FLT PET/CT vid mätning av respons hos patienter med tidigare obehandlad akut myeloid leukemi
Tidig bedömning av behandlingsrespons vid AML med hjälp av FLT PET/CT-avbildning
This phase II trial studies fluorothymidine F 18 (FLT) positron emission tomography (PET)/computed tomography (CT) in measuring response in patients with previously untreated acute myeloid leukemia. FLT is a radioactive substance that may "light up" where cancer is in the body. FLT is injected into the blood and builds up in cells that are dividing, including cancer cells. Diagnostic procedures, such as PET/CT, may help measure a patient's response to earlier treatment.
Studieöversikt
Status
Betingelser
Intervention / Behandling
Detaljerad beskrivning
PRIMARY OBJECTIVES:
I. To evaluate the negative predictive value (NPV) of post-treatment FLT PET/CT imaging for complete remission (CR) in patients receiving induction chemotherapy for acute myeloid leukemia (AML).
SECONDARY OBJECTIVES:
I. To evaluate the positive predictive value (PPV) of post-treatment FLT PET/CT imaging for complete remission.
II. To estimate the sensitivity and specificity of post-treatment FLT PET/CT imaging for detecting complete remission.
III. To correlate FLT PET/CT imaging with biologic correlates (minimal residual disease [MRD] assessment) IV. To correlate FLT PET/CT imaging with relapse-free survival and overall survival.
EXPLORATORY OBJECTIVES:
III. To evaluate pre-treatment FLT PET/CT imaging as a predictor of complete remission.
IV. To evaluate the change between pre-treatment and post-treatment FLT PET/CT imaging as a predictor of complete remission.
OUTLINE:
Patients receive anthracycline intravenously (IV) on days 1-3 and cytarabine IV on days 1-7 for up to 2 courses. Patients then undergo FLT PET/CT within 3 days before or after the nadir bone marrow biopsy (between days 10-17 after initiation of first induction cycle and prior to reinduction). Patients may undergo an optional FLT PET/CT prior to induction chemotherapy if it does not interfere with commencement of treatment. Patients also undergo bone marrow biopsy and aspiration and blood sample collection during screening and on the trial.
After completion of study, patients are followed up at day 28-35, and then up to 1 year beyond the end of study accrual period.
Studietyp
Inskrivning (Faktisk)
Fas
- Fas 2
Kontakter och platser
Studieorter
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Minnesota
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Rochester, Minnesota, Förenta staterna, 55905
- Mayo Clinic in Rochester
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Missouri
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St Louis, Missouri, Förenta staterna, 63110
- Washington University School of Medicine
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New York
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New York, New York, Förenta staterna, 10029
- Mount Sinai Hospital
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North Carolina
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Chapel Hill, North Carolina, Förenta staterna, 27599
- UNC Lineberger Comprehensive Cancer Center
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Oklahoma
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Oklahoma City, Oklahoma, Förenta staterna, 73104
- University of Oklahoma Health Sciences Center
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Pennsylvania
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Philadelphia, Pennsylvania, Förenta staterna, 19111
- Fox Chase Cancer Center
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Philadelphia, Pennsylvania, Förenta staterna, 19104
- University of Pennsylvania/Abramson Cancer Center
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Tennessee
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Nashville, Tennessee, Förenta staterna, 37232
- Vanderbilt University/Ingram Cancer Center
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Texas
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Dallas, Texas, Förenta staterna, 75390
- UT Southwestern/Simmons Cancer Center-Dallas
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Utah
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Salt Lake City, Utah, Förenta staterna, 84112
- Huntsman Cancer Institute/University of Utah
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Wisconsin
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Madison, Wisconsin, Förenta staterna, 53792
- University of Wisconsin Carbone Cancer Center - University Hospital
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-
Deltagandekriterier
Urvalskriterier
Åldrar som är berättigade till studier
Tar emot friska volontärer
Kön som är behöriga för studier
Beskrivning
Inclusion Criteria:
- Age ≥ 18 years
- Patients must have previously untreated AML and be candidates for intensive induction chemotherapy; patients are allowed to have had prior hydroxyurea
- Patients must not have acute promyelocytic leukemia (APL) and must not have evidence of t(15;17)(q22;q21)
- Patients must have an Eastern Cooperative Oncology Group (ECOG) performance status of 0-3 (restricted to ECOG performance status [PS] 0-2 if age > 70 years)
- Patients must have left ventricular ejection fraction (LVEF) > 45% or within institutional normal limits
- Patients must be able to lie still for a 1.5 hour PET scan
- Patient must NOT have a history of allergic reaction attributable to compounds of similar chemical or biologic composition to 18F-fluorothymidine
- Patient must NOT weigh more than the maximum weight limit for the PET/CT table for the scanner(s) to be used at each center
- The patient is participating in the trial at an institution which has agreed to perform the imaging research studies, completed the ECOG-American College of Radiology Imaging Network (ACRIN) defined scanner qualification procedures and received ECOG-ACRIN approval as outlined
- Women must not be pregnant or breast-feeding; all females of childbearing potential must have a blood test or urine study within 2 weeks prior to registration to rule out pregnancy; a female of childbearing potential is any woman, regardless of sexual orientation or whether they have undergone tubal ligation, who meets the following criteria: 1) has not undergone a hysterectomy or bilateral oophorectomy; or 2) has not been naturally postmenopausal for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months)
Studieplan
Hur är studien utformad?
