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Chemotherapy With or Without Bone Marrow Transplantation in Treating Patients With Acute Lymphoblastic Leukemia

11 giugno 2013 aggiornato da: European Organisation for Research and Treatment of Cancer - EORTC

A RANDOMIZED PHASE III TRIAL COMPARING DEXAMETHASONE WITH PREDNISONE IN INDUCTION TREATMENT AND BONE MARROW TRANSPLANTATION WITH INTENSIVE MAINTENANCE TREATMENT IN ADOLESCENT AND ADULT ACUTE LYMPHOBLASTIC LEUKEMIA (ALL-4)

RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining chemotherapy with radiation therapy may kill more tumor cells. Bone marrow transplantation can replace immune cells that were destroyed by chemotherapy.

PURPOSE: Randomized phase III trial to study the effectiveness of chemotherapy compared with or without bone marrow transplantation in treating patients with acute lymphoblastic leukemia.

Panoramica dello studio

Stato

Completato

Condizioni

Intervento / Trattamento

Descrizione dettagliata

OBJECTIVES:

  • Compare the remission induction, toxicity, and duration of remission in patients with newly diagnosed acute lymphoblastic leukemia or lymphoblastic lymphoma treated with prednisone vs dexamethasone plus cyclophosphamide, daunorubicin, and vincristine as induction.
  • Compare the survival and disease-free survival of patients treated with autologous bone marrow transplantation (BMT) followed by low- or high-intensity maintenance chemotherapy with cranial irradiation after consolidation.
  • Determine the relative and disease-free survival of patients treated with autologous or allogeneic BMT after identical induction, consolidation, and conditioning regimens.

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to center and risk group (high vs standard).

Induction

  • Patients are randomized to 1 of 2 treatment arms.

    • Arm I:Patients receive daunorubicin IV on days 1-3 and 15 and 16; cyclophosphamide (CTX) IV on days 1 and 8; vincristine (VCR) IV on days 1, 8, 15, and 22; and prednisone IV or orally every 8 hours on days 1-7 and 15-21.
    • Arm II: Patients receive daunorubicin, CTX, and VCR as in arm I and dexamethasone IV or orally on days 1-8 and 15-22.
  • Patients on both arms without CNS disease at presentation receive CNS prophylaxis comprising methotrexate (MTX) intrathecally (IT) on days 1, 8, 15, and 22. Patients on both arms with CNS disease at presentation receive CNS therapy comprising hydrocortisone (HC) IT and MTX IT alternating with cytarabine (ARA-C) IT twice a week until CSF clears. After induction, patients on both arms proceed to consolidation, regardless of response.

Consolidation

  • Patients receive ARA-C IV over 2 hours every 12 hours on days 29-34 and mitoxantrone IV on days 33-35. Patients without CNS disease at presentation receive CNS prophylaxis comprising MTX IT on day 29. Patients with CNS disease at presentation receive CNS therapy comprising HC IT and MTX IT alternating with ARA-C weekly for 6 weeks. Patients who achieve complete response (CR) at day 55-60 receive MTX IV on days 64 and 79, leucovorin calcium IV or orally every 6 hours on days 65-67 and 80-82, and asparaginase IV over 1 hour or intramuscularly on days 65 and 80.
  • Standard-risk patients who are under age 20 and achieve CR after day 80 are assigned to arm IV of group A. Patients who achieve CR after day 80 and have a genotypically or phenotypically HLA-matched family donor, a family donor mismatched at only 1 locus (A, B, or DR), or an HLA-matched unrelated donor proceed to group B. Patients who achieve CR after day 80 and are eligible for autologous bone marrow transplantation (BMT) proceed to group A. Patients found to be at extremely high risk are taken off study.

Group A

  • Patients are randomized to 1 of 2 treatment arms.

    • Arm III: Autologous bone marrow is harvested. Patients receive bone marrow ablation comprising CTX IV over 1 hour on days -4 and -3 and total body irradiation on day -1. Autologous bone marrow is reinfused on day 0. Beginning at month 8 (4 months after BMT), patients receive first maintenance comprising VCR IV, doxorubicin IV, and dexamethasone IV (VAD) or VCR IV, doxorubicin IV, and prednisolone IV (VAP) on days 1-4 and 29-32. Patients receive second maintenance comprising oral mercaptopurine daily and oral MTX daily beginning at month 10 and continuing through year 3. Patients without CNS disease at presentation receive CNS prophylaxis comprising MTX IT on days 1 and 29. Patients with CNS disease at presentation receive CNS therapy comprising ARA-C IT, MTX IT, and HC IT beginning at 1 month after BMT and continuing monthly for 1 year and then every 3 months through year 3.
    • Arm IV: Patients receive CTX IV and ARA-C IV continuously on day 1, oral mercaptopurine on days 8-28, and oral MTX on days 8, 15, and 22 during months 4, 7, 11, 13, 17, 21, 25, and 29. Patients receive MTX IV over 30 minutes on day 1, leucovorin calcium IV or orally every 6 hours on days 2-4, asparaginase IV over 1 hour or intramuscularly on day 2, oral mercaptopurine on days 8-28, and oral MTX on days 8, 15, and 22 during months 6, 10, 12, 15, 19, 23, and 27. Patients receive VAD or VAP as in arm III beginning at month 8. Patients without CNS disease at presentation receive CNS prophylaxis comprising whole brain radiotherapy and MTX IT on day 1 of radiotherapy during month 5. Patients with CNS disease at presentation receive CNS therapy as in arm III.

