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Chemotherapy, Imatinib Mesylate, and Peripheral Stem Cell Transplantation in Treating Patients With Newly Diagnosed Acute Lymphoblastic Leukemia

13. november 2014 opdateret af: National Cancer Institute (NCI)

A Phase II Trial of Sequential Chemotherapy, Imatinib Mesylate (Gleevec, STI571) (NSC # 716051), and Transplantation for Adults With Newly Diagnosed Ph+ Acute Lymphoblastic Leukemia by the CALGB and SWOG

This phase II trial studies how well giving imatinib mesylate together with chemotherapy and peripheral stem cell transplantation works in treating patients with newly diagnosed acute lymphoblastic leukemia. Drugs used in chemotherapy use different ways to stop cancer cells from dividing so they stop growing or die. Imatinib mesylate may stop the growth of cancer cells by blocking the enzymes necessary for cancer cell growth. Giving imatinib mesylate together with chemotherapy and peripheral stem cell transplantation may be an effective treatment for acute lymphoblastic leukemia.

Studieoversigt

Status

Afsluttet

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

PRIMARY OBJECTIVES:

I. Determine the activity of imatinib mesylate (Gleevec) to prolong disease-free survival (DFS) and overall survival in acute lymphoblastic leukemia (ALL) patients with t(9;22).

II. Determine the ability of imatinib mesylate (Gleevec) to produce or maintain a BCR-ABL-negative status, as judged by real-time-polymerase chain reaction (RT-PCR) following sequential chemotherapy, imatinib mesylate (Gleevec) and transplantation.

III. Determine the feasibility of collecting adequate peripheral blood stem cells for autologous transplantation following imatinib mesylate (Gleevec) therapy.

IV. Study the safety and efficacy of autologous peripheral stem cell transplantation following therapy with imatinib mesylate (Gleevec).

V. Study the safety and efficacy of allogeneic stem cell transplantation following therapy with imatinib mesylate (Gleevec).

VI. Study the safety and efficacy of imatinib mesylate (Gleevec) administered after allogeneic or autologous stem cell transplant.

OUTLINE:

COURSE I (remission induction): Patients receive 1 course of front-line induction therapy on a Cancer and Leukemia Group B (CALGB)/Southwest Oncology Group (SWOG) protocol prior to enrollment.

COURSE II (imatinib mesylate): Patients receive imatinib mesylate orally (PO) twice daily on days 1-28.

COURSE III (CNS prophylaxis): Within 7 days after completing course II, patients receive methotrexate intrathecally (IT), methotrexate intravenously (IV) over 3 hours, and vincristine sulfate IV on days 1, 8, and 15; methotrexate PO every 6 hours on days 1-2, 8-9, and 15-16; leucovorin calcium IV on days 2, 9, and 16; and leucovorin calcium PO every 6 hours on days 3, 4, 10, 11, 17, and 18.

COURSE IV (imatinib mesylate): After blood counts recover after completion of course III, patients receive imatinib mesylate as in course II.

COURSE V: Patients undergo allogeneic peripheral blood stem cell transplantation (PBSCT), autologous PBSCT, or no PBSCT.

COURSE Va (allogeneic PBSCT for patients with human leukocyte antigen [HLA]-matched sibling donor): Beginning 3-10 days after completion of course IV, patients with an HLA-matched sibling donor undergo total body irradiation (TBI) 2-3 times daily on days -7 to -4. Patients receive etoposide IV over 4 hours on day -3. Patients then undergo PBSCT on day 0. Patients then receive graft-vs-host disease prophylaxis with tacrolimus IV continuously on days -1 to 56 (or IV continuously on days -1 to 14 and then PO or IV every 12 hours on days 15-56) followed by a taper. Patients also receive methotrexate IV on days 1, 3, and 6, and filgrastim subcutaneously (SC) beginning on day 4 and continuing until blood counts recover.

COURSE Vb (autologous PBSCT for patients without HLA-matched sibling donor): Beginning 3-10 days after completion of course IV, patients without an HLA-matched sibling donor receive etoposide IV continuously and cytarabine IV over 2 hours on days 1-4. Patients also receive filgrastim SC beginning on day 14 and continuing until PBSC collection is complete. Patients receive imatinib mesylate PO twice daily beginning after completion of PBSC collection and continuing until 3 days before PBSCT. Patients then undergo TBI 2-3 times daily on days -8 to -5. Patients receive etoposide IV over 4 hours on day -4 and cyclophosphamide IV over 2 hours on day -2. Patients undergo PBSCT on day 0. Patients receive filgrastim SC beginning on day 0 and continuing until blood counts recover.