Designdetaljer
- Primärt syfte: Diagnostisk
- Tilldelning: N/A
- Interventionsmodell: Enskild gruppuppgift
- Maskning: Ingen (Open Label)
Vapen och interventioner
Deltagargrupp / Arm |
Intervention / Behandling |
|---|---|
|
Experimentell: Diagnostic (anthracycline, cytarabine, FLT PET/CT)
Patients receive anthracycline IV on days 1-3 and cytarabine IV on days 1-7 for up to 2 courses. Patients then undergo FLT PET/CT within 3 days before or after the nadir bone marrow biopsy (between days 10-17 after initiation of first induction cycle and prior to reinduction). Patients may undergo an optional FLT PET/CT prior to induction chemotherapy if it does not interfere with commencement of treatment. Patients also undergo bone marrow biopsy and aspiration and blood sample collection during screening and on the trial. |
Correlative studies Given IV
Andra namn:
Undergo blood sample collection
Andra namn:
Undergo bone marrow biopsy and aspiration Undergo bone marrow biopsy and aspiration
Andra namn:
Given anthracycline IV
Andra namn:
Undergo FLT PET/CT
Andra namn:
Undergo FLT PET/CT
Andra namn:
Undergo FLT PET/CT
Andra namn:
|
Vad mäter studien?
Primära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
|---|---|---|
|
Negative Predictive Value of Post-treatment Fluorothymidine F 18 (FLT) Positron Emission Tomography (PET)/Computed Tomography (CT) Imaging for Complete Remission (CR) in Comparison With Blast Counts From Bone Marrow Biopsy (BMBX)
Tidsram: Up to day 35
|
Three imaging parameters (standardized uptake value [SUV]mean, SUVmax, heterogeneity of FLT uptake [SUVhetero]) will be measured from an FLT PET/CT scan and SUVmax will be the primary endpoint. Higher values of SUVmax assume to indicate a non-response the therapy and a cut point of 7 (SUVmax >7) will be used as the threshold indicating a negative scan. The binomial proportion of negative predictive value (NPV) and the corresponding exact confidence intervals will be calculated. In addition, the calculated NPV will be tested against the null hypothesis to see if it's significantly larger than 0.64 (NPV of day-14 BMBX in CR prediction). CR:Complete remission CRi: Complete remission with incomplete platelet recovery LFS: Leukemia-free state Non-responders defined as Not (CR,CRi,or LFS) Negative predictive value (NPV) of the post-treatment FLT PET/CT scan is Probability ((not CR,CRi,or LFS) │ SUVmax >7 ) |
Up to day 35
|
Sekundära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
|---|---|---|
|
Positive Predictive Value (PPV) of Post-treatment FLT PET/CT Imaging for Complete Remission
Tidsram: Up to day 35
|
The binomial proportion of PPV and the corresponding exact confidence intervals will be calculated. In addition, the calculated PPV will be tested to see if it's significantly larger than 0.79 (PPV of day-14 BMBX in CR prediction). |
Up to day 35
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|
Sensitivity of Post-treatment FLT PET/CT for Detecting Complete Remission (a Clinical Response of CR, CRi, or LFS )
Tidsram: Up to day 35
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The binomial proportions and the corresponding exact confidence intervals will be calculated for sensitivity estimation where FLT Test : Negative: SUV >7; Positive: SUV<=7 Clinical Response: Negative: not (CR, CRi, or LFS); Positive (Responders): CR, CRi, or LFS |
Up to day 35
|
|
Specificity of Post-treatment FLT PET/CT for Detecting Complete Remission
Tidsram: Up to day 35
|
The binomial proportions and the corresponding exact confidence intervals will be calculated for specificity estimation. Test response: Negative: SUV >7; Positive: SUV<=7 Clinical Response = Complete remissions: Negative (Non-Responders): not (CR, CRi, or LFS); Positive (Responders): CR, CRi, or LFS |
