Decitabine as Maintenance Therapy After Standard Therapy in Treating Patients With Previously Untreated Acute Myeloid Leukemia
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
연구 개요
상태
정황
상세 설명
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.
연구 유형
등록 (실제)
단계
- 2 단계
연락처 및 위치
연구 장소
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California
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San Francisco, California, 미국, 94115
- UCSF Medical Center-Mount Zion
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Delaware
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Lewes, Delaware, 미국, 19958
- Beebe Medical Center
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Newark, Delaware, 미국, 19718
- Christiana Care Health System-Christiana Hospital
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Florida
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Orlando, Florida, 미국, 32803
- Florida Hospital Orlando
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Georgia
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Atlanta, Georgia, 미국, 30342
- Blood and Marrow Transplant Group of Georgia
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Illinois
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Chicago, Illinois, 미국, 60637
- University of Chicago Comprehensive Cancer Center
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Chicago, Illinois, 미국, 60612
- University of Illinois
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Evanston, Illinois, 미국, 60201
- NorthShore University HealthSystem-Evanston Hospital
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Indiana
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Fort Wayne, Indiana, 미국, 46845
- Fort Wayne Medical Oncology and Hematology Inc-Parkview
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Iowa
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Iowa City, Iowa, 미국, 52242
- University of Iowa/Holden Comprehensive Cancer Center
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Maine
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Bangor, Maine, 미국, 04401
- Eastern Maine Medical Center
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Maryland
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Baltimore, Maryland, 미국, 21201
- University of Maryland/Greenebaum Cancer Center
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Bethesda, Maryland, 미국, 20889-5600
- Walter Reed National Military Medical Center
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Elkton, Maryland, 미국, 21921
- Union Hospital of Cecil County
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Massachusetts
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Boston, Massachusetts, 미국, 02215
- Dana-Farber Cancer Institute
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Boston, Massachusetts, 미국, 02115
- Brigham and Women's Hospital
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Boston, Massachusetts, 미국, 02114
- Massachusetts General Hospital Cancer Center
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Worcester, Massachusetts, 미국, 01605
- Commonwealth Hematology Oncology PC-Worcester
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Missouri
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Columbia, Missouri, 미국, 65212
- University of Missouri - Ellis Fischel
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Columbia, Missouri, 미국, 65201
- Veterans Administration
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Saint Louis, Missouri, 미국, 63110
- Washington University School of Medicine
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Nebraska
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North Platte, Nebraska, 미국, 69101
- Great Plains Health Callahan Cancer Center
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Omaha, Nebraska, 미국, 68198
- University of Nebraska Medical Center
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Nevada
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Las Vegas, Nevada, 미국, 89109
- Sunrise Hospital and Medical Center
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Las Vegas, Nevada, 미국, 89102
- University Medical Center of Southern Nevada
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Las Vegas, Nevada, 미국, 89106
- Nevada Cancer Research Foundation CCOP
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New Hampshire
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Keene, New Hampshire, 미국, 03431
- Cheshire Medical Center-Dartmouth-Hitchcock Keene
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Lebanon, New Hampshire, 미국, 03756
- Dartmouth Hitchcock Medical Center
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New Jersey
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Camden, New Jersey, 미국, 08103
- Cooper Hospital University Medical Center
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New York
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Buffalo, New York, 미국, 14263
- Roswell Park Cancer Institute
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Lake Success, New York, 미국, 11042
- Northwell Health NCORP
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Lake Success, New York, 미국, 11042
- Northwell Health/Center for Advanced Medicine
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Manhasset, New York, 미국, 11030
- North Shore University Hospital
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New Hyde Park, New York, 미국, 11040
- Long Island Jewish Medical Center
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New York, New York, 미국, 10029
- Mount Sinai Hospital
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Syracuse, New York, 미국, 13210
- State University of New York Upstate Medical University
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North Carolina
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Chapel Hill, North Carolina, 미국, 27599
- UNC Lineberger Comprehensive Cancer Center
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Goldsboro, North Carolina, 미국, 27534
- Wayne Memorial Hospital
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Winston-Salem, North Carolina, 미국, 27157
- Wake Forest University Health Sciences
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Ohio
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Columbus, Ohio, 미국, 43210
- Ohio State University Comprehensive Cancer Center
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Oklahoma
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Oklahoma City, Oklahoma, 미국, 73104
- University of Oklahoma Health Sciences Center
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Pennsylvania
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Pittsburgh, Pennsylvania, 미국, 15224
- West Penn Hospital
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Rhode Island
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Providence, Rhode Island, 미국, 02903
- Rhode Island Hospital
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Providence, Rhode Island, 미국, 02906
- Miriam Hospital
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Vermont
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Berlin, Vermont, 미국, 05602
- Central Vermont Medical Center/National Life Cancer Treatment
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Burlington, Vermont, 미국, 05405
- University of Vermont College of Medicine
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참여기준
자격 기준
공부할 수 있는 나이
건강한 자원 봉사자를 받아들입니다
연구 대상 성별
설명
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
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 |
|---|---|
|
실험적: Treatment (chemotherapy, PBSC or bone marrow transplantation)
See Detailed Description.
