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Decitabine as Maintenance Therapy After Standard Therapy in Treating Patients With Previously Untreated Acute Myeloid Leukemia

29 gennaio 2019 aggiornato da: National Cancer Institute (NCI)

Phase II Study of Maintenance Therapy With Decitabine (NSC #127716) Following Standard Induction and Cytogenetic Risk-Adapted Intensification in Previously Untreated Patients With AML < 60 Years

This phase II trial is studying the side effects and how well decitabine works when given as maintenance therapy after standard therapy in treating patients with previously untreated acute myeloid leukemia. Drugs used in chemotherapy, such as cytarabine, daunorubicin, etoposide, busulfan, and decitabine, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Giving decitabine as maintenance therapy after standard therapy may keep cancer cells from coming back.

Panoramica dello studio

Stato

Completato

Condizioni

Intervento / Trattamento

Descrizione dettagliata

PRIMARY OBJECTIVES:

I. To determine the efficacy, feasibility, and toxicities when one year of maintenance therapy with decitabine is given to patients < 60 years with untreated acute myeloid leukemia (AML) who achieve and maintain first complete remission (CR) following an established induction and intensification regimen.

II. To determine the 1-year disease free survival rate for AML patients in first CR treated with maintenance decitabine.

SECONDARY OBJECTIVES:

I. To measure biologic response to decitabine in evaluable patients with fusion genes to determine eradication of minimal residual disease.

II. To measure surrogates for deoxyribonucleic acid (DNA) demethylation including downregulation of DNA methyltransferase 1 (DNMT1) and induction of fetal hemoglobin.

III. To examine the significance of gene re expression following ex vivo decitabine exposure in primary AML cells taken at the time of diagnosis on clinical outcome and on gene expression at the time of relapse after in vivo decitabine exposure.

IV. To continue to evaluate the effectiveness of a cytogenetically risk-adapted approach for consolidation therapy for patients with core binding factor (CBF) or non-CBF AML.

V. To continue the investigation begun in Cancer and Leukemia Group B (CALGB) 19808 aimed at correlation of the rate of relapse and toxicity with intravenous (IV) busulfan pharmacokinetics when busulfan and etoposide are used as the preparative regimen for autologous stem cell transplantation for AML patients in first CR.

VI. To correlate outcome measures such as complete response (CR), disease-free survival (DFS), event-free survival (EFS), and overall survival (OS), with pretreatment characteristics such as age, sex, race, blood counts, morphology, immunophenotype, cytogenetics, and molecular features of AML.

OUTLINE:

REMISSION INDUCTION THERAPY: Patients receive cytarabine IV over 168 hours on days 1-7 and daunorubicin hydrochloride IV over 5-10 minutes and etoposide IV over 2 hours on days 1-3. Patients undergo bone marrow biopsy on day 14. Patients with residual leukemia proceed to second remission induction therapy. Patients achieving complete remission (CR) proceed to intensification therapy.

SECOND REMISSION INDUCTION THERAPY: Patients receive cytarabine IV over 120 hours on days 1-5 and daunorubicin hydrochloride IV and etoposide IV over 2 hours on days 1 and 2. Patients undergo bone marrow biopsy on day 42. Patients with residual leukemia are removed from the study. Patients achieving CR proceed to intensification therapy.

INTENSIFICATION THERAPY: Patients are stratified and receive intensification therapy according to cytogenetic findings (favorable cytogenetics [t(8;21)(q22q22), inv(16)(p13;q22), or t(16;16)(p13;q22) by cytogenetic and/or molecular analysis] vs unfavorable cytogenetics [all other cytogenetic findings, including normal cytogenetics]).

FAVORABLE CYTOGENETICS: Within 2-4 weeks after achieving CR, patients receive high-dose cytarabine IV over 3 hours twice daily on days 1, 3, and 5.

Treatment repeats every 28 days for up to 3 courses.

UNFAVORABLE CYTOGENETICS: Peripheral blood stem cell (PBSC) mobilization: Within 2-4 weeks after achieving CR, patients receive etoposide IV over 96 hours and high-dose cytarabine IV over 2 hours twice daily on days 1-4 and filgrastim (G-CSF) subcutaneously (SC) once daily beginning on day 14 and continuing until blood counts recover. Patients then proceed to transplantation.

PBSC OR BONE MARROW TRANSPLANTATION: Patients receive busulfan IV over 2 hours 4 times daily on days -7 to -4 and etoposide IV over 4 hours on day -3. Patients undergo autologous PBSC or bone marrow transplantation on day 0 and receive G-CSF SC once daily beginning on day 0 and continuing until blood counts recover.