Up to day 35
|
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FLT PET/CT Imaging Parameters With Biologic Correlates (Minimal Residual Disease Assessment)
Tidsram: Up to day 35
|
FLT PET/CT imaging features will be compared with biologic correlates (minimal residual disease [MRD] assessment). |
Up to day 35
|
|
FLT PET/CT Imaging to Predict Relapse-free Survival
Tidsram: Up to day 35 and up to 4 years for RFS
|
compare the Recurrence-Free Survival (RFS) between positive and negative post-treatment FLT PET/CT scans, where an SUVmax less than or equal to 7 (i.e., low FLT uptake) was considered a positive result, and an SUVmax greater than 7 (i.e., high FLT uptake) was a negative result. Participants were followed for survival outcomes until study closure when the last participant has been followed for 1 year after study enrollment. The relapse endpoint included both reappearance of blasts in the blood; and presence of more than 5% blasts not attributable to another cause Time-to-relapse was measured from the date of the remission bone marrow biopsy to the date of first recurrence or death, whichever came first. RFS was only evaluable for participants with a clinical response of CR, CRi, or LFS at the remission bone marrow biopsy. |
Up to day 35 and up to 4 years for RFS
|
|
FLT PET/CT Imaging to Predict Overall Survival
Tidsram: Up to day 35 and up to 4 years for RFS
|
compare the Overall Survival (OS) between positive and negative post-treatment FLT PET/CT scans, where an SUVmax<= 7 (i.e., low FLT uptake) was considered a positive result, and an SUVmax > 7 (i.e., high FLT uptake) was a negative result. Participants were followed for survival outcomes until study closure when the last participant has been followed for 1 year after study enrollment. |
Up to day 35 and up to 4 years for RFS
|
Samarbetspartners och utredare
Sponsor
Utredare
- Huvudutredare: Robert Jeraj, ECOG-ACRIN Cancer Research Group
Studieavstämningsdatum
Studera stora datum
Studiestart (Faktisk)
Primärt slutförande (Faktisk)
Avslutad studie (Beräknad)
Studieregistreringsdatum
Först inskickad
Först inskickad som uppfyllde QC-kriterierna
Första postat (Beräknad)
Uppdateringar av studier
Senaste uppdatering publicerad (Faktisk)
Senaste inskickade uppdateringen som uppfyllde QC-kriterierna
Senast verifierad
Mer information
Termer relaterade till denna studie
Ytterligare relevanta MeSH-villkor
- Neoplasmer
- Neoplasmer efter histologisk typ
- Hematologiska sjukdomar
- Leukemi, myeloid
- Leukemi
- Hemiska och lymfsjukdomar
- Leukemi, Myeloid, Akut
- Heterocykliska föreningar, 1-ring
- Heterocykliska föreningar
- Undersökningstekniker
- Terapeutik
- Kliniska laboratorietekniker
- Diagnostiska tekniker och procedurer
- Diagnos
- Kirurgiska ingrepp, operativ
- Cytologiska tekniker
- Nukleinsyror, nukleotider och nukleosider
- Cytodiagnos
- Cytidin
- Pyrimidin nukleosider
- Pyrimidiner
- Diagnostiska tekniker, kirurgiska
- Kemitekniker, analytiska
- Spektrumanalys
- Nukleosider
- Arabinonukleosider
- Cytarabin
- Biopsi
- Provhantering
- Magnetresonansspektroskopi
- Narkotikabehandling
- alovudin
Andra studie-ID-nummer
- NCI-2015-00328
- U10CA180820 (U.S.S. NIH-anslag/kontrakt)
- NCI-2015-00328 (Registeridentifierare: CTRP (Clinical Trial Reporting Program))
- EAI141 (Annan identifierare: CTEP)
- U10CA180827 (U.S.S. NIH-anslag/kontrakt)
- EAI141
- EAI141 (Annan identifierare: ECOG-ACRIN Cancer Research Group)
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