COURSE Vc (no transplantation for patients who are not transplant candidates): Beginning 3-10 days after completion of course IV, patients who are not candidates for PBSCT receive etoposide IV over 4 hours and cytarabine IV over 2 hours on days 1-4. Patients also receive filgrastim SC once or twice a day beginning on day 14 and continuing until blood counts recover.

COURSE VI: Patients receive imatinib mesylate PO once or twice daily beginning on day 30 post transplantation or on day 30 if no transplantation received and continuing for at least 1 year or until patient has 2 consecutive negative reverse transcriptase-polymerase chain reaction assays at least 3 months apart or until relapse.

After completion of study treatment, patients are followed up monthly for 1 year, every 3 months for 2 years, every 6 months for 2 years, then yearly for 5 years.

Undersøgelsestype

Interventionel

Tilmelding (Faktiske)

58

Fase

  • Fase 2

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

  • Forenede Stater
    • Georgia
      • Atlanta, Georgia, Forenede Stater, 30342
        • Blood and Marrow Transplant Group of Georgia
    • Illinois
      • Bloomington, Illinois, Forenede Stater, 61701
        • Saint Joseph Medical Center
      • Canton, Illinois, Forenede Stater, 61520
        • Graham Hospital Association
      • Carthage, Illinois, Forenede Stater, 62321
        • Memorial Hospital
      • Chicago, Illinois, Forenede Stater, 60637
        • University of Chicago
      • Chicago, Illinois, Forenede Stater, 60640
        • Weiss Memorial Hospital
      • Eureka, Illinois, Forenede Stater, 61530
        • Eureka Hospital
      • Galesburg, Illinois, Forenede Stater, 61401
        • Galesburg Cottage Hospital
      • Galesburg, Illinois, Forenede Stater, 61401
        • Illinois CancerCare Galesburg
      • Havana, Illinois, Forenede Stater, 62644
        • Mason District Hospital
      • Hopedale, Illinois, Forenede Stater, 61747
        • Hopedale Medical Complex - Hospital
      • Macomb, Illinois, Forenede Stater, 61455
        • Mcdonough District Hospital
      • Maywood, Illinois, Forenede Stater, 60153
        • Loyola University Medical Center
      • Normal, Illinois, Forenede Stater, 61761
        • Community Cancer Center Foundation
      • Normal, Illinois, Forenede Stater, 61761
        • Bromenn Regional Medical Center
      • Ottawa, Illinois, Forenede Stater, 61350
        • Illinois CancerCare-Ottawa Clinic
      • Ottawa, Illinois, Forenede Stater, 61350
        • Ottawa Regional Hospital and Healthcare Center
      • Pekin, Illinois, Forenede Stater, 61554
        • Pekin Cancer Treatment Center
      • Pekin, Illinois, Forenede Stater, 61554
        • Pekin Hospital
      • Peoria, Illinois, Forenede Stater, 61637
        • OSF Saint Francis Medical Center
      • Peoria, Illinois, Forenede Stater, 61615
        • Illinois CancerCare-Peoria
      • Peoria, Illinois, Forenede Stater, 61614
        • Proctor Hospital
      • Peoria, Illinois, Forenede Stater, 61603
        • Methodist Medical Center of Illinois
      • Peoria, Illinois, Forenede Stater, 61615
        • Illinois Oncology Research Association CCOP
      • Peru, Illinois, Forenede Stater, 61354
        • Illinois Valley Hospital
      • Princeton, Illinois, Forenede Stater, 61356
        • Perry Memorial Hospital
      • Spring Valley, Illinois, Forenede Stater, 61362
        • Saint Margaret's Hospital
    • Indiana
      • Fort Wayne, Indiana, Forenede Stater, 46845
        • Fort Wayne Medical Oncology and Hematology Inc-Parkview
    • Kansas
      • Chanute, Kansas, Forenede Stater, 66720
        • Cancer Center of Kansas - Chanute
      • Dodge City, Kansas, Forenede Stater, 67801
        • Cancer Center of Kansas - Dodge City
      • El Dorado, Kansas, Forenede Stater, 67042
        • Cancer Center of Kansas - El Dorado
      • Kansas City, Kansas, Forenede Stater, 66112
        • Providence Medical Center
      • Kingman, Kansas, Forenede Stater, 67068
        • Cancer Center of Kansas-Kingman
      • Lawrence, Kansas, Forenede Stater, 66044
        • Lawrence Memorial Hospital
      • Newton, Kansas, Forenede Stater, 67114
        • Cancer Center of Kansas - Newton
      • Olathe, Kansas, Forenede Stater, 66061
        • Radiation Oncology Center of Olathe
      • Overland Park, Kansas, Forenede Stater, 66210
        • Radiation Oncology Practice Corporation Southwest
      • Parsons, Kansas, Forenede Stater, 67357
        • Cancer Center of Kansas - Parsons
      • Pratt, Kansas, Forenede Stater, 67124
        • Cancer Center of Kansas - Pratt
      • Salina, Kansas, Forenede Stater, 67401
        • Salina Regional Health Center
      • Salina, Kansas, Forenede Stater, 67401
        • Cancer Center of Kansas - Salina
      • Wellington, Kansas, Forenede Stater, 67152
        • Cancer Center of Kansas - Wellington
      • Wichita, Kansas, Forenede Stater, 67208
        • Cancer Center of Kansas-Wichita Medical Arts Tower
      • Wichita, Kansas, Forenede Stater, 67208
        • Associates In Womens Health
      • Wichita, Kansas, Forenede Stater, 67214
        • Cancer Center of Kansas - Main Office