UNFAVORABLE CYTOGENETICS AND UNABLE TO UNDERGO PBSC TRANSPLANTATION: Within 2-4 weeks after achieving CR, patients receive etoposide, high-dose cytarabine, and G-CSF as in unfavorable cytogenetics (PBSC mobilization) followed by 2 courses of high-dose cytarabine as in favorable genetics.

MAINTENANCE THERAPY: Within 60-90 days after completion of intensification therapy, patients receive decitabine IV over 1 hour on days 1-5. Treatment repeats every 6 weeks for up to 8 courses.

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

Tipo di studio

Interventistico

Iscrizione (Effettivo)

546

Fase

  • Fase 2

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

  • Stati Uniti
    • California
      • San Francisco, California, Stati Uniti, 94115
        • UCSF Medical Center-Mount Zion
    • Delaware
      • Lewes, Delaware, Stati Uniti, 19958
        • Beebe Medical Center
      • Newark, Delaware, Stati Uniti, 19718
        • Christiana Care Health System-Christiana Hospital
    • Florida
      • Orlando, Florida, Stati Uniti, 32803
        • Florida Hospital Orlando
    • Georgia
      • Atlanta, Georgia, Stati Uniti, 30342
        • Blood and Marrow Transplant Group of Georgia
    • Illinois
      • Chicago, Illinois, Stati Uniti, 60637
        • University of Chicago Comprehensive Cancer Center
      • Chicago, Illinois, Stati Uniti, 60612
        • University of Illinois
      • Evanston, Illinois, Stati Uniti, 60201
        • NorthShore University HealthSystem-Evanston Hospital
    • Indiana
      • Fort Wayne, Indiana, Stati Uniti, 46845
        • Fort Wayne Medical Oncology and Hematology Inc-Parkview
    • Iowa
      • Iowa City, Iowa, Stati Uniti, 52242
        • University of Iowa/Holden Comprehensive Cancer Center
    • Maine
      • Bangor, Maine, Stati Uniti, 04401
        • Eastern Maine Medical Center
    • Maryland
      • Baltimore, Maryland, Stati Uniti, 21201
        • University of Maryland/Greenebaum Cancer Center
      • Bethesda, Maryland, Stati Uniti, 20889-5600
        • Walter Reed National Military Medical Center
      • Elkton, Maryland, Stati Uniti, 21921
        • Union Hospital of Cecil County
    • Massachusetts
      • Boston, Massachusetts, Stati Uniti, 02215
        • Dana-Farber Cancer Institute
      • Boston, Massachusetts, Stati Uniti, 02115
        • Brigham and Women's Hospital
      • Boston, Massachusetts, Stati Uniti, 02114
        • Massachusetts General Hospital Cancer Center
      • Worcester, Massachusetts, Stati Uniti, 01605
        • Commonwealth Hematology Oncology PC-Worcester
    • Missouri
      • Columbia, Missouri, Stati Uniti, 65212
        • University of Missouri - Ellis Fischel
      • Columbia, Missouri, Stati Uniti, 65201
        • Veterans Administration
      • Saint Louis, Missouri, Stati Uniti, 63110
        • Washington University School of Medicine
    • Nebraska
      • North Platte, Nebraska, Stati Uniti, 69101
        • Great Plains Health Callahan Cancer Center
      • Omaha, Nebraska, Stati Uniti, 68198
        • University of Nebraska Medical Center
    • Nevada
      • Las Vegas, Nevada, Stati Uniti, 89109
        • Sunrise Hospital and Medical Center
      • Las Vegas, Nevada, Stati Uniti, 89102
        • University Medical Center of Southern Nevada
      • Las Vegas, Nevada, Stati Uniti, 89106
        • Nevada Cancer Research Foundation CCOP
    • New Hampshire
      • Keene, New Hampshire, Stati Uniti, 03431
        • Cheshire Medical Center-Dartmouth-Hitchcock Keene
      • Lebanon, New Hampshire, Stati Uniti, 03756
        • Dartmouth Hitchcock Medical Center
    • New Jersey
      • Camden, New Jersey, Stati Uniti, 08103
        • Cooper Hospital University Medical Center
    • New York
      • Buffalo, New York, Stati Uniti, 14263
        • Roswell Park Cancer Institute
      • Lake Success, New York, Stati Uniti, 11042
        • Northwell Health NCORP
      • Lake Success, New York, Stati Uniti, 11042
        • Northwell Health/Center for Advanced Medicine
      • Manhasset, New York, Stati Uniti, 11030
        • North Shore University Hospital
      • New Hyde Park, New York, Stati Uniti, 11040
        • Long Island Jewish Medical Center
      • New York, New York, Stati Uniti, 10029
        • Mount Sinai Hospital
      • Syracuse, New York, Stati Uniti, 13210
        • State University of New York Upstate Medical University
    • North Carolina
      • Chapel Hill, North Carolina, Stati Uniti, 27599
        • UNC Lineberger Comprehensive Cancer Center
      • Goldsboro, North Carolina, Stati Uniti, 27534
        • Wayne Memorial Hospital
      • Winston-Salem, North Carolina, Stati Uniti, 27157
        • Wake Forest University Health Sciences
    • Ohio
      • Columbus, Ohio, Stati Uniti, 43210
        • Ohio State University Comprehensive Cancer Center
    • Oklahoma
      • Oklahoma City, Oklahoma, Stati Uniti, 73104
        • University of Oklahoma Health Sciences Center
    • Pennsylvania
      • Pittsburgh, Pennsylvania, Stati Uniti, 15224
        • West Penn Hospital
    • Rhode Island
      • Providence, Rhode Island, Stati Uniti, 02903
        • Rhode Island Hospital
      • Providence, Rhode Island, Stati Uniti, 02906
        • Miriam Hospital
    • Vermont
      • Berlin, Vermont, Stati Uniti, 05602
        • Central Vermont Medical Center/National Life Cancer Treatment
      • Burlington, Vermont, Stati Uniti, 05405
        • University of Vermont College of Medicine

