Combination Chemotherapy in Treating Patients With Acute Myeloid Leukemia or Myelodysplastic Syndrome
Acute Myeloid Leukemia Salvage Therapy for Patients in First Relapse or Who Fail to Achieve an Initial Remission or Who Develop AML as a Second Malignant Neoplasm
RATIONALE: Drugs used in chemotherapy use different ways to stop cancer cells from dividing so they stop growing or die. Combining more than one drug may kill more cancer cells.
PURPOSE: Phase II trial to study the effectiveness of combination chemotherapy in treating patients with acute myeloid leukemia or myelodysplastic syndrome in first relapse or who did not achieve first remission.
Aperçu de l'étude
Statut
Les conditions
Intervention / Traitement
- Médicament: chlorhydrate de mitoxantrone
- Médicament: cladribine
- Médicament: la cytarabine
- Médicament: étoposide
- Médicament: méthotrexate
- Médicament: hydrocortisone thérapeutique
- Procédure: allogreffe de moelle osseuse
- Procédure: greffe de cellules souches du sang périphérique
- Biologique: filgrastim
- Procédure: greffe de moelle osseuse autologue
- Radiation: thérapie électronique à faible LET
- Radiation: photonthérapie à faible LET
- Radiation: thérapie par rayons gamma au cobalt 60 à faible LET
Description détaillée
OBJECTIVES: I. Determine the toxicity, remission rate, event-free survival, and overall survival following induction with cytarabine/mitoxantrone (ARA-C/DHAD), intensification with ARA-C and etoposide (VP-16), and consolidation with cladribine (2-CdA) and VP-16 in patients with acute myeloid leukemia (AML) that is secondary, in first relapse, or has failed initial remission induction therapy. II. Compare the remission induction rate and event-free survival on this trial with prior second-line studies (i.e., protocols CCG-243, CCG-201, and CCG-261P). III. Compare survival of patients on this trial with the survival of patients relapsing or failing to achieve an initial complete remission (CR) on previous front-line AML trials (i.e., protocols CCG-251, CCG-213, CCG-2861, and CCG-2891). IV. Determine the frequency and prognostic significance of mdr1 gene expression and p53, topoisomerase II, and deoxycytidine kinase gene mutations in these patients. V. Determine the disease-free and overall survival of patients achieving a CR on this study in relation to the post-intensification therapy received (i.e., bone marrow transplantation, chemotherapy, or no further therapy). VI. Determine the frequency and degree of abnormal cardiac function on echocardiogram or MUGA at 1 and 5 years in patients treated with mitoxantrone following anthracycline therapy during initial treatment. VII. Provide a control arm evaluating the safety of using phase I or II agents in an "upfront window" approach planned for future CCG studies. VIII. Determine the toxicity, remission rate, event-free survival, and overall survival in patients who fail to achieve a CR with ARA-C/DHAD induction and are then treated with 2-CdA/VP-16. IX. Determine the biologic characteristics, toxicity, remission rate, event-free survival, and overall survival following this treatment regimen in patients who develop AML as a second malignancy.
OUTLINE: Patients who do not achieve M1/M2a marrow following Induction proceed to Salvage Induction; all others proceed to Intensification. Patients receive Consolidation therapy on Regimen A, B, or C according to the investigator's choice. The following acronyms are used: ARA-C Cytarabine, NSC-63878 2-CdA Cladribine (2-Chlorodeoxyadenosine), NSC-105014 DHAD Mitoxantrone, NSC-301739 G-CSF Filgrastim, NSC-614629 HC Hydrocortisone, NSC-10483 HD High Dose MTX Methotrexate, NSC-740 PBSC Peripheral Blood Stem Cells TBI Total-Body Irradiation TIT Triple Intrathecal Therapy (IT ARA-C/IT HC/IT MTX) VP-16 Etoposide, NSC-141540 INDUCTION: 2-Drug Combination Chemotherapy plus CNS Prophylaxis/Therapy. ARA-C/DHAD; G-CSF; plus IT ARA-C and, if CNS disease at entry, TIT. SALVAGE INDUCTION: 2-Drug Combination Chemotherapy. 2-CdA/VP-16. INTENSIFICATION: 2-Drug Combination Chemotherapy followed, as indicated, by Radiotherapy. HD ARA-C/VP-16; followed, in patients with persistent CNS disease, CNS relapse, or chloromas, by irradiation using megavoltage equipment (minimum Co60 and maximum 6 MV x-rays or electrons). CONSOLIDATION: Regimen A: 2-Drug Combination Chemotherapy. 2-CdA/VP-16. Regimen B: Myeloablative Chemoradiotherapy followed by Hematopoietic Rescue. TBI (equipment unspecified) with electron boosts to the testes, chest, extramedullary sites, and, if indicated, craniospinal region; VP-16; followed by allogeneic or autologous bone marrow or PBSC. Regimen C: No further therapy.
