Ignite Creation Date:
2024-05-05 @ 5:02 PM
Last Modification Date:
2024-10-26 @ 9:27 AM
Study NCT ID:
NCT00372593
Status:
COMPLETED
Last Update Posted:
2021-03-24
First Post:
2006-09-06
Brief Title:
Combination Chemotherapy With or Without Gemtuzumab in Treating Young Patients With Newly Diagnosed Acute Myeloid Leukemia
Sponsor:
Childrens Oncology Group
Organization:
Childrens Oncology Group
Study Overview
Official Title:
A Phase III Randomized Trial of Gemtuzumab Ozogamicin Mylotarg Combined With Conventional Chemotherapy for De Novo Acute Myeloid Leukemia AML in Children Adolescents and Young Adults
Status:
COMPLETED
Status Verified Date:
2017-02
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
RATIONALE Drugs used in chemotherapy work in different ways to stop the growth of cancer cells either by killing the cells or by stopping them from dividing Monoclonal antibodies such as gemtuzumab can block cancer growth in different ways Some block the ability of cancer cells to grow and spread Others find cancer cells and help kill them or carry cancer-killing substances to them Giving combination chemotherapy together with gemtuzumab may kill more cancer cells It is not yet known whether combination chemotherapy is more effective with or without gemtuzumab in treating patients with newly diagnosed acute myeloid leukemia
PURPOSE This randomized phase III trial is studying combination chemotherapy and gemtuzumab to see how well they work compared with combination chemotherapy alone in treating young patients with newly diagnosed acute myeloid leukemia
PURPOSE This randomized phase III trial is studying combination chemotherapy and gemtuzumab to see how well they work compared with combination chemotherapy alone in treating young patients with newly diagnosed acute myeloid leukemia
Detailed Description:
OBJECTIVES
Primary
Compare the event-free survival EFS and overall survival OS of young patients with newly diagnosed acute myeloid leukemia AML treated with conventional combination chemotherapy with vs without gemtuzumab ozogamicin GMTZ
Secondary
Compare the remission induction rates after two courses of therapy in these patients
Compare disease-free survival and OS in patients who are eligible for an human leukocyte antigen HLA-matched family donor MFD stem cell transplant SCT by virtue of their risk classification with patients assigned to MFD SCT if a MFD is available or to chemotherapy if a MFD is not available
Determine the outcome of patients with Down syndrome who are 4 years of age or older at diagnosis and treated with conventional combination chemotherapy without GMTZ
Compare the EFS and OS of patients with de novo AML treated with conventional combination chemotherapy with vs without GMTZ censoring MFD SCT recipients
Determine the prevalence and prognostic significance of molecular abnormalities of KIT CCAAT-enhancer binding protein alpha CEBPα and MLL-Partial tandem duplications PTD genes in these patients
Determine the leukemic involvement of hematopoietic early progenitor and its role in defining response to therapy
Assess the ability of a second-generation flow cytometric assay to predict patients at high risk for relapse during periods of clinical remission
Examine whether GMTZ significantly improves EFS and OS in patients with higher CD33 concentrationsintensity
Examine whether GMTZ significantly improves complete remission EFS and OS in each of the cytogenetic risk groups high- intermediate- and low-risk identified in prior Medical Research Council trials
Utilize fluorescence in situ hybridization FISH analysis to identify variant patterns among subgroups of patients who demonstrate the same G-banded chromosomal abnormality eg inv16t1616 t821 11q23 abnormality and determine whether these variant patterns account for the heterogeneity of responses to therapy
Examine the impact of complex karyotypes 3 4 and 5 abnormalities on OS and EFS in intermediate-risk patients for whom no high-risk or low-risk cytogenetic abnormalities exist
OUTLINE This is a randomized multicenter study Patients are stratified according to relapse risk high vs intermediate vs low Patients are randomized to 1 of 2 treatment arms Patients with Down syndrome are nonrandomly assigned to arm I but do not undergo allogeneic stem cell transplant SCT
Arm I standard therapy
Induction 1 Patients receive cytarabine IT at the time of diagnosis or on day 1 Patients also receive cytarabine IV on days 1-10 daunorubicin hydrochloride IV over 6 hours on days 1 3 and 5 and etoposide IV over 4 hours on days 1-5 After 3 weeks of rest all patients regardless of remission status proceed to induction 2
NOTE Patients with Central Nervous System CNS disease receive cytarabine IT twice weekly until the cerebrospinal fluid is clear followed by two additional IT treatments Patients with refractory CNS leukemia after 6 doses of IT treatment are removed from the study
Induction 2 Patients receive cytarabine IT on day 1 cytarabine IV on days 1-8 daunorubicin hydrochloride IV over 6 hours on days 1 3 and 5 and etoposide IV over 4 hours on days 1-5 After 3 weeks of rest patients in complete remission CR proceed to intensification 1 Patients with refractory disease are removed from protocol therapy
Intensification 1 Patients receive cytarabine IT on day 1 high-dose cytarabine IV over 1 hour on days 1-5 and etoposide IV over 1 hour on days 1-5 After 3 weeks of rest patients in remission proceed to intensification 2 followed by intensification 3 Patients in remission proceed to allogeneic SCT 2-8 weeks after blood counts recover Patients with high-risk disease with an alternative donor proceed to intensification 2 and 3 followed by allogeneic SCT Patients not in remission are removed from protocol therapy
Intensification 2 Patients receive cytarabine IT on day 1 high-dose cytarabine IV over 2 hours on days 1-4 and mitoxantrone hydrochloride IV over 1 hour on days 3-6 After 3 weeks of rest patients proceed to intensification 3
Intensification 3 Patients receive high-dose cytarabine IV over 3 hours on days 1 2 8 and 9 and asparaginase intramuscularly on days 2 and 9
Arm II
Induction 1 Patients receive treatment as in induction 1 of arm I Patients also receive gemtuzumab ozogamicin GMTZ IV over 2 hours on day 6
Induction 2 Patients receive treatment as in induction 2 of arm I
Intensification 1 Patients receive treatment as in intensification 1 of arm I
Intensification 2 Patients receive treatment as in intensification 2 of arm I Patients also receive GMTZ IV over 2 hours on day 7
Intensification 3 Patients receive treatment as in intensification 3 of arm I
Allogeneic SCT for patients with intermediate- or high-risk disease
MFD Patients receive a conditioning regimen comprising busulfan IV over 2 hours every 6 hours on days -9 to -6 and cyclophosphamide IV over 1 hour on days -5 to -2 Patients undergo allogeneic SCT on day 0 Patients receive cyclosporine IV or orally twice daily on days -1 to 180 and methotrexate IV on days 1 3 6 and 11 Patients receive graft-vs-host disease GVHD prophylaxis comprising cyclosporine IV over 1-4 hours or orally twice daily on days -1 to 180 and methotrexate IV on days 1 3 6 and 11
Matched alternative donor Patients receive a conditioning regimen comprising busulfan and cyclophosphamide as above Patients also receive antithymocyte globulin IV over 6-8 hours on days -3 to -1 Patients then undergo allogeneic SCT and receive GVHD prophylaxis as above
After completion of study treatment patients are followed periodically for 3 years and then annually thereafter
PROJECTED ACCRUAL A total of 1012 patients will be accrued for this study
Primary
Compare the event-free survival EFS and overall survival OS of young patients with newly diagnosed acute myeloid leukemia AML treated with conventional combination chemotherapy with vs without gemtuzumab ozogamicin GMTZ
Secondary
Compare the remission induction rates after two courses of therapy in these patients
Compare disease-free survival and OS in patients who are eligible for an human leukocyte antigen HLA-matched family donor MFD stem cell transplant SCT by virtue of their risk classification with patients assigned to MFD SCT if a MFD is available or to chemotherapy if a MFD is not available
Determine the outcome of patients with Down syndrome who are 4 years of age or older at diagnosis and treated with conventional combination chemotherapy without GMTZ
Compare the EFS and OS of patients with de novo AML treated with conventional combination chemotherapy with vs without GMTZ censoring MFD SCT recipients
Determine the prevalence and prognostic significance of molecular abnormalities of KIT CCAAT-enhancer binding protein alpha CEBPα and MLL-Partial tandem duplications PTD genes in these patients
Determine the leukemic involvement of hematopoietic early progenitor and its role in defining response to therapy
Assess the ability of a second-generation flow cytometric assay to predict patients at high risk for relapse during periods of clinical remission
Examine whether GMTZ significantly improves EFS and OS in patients with higher CD33 concentrationsintensity
Examine whether GMTZ significantly improves complete remission EFS and OS in each of the cytogenetic risk groups high- intermediate- and low-risk identified in prior Medical Research Council trials
Utilize fluorescence in situ hybridization FISH analysis to identify variant patterns among subgroups of patients who demonstrate the same G-banded chromosomal abnormality eg inv16t1616 t821 11q23 abnormality and determine whether these variant patterns account for the heterogeneity of responses to therapy
Examine the impact of complex karyotypes 3 4 and 5 abnormalities on OS and EFS in intermediate-risk patients for whom no high-risk or low-risk cytogenetic abnormalities exist
OUTLINE This is a randomized multicenter study Patients are stratified according to relapse risk high vs intermediate vs low Patients are randomized to 1 of 2 treatment arms Patients with Down syndrome are nonrandomly assigned to arm I but do not undergo allogeneic stem cell transplant SCT
Arm I standard therapy
Induction 1 Patients receive cytarabine IT at the time of diagnosis or on day 1 Patients also receive cytarabine IV on days 1-10 daunorubicin hydrochloride IV over 6 hours on days 1 3 and 5 and etoposide IV over 4 hours on days 1-5 After 3 weeks of rest all patients regardless of remission status proceed to induction 2
NOTE Patients with Central Nervous System CNS disease receive cytarabine IT twice weekly until the cerebrospinal fluid is clear followed by two additional IT treatments Patients with refractory CNS leukemia after 6 doses of IT treatment are removed from the study
Induction 2 Patients receive cytarabine IT on day 1 cytarabine IV on days 1-8 daunorubicin hydrochloride IV over 6 hours on days 1 3 and 5 and etoposide IV over 4 hours on days 1-5 After 3 weeks of rest patients in complete remission CR proceed to intensification 1 Patients with refractory disease are removed from protocol therapy
Intensification 1 Patients receive cytarabine IT on day 1 high-dose cytarabine IV over 1 hour on days 1-5 and etoposide IV over 1 hour on days 1-5 After 3 weeks of rest patients in remission proceed to intensification 2 followed by intensification 3 Patients in remission proceed to allogeneic SCT 2-8 weeks after blood counts recover Patients with high-risk disease with an alternative donor proceed to intensification 2 and 3 followed by allogeneic SCT Patients not in remission are removed from protocol therapy
Intensification 2 Patients receive cytarabine IT on day 1 high-dose cytarabine IV over 2 hours on days 1-4 and mitoxantrone hydrochloride IV over 1 hour on days 3-6 After 3 weeks of rest patients proceed to intensification 3
Intensification 3 Patients receive high-dose cytarabine IV over 3 hours on days 1 2 8 and 9 and asparaginase intramuscularly on days 2 and 9
Arm II
Induction 1 Patients receive treatment as in induction 1 of arm I Patients also receive gemtuzumab ozogamicin GMTZ IV over 2 hours on day 6
Induction 2 Patients receive treatment as in induction 2 of arm I
Intensification 1 Patients receive treatment as in intensification 1 of arm I
Intensification 2 Patients receive treatment as in intensification 2 of arm I Patients also receive GMTZ IV over 2 hours on day 7
Intensification 3 Patients receive treatment as in intensification 3 of arm I
Allogeneic SCT for patients with intermediate- or high-risk disease
MFD Patients receive a conditioning regimen comprising busulfan IV over 2 hours every 6 hours on days -9 to -6 and cyclophosphamide IV over 1 hour on days -5 to -2 Patients undergo allogeneic SCT on day 0 Patients receive cyclosporine IV or orally twice daily on days -1 to 180 and methotrexate IV on days 1 3 6 and 11 Patients receive graft-vs-host disease GVHD prophylaxis comprising cyclosporine IV over 1-4 hours or orally twice daily on days -1 to 180 and methotrexate IV on days 1 3 6 and 11
Matched alternative donor Patients receive a conditioning regimen comprising busulfan and cyclophosphamide as above Patients also receive antithymocyte globulin IV over 6-8 hours on days -3 to -1 Patients then undergo allogeneic SCT and receive GVHD prophylaxis as above
After completion of study treatment patients are followed periodically for 3 years and then annually thereafter
PROJECTED ACCRUAL A total of 1012 patients will be accrued for this study
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None
Secondary IDs
| Secondary ID | Type | Domain | Link |
|---|---|---|---|
| COG-AAML0531 | OTHER | None | None |
| CDR0000487497 | OTHER | None | None |
| NCI-2009-00320 | REGISTRY | Clinical Trials Reporting Program | None |