      • Wichita, Kansas, Forenede Stater, 67214
        • Via Christi Regional Medical Center
      • Wichita, Kansas, Forenede Stater, 67214
        • Wichita CCOP
      • Winfield, Kansas, Forenede Stater, 67156
        • Cancer Center of Kansas - Winfield
    • Maine
      • Bangor, Maine, Forenede Stater, 04401
        • Eastern Maine Medical Center
    • Massachusetts
      • Beverly, Massachusetts, Forenede Stater, 01915
        • Beverly Hospital
      • Gloucester, Massachusetts, Forenede Stater, 01930
        • Addison Gilbert Hospital
      • Worcester, Massachusetts, Forenede Stater, 01605
        • Commonwealth Hematology Oncology PC-Worcester
    • Missouri
      • Independence, Missouri, Forenede Stater, 64057
        • Centerpoint Medical Center LLC
      • Kansas City, Missouri, Forenede Stater, 64111
        • Saint Luke's Cancer Institute
      • Kansas City, Missouri, Forenede Stater, 64114
        • Radiation Oncology Practice Corporation South
      • Kansas City, Missouri, Forenede Stater, 64154
        • Radiation Oncology Practice Corporation - North
      • Liberty, Missouri, Forenede Stater, 64068
        • Liberty Hospital
      • Saint Louis, Missouri, Forenede Stater, 63110
        • Washington University School of Medicine
    • Montana
      • Billings, Montana, Forenede Stater, 59101
        • Saint Vincent Healthcare
      • Billings, Montana, Forenede Stater, 59101
        • Northern Rockies Radiation Oncology Center
      • Billings, Montana, Forenede Stater, 59101
        • Montana Cancer Consortium CCOP
      • Billings, Montana, Forenede Stater, 59102
        • Hematology-Oncology Centers of the Northern Rockies PC
      • Billings, Montana, Forenede Stater, 59107-7000
        • Billings Clinic
      • Billings, Montana, Forenede Stater, 59107
        • Deaconess Medical Center
      • Bozeman, Montana, Forenede Stater, 59715
        • Bozeman Deaconess Hospital
      • Bozeman, Montana, Forenede Stater, 59715
        • Bozeman Deaconess Cancer Center
      • Bozeman, Montana, Forenede Stater, 59715
        • Internal Medicine of Bozeman
      • Butte, Montana, Forenede Stater, 59701
        • Saint James Community Hospital and Cancer Treatment Center
      • Great Falls, Montana, Forenede Stater, 59405
        • Great Falls Clinic
      • Great Falls, Montana, Forenede Stater, 59405
        • Berdeaux, Donald MD (UIA Investigator)
      • Helena, Montana, Forenede Stater, 59601
        • Saint Peter's Community Hospital
      • Kalispell, Montana, Forenede Stater, 59901
        • Kalispell Regional Medical Center
      • Kalispell, Montana, Forenede Stater, 59901
        • Glacier Oncology PLLC
      • Kalispell, Montana, Forenede Stater, 59901
        • Kalispell Medical Oncology
      • Missoula, Montana, Forenede Stater, 59802
        • Saint Patrick Hospital - Community Hospital
      • Missoula, Montana, Forenede Stater, 59804
        • Guardian Oncology and Center for Wellness
      • Missoula, Montana, Forenede Stater, 59801
        • Community Medical Hospital
      • Missoula, Montana, Forenede Stater, 59802
        • Montana Cancer Specialists
    • New Hampshire
      • Keene, New Hampshire, Forenede Stater, 03431
        • Cheshire Medical Center-Dartmouth-Hitchcock Keene
      • Rochester, New Hampshire, Forenede Stater, 03867
        • Frisbie Hospital
    • New York
      • Buffalo, New York, Forenede Stater, 14263
        • Roswell Park Cancer Institute
      • Manhasset, New York, Forenede Stater, 11030
        • North Shore University Hospital
      • Manhasset, New York, Forenede Stater, 11030
        • North Shore-LIJ Health System CCOP
      • New Hyde Park, New York, Forenede Stater, 11040
        • Long Island Jewish Medical Center
      • New Hyde Park, New York, Forenede Stater, 11040
        • North Shore-LIJ Health System/Center for Advanced Medicine
      • New York, New York, Forenede Stater, 10065
        • Weill Medical College of Cornell University
      • Oswego, New York, Forenede Stater, 13126
        • Oswego Hospital
      • Rochester, New York, Forenede Stater, 14642
        • University of Rochester
      • Syracuse, New York, Forenede Stater, 13210
        • State University of New York Upstate Medical University
    • North Carolina
      • Kinston, North Carolina, Forenede Stater, 28501
        • Kinston Medical Specialists PA
      • Winston-Salem, North Carolina, Forenede Stater, 27157
        • Wake Forest University Health Sciences
    • Ohio
      • Columbus, Ohio, Forenede Stater, 43210
        • Arthur G. James Cancer Hospital and Solove Research Institute at Ohio State University Medical Center
    • Pennsylvania
      • Pittsburgh, Pennsylvania, Forenede Stater, 15224-1791
        • Western Pennsylvania Hospital
    • South Carolina
      • Charleston, South Carolina, Forenede Stater, 29425
        • Medical University of South Carolina
    • Vermont
      • St. Johnsbury, Vermont, Forenede Stater, 05819
        • Northeastern
    • Virginia
      • Richmond, Virginia, Forenede Stater, 23298
        • Virginia Commonwealth University
    • Wyoming
      • Sheridan, Wyoming, Forenede Stater, 82801
        • Welch Cancer Center

