organization (WHO) criteria undergoing alloHCST. All screening procedures are part the patients clinical care.

  • Patients, or their legal authorized representative, will provide written informed consent for the study prior to alloHSCT, or through 100 days following alloHSCT
  • Patients will undergo alloHSCT as per institutional guidelines. AlloHSCT may be performed using both related and unrelated donors, myeloablative or non-myeloablative preparative regimens, and with either peripheral blood or bone marrow as a source of graft.
  • Patients who fulfill both the Inclusion Criteria and Exclusion Criteria in the period of ≥ 50 and ≤ 100 days after alloHSCT will be registered on the study and will receive decitabine maintenance. Bone marrow biopsy will be performed ≤ 14 days prior to starting decitabine to confirm remission. Any GVHD prophylaxis or therapy is allowed during the study.
  • Patients who do not fulfill Inclusion Criteria are not eligible to be registered on the study and are considered screening failures.
  • Study will include maximum of 32 evaluable patients.

Inclusion Criteria

  • History of AML or MDS using WHO classification.
  • >50 and <100 days following HLA-matched related or unrelated donor alloHSCT. Donors may be mismatched at single antigen at HLA-A, -B or -DR locus plus possible single antigen mismatch at HLA-C according to institution guidelines. Two-antigen mismatch at a single locus is not allowed.
  • Age >=18 years.

  • Bone marrow biopsy confirming complete remission after alloHSCT

    o Complete remission: less than 5% blasts in an aspirate bone marrow sample with a count of at least 200 nucleated cells, no blasts with Auer rods or persistence of extramedullary disease PLUS absolute neutrophil count (ANC) > 1,500/μL, platelet count ≥ 50,000/μL and no leukemic blasts in the peripheral blood.

  • Platelet count ≥ 50,000/µL without platelet transfusion for 7 days and ANC ≥ 1,500/µL without colony stimulating factor support.
  • Performance status < ECOG 2.

  • Acceptable organ function defined as:

    • creatinine < 1.5 times the institutional ULN or creatinine clearance (calculated by the Cockroft and Gault method) ≥ 30 mL/min
    • bilirubin < 1.5 times the institutional ULN
    • AST, ALT and alkaline phosphatase < 2.5 times the institutional ULN.
  • Each Patient or their legal authorized representative must sign an institutional review board/ethics committee-approved informed consent indicating their awareness of the investigational nature of this study.
  • Female Subjects:
  • Female of childbearing potential (FCBP*) must agree to use a reliable form of contraception or to practice complete abstinence from heterosexual intercourse for at least 28 days before starting study drug, while participating in the study, and for at least 28 days after discontinuation from the study. The methods of reliable contraception include intrauterine device (IUD), hormonal (birth control pills, injections, or implants), tubal ligation, partner's vasectomy, latex condom, diaphragm and cervical cap.
  • FCBP must agree to pregnancy testing.
  • FCBP must a negative pregnancy test prior to starting study drug.

  • FCBP must agree to abstain from donating blood and/or egg during study participation and for at least 28 days after discontinuation from the study

    * A female of childbearing potential is a sexually mature woman who: 1) has not undergone a hysterectomy or bilateral oophorectomy; or 2) has not been naturally postmenopausal for at least 24 consecutive months (i.e., who has had menses at any time in the preceding 24 consecutive months).

  • Male Subjects:
  • Must agree to use a latex condom during sexual contact with FCBP while participating in the study and for at least 28 days following discontinuation from the study even if he has undergone a successful vasectomy
  • Must agree to abstain from donating blood, semen, or sperm during study participation and for at least 28 days after discontinuation from the study.
  • Must agree that if a pregnancy or a positive pregnancy test does occur in a female partner of a male study subject during study participation, study drug must be immediately discontinued and must immediately notify the principal investigator.

