- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02204020
Phase II Study of 5-azacytidine Maintenance After Transplant for AML or MDS (UPCI 13-165)
Phase II Study of 5-azacytidine Maintenance After Allogeneic Hematopoietic Cell Transplantation for High-risk Acute Myeloid Leukemia (AML) or Myelodysplastic Syndrome (MDS)
Study Overview
Status
Intervention / Treatment
Detailed Description
Phase II study of 5-aza maintenance after allogeneic Hematopoietic Cell Transplantation (HCT) for high-risk Acute Myeloid Leukemia (AML) and Myelodysplastic Syndrome (MDS). Early studies indicate 5-aza is a hypomethylating agent that has shown immune modulating properties that may enhance the graft-versus-leukemia (GVL) effect, including upregulation of tumor-associated antigen and costimulatory molecule expression. 5-aza also has properties that suggest protection against graft-versus-host disease (GVHD). The primary objective is to evaluate relapse rate at one year. Secondary objectives will include the incidence of both acute and chronic GVHD as well as relapse-free survival, overall survival and toxicity. Correlatives will be performed to evaluate the effect of 5-aza maintenance on the immune system.
Subjects must be transplant candidates with MDS or high risk characteristics of AML. Subjects are consented, screened, then transplanted. Those showing complete response and no active GVHD after transplant can proceed to maintenance with 5-aza. Bone marrow biopsies are performed for response assessment after transplant as well as every three cycles (1 cycle=28 days) while on treatment. Dosing starts at 32mg/m2 and can be increased every 2 cycles without a serious adverse event (SAE), or reduced per toxicity for up to 12 cycles.
Study Type
Phase
- Phase 2
Contacts and Locations
Study Locations
-
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Pennsylvania
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Pittsburgh, Pennsylvania, United States, 15232
- University of Pittsburgh Medical Center
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
Age≥18 with MDS or high-risk AML, morphologically confirmed and based on World Health Organization criteria (see below for definition of high-risk AML)*, who are transplant candidates with an available human leukocyte antigen (HLA) -matched sibling or unrelated donor with at least 8/8 match
*Definition of high-risk AML:
- Age≥60 years
Age<60 years with any of the following:
- Secondary AML
- Poor risk cytogenetics, which include abnormalities of chromosome 3, 5, or 7, trisomy 8, 11q23 abnormalities, t(6;9), 20q-, and complex karyotype
- Fms-like tyrosine kinase 3 (FLT3) mutation
- Disease status ≥ second complete remission (CR2) at time of HCT
- Detectable disease at time of HCT
- Eastern Cooperative Oncology Group (ECOG) performance status 0-2
- Adequate major organ function, as defined by AST and ALT < 2 x upper limit of normal, total serum bilirubin < 2 x upper limit of normal (unless due to hemolysis or Gilbert's syndrome, then no upper limit), creatinine < 2 x upper limit of normal, unless there is known chronic kidney disease (creatinine must be at baseline for subjects with chronic kidney disease)
- In agreement to use an effective barrier method of birth control to avoid pregnancy during the study and for a minimum of 30 days after study treatment, for all male and female patients who are fertile
Exclusion Criteria:
- Uncontrolled, life-threatening infection that is not responding to antimicrobial therapy
- Serum creatinine > 2 x upper limit of normal, unless there is known chronic kidney disease (creatinine must be at baseline for subjects with chronic kidney disease), aspartate aminotransferase (AST),alanine aminotransferase (ALT), or total bilirubin > 2x upper limit of normal
- History of psychiatric disorder which may compromise compliance with the protocol or which does not allow for appropriate informed consent
- Patient may not be receiving any other antineoplastic agents
- Pregnancy
- Concurrent use of any other investigational agents on a clinical trial
- Prior allogeneic stem cell transplant
- Known hypersensitivity to 5-azacytidine * Prior treatment with 5-azacytidine is allowed
Post-transplant eligibility and exclusion criteria
Patients will have to meet the following post-transplant eligibility criteria to initiate treatment:
- In complete response (including complete remission with incomplete blood count recovery and marrow complete response) on bone marrow biopsy for response assessment after HCT (typically day +30)
- Patient is within 30-100 days after HCT
- Absolute neutrophil count (ANC) ≥ 1000/µL, platelet count ≥ 20,000/µL
- ECOG performance status 0-2
