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Eligibility
for people ages 15 years to 59 years
Location
at San Francisco, California and other locations
Dates
study started

Description

Summary

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.

Official Title

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

Details

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.

Keywords

Acute Myeloid Leukemia With Myelodysplasia-Related Changes Adult Acute Myeloid Leukemia With Inv(16)(p13.1q22); CBFB-MYH11 Adult Acute Myeloid Leukemia With t(16;16)(p13.1;q22); CBFB-MYH11 Adult Acute Myeloid Leukemia With t(8;21); (q22; q22.1); RUNX1-RUNX1T1 Adult Acute Myeloid Leukemia With t(9;11)(p22.3;q23.3); MLLT3-KMT2A Untreated Adult Acute Myeloid Leukemia Etoposide Podophyllotoxin Daunorubicin Etoposide phosphate Decitabine Cytarabine Busulfan Azacitidine Lenograstim

Eligibility

For people ages 15 years to 59 years

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

Locations

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

Details

Status
in progress, not accepting new patients
Start Date
Sponsor
National Cancer Institute (NCI)
ID
NCT00416598
Phase
Phase 2
Study Type
Interventional
Last Updated
February 2017