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.
研究概览
地位
条件
详细说明
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.
研究类型
注册 (实际的)
阶段
- 阶段2
联系人和位置
学习地点
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British Columbia
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Vancouver、British Columbia、加拿大、V6H 3V4
- British Columbia Children's Hospital
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Nova Scotia
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Halifax、Nova Scotia、加拿大、B3J 3G9
- IWK Grace Health Centre
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Western Australia
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Perth、Western Australia、澳大利亚、6001
- Princess Margaret Hospital for Children
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California
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Long Beach、California、美国、90806
- Long Beach Memorial Medical Center
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Los Angeles、California、美国、90095-1781
- Jonsson Comprehensive Cancer Center, UCLA
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Los Angeles、California、美国、90027-0700
- Children's Hospital Los Angeles
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Orange、California、美国、92668
- Children's Hospital of Orange County
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San Francisco、California、美国、94115-0128
- UCSF Cancer Center and Cancer Research Institute
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Colorado
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Denver、Colorado、美国、80218
- Children's Hospital of Denver
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District of Columbia
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Washington、District of Columbia、美国、20010-2970
- Children's National Medical Center
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Illinois
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Chicago、Illinois、美国、60637
- University of Chicago Cancer Research Center
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Indiana
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Indianapolis、Indiana、美国、46202-5265
- Indiana University Cancer Center
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Iowa
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Iowa City、Iowa、美国、52242
- University of Iowa Hospitals and Clinics
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Michigan
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Ann Arbor、Michigan、美国、48109-0752
- University Of Michigan Comprehensive Cancer Center
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Kalamazoo、Michigan、美国、49007-3731
- CCOP - Kalamazoo
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Minnesota
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Minneapolis、Minnesota、美国、55455
- University of Minnesota Cancer Center
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Rochester、Minnesota、美国、55905
- Mayo Clinic Cancer Center
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Missouri
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Kansas City、Missouri、美国、64108
- Children's Mercy Hospital - Kansas City
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Nebraska
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Omaha、Nebraska、美国、68198-3330
- University of Nebraska Medical Center
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New Jersey
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New Brunswick、New Jersey、美国、08901
- Cancer Institute Of New Jersey
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New York
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New York、New York、美国、10021
- Memorial Sloan-Kettering Cancer Center
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New York、New York、美国、10016
- Kaplan Cancer Center
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New York、New York、美国、10032
- Herbert Irving Comprehensive Cancer Center
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North Carolina
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Chapel Hill、North Carolina、美国、27599-7295
- Lineberger Comprehensive Cancer Center, UNC
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North Dakota
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Fargo、North Dakota、美国、58102
- Veterans Affairs Medical Center - Fargo
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Fargo、North Dakota、美国、58122
- CCOP - Merit Care Hospital
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Ohio
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Cincinnati、Ohio、美国、45229-3039
- Children's Hospital Medical Center - Cincinnati
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Cleveland、Ohio、美国、44106-5065
- Ireland Cancer Center
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Columbus、Ohio、美国、43205-2696
- Children's Hospital of Columbus
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Oregon
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Portland、Oregon、美国、97201-3098
- Doernbecher Children's Hospital
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Pennsylvania
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Philadelphia、Pennsylvania、美国、19104
- Children's Hospital of Philadelphia
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Pittsburgh、Pennsylvania、美国、15213
- Children's Hospital of Pittsburgh
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Tennessee
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Nashville、Tennessee、美国、37232-6838
- Vanderbilt Cancer Center
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Texas
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Houston、Texas、美国、77030
- University of Texas - MD Anderson Cancer Center
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Utah
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Salt Lake City、Utah、美国、84132
- Huntsman Cancer Institute
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Washington
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Seattle、Washington、美国、98109
- Fred Hutchinson Cancer Research Center
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Seattle、Washington、美国、98105
- Children's Hospital and Medical Center - Seattle
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Wisconsin
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Madison、Wisconsin、美国、53792
- University of Wisconsin Comprehensive Cancer Center
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
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
学习计划
研究是如何设计的？
设计细节
- 主要用途：治疗
- 分配：不适用
- 介入模型：单组作业
- 屏蔽：无（打开标签）
武器和干预
参与者组/臂 |
干预/治疗 |
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实验性的：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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研究衡量的是什么？
主要结果指标
结果测量 |
大体时间 |
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Estimate second remission rate and survival rate
大体时间：3 years
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3 years
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
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Evaluate the mortality of the start of VP-16/Ara-C intensification
大体时间：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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合作者和调查者
调查人员
- 学习椅：Robert J. Wells, MD、Children's Hospital Medical Center, Cincinnati
研究记录日期
研究主要日期
学习开始
初级完成 (实际的)
研究完成 (实际的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (估计)
研究记录更新
最后更新发布 (估计)
上次提交的符合 QC 标准的更新
最后验证
更多信息
与本研究相关的术语
其他相关的 MeSH 术语
其他研究编号
- 2951
- CCG-2951
- CDR0000064907 (其他标识符：Clinical Trials.gov)
此信息直接从 clinicaltrials.gov 网站检索，没有任何更改。如果您有任何更改、删除或更新研究详细信息的请求，请联系 register@clinicaltrials.gov. clinicaltrials.gov 上实施更改，我们的网站上也会自动更新.