Deze pagina is automatisch vertaald en de nauwkeurigheid van de vertaling kan niet worden gegarandeerd. Raadpleeg de Engelse versie voor een brontekst.

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

29 januari 2019 bijgewerkt door: 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.

Studie Overzicht

Toestand

Voltooid

Conditie

Interventie / Behandeling

Gedetailleerde beschrijving

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.

Studietype

Ingrijpend

Inschrijving (Werkelijk)

546

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

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

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

15 jaar tot 59 jaar (Kind, Volwassen)

Accepteert gezonde vrijwilligers

Nee

Geslachten die in aanmerking komen voor studie

Allemaal

Beschrijving

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

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 (chemotherapy, PBSC or bone marrow transplantation)
See Detailed Description.
Ander: Laboratorium Biomarker Analyse
Correlatieve studies
Geneesmiddel: Etoposide
IV gegeven
Andere namen:
  • Demethyl Epipodofyllotoxine Ethylidine Glucoside
  • EPEG
  • Laatste
  • Toposar
  • Vepesid
  • VP 16-213
  • VP-16
  • VP-16-213
Geneesmiddel: Decitabine
IV gegeven
Andere namen:
  • 5-Aza-2'-deoxycytidine
  • Dacogen
  • Decitabine voor injectie
  • Deoxyazacytidine
  • Dezocitidine
  • Aza-TdC
Ander: Farmacologische studie
Correlatieve studies
Geneesmiddel: Cytarabine
IV gegeven
Andere namen:
  • Β-Cytosine arabinoside
  • 1-ß-D-Arabinofuranosyl-4-amino-2(1H)pyrimidinon
  • 1-P-D-Arabinofuranosylcytosine
  • 1-Beta-D-arabinofuranosyl-4-amino-2(1H)pyrimidinon
  • 1-Beta-D-arabinofuranosylcytosine
  • 1.beta.-D-Arabinofuranosylcytosine
  • 2(1H)-pyrimidinon, 4-amino-1-bèta-D-arabinofuranosyl-
  • 2(1H)-pyrimidinon, 4-amino-1β-D-arabinofuranosyl-
  • Alexan
  • Ara-C
  • ARA-cel
  • Arabier
  • Arabinofuranosylcytosine
  • Arabinosylcytosine
  • Aracytidine
  • Aracytine
  • CHX-3311
  • Cytarabinum
  • Cytarbel
  • Cytosar
  • Cytosine arabinoside
  • Cytosine-β-arabinoside
  • Cytosine-bèta-arabinoside
  • Erpalfa
  • Starasid
  • Tarabine PFS
  • U 19920
  • U-19920
  • Udicil
  • WR-28453
  • Bèta-cytosine Arabinoside
Geneesmiddel: Daunorubicine Hydrochloride
IV gegeven
Andere namen:
  • Cerubidine
  • Cloridrato de Daunorubicina
  • Daunoblastine
  • Daunoblastina
  • Daunomycine Hydrochloride
  • Daunomycine, hydrochloride
  • Daunorubicine.HCl
  • Daunorubicini Hydrochloridum
  • FI-6339
  • Ondena
  • RP-13057
  • Rubidomycine Hydrochloride
  • Rubilem
Biologisch: Filgrastim
SC gegeven
Andere namen:
  • G-CSF
  • r-metHuG-CSF
  • Neupogen
  • Recombinant Methionyl Menselijke Granulocyt Kolonie Stimulerende Factor
  • rG-CSF
  • Tevagrastim
  • FILGRASTIM, LICENTIEHOUDER NIET GESPECIFICEERD
Geneesmiddel: Busulfan
IV gegeven
Andere namen:
  • Busulfex
  • Misulfan
  • Mitosan
  • Myeloleukon
  • Myelosan
  • 1,4-Bis[methaansulfonoxy]butaan
  • BUS
  • Bussulfam
  • Busulfanum
  • Busulfan
  • CB 2041
  • CB-2041
  • Glyzophrol
  • GT 41
  • GT-41
  • Joacamine
  • Methaansulfonzuur tetramethyleenester
  • Methaansulfonzuur, tetramethyleenester
  • Mielucin
  • Misulban
  • Myeleukon
  • Mylecytaan
  • Myleran
  • Sulfabutine
  • Tetramethyleen Bis(methaansulfonaat)
  • Tetramethyleen bis[methaansulfonaat]
  • WR-19508
Procedure: Autologous Bone Marrow Transplantation
Undergo autologous bone marrow transplantation
Andere namen:
  • ABMT
  • Autologe beenmergtransplantatie
  • Autologe mergtransplantatie
Procedure: Autologous Hematopoietic Stem Cell Transplantation
Undergo autologous PBSC transplantation
Andere namen:
  • Autologe hematopoietische celtransplantatie
  • autologe stamceltransplantatie

Wat meet het onderzoek?

Primaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Number of Participants Who Completed Maintenance Decitabine.
Tijdsspanne: 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
Tijdsspanne: 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

Andere uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Relationship Between Busulfan Pharmacokinetics (Area Under the Curve) and Relapsed Disease
Tijdsspanne: 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

Medewerkers en onderzoekers

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

Sponsor

National Cancer Institute (NCI)

Onderzoekers

  • Hoofdonderzoeker: William Blum, Alliance for Clinical Trials in Oncology

Publicaties en nuttige links

De persoon die verantwoordelijk is voor het invoeren van informatie over het onderzoek stelt deze publicaties vrijwillig ter beschikking. Dit kan gaan over alles wat met het onderzoek te maken heeft.

Algemene publicaties

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 (Werkelijk)

15 november 2006

Primaire voltooiing (Werkelijk)

31 januari 2011

Studie voltooiing (Werkelijk)

1 december 2016

Studieregistratiedata

Eerst ingediend

27 december 2006

Eerst ingediend dat voldeed aan de QC-criteria

27 december 2006

Eerst geplaatst (Schatting)

28 december 2006

Updates van studierecords

Laatste update geplaatst (Werkelijk)

19 februari 2019

Laatste update ingediend die voldeed aan QC-criteria

29 januari 2019

Laatst geverifieerd

1 januari 2019

Meer informatie

Termen gerelateerd aan deze studie

Aanvullende relevante MeSH-voorwaarden

Andere studie-ID-nummers

  • NCI-2009-00444 (Register-ID: CTRP (Clinical Trial Reporting Program))
  • U10CA180821 (Subsidie/contract van de Amerikaanse NIH)
  • U10CA031946 (Subsidie/contract van de Amerikaanse NIH)
  • CDR0000521603
  • CALGB 10503 (Andere identificatie: Alliance for Clinical Trials in Oncology)
  • CALGB-10503 (Andere identificatie: CTEP)
  • R21CA128377 (Subsidie/contract van de Amerikaanse NIH)

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 .

Abonneren