- Adequate major organ function, as defined by AST and ALT < 2 x upper limit of normal, total serum bilirubin < 2 x upper limit of normal (unless due to hemolysis or Gilbert's syndrome, then no upper limit), creatinine < 2 x upper limit of normal unless there is known chronic kidney disease (creatinine must be at baseline for subjects with chronic kidney disease)
- In agreement to use an effective barrier method of birth control to avoid pregnancy during the study and for a minimum of 30 days after study treatment, for all male and female patients who are fertile
Patients may not have any of the following post-transplant exclusion criteria:
- Active grade II-IV acute GVHD, for example requiring treatment with steroids at a dose equivalent to prednisone 1mg/kg daily or higher
- Uncontrolled, life-threatening infection that is not responding to antimicrobial therapy
- Serum creatinine > 2 x upper limit of normal unless there is known chronic kidney disease (creatinine must be at baseline for subjects with chronic kidney disease), aspartate aminotransferase (AST),alanine aminotransferase (ALT), or total bilirubin > 2x upper limit of normal
- History of psychiatric disorder which may compromise compliance with the protocol or which does not allow for appropriate informed consent
- Pregnancy
- Concurrent use of any other investigational agents on a clinical trial
- Known hypersensitivity to 5-azacytidine * Prior treatment with 5-azacytidine is allowed
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: 5-azacytidine
5-aza SC or IV 32mg/m2 - 75mg/m2 (based on dose escalation)
|
The planned initial dose of 5-aza is 32mg/m2 (Level 0) administered either subcutaneously or intravenously for days 1 through 5 of a 28-day cycle, which will be initiated between day+30 and day+100 after HCT.
Patients who tolerate this dose based on hematologic parameters and with no SAEs for two consecutive cycles will be eligible for a dose escalation to 50mg/m2 (Level +1).
Patients who tolerate this dose based on the same criteria as above for two consecutive cycles will be eligible for a dose escalation to 75mg/m² (Level +2).
Patients will continue at dose Level +2 for the remainder of the study provided there are no toxicities that require dose reduction.
Patients requiring a dose reduction are not eligible for re-escalation.
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Relapse rate at 1 year
Time Frame: 3 years
|
Study will evaluate the relapse rate associated with 5-azacytidine (5-aza) as maintenance therapy after HCT in patients with high-risk AML or MDS.
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3 years
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Overall survival
Time Frame: 3 years
|
3 years
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Safety of Toxicity Requiring Treatment Discontinuation (TRTD)
Time Frame: 3 years
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3 years
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Incidence of acute GVHD
Time Frame: 3 years
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3 years
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Percentage of Toxicity Requiring Treatment Discontinuation (TRTD)
Time Frame: 3 years
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3 years
|
relapse-free survival
Time Frame: 3 years
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3 years
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Incidence of chronic GVHD
Time Frame: 3 years
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3 years
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Effect on the immune system
Time Frame: 3 years
|
Study will evaluate the effect of 5-aza maintenance on the immune system using T-cell phenotype subsets and receptor expression, cytokine levels including tumor necrosis factor alpha (TNFα) and Interferon-y (IFNγ) (proinflammatory), and interleukin 7 (IL-7) and interleukin 15 (IL-15) (homeostatic) and association of correlative measures with relapse and incidence of GVHD.
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3 years
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Annie Im, MD, University of Pittsburgh Medical Center
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Pathologic Processes
- Neoplasms by Histologic Type
- Neoplasms
- Disease
- Bone Marrow Diseases
- Hematologic Diseases
- Precancerous Conditions
- Syndrome
- Myelodysplastic Syndromes
- Leukemia
- Leukemia, Myeloid
- Leukemia, Myeloid, Acute
- Preleukemia
- Molecular Mechanisms of Pharmacological Action
- Enzyme Inhibitors
- Antimetabolites, Antineoplastic
- Antimetabolites
- Antineoplastic Agents
- Azacitidine
Other Study ID Numbers
- UPCI 13-165
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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