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Combination Chemotherapy in Treating Patients With Acute Myeloid Leukemia or Myelodysplastic Syndrome

23 juli 2014 bijgewerkt door: Children's Oncology Group

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.

Studie Overzicht

Toestand

Voltooid

Conditie

Interventie / Behandeling

Gedetailleerde beschrijving

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.

Studietype

Ingrijpend

Inschrijving (Werkelijk)

115

Fase

  • Fase 2

Contacten en locaties

In dit gedeelte vindt u de contactgegevens van degenen die het onderzoek uitvoeren en informatie over waar dit onderzoek wordt uitgevoerd.

Studie Locaties

  • Australië
    • Western Australia
      • Perth, Western Australia, Australië, 6001
        • Princess Margaret Hospital for Children
  • Canada
    • British Columbia
      • Vancouver, British Columbia, Canada, V6H 3V4
        • British Columbia Children's Hospital
    • Nova Scotia
      • Halifax, Nova Scotia, Canada, B3J 3G9
        • IWK Grace Health Centre
  • Verenigde Staten
    • California
      • Long Beach, California, Verenigde Staten, 90806
        • Long Beach Memorial Medical Center
      • Los Angeles, California, Verenigde Staten, 90095-1781
        • Jonsson Comprehensive Cancer Center, UCLA
      • Los Angeles, California, Verenigde Staten, 90027-0700
        • Children's Hospital Los Angeles
      • Orange, California, Verenigde Staten, 92668
        • Children's Hospital of Orange County
      • San Francisco, California, Verenigde Staten, 94115-0128
        • UCSF Cancer Center and Cancer Research Institute
    • Colorado
      • Denver, Colorado, Verenigde Staten, 80218
        • Children's Hospital of Denver
    • District of Columbia
      • Washington, District of Columbia, Verenigde Staten, 20010-2970
        • Children's National Medical Center
    • Illinois
      • Chicago, Illinois, Verenigde Staten, 60637
        • University of Chicago Cancer Research Center
    • Indiana
      • Indianapolis, Indiana, Verenigde Staten, 46202-5265
        • Indiana University Cancer Center
    • Iowa
      • Iowa City, Iowa, Verenigde Staten, 52242
        • University of Iowa Hospitals and Clinics
    • Michigan
      • Ann Arbor, Michigan, Verenigde Staten, 48109-0752
        • University Of Michigan Comprehensive Cancer Center
      • Kalamazoo, Michigan, Verenigde Staten, 49007-3731
        • CCOP - Kalamazoo
    • Minnesota
      • Minneapolis, Minnesota, Verenigde Staten, 55455
        • University of Minnesota Cancer Center
      • Rochester, Minnesota, Verenigde Staten, 55905
        • Mayo Clinic Cancer Center
    • Missouri
      • Kansas City, Missouri, Verenigde Staten, 64108
        • Children's Mercy Hospital - Kansas City
    • Nebraska
      • Omaha, Nebraska, Verenigde Staten, 68198-3330
        • University of Nebraska Medical Center
    • New Jersey
      • New Brunswick, New Jersey, Verenigde Staten, 08901
        • Cancer Institute Of New Jersey
    • New York
      • New York, New York, Verenigde Staten, 10021
        • Memorial Sloan-Kettering Cancer Center
      • New York, New York, Verenigde Staten, 10016
        • Kaplan Cancer Center
      • New York, New York, Verenigde Staten, 10032
        • Herbert Irving Comprehensive Cancer Center
    • North Carolina
      • Chapel Hill, North Carolina, Verenigde Staten, 27599-7295
        • Lineberger Comprehensive Cancer Center, UNC
    • North Dakota
      • Fargo, North Dakota, Verenigde Staten, 58102
        • Veterans Affairs Medical Center - Fargo
      • Fargo, North Dakota, Verenigde Staten, 58122
        • CCOP - Merit Care Hospital
    • Ohio
      • Cincinnati, Ohio, Verenigde Staten, 45229-3039
        • Children's Hospital Medical Center - Cincinnati
      • Cleveland, Ohio, Verenigde Staten, 44106-5065
        • Ireland Cancer Center
      • Columbus, Ohio, Verenigde Staten, 43205-2696
        • Children's Hospital of Columbus
    • Oregon
      • Portland, Oregon, Verenigde Staten, 97201-3098
        • Doernbecher Children's Hospital
    • Pennsylvania
      • Philadelphia, Pennsylvania, Verenigde Staten, 19104
        • Children's Hospital of Philadelphia
      • Pittsburgh, Pennsylvania, Verenigde Staten, 15213
        • Children's Hospital of Pittsburgh
    • Tennessee
      • Nashville, Tennessee, Verenigde Staten, 37232-6838
        • Vanderbilt Cancer Center
    • Texas
      • Houston, Texas, Verenigde Staten, 77030
        • University of Texas - MD Anderson Cancer Center
    • Utah
      • Salt Lake City, Utah, Verenigde Staten, 84132
        • Huntsman Cancer Institute
    • Washington
      • Seattle, Washington, Verenigde Staten, 98109
        • Fred Hutchinson Cancer Research Center
      • Seattle, Washington, Verenigde Staten, 98105
        • Children's Hospital and Medical Center - Seattle
    • Wisconsin
      • Madison, Wisconsin, Verenigde Staten, 53792
        • University of Wisconsin Comprehensive Cancer Center

Deelname Criteria

Onderzoekers zoeken naar mensen die aan een bepaalde beschrijving voldoen, de zogenaamde geschiktheidscriteria. Enkele voorbeelden van deze criteria zijn iemands algemene gezondheidstoestand of eerdere behandelingen.