Group B

  • Allogeneic bone marrow is harvested. Patients receive bone marrow ablation as in arm III beginning on day 100. Allogeneic bone marrow is infused over 15-30 minutes on day 0.

    • Patients in groups A and B with CNS disease at presentation undergo radiotherapy to focal infiltration at entry or concurrently with total body irradiation, or whole brain radiotherapy during maintenance (if no prior CNS irradiation). At any time during the study, patients who develop marrow relapse (more than 5% leukemic blasts in bone marrow on 2 occasions), CNS relapse (blasts in CSF, cranial nerve palsy, or CNS mass), or testis or other extramedullary relapse are taken off study.

PROJECTED ACCRUAL: A total of 392 patients will be accrued for this study within approximately 6 years.

Tipo di studio

Interventistico

Iscrizione (Anticipato)

392

Fase

  • Fase 3

Contatti e Sedi

Questa sezione fornisce i recapiti di coloro che conducono lo studio e informazioni su dove viene condotto lo studio.

Luoghi di studio

  • Belgio
      • Antwerpen, Belgio, B-2020
        • Algemeen Ziekenhuis Middelheim
      • Brugge, Belgio, 8000
        • A.Z. St. Jan
      • Brussels, Belgio, 1070
        • Hopital Universitaire Erasme
      • Brussels, Belgio, 1000
        • C.H.U. Saint-Pierre
      • Edegem, Belgio, B-2650
        • Universitair Ziekenhuis Antwerpen
      • Liege, Belgio, B-4000
        • CHU Sart-Tilman
      • Verviers, Belgio, B-4800
        • Centre Hospitalier Peltzer-La Tourelle
  • Croazia
      • Zagreb, Croazia, 10000
        • University Hospital Rebro
      • Zagreb (Agram), Croazia, 10000
        • Medical School/University of Zagreb
  • Francia
      • Lyon, Francia, 69437
        • Hôpital Edouard Herriot
      • Paris, Francia, 75743
        • Hopital Necker
      • Paris, Francia, 75181
        • Hotel Dieu de Paris
      • Suresnes, Francia, 92151
        • Centre Medico-Chirurgical Foch
  • Germania
      • Meissen, Germania, D-01662
        • Kreiskrankenhaus Meissen
  • Italia
      • Alessandria, Italia, I-15100
        • Ospedale Civile Alessandria
      • Avellino, Italia
        • Ospedale Civile Avellino
      • Bari, Italia, 70124
        • Universita Degli Studi di Bari Policlinico
      • Brindisi, Italia, 72100
        • A. Perrino Hospital
      • Catania, Italia, 95124
        • Ospedale Ferrarotto
      • Catanzaro, Italia, 88100
        • Ospedale Regionale A. Pugliese
      • Cuneo, Italia, 12100
        • Ospedale Santa Croce
      • Firenze (Florence), Italia, 50134
        • Policlinico di Careggi
      • Foggia, Italia, 71100
        • Ospedali Riuniti Foggia
      • Gallarate Varese, Italia, 21013
        • Ospedale S. Antonio Abate
      • Latina, Italia, 04100
        • Ospedale Gen. Provinciale Santa Maria Goretti
      • Lodi, Italia, I-20075
        • Ospedale Maggiore Lodi
      • Montefiascone, Italia, I-01027
        • Ospedale Di Montefiascone
      • Naples (Napoli), Italia, 80136
        • Ospedale S. Gennaro ASL NA1
      • Palermo, Italia, 90100
        • Policlinico - Cattedra di Ematologia
      • Perugia, Italia, 06122
        • Policlinico Monteluce
      • Potenza, Italia, 85100
        • Ospedale San Carlo
      • San Giovanni - Rotondo, Italia, 71013
        • Ospedale Casa Sollievo della Sofferenza
      • Sassari, Italia, 07100
        • Istituto di Ematologia Universita - University di Sassari
      • Taranto, Italia, 74100
        • Ospedal SS Annunziata
      • Turin (Torino), Italia, 10126
        • Ospedale Molinette
  • Olanda
      • 's-Hertogenbosch, Olanda, 5211 NL
        • Groot Ziekengasthuis 's-Hertogenbosch
      • Amsterdam, Olanda, 1091 HA
        • Onze Lieve Vrouwe Gasthuis
      • Eindhoven, Olanda, 5631 BM
        • Maxima Medisch Centrum - locatie Eindhoven
      • Leiden, Olanda, 2300 CA
        • Leiden University Medical Center
      • Nijmegen, Olanda, NL-6500 HB
        • University Medical Center Nijmegen
  • Portogallo
      • Porto, Portogallo, 4200
        • Hospital Escolar San Joao
  • Repubblica Ceca
      • Olomouc, Repubblica Ceca, 775 20
        • University Hospital - Olomouc
  • Slovacchia
      • Bratislava, Slovacchia, 85107
        • Institute of Hematology & Transfusiology, University Hospital
  • Tacchino
      • Ankara, Tacchino, 06100
        • Ibn-i Sina Hospital