PROJECTED ACCRUAL: A total of 90 patients will be entered. The study may be closed if there are 7 or more deaths in the first 45 patients who complete Intensification.
Type d'étude
Inscription (Réel)
Phase
- Phase 2
Contacts et emplacements
Lieux d'étude
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Western Australia
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Perth, Western Australia, Australie, 6001
- Princess Margaret Hospital for Children
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British Columbia
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Vancouver, British Columbia, Canada, V6H 3V4
- British Columbia Children's Hospital
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Nova Scotia
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Halifax, Nova Scotia, Canada, B3J 3G9
- IWK Grace Health Centre
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California
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Long Beach, California, États-Unis, 90806
- Long Beach Memorial Medical Center
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Los Angeles, California, États-Unis, 90095-1781
- Jonsson Comprehensive Cancer Center, UCLA
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Los Angeles, California, États-Unis, 90027-0700
- Children's Hospital Los Angeles
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Orange, California, États-Unis, 92668
- Children's Hospital of Orange County
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San Francisco, California, États-Unis, 94115-0128
- UCSF Cancer Center and Cancer Research Institute
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Colorado
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Denver, Colorado, États-Unis, 80218
- Children's Hospital of Denver
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District of Columbia
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Washington, District of Columbia, États-Unis, 20010-2970
- Children's National Medical Center
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Illinois
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Chicago, Illinois, États-Unis, 60637
- University of Chicago Cancer Research Center
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Indiana
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Indianapolis, Indiana, États-Unis, 46202-5265
- Indiana University Cancer Center
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Iowa
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Iowa City, Iowa, États-Unis, 52242
- University of Iowa Hospitals and Clinics
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Michigan
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Ann Arbor, Michigan, États-Unis, 48109-0752
- University Of Michigan Comprehensive Cancer Center
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Kalamazoo, Michigan, États-Unis, 49007-3731
- CCOP - Kalamazoo
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Minnesota
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Minneapolis, Minnesota, États-Unis, 55455
- University of Minnesota Cancer Center
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Rochester, Minnesota, États-Unis, 55905
- Mayo Clinic Cancer Center
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Missouri
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Kansas City, Missouri, États-Unis, 64108
- Children's Mercy Hospital - Kansas City
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Nebraska
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Omaha, Nebraska, États-Unis, 68198-3330
- University of Nebraska Medical Center
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New Jersey
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New Brunswick, New Jersey, États-Unis, 08901
- Cancer Institute Of New Jersey
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New York
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New York, New York, États-Unis, 10021
- Memorial Sloan-Kettering Cancer Center
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New York, New York, États-Unis, 10016
- Kaplan Cancer Center
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New York, New York, États-Unis, 10032
- Herbert Irving Comprehensive Cancer Center
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North Carolina
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Chapel Hill, North Carolina, États-Unis, 27599-7295
- Lineberger Comprehensive Cancer Center, UNC
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North Dakota
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Fargo, North Dakota, États-Unis, 58102
- Veterans Affairs Medical Center - Fargo
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Fargo, North Dakota, États-Unis, 58122
- CCOP - Merit Care Hospital
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Ohio
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Cincinnati, Ohio, États-Unis, 45229-3039
- Children's Hospital Medical Center - Cincinnati
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Cleveland, Ohio, États-Unis, 44106-5065
- Ireland Cancer Center
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Columbus, Ohio, États-Unis, 43205-2696
- Children's Hospital of Columbus
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Oregon
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Portland, Oregon, États-Unis, 97201-3098
- Doernbecher Children's Hospital
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Pennsylvania
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Philadelphia, Pennsylvania, États-Unis, 19104
- Children's Hospital of Philadelphia
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Pittsburgh, Pennsylvania, États-Unis, 15213
- Children's Hospital of Pittsburgh
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Tennessee
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Nashville, Tennessee, États-Unis, 37232-6838
- Vanderbilt Cancer Center
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Texas