Geschiktheidscriteria

Leeftijden die in aanmerking komen voor studie

Niet ouder dan 21 jaar (Kind, Volwassen)

Accepteert gezonde vrijwilligers

Nee

Geslachten die in aanmerking komen voor studie

Allemaal

Beschrijving

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

Studie plan

Dit gedeelte bevat details van het studieplan, inclusief hoe de studie is opgezet en wat de studie meet.

Hoe is de studie opgezet?

Ontwerpdetails

  • Primair doel: Behandeling
  • Toewijzing: NVT
  • Interventioneel model: Opdracht voor een enkele groep
  • Masker: Geen (open label)

Wapens en interventies

Deelnemersgroep / Arm
Interventie / Behandeling
Experimenteel: 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.
Geneesmiddel: mitoxantron hydrochloride
Andere namen:
  • Novantron
  • NSC-301739
Geneesmiddel: cladribine
Andere namen:
  • Leustatin
  • 2CdA
  • 2-Chloordeoxyadenosine
Geneesmiddel: cytarabine
Andere namen:
  • Ara-C
  • Cytosar-U
  • Cytosine arabinoside
Geneesmiddel: etoposide
Andere namen:
  • VP-16
  • VePesid
  • NSC-141540
Geneesmiddel: methotrexaat
Andere namen:
  • MTX
  • NSC-740
Geneesmiddel: therapeutische hydrocortison
Andere namen:
  • Hydrocortison natriumsuccinaat
  • NSC-10483
Procedure: allogene beenmergtransplantatie
Procedure: stamceltransplantatie uit perifeer bloed
Biologisch: filgrastim
Andere namen:
  • G-CSF
  • Neupogen
  • NSC-614629
Procedure: autologe beenmergtransplantatie
Straling: low-LET elektronentherapie
Straling: low-LET fotonentherapie
Straling: low-LET kobalt-60 gammastralingstherapie

Wat meet het onderzoek?

Primaire uitkomstmaten

Uitkomstmaat
Tijdsspanne
Estimate second remission rate and survival rate
Tijdsspanne: 3 years
3 years

Secundaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Evaluate the mortality of the start of VP-16/Ara-C intensification
Tijdsspanne: 45 days
45 days
Compare outcomes by the ethnicity and gender
Compare outcomes by the ethnicity (and gender) in study CCG-2951, and will control for ethnicity in multivariate models comparing the treatment arms

Medewerkers en onderzoekers

Hier vindt u mensen en organisaties die betrokken zijn bij dit onderzoek.

Sponsor

Children's Oncology Group

Medewerkers

National Cancer Institute (NCI)

Onderzoekers

  • Studie stoel: Robert J. Wells, MD, Children's Hospital Medical Center, Cincinnati

Studie record data

Deze datums volgen de voortgang van het onderzoeksdossier en de samenvatting van de ingediende resultaten bij ClinicalTrials.gov. Studieverslagen en gerapporteerde resultaten worden beoordeeld door de National Library of Medicine (NLM) om er zeker van te zijn dat ze voldoen aan specifieke kwaliteitscontrolenormen voordat ze op de openbare website worden geplaatst.

Bestudeer belangrijke data

Studie start

1 augustus 1997

Primaire voltooiing (Werkelijk)

1 mei 2001

Studie voltooiing (Werkelijk)

1 juni 2008

Studieregistratiedata

Eerst ingediend

1 november 1999

Eerst ingediend dat voldeed aan de QC-criteria

1 september 2004

Eerst geplaatst (Schatting)

2 september 2004

Updates van studierecords

Laatste update geplaatst (Schatting)

24 juli 2014

Laatste update ingediend die voldeed aan QC-criteria

23 juli 2014

Laatst geverifieerd

1 juli 2014

Meer informatie

Termen gerelateerd aan deze studie

Trefwoorden

Aanvullende relevante MeSH-voorwaarden

Andere studie-ID-nummers

  • 2951
  • CCG-2951
  • CDR0000064907 (Andere identificatie: Clinical Trials.gov)

Deze informatie is zonder wijzigingen rechtstreeks van de website clinicaltrials.gov gehaald. Als u verzoeken heeft om uw onderzoeksgegevens te wijzigen, te verwijderen of bij te werken, neem dan contact op met register@clinicaltrials.gov. Zodra er een wijziging wordt doorgevoerd op clinicaltrials.gov, wordt deze ook automatisch bijgewerkt op onze website .

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