ACUTE MYELOID LEUKEMIA SALVAGE THERAPY FOR PATIENTS IN FIRST RELAPSE OR WHO FAIL TO ACHIEVE AN INITIAL REMISSION OR WHO DEVELOP ACUTE MYELOID LEUKEMIA AS A SECOND MALIGNANT NEOPLASM
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.
Interventional
Primary Purpose: Treatment
Robert J. Wells, MD
Study Chair
Children's Hospital Medical Center, Cincinnati
United States: Federal Government
CDR0000064907
NCT00002805
August 1997
Name | Location |
---|---|
Fred Hutchinson Cancer Research Center | Seattle, Washington 98109 |
Memorial Sloan-Kettering Cancer Center | New York, New York 10021 |
University of Texas - MD Anderson Cancer Center | Houston, Texas 77030-4009 |
University of Michigan Comprehensive Cancer Center | Ann Arbor, Michigan 48109-0752 |
Kaplan Cancer Center | New York, New York 10016 |
Children's Hospital of Philadelphia | Philadelphia, Pennsylvania 19104 |
Mayo Clinic Cancer Center | Rochester, Minnesota 55905 |
Jonsson Comprehensive Cancer Center, UCLA | Los Angeles, California 90095-1781 |
University of Chicago Cancer Research Center | Chicago, Illinois 60637 |
Indiana University Cancer Center | Indianapolis, Indiana 46202-5265 |
University of Iowa Hospitals and Clinics | Iowa City, Iowa 52242 |
University of Minnesota Cancer Center | Minneapolis, Minnesota 55455 |
Lineberger Comprehensive Cancer Center, UNC | Chapel Hill, North Carolina 27599-7295 |
Ireland Cancer Center | Cleveland, Ohio 44106-5065 |
UCSF Cancer Center and Cancer Research Institute | San Francisco, California 94115-0128 |
CCOP - Kalamazoo | Kalamazoo, Michigan 49007-3731 |
Vanderbilt Cancer Center | Nashville, Tennessee 37232-6838 |
CCOP - Merit Care Hospital | Fargo, North Dakota 58122 |
Huntsman Cancer Institute | Salt Lake City, Utah 84112 |
University of Wisconsin Comprehensive Cancer Center | Madison, Wisconsin 53792 |
Herbert Irving Comprehensive Cancer Center | New York, New York 10032 |
Veterans Affairs Medical Center - Fargo | Fargo, North Dakota 58102 |
Cancer Institute of New Jersey | New Brunswick, New Jersey 08901 |
University of Nebraska Medical Center | Omaha, Nebraska 68198-3330 |
Long Beach Memorial Medical Center | Long Beach, California 90806 |
Children's Hospital Los Angeles | Los Angeles, California 90027-0700 |
Children's Hospital of Orange County | Orange, California 92668 |
Children's Hospital of Denver | Denver, Colorado 80218 |
Children's National Medical Center | Washington, District of Columbia 20010-2970 |
Children's Hospital Medical Center - Cincinnati | Cincinnati, Ohio 45229-3039 |
Children's Hospital of Columbus | Columbus, Ohio 43205-2696 |
Doernbecher Children's Hospital | Portland, Oregon 97201-3098 |
Children's Hospital of Pittsburgh | Pittsburgh, Pennsylvania 15213 |
Children's Mercy Hospital - Kansas City | Kansas City, Missouri 64108 |
Children's Hospital and Medical Center - Seattle | Seattle, Washington 98105 |