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 59 anni (Bambino, Adulto)

Accetta volontari sani

No

Sessi ammissibili allo studio

Tutto

Descrizione

Inclusion Criteria:

  • Unequivocal histologic diagnosis of AML (> 20% blasts in the bone marrow based on the World Health Organization [WHO] and/or French American British [FAB] classifications), excluding M3 (acute promyelocytic leukemia); patients with antecedent myelodysplasia are eligible for treatment on this trial only if there were no bone marrow biopsy showing myelodysplastic syndrome (MDS) > 3 months prior to enrollment; patients with therapy-related AML are eligible if they have been free of their primary disease and have not received any chemotherapy for at least 2 years
  • No prior 5-azacitidine or decitabine therapy

  • No prior treatment for leukemia or myelodysplastic syndrome with four permissible exceptions:

    • Emergency leukapheresis
    • Emergency treatment for hyperleukocytosis with hydroxyurea
    • Cranial radiation therapy (RT) for central nervous system (CNS) leukostasis (one dose only)
    • Growth factor/cytokine support

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: N / A
  • Modello interventistico: Assegnazione di gruppo singolo
  • Mascheramento: Nessuno (etichetta aperta)

Armi e interventi

Gruppo di partecipanti / Arm
Intervento / Trattamento
Sperimentale: Treatment (chemotherapy, PBSC or bone marrow transplantation)
See Detailed Description.
Altro: Analisi dei biomarcatori di laboratorio
Studi correlati
Droga: Etoposide
Dato IV
Altri nomi:
  • Demetil Epipodofillotossina Etilidina Glucoside
  • EPEG
  • Ultimo
  • Toposar
  • Vepesid
  • PV 16-213
  • VP-16
  • VP-16-213
Droga: Decitabina
Dato IV
Altri nomi:
  • 5-Aza-2'-deossicitidina
  • Dacogeno
  • Decitabina per iniezione
  • Deossiazacitidina
  • Dezocitidina
  • Aza-TdC
Altro: Studio farmacologico
Studi correlati
Droga: Citarabina
Dato IV
Altri nomi:
  • .beta.-Citosina arabinoside
  • 1-.beta.-D-Arabinofuranosil-4-ammino-2(1H)pirimidinone
  • 1-.beta.-D-Arabinofuranosilcitosina
  • 1-Beta-D-arabinofuranosil-4-ammino-2(1H)pirimidinone
  • 1-Beta-D-arabinofuranosilcitosina
  • 1.beta.-D-Arabinofuranosilcitosina
  • 2(1H)-pirimidinone, 4-ammino-1-beta-D-arabinofuranosil-
  • 2(1H)-pirimidinone, 4-ammino-1.beta.-D-arabinofuranosil-
  • Alessandro
  • Ara-C
  • Cellula ARA
  • Arabo
  • Arabinofuranosilcitosina
  • Arabinosilcitosina
  • Aracitidina
  • Aracitina
  • CHX-3311
  • Citarabinum
  • Cytarbel
  • Cytosar
  • Citosina Arabinoside
  • Citosina-.beta.-arabinoside
  • Citosina-beta-arabinoside
  • Erpalfa
  • Starasid
  • Tarabina PFS
  • U19920
  • U-19920
  • Udicil
  • WR-28453
  • Beta-citosina Arabinoside
Droga: Daunorubicina cloridrato
Dato IV
Altri nomi:
  • Cerubidina
  • Cloridrato de Daunorubicina
  • Daunoblastina
  • Daunomicina cloridrato
  • Daunomicina, cloridrato
  • Daunorubicina.HCl
  • Daunorubicini cloridrato
  • FI-6339
  • Ondena
  • RP-13057
  • Rubidomicina cloridrato
  • Rubilem
Biologico: Filgrastim
Dato SC
Altri nomi:
  • G-CSF
  • r-metHuG-CSF
  • Neupogen
  • Fattore stimolante le colonie di granulociti umani metionilici ricombinanti
  • rG-CSF
  • Tevagrastim
  • FILGRASTIM, TITOLARE NON SPECIFICATO
Droga: Busulfano
Dato IV
Altri nomi:
  • Busulfex
  • Misulfan
  • Mitosano
  • Mieloleucone
  • Mielosano
  • 1,4-Bis[metansolfonossi]butano
  • AUTOBUS
  • Bussulfam
  • Busulfano
  • CB 2041
  • CB-2041
  • Glizofrolo
  • GT 41
  • GT-41
  • Joacamine
  • Estere di tetrametilene dell'acido metansolfonico
  • Acido metansolfonico, tetrametilene estere
  • Mielucin
  • Misulban
  • Mieleukon
  • Mylecytan
  • Myleran
  • Sulfabutina
  • Tetrametilene Bis(metansolfonato)
  • Tetrametilene bis[metansolfonato]
  • WR-19508
Procedura: Autologous Bone Marrow Transplantation
Undergo autologous bone marrow transplantation
Altri nomi:
  • ABMT
  • Trapianto autologo di midollo osseo
  • Trapianto Autologo Di Midollo
Procedura: Autologous Hematopoietic Stem Cell Transplantation
Undergo autologous PBSC transplantation
Altri nomi:
  • Trapianto autologo di cellule emopoietiche
  • trapianto autologo di cellule staminali