Exclusion Criteria

  • History of previous alloHSCT prior to the current alloHSCT.
  • Persistent AML or MDS after alloHSCT.
  • Grade 3- 4 acute GVHD, See Appendix A.
  • Positive serology for HIV.
  • Pregnancy or nursing.
  • Other cancers less than or equal to 2 years prior study entry except: basal cell carcinoma of the skin, squamous cell carcinoma of the skin, carcinoma in situ of the cervix, carcinoma in situ of the breast, prostate cancer stage T1a or T1b.
  • Uncontrolled active infections requiring intravenous antibiotics.
  • Clinically significant systemic illness (e.g. serious active infections or significant cardiac, pulmonary, hepatic or other organ dysfunction), which, in the judgment of the Principal or Associate Investigator would compromise the patient's ability to tolerate protocol therapy.
  • Known or suspected hypersensitivity to decitabine.
  • Patients may not be receiving any other investigational agents.
  • General or specific changes in patient's condition that render the patient unacceptable for further treatment in judgment of the investigators.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Non-Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Level 1
Decitabine 5.0 mg/m2/day on Days 1 thru 5 every 6 weeks for as many as 8 cycles.
Drug: Decitabine
Other Names:
  • Dacogen
Experimental: Level 2
Decitabine 7.5 mg/m2/day on Days 1 thru 5 every 6 weeks for as many as 8 cycles.
Drug: Decitabine
Other Names:
  • Dacogen
Experimental: Level 3
Decitabine 10.0 mg/m2/day on Days 1 thru 5 every 6 weeks for as many as 8 cycles.
Drug: Decitabine
Other Names:
  • Dacogen
Experimental: Level 4
Decitabine 15.0 mg/m2/day on Days 1 thru 5 every 6 weeks for as many as 8 cycles.
Drug: Decitabine
Other Names:
  • Dacogen

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
To determine the maximum tolerated dose and schedule of decitabine when administered as maintenance therapy after alloHSCT performed for AML or high-risk MDS.
Time Frame: Up to 6 weeks (completion of first cycle)
Up to 6 weeks (completion of first cycle)

Secondary Outcome Measures

Outcome Measure
Time Frame
To determine the safety and tolerability of decitabine as maintenance therapy after alloHSCT.
Time Frame: Up to 30 days after end of study (approximately 46 weeks)
Up to 30 days after end of study (approximately 46 weeks)
To determine the rates disease relapse
Time Frame: Every 3 months for 2 years then every 6 months for 3 years
Every 3 months for 2 years then every 6 months for 3 years
To assess lymphoid and myeloid chimerism while on decitabine maintenance.
Time Frame: End of cycle 3 (18 weeks)
End of cycle 3 (18 weeks)
To determine the incidence of acute GVHD.
Time Frame: End of study (42 weeks)
End of study (42 weeks)
To assess immunologic reconstitution after alloHSCT.
Time Frame: End of study (42 weeks)
End of study (42 weeks)
To assess changes in gene expression and methylation patterns following decitabine treatment
Time Frame: End of study (42 weeks)
End of study (42 weeks)
To assess the effects of decitabine on immune reconstitution post transplant.
Time Frame: End of study (42 weeks)
End of study (42 weeks)
To access the frequency of FoxP3+ CD3+/CD4+ and CD3+/CD8+ lymphocytes before and after decitabine treatment.
Time Frame: End of cycle 3 (18 weeks)
End of cycle 3 (18 weeks)
To determine the 1-year disease-free survival
Time Frame: 1 year
1 year
To determine overall survival.
Time Frame: Every 3 months for 2 years then every 6 months for 3 years
Every 3 months for 2 years then every 6 months for 3 years
To determine the incidence of chronic GVHD.
Time Frame: End of study (42 weeks)
End of study (42 weeks)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Washington University School of Medicine

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

December 1, 2009

Primary Completion (Actual)

May 1, 2014

Study Completion (Actual)

February 1, 2016

Study Registration Dates

First Submitted

September 29, 2009

First Submitted That Met QC Criteria

September 29, 2009

First Posted (Estimate)

September 30, 2009

Study Record Updates

Last Update Posted (Estimate)

February 15, 2016

Last Update Submitted That Met QC Criteria

February 11, 2016

Last Verified

February 1, 2016

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 09-1126 / 201108378

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.

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