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.
연구 개요
상태
정황
상세 설명
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.
연구 유형
등록 (실제)
단계
- 2 단계
연락처 및 위치
연구 장소
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California
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Long Beach, California, 미국, 90806
- Long Beach Memorial Medical Center
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Los Angeles, California, 미국, 90095-1781
- Jonsson Comprehensive Cancer Center, UCLA
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Los Angeles, California, 미국, 90027-0700
- Children's Hospital Los Angeles
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Orange, California, 미국, 92668
- Children's Hospital of Orange County
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San Francisco, California, 미국, 94115-0128
- UCSF Cancer Center and Cancer Research Institute
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Colorado
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Denver, Colorado, 미국, 80218
- Children's Hospital of Denver
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District of Columbia
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Washington, District of Columbia, 미국, 20010-2970
- Children's National Medical Center
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Illinois
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Chicago, Illinois, 미국, 60637
- University of Chicago Cancer Research Center
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Indiana
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Indianapolis, Indiana, 미국, 46202-5265
- Indiana University Cancer Center
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Iowa
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Iowa City, Iowa, 미국, 52242
- University of Iowa Hospitals and Clinics
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Michigan
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Ann Arbor, Michigan, 미국, 48109-0752
- University of Michigan Comprehensive Cancer Center
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Kalamazoo, Michigan, 미국, 49007-3731
- CCOP - Kalamazoo
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Minnesota
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Minneapolis, Minnesota, 미국, 55455
- University of Minnesota Cancer Center
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Rochester, Minnesota, 미국, 55905
- Mayo Clinic Cancer Center
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Missouri
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Kansas City, Missouri, 미국, 64108
- Children's Mercy Hospital - Kansas City
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Nebraska
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Omaha, Nebraska, 미국, 68198-3330
- University Of Nebraska Medical Center
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New Jersey
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New Brunswick, New Jersey, 미국, 08901
- Cancer Institute Of New Jersey
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New York
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New York, New York, 미국, 10021
- Memorial Sloan-Kettering Cancer Center
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New York, New York, 미국, 10016
- Kaplan Cancer Center
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New York, New York, 미국, 10032
- Herbert Irving Comprehensive Cancer Center
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North Carolina
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Chapel Hill, North Carolina, 미국, 27599-7295
- Lineberger Comprehensive Cancer Center, UNC
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North Dakota
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Fargo, North Dakota, 미국, 58102
- Veterans Affairs Medical Center - Fargo
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Fargo, North Dakota, 미국, 58122
- CCOP - Merit Care Hospital
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Ohio
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Cincinnati, Ohio, 미국, 45229-3039
- Children's Hospital Medical Center - Cincinnati
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Cleveland, Ohio, 미국, 44106-5065
- Ireland Cancer Center
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Columbus, Ohio, 미국, 43205-2696
- Children's Hospital of Columbus
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Oregon
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Portland, Oregon, 미국, 97201-3098
- Doernbecher Children's Hospital
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Pennsylvania
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Philadelphia, Pennsylvania, 미국, 19104
- Children's Hospital of Philadelphia
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Pittsburgh, Pennsylvania, 미국, 15213
- Children's Hospital of Pittsburgh
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Tennessee
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Nashville, Tennessee, 미국, 37232-6838
- Vanderbilt Cancer Center
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Texas
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Houston, Texas, 미국, 77030
- University of Texas - MD Anderson Cancer Center
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Utah
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Salt Lake City, Utah, 미국, 84132
- Huntsman Cancer Institute
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Washington
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Seattle, Washington, 미국, 98109
- Fred Hutchinson Cancer Research Center
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Seattle, Washington, 미국, 98105
- Children's Hospital and Medical Center - Seattle
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Wisconsin
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Madison, Wisconsin, 미국, 53792
- University of Wisconsin Comprehensive Cancer Center
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British Columbia
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Vancouver, British Columbia, 캐나다, V6H 3V4
- British Columbia Children's Hospital
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Nova Scotia
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Halifax, Nova Scotia, 캐나다, B3J 3G9
- IWK Grace Health Centre
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Western Australia
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Perth, Western Australia, 호주, 6001
- Princess Margaret Hospital for Children
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참여기준
자격 기준
공부할 수 있는 나이
건강한 자원 봉사자를 받아들입니다
연구 대상 성별
설명
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
공부 계획
연구는 어떻게 설계됩니까?
디자인 세부사항
- 주 목적: 치료
- 할당: 해당 없음
- 중재 모델: 단일 그룹 할당
- 마스킹: 없음(오픈 라벨)
무기와 개입
참가자 그룹 / 팔 |
개입 / 치료 |
|---|---|
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실험적: 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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다른 이름들:
다른 이름들:
다른 이름들:
다른 이름들:
다른 이름들:
다른 이름들:
다른 이름들:
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연구는 무엇을 측정합니까?
주요 결과 측정
결과 측정 |
기간 |
|---|---|
|
Estimate second remission rate and survival rate
기간: 3 years
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3 years
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2차 결과 측정
결과 측정 |
측정값 설명 |
기간 |
|---|---|---|
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Evaluate the mortality of the start of VP-16/Ara-C intensification
기간: 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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공동 작업자 및 조사자
수사관
- 연구 의자: Robert J. Wells, MD, Children's Hospital Medical Center, Cincinnati
연구 기록 날짜
연구 주요 날짜
연구 시작
기본 완료 (실제)
연구 완료 (실제)
연구 등록 날짜
최초 제출
QC 기준을 충족하는 최초 제출
처음 게시됨 (추정)
연구 기록 업데이트
마지막 업데이트 게시됨 (추정)
QC 기준을 충족하는 마지막 업데이트 제출
마지막으로 확인됨
추가 정보
이 연구와 관련된 용어
추가 관련 MeSH 약관
- 조직학적 유형에 따른 신생물
- 신생물
- 골수 질환
- 혈액 질환
- 골수이형성 증후군
- 백혈병
- 백혈병, 골수성
- 백혈병, 골수성, 급성
- 약물의 생리적 효과
- 약리작용의 분자기전
- 항감염제
- 말초 신경계 작용제
- 항바이러스제
- 핵산 합성 억제제
- 효소 억제제
- 진통제
- 감각 시스템 에이전트
- 항염증제
- 항류마티스제
- 항대사물질, 항종양
- 항대사물질
- 항종양제
- 면역억제제
- 면역학적 요인
- 항종양제, 식물성
- 토포이소머라제 II 억제제
- 토포이소머라제 억제제
- 피부과 약제
- 미량 원소
- 미량 영양소
- 생식 조절제
- 낙태약제, 비스테로이드성
- 낙태 에이전트
- 엽산 길항제
- 에토포사이드
- 시타라빈
- 메토트렉세이트
- 미톡산트론
- 클라드리빈
- 하이드로코르티손
- 하이드로코르티손 17-부티레이트 21-프로피오네이트
- 히드로코르티손 아세테이트
- 히드로코르티손 헤미숙시네이트
- 코발트
기타 연구 ID 번호
- 2951
- CCG-2951
- CDR0000064907 (기타 식별자: Clinical Trials.gov)
이 정보는 변경 없이 clinicaltrials.gov 웹사이트에서 직접 가져온 것입니다. 귀하의 연구 세부 정보를 변경, 제거 또는 업데이트하도록 요청하는 경우 register@clinicaltrials.gov. 문의하십시오. 변경 사항이 clinicaltrials.gov에 구현되는 즉시 저희 웹사이트에도 자동으로 업데이트됩니다. .