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Study of Decitabine Induction Prior to Allogeneic Hematopoietic Cell Transplant in Newly Diagnosed MDS Patients

16. juni 2014 opdateret af: Singapore General Hospital

Prospective Phase II Study of Decitabine Induction Therapy to Reduce Pre-transplant Disease Burden Prior to Allogeneic Hematopoietic Cell Transplant in Patients With Newly Diagnosed Myelodysplastic Syndromes.

Allogeneic blood stem cell transplant remains the only potential curative treatment for myelodysplastic syndromes (MDS) to date. Pre-transplant induction chemotherapy with leukemia-type regimens is associated with significant toxicity and even death. The hypomethylating agents decitabine and 5-azacytidine have been shown in studies to cause improved hematologic parameters and partial or complete responses in patients with high risk MDS compared to standard therapy. In contrast to leukemia-type chemotherapy, decitabine is associated with a relatively low risk of toxicity. We therefore propose to treat transplant-eligible MDS patients with Decitabine as induction therapy and a bridge to transplant.

Hypothesis:

  1. Decitabine is able to reduce disease burden as measured by blood and marrow blast counts prior to allogeneic hematopoietic stem cell transplant to below 5%.
  2. Decitabine is well-tolerated by patients with high-risk MDS and will be a safe induction agent and bridge prior to allogeneic transplant in transplant-eligible patients.

Studieoversigt

Status

Afsluttet

Intervention / Behandling

Detaljeret beskrivelse

Primary endpoint:

  1. safety and tolerability of Decitabine prior to transplant (assessed by occurence of non-hematologic toxicities of grade 3 or more as defined by CTC grading)
  2. reduction in pre-transplant disease burden ability to achieve blast <5% in the bone marrow and peripheral blood

Secondary endpoints:

  1. Proportion of patients with suitable donor able to proceed to an allogeneic hematopoietic cell transplant.
  2. Non-relapse mortality
  3. time to neutrophil engraftment
  4. Overall survival and disease-free survival.

Patients will receive Decitabine until blast <5% is achieved, suitable HLA-matched donor or umbilical cord blood is available up to a maximum of 6 cycles. Patient who progress on therapy or are unable to find a donor by 6 cycles will be removed from protocol. The method, conditioning regimen and choice of donor will be determined based on patient's age and functional status, and transplant physician's discretion. The available regimens are standardized within the center

Undersøgelsestype

Interventionel

Tilmelding (Faktiske)

6

Fase

  • Fase 2

Kontakter og lokationer

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

Studiesteder

      • Singapore, Singapore, 169608
        • Singapore General Hospital

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

21 år til 65 år (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion Criteria:

  1. Newly diagnosed MDS patients aged 21 to 65 years belonging to any of the following categories: refractory cytopenia with multilineage dysplasia (RCMD) with or without ringed sideroblasts (i.e. RCMD and RCMD-RS), refractory anemia with excess blasts-1 (RAEB-1) or RAEB-2 if the prognostic scores are IPSS (international prognostic scoring system) Int-2 or IPSS-high or with WPSS (WHO prognostic scoring system) 3 and above
  2. Therapy-related MDS with IPSS Int-2 and above or WPSS 3
  3. Acceptable cardiac function MUGA or Echocardiography left ventricular ejection fraction of 40% and above
  4. Acceptable lung function: FEV1>70% predicted, DLCO>60% predicted
  5. Acceptable renal function: CCT > 50ml/min
  6. Acceptable liver function: abnormalities in bilirubin or transaminases not > 2times upper limit of normal
  7. Performance status of ECOG 2 or HCT-specific Comorbidity Index < 3

Exclusion Criteria:

  1. Any co-morbidity other than MDS which limits life-expectancy to <3mth
  2. Diagnosis of other active cancer other than squamous cell carcinoma, basal cell carcinoma or carcinoma-in-situ 1 or 2 of the cervix
  3. Presence of active infections not under control
  4. Receipt of 5-azacytidine or other induction chemotherapy for MDS/AML
  5. Patients not keen to explore allogeneic HCT as part of curative treatment plan
  6. Pregnancy

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: Ikke-randomiseret
  • Interventionel model: Enkelt gruppeopgave
  • Maskning: Ingen (Åben etiket)

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Eksperimentel: Single Arm
Decitabine 20mg/m^2 infusion one hour per day, for 5days,every 28days,total 2-6cycles.
20mg/m^2 infusion one hour per day, for 5days,every 28days,total 2-6cycles.
Andre navne:
  • Dacogen

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Tidsramme
Reduction in pre-transplant disease burden
Tidsramme: 2 years
2 years

Sekundære resultatmål

Resultatmål
Tidsramme
Sygdomsfri overlevelse
Tidsramme: 3 år
3 år
Proportion of patients with suitable donor able to proceed to an allogeneic HCT
Tidsramme: 2 years
2 years
Non-relapse mortality
Tidsramme: 3 years
3 years
Time to neutrophil engraftment
Tidsramme: 2 years
2 years
Overall survival survival
Tidsramme: 3 years
3 years

Samarbejdspartnere og efterforskere

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

Samarbejdspartnere

Efterforskere

  • Ledende efterforsker: Aloysius Ho, Singapore General Hospital

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. juli 2010

Primær færdiggørelse (Faktiske)

1. august 2013

Studieafslutning (Faktiske)

1. august 2013

Datoer for studieregistrering

Først indsendt

30. november 2010

Først indsendt, der opfyldte QC-kriterier

10. april 2011

Først opslået (Skøn)

12. april 2011

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Skøn)

17. juni 2014

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

16. juni 2014

Sidst verificeret

1. juni 2014

Mere information

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 .

Kliniske forsøg med Myelodysplastisk syndrom

Kliniske forsøg med Decitabine

Abonner