Criteri di partecipazione

I ricercatori cercano persone che corrispondano a una certa descrizione, chiamata criteri di ammissibilità. Alcuni esempi di questi criteri sono le condizioni generali di salute di una persona o trattamenti precedenti.

Criteri di ammissibilità

Età idonea allo studio

Da 15 anni a 60 anni (Bambino, Adulto)

Accetta volontari sani

No

Sessi ammissibili allo studio

Tutto

Descrizione

DISEASE CHARACTERISTICS:

  • Newly diagnosed acute lymphoblastic leukemia or lymphoblastic lymphoma with more than 30% blasts in bone marrow

PATIENT CHARACTERISTICS:

Age:

  • 15 to 60

Performance status:

  • Not specified

Life expectancy:

  • Not specified

Hematopoietic:

  • See Disease Characteristics

Hepatic:

  • Bilirubin less than 2 mg/dL (unless elevation due to leukemic involvement of liver)

Renal:

  • Creatinine less than 2 mg/dL (unless elevation due to leukemic involvement of kidneys)

Cardiovascular:

  • No severe cardiac disease

Pulmonary:

  • No severe pulmonary disease

Other:

  • No severe neurologic or metabolic disease
  • HIV negative (if tested)
  • No other prior malignancy except nonmelanomatous skin cancer, stage I cervical carcinoma, or other curatively treated malignancy

PRIOR CONCURRENT THERAPY:

Biologic therapy:

  • No prior biologic therapy

Chemotherapy:

  • No prior chemotherapy

Endocrine therapy:

  • No prior endocrine therapy

Radiotherapy:

  • No prior radiotherapy

Surgery:

  • No prior surgery

Piano di studio

Questa sezione fornisce i dettagli del piano di studio, compreso il modo in cui lo studio è progettato e ciò che lo studio sta misurando.

Come è strutturato lo studio?

Dettagli di progettazione

  • Scopo principale: Trattamento
  • Assegnazione: Randomizzato

Collaboratori e investigatori

Qui è dove troverai le persone e le organizzazioni coinvolte in questo studio.

Sponsor

European Organisation for Research and Treatment of Cancer - EORTC

Collaboratori

Acute Leukemia French Association

Investigatori

  • Cattedra di studio: Roel Willemze, MD, PhD, Leiden University Medical Center
  • Cattedra di studio: Denis Fiere, MD, Acute Leukemia French Association

Pubblicazioni e link utili

La persona responsabile dell'inserimento delle informazioni sullo studio fornisce volontariamente queste pubblicazioni. Questi possono riguardare qualsiasi cosa relativa allo studio.

Pubblicazioni generali

Studiare le date dei record

Queste date tengono traccia dell'avanzamento della registrazione dello studio e dell'invio dei risultati di sintesi a ClinicalTrials.gov. I record degli studi e i risultati riportati vengono esaminati dalla National Library of Medicine (NLM) per assicurarsi che soddisfino specifici standard di controllo della qualità prima di essere pubblicati sul sito Web pubblico.

Studia le date principali

Inizio studio

1 agosto 1995

Completamento primario (Effettivo)

1 marzo 2004

Date di iscrizione allo studio

Primo inviato

1 novembre 1999

Primo inviato che soddisfa i criteri di controllo qualità

26 gennaio 2003

Primo Inserito (Stima)

27 gennaio 2003

Aggiornamenti dei record di studio

Ultimo aggiornamento pubblicato (Stima)

12 giugno 2013

Ultimo aggiornamento inviato che soddisfa i criteri QC

11 giugno 2013

Ultimo verificato

1 giugno 2013

Maggiori informazioni

Termini relativi a questo studio

Parole chiave

Termini MeSH pertinenti aggiuntivi

Altri numeri di identificazione dello studio

  • EORTC-06951
  • FRE-LALA-94

Queste informazioni sono state recuperate direttamente dal sito web clinicaltrials.gov senza alcuna modifica. In caso di richieste di modifica, rimozione o aggiornamento dei dettagli dello studio, contattare register@clinicaltrials.gov. Non appena verrà implementata una modifica su clinicaltrials.gov, questa verrà aggiornata automaticamente anche sul nostro sito web .

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