|
상관 연구
주어진 IV
다른 이름들:
주어진 IV
다른 이름들:
상관 연구
주어진 IV
다른 이름들:
주어진 IV
다른 이름들:
주어진 SC
다른 이름들:
주어진 IV
다른 이름들:
Undergo autologous bone marrow transplantation
다른 이름들:
Undergo autologous PBSC transplantation
다른 이름들:
|
연구는 무엇을 측정합니까?
주요 결과 측정
결과 측정 |
측정값 설명 |
기간 |
|---|---|---|
|
Number of Participants Who Completed Maintenance Decitabine.
기간: 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.
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Up to 5 years
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Disease-free Survival (DFS) Rate at 1 Year
기간: At 1 year
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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
|
기타 결과 측정
결과 측정 |
측정값 설명 |
기간 |
|---|---|---|
|
Relationship Between Busulfan Pharmacokinetics (Area Under the Curve) and Relapsed Disease
기간: At baseline, after 2, 4, and 6 hours after the start of busulfan infusion
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Results from busulfan pharmacokinetics will be pooled with those from CALGB 19808.
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At baseline, after 2, 4, and 6 hours after the start of busulfan infusion
|
공동 작업자 및 조사자
수사관
- 수석 연구원: William Blum, Alliance for Clinical Trials in Oncology
간행물 및 유용한 링크
일반 간행물
- Yin J, LaPlant B, Uy GL, Marcucci G, Blum W, Larson RA, Stone RM, Mandrekar SJ. Evaluation of event-free survival as a robust end point in untreated acute myeloid leukemia (Alliance A151614). Blood Adv. 2019 Jun 11;3(11):1714-1721. doi: 10.1182/bloodadvances.2018026112.
- Blum W, Sanford BL, Klisovic R, DeAngelo DJ, Uy G, Powell BL, Stock W, Baer MR, Kolitz JE, Wang ES, Hoke E, Mrozek K, Kohlschmidt J, Bloomfield CD, Geyer S, Marcucci G, Stone RM, Larson RA; Alliance for Clinical Trials in Oncology. Maintenance therapy with decitabine in younger adults with acute myeloid leukemia in first remission: a phase 2 Cancer and Leukemia Group B Study (CALGB 10503). Leukemia. 2017 Jan;31(1):34-39. doi: 10.1038/leu.2016.252. Epub 2016 Sep 13.
연구 기록 날짜
연구 주요 날짜
연구 시작 (실제)
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 (실제)
QC 기준을 충족하는 마지막 업데이트 제출
마지막으로 확인됨
추가 정보
이 연구와 관련된 용어
추가 관련 MeSH 약관
기타 연구 ID 번호
- NCI-2009-00444 (레지스트리 식별자: CTRP (Clinical Trial Reporting Program))
- U10CA180821 (미국 NIH 보조금/계약)
- U10CA031946 (미국 NIH 보조금/계약)
- CDR0000521603
- CALGB 10503 (기타 식별자: Alliance for Clinical Trials in Oncology)
- CALGB-10503 (기타 식별자: CTEP)
- R21CA128377 (미국 NIH 보조금/계약)
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