Cosa sta misurando lo studio?

Misure di risultato primarie

Misura del risultato
Misura Descrizione
Lasso di tempo
Number of Participants Who Completed Maintenance Decitabine.
Lasso di tempo: Up to 5 years
To determine feasibility of decitabine maintenance, this outcome measures the number of participants who completed all 8 planned cycles of decitabine maintenance as per protocol.
Up to 5 years
Disease-free Survival (DFS) Rate at 1 Year
Lasso di tempo: At 1 year

For participants who achieved a complete remission (CR), this is the percentage of participants who were alive and relapse free at 1 year. The 1 year rate, with 95% confidence interval, was estimated using the Kaplan-Meier method

A CR is defined as those with > 20% cellularity of bone marrow biopsy, no presence of extramedullary leukemia for AML, <5 % myeloblast cells for bone marrow with peripheral blood and normal complete blood count (absolute neutrophils > 1000 mL and platelets >= 100,000 mL).
At 1 year

Altre misure di risultato

Misura del risultato
Misura Descrizione
Lasso di tempo
Relationship Between Busulfan Pharmacokinetics (Area Under the Curve) and Relapsed Disease
Lasso di tempo: At baseline, after 2, 4, and 6 hours after the start of busulfan infusion
Results from busulfan pharmacokinetics will be pooled with those from CALGB 19808.
At baseline, after 2, 4, and 6 hours after the start of busulfan infusion

Collaboratori e investigatori

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

Sponsor

National Cancer Institute (NCI)

Investigatori

  • Investigatore principale: William Blum, Alliance for Clinical Trials in Oncology

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 (Effettivo)

15 novembre 2006

Completamento primario (Effettivo)

31 gennaio 2011

Completamento dello studio (Effettivo)

1 dicembre 2016

Date di iscrizione allo studio

Primo inviato

27 dicembre 2006

Primo inviato che soddisfa i criteri di controllo qualità

27 dicembre 2006

Primo Inserito (Stima)

28 dicembre 2006

Aggiornamenti dei record di studio

Ultimo aggiornamento pubblicato (Effettivo)

19 febbraio 2019

Ultimo aggiornamento inviato che soddisfa i criteri QC

29 gennaio 2019

Ultimo verificato

1 gennaio 2019

Maggiori informazioni

Termini relativi a questo studio

Termini MeSH pertinenti aggiuntivi

Altri numeri di identificazione dello studio

  • NCI-2009-00444 (Identificatore di registro: CTRP (Clinical Trial Reporting Program))
  • U10CA180821 (Sovvenzione/contratto NIH degli Stati Uniti)
  • U10CA031946 (Sovvenzione/contratto NIH degli Stati Uniti)
  • CDR0000521603
  • CALGB 10503 (Altro identificatore: Alliance for Clinical Trials in Oncology)
  • CALGB-10503 (Altro identificatore: CTEP)
  • R21CA128377 (Sovvenzione/contratto NIH degli Stati Uniti)

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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