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Houston, Texas, États-Unis, 77030
- University of Texas - MD Anderson Cancer Center
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Utah
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Salt Lake City, Utah, États-Unis, 84132
- Huntsman Cancer Institute
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Washington
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Seattle, Washington, États-Unis, 98109
- Fred Hutchinson Cancer Research Center
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Seattle, Washington, États-Unis, 98105
- Children's Hospital and Medical Center - Seattle
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Wisconsin
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Madison, Wisconsin, États-Unis, 53792
- University of Wisconsin Comprehensive Cancer Center
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Critères de participation
Critère d'éligibilité
Âges éligibles pour étudier
Accepte les volontaires sains
Sexes éligibles pour l'étude
La description
DISEASE CHARACTERISTICS: Acute myeloid leukemia (AML) or myelodysplastic syndrome in one of the following categories: In first relapse Failed to achieve initial complete remission Newly diagnosed secondary AML eligible Required bone marrow status: Greater than 25% blasts (M3) OR Persistent abnormal clone on cytogenetics and 5-25% blasts (M2) No Fanconi's anemia
PATIENT CHARACTERISTICS: Age: Under 22 Performance status: Not specified Hematopoietic: See Disease Characteristics Hepatic: Bilirubin no greater than 1.5 times normal AST or ALT less than 4.0 times normal Renal: Creatinine no greater than 1.5 times normal OR Creatinine clearance or GFR greater than 70 mL/min per 1.73 square meters or GFR in equivalent institutional normal range Cardiovascular: Shortening fraction greater than 27% by echocardiogram or in institutional normal range OR Ejection fraction greater than 47% by radionuclide angiogram
PRIOR CONCURRENT THERAPY: No more than 1 prior treatment No prior salvage therapy No prior mitoxantrone
Plan d'étude
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Traitement
- Répartition: N / A
- Modèle interventionnel: Affectation à un seul groupe
- Masquage: Aucun (étiquette ouverte)
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
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Expérimental: Treatment
Induction will consist of one course of cytarabine and mitoxantrone.
Patients achieving a complete or partial response by the end of induction will start intensification.
Intensification will consist of one course of chemotherapy (Cytarabine (Ara-C), Etoposide (VP-16), Filgrastim (G-CSF)).
Patients who do not attain a CNS remission following the completion of intensification therapy, or who develop recurrence of CNS disease and have not previously received radiation therapy involving the central nervous system should receive craniospinal radiotherapy.
Continuation Therapy: cladribine (2CdA), Etoposide.
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Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Délai |
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Estimate second remission rate and survival rate
Délai: 3 years
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3 years
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Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
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Evaluate the mortality of the start of VP-16/Ara-C intensification
Délai: 45 days
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45 days
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Compare outcomes by the ethnicity and gender
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Compare outcomes by the ethnicity (and gender) in study CCG-2951, and will control for ethnicity in multivariate models comparing the treatment arms
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Collaborateurs et enquêteurs
Parrainer
Collaborateurs
Les enquêteurs
- Chaise d'étude: Robert J. Wells, MD, Children's Hospital Medical Center, Cincinnati
Dates d'enregistrement des études
Dates principales de l'étude
Début de l'étude
Achèvement primaire (Réel)
Achèvement de l'étude (Réel)
Dates d'inscription aux études
Première soumission
Première soumission répondant aux critères de contrôle qualité
Première publication (Estimation)
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Estimation)
Dernière mise à jour soumise répondant aux critères de contrôle qualité
Dernière vérification
Plus d'information
Termes liés à cette étude
Mots clés
Termes MeSH pertinents supplémentaires
- Tumeurs par type histologique
- Tumeurs
- Maladies de la moelle osseuse
- Maladies hématologiques
- Syndromes myélodysplasiques
- Leucémie
- Leucémie myéloïde
- Leucémie, myéloïde, aiguë
- Effets physiologiques des médicaments
- Mécanismes moléculaires de l'action pharmacologique
- Agents anti-infectieux
- Agents du système nerveux périphérique
- Agents antiviraux
- Inhibiteurs de la synthèse des acides nucléiques
- Inhibiteurs d'enzymes
- Analgésiques
- Agents du système sensoriel
- Agents anti-inflammatoires
- Agents antirhumatismaux
- Antimétabolites, Antinéoplasique
- Antimétabolites
- Agents antinéoplasiques
- Agents immunosuppresseurs
- Facteurs immunologiques
- Agents antinéoplasiques phytogéniques
- Inhibiteurs de la topoisomérase II
- Inhibiteurs de la topoisomérase
- Agents dermatologiques
- Oligo-éléments
- Micronutriments
- Agents de contrôle de la reproduction
- Agents abortifs, non stéroïdiens
- Agents abortifs
- Antagonistes de l'acide folique
- Étoposide
- Cytarabine
- Méthotrexate
- Mitoxantrone
- Cladribine
- Hydrocortisone
- Hydrocortisone 17-butyrate 21-propionate
- Acétate d'hydrocortisone
- Hémisuccinate d'hydrocortisone
- Cobalt
Autres numéros d'identification d'étude
- 2951
- CCG-2951
- CDR0000064907 (Autre identifiant: Clinical Trials.gov)
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