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

15 år til 59 år (Barn, Voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion Criteria:

  • Unequivocal histologic diagnosis of ALL
  • Detection of the t(9;22)(q34;q11) or 3-way variant by metaphase cytogenetics or BCR-ABL positive by molecular analysis (RT-PCR or fluorescence in situ hybridization [FISH})

  • Prior Therapy:

    • Complete or partial remission following one course of induction chemotherapy with an intensive 4 or 5 drug regimen (with or without imatinib mesylate) on a CALGB or SWOG ALL protocol for previously untreated ALL patients

      • Note: The double induction regimen of SWOG S0333 is considered to be one course of induction chemotherapy for the purpose of this eligibility criterion; therefore, patients from S0333 may be eligible for this study only after completing the entire double induction regimen

    • Complete or partial remission following one course of therapy on any standard induction regimen (with or without imatinib mesylate) without prior enrollment on a cooperative group frontline protocol; in these instances, documentation of Philadelphia chromosome (Ph)+ positivity may occur outside a CALGB or SWOG laboratory

      • Note: CALGB institutions must enroll patients on CALGB 9862 and submission of an initial sample for the companion trial must occur at time of enrollment on CALGB C10001; enrollment on companion studies CALGB 8461 and 9665 is not required
  • No more than six weeks of prior imatinib mesylate during induction therapy before study enrollment
  • Non-pregnant and non-nursing; treatment under this protocol would expose an unborn child to significant risks; women and men of reproductive potential should agree to use an effective means of birth control and contraception should continue for three months after the last dose of imatinib mesylate (Gleevec) to allow complete clearance of drug and its principle metabolites from the body; in women of childbearing potential, a pregnancy test will be required at study entry

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Behandling
  • Tildeling: N/A
  • Interventionel model: Enkelt gruppeopgave
  • Maskning: Ingen (Åben etiket)

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Eksperimentel: Treatment (imatinib mesylate, chemotherapy, PBSCT)
See Detailed Description.
Andet: laboratoriebiomarkøranalyse
Korrelative undersøgelser
Medicin: cyclophosphamid
Givet IV
Andre navne:
  • Cytoxan
  • Endoxan
  • CPM
  • CTX
  • Endoxana
Medicin: etoposid
Givet IV
Andre navne:
  • EPEG
  • VP-16
  • VP-16-213
Medicin: cytarabin
Givet IV
Andre navne:
  • Cytosar-U
  • cytosin arabinosid
  • ARA-C
  • arabinofuranosylcytosin
  • arabinosylcytosin
Medicin: vincristinsulfat
Givet IV
Andre navne:
  • VCR
  • leurokristinsulfat
  • Vincasar PFS
Biologisk: filgrastim
Givet SC
Andre navne:
  • G-CSF
  • Neupogen
Stråling: bestråling af hele kroppen
Gennemgå TBI
Andre navne:
  • TBI
Medicin: tacrolimus
Givet IV eller PO
Andre navne:
  • Prograf
  • FK 506
Procedure: allogen hæmatopoietisk stamcelletransplantation
Gennemgå allogen PBSCT
Procedure: perifer blodstamcelletransplantation
Gennemgå PBSCT
Andre navne:
  • PBPC transplantation
  • PBSC transplantation
  • transplantation af perifer blodprogenitorcelle
  • transplantation, perifer blodstamcelle
Procedure: autolog hæmatopoietisk stamcelletransplantation
Gennemgå autolog PBSCT
Medicin: imatinibmesylat
Givet PO
Andre navne:
  • Gleevec
  • CGP 57148
  • Glivec
Medicin: leucovorin calcium
Givet IV og PO
Andre navne:
  • CF
  • CFR
  • LV
Medicin: methotrexate
Given IT and IV
Andre navne:
  • amethopterin
  • Folex
  • methylaminopterin
  • Mexate
  • MTX

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Disease Free Survival
Tidsramme: Duration of treatment (up to 10 years)

Disease-free survival (DFS) was measured as the interval from achievement of complete remission (CR) until relapse or death, regardless of cause; patients alive and in CR were censored at last follow-up. DFS was estimated using the Kaplan Meier method.

A complete remission (CR) was defined as recovery of morphologically normal bone marrow and blood counts (i.e., neutrophils >= 1.5 x 10^9/L and platelets > 100 x 10^9/L) and no circulating leukemic blasts or evidence of extramedullary leukemia and persisting for at least one month.
Duration of treatment (up to 10 years)

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Samlet overlevelse
Tidsramme: Studiets varighed (op til 10 år)
Samlet overlevelse (OS) som intervallet fra undersøgelsesdatoen til døden. OS blev estimeret ved hjælp af Kaplan Meier-metoden.
Studiets varighed (op til 10 år)
Number of Participants Who Achieved a BCR-ABL Response at 12 Months
Tidsramme: 12 months

BCR-ABL response is defined in two ways: complete molecular response (CMR) and major molecular response (MMR).

Complete Molecular Response is defined as a Bcr-Abl (a fusion of gene of Bcr and ABl genes) ratio ≤0.0032% on the International Scale Bcr = breakpoint cluster gene Abl = abelson proto-oncogene

MMR is defined as Bcr-Abl (A fusion gene of the breakpoint cluster region [Bcr] gene and Abelson proto-oncogene [Abl] genes) transcript ratio ≤0.1% (≥ 3 log reduction of BCR-ABL transcripts from a standardized baseline), as detected by reverse transcriptase polymerase chain reaction [RT-PCR] (performed centrally).
12 months
5 Year Disease-free Survival for Autologous & Allogeneic Transplant Groups
Tidsramme: 5 years from CR
Percentage of patients who achieved a complete remission (CR) and were alive and relapse free at 5 years. The 5-year progression free survival was estimated using the Kaplan Meier method.
5 years from CR
5 Year Overall Survival for Autologous & Allogeneic Transplant Groups
Tidsramme: 5 years from registration
Percentage of patients who were alive at 5 years. The 5-year progression free survival was estimated using the Kaplan Meier method.
5 years from registration

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

National Cancer Institute (NCI)

Efterforskere

  • Ledende efterforsker: Meir Wetzler, Cancer and Leukemia Group B

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Generelle publikationer

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart

1. april 2002

Primær færdiggørelse (Faktiske)

1. april 2012

Studieafslutning (Faktiske)

1. februar 2014

Datoer for studieregistrering

Først indsendt

6. juni 2002

Først indsendt, der opfyldte QC-kriterier

26. januar 2003

Først opslået (Skøn)

27. januar 2003

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Skøn)

24. november 2014

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

13. november 2014

Sidst verificeret

1. juni 2014

Mere information

Begreber relateret til denne undersøgelse

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • NCI-2009-00436 (Registry Identifier: CTRP (Clinical Trial Reporting Program))
  • U10CA031946 (U.S. NIH-bevilling/kontrakt)
  • CDR0000069378
  • CALGB 10001/SWOG C10001 (Anden identifikator: Cancer and Leukemia Group B)
  • CALGB-10001 (Anden identifikator: CTEP)

Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .

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