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Phase III Randomized Trial of Clofarabine as Induction and Post-Remission Therapy vs. Standard Daunorubicin & Cytarabine Induction and Intermediate Dose Cytarabine Post-Remission Therapy, Followed by Decitabine Maintenance vs. Observation in Newly-Diagnosed Acute Myeloid Leukemia in Older Adults (Age >/= 60 Years)


Phase 3
60 Years
N/A
Open (Enrolling)
Both
Leukemia

Thank you

Trial Information

Phase III Randomized Trial of Clofarabine as Induction and Post-Remission Therapy vs. Standard Daunorubicin & Cytarabine Induction and Intermediate Dose Cytarabine Post-Remission Therapy, Followed by Decitabine Maintenance vs. Observation in Newly-Diagnosed Acute Myeloid Leukemia in Older Adults (Age >/= 60 Years)


OBJECTIVES:

Primary

- To compare the overall survival of older patients with newly diagnosed acute myeloid
leukemia (AML) treated with clofarabine as induction therapy and consolidation therapy
vs standard daunorubicin hydrochloride and cytarabine.

Secondary

- To evaluate complete remission (CR) rates, duration of remission, and
toxicity/treatment-related mortality of patients treated with these regimens.

- To evaluate the feasibility of consolidation therapy with reduced-intensity
conditioning and allogeneic hematopoietic stem cell transplantation from HLA-identical
donors, in terms of the incidence of successful engraftment, acute and chronic
graft-vs-host disease, and transplant-related mortality in select patients age 60-69
years who achieve a response to induction therapy.

- To determine the impact of reduced-intensity conditioning and allogeneic stem cell
transplantation on overall survival of select patients.

- To compare the duration of remission and disease-free survival of patients in CR
following completion of consolidation therapy who are subsequently randomized to
receive decitabine as maintenance therapy vs observation.

- To perform expression and methylation profiling in patients treated with decitabine as
maintenance therapy and to correlate their integrated epigenetic signatures with
response to decitabine.

- To examine the epigenetic profiles of remission marrow in patients randomized to
receive decitabine as maintenance therapy vs observation to determine whether
epigenetic signatures of apparently morphologically normal bone marrow is predictive of
relapse or response to decitabine.

- To explore the possible association of response to clofarabine with nucleoside
transporters hENT1, hCNT3, and ABC-transporter P-glycoprotein.

- To assess the intensity of expression of CXCR4 on diagnostic leukemia cells and to
correlate this parameter with other established prognostic factors.

- To assess the entire spectrum of somatic mutations and affected pathways at diagnosis
of AML and elucidate the association between gene mutation and outcome.

Tertiary

- To compare health-related quality of life (QOL) (physical, functional,
leukemia-specific well-being) and fatigue in patients treated with clofarabine vs
standard induction therapy.

- To measure the change in health-related QOL that occurs over time.

- To comprehensively assess patient function at the time of study enrollment.

- To determine if components of a comprehensive geriatric assessment or QOL scale predict
ability to complete treatment for AML.

- To describe the impact of transplantation on QOL in patients with AML over 60 years of
age.

OUTLINE: This is a multicenter study. Patients are stratified according to age (60-69 years
vs ≥ 70 years), , disease type (secondary vs de novo), therapy-related AML (yes vs no), and
antecedent hematologic disorder (yes vs no).

- Induction therapy: Patients are randomized to 1 of 2 treatment arms.

- Arm I (standard therapy): Patients receive daunorubicin hydrochloride IV over
10-15 minutes on days 1-3 and cytarabine IV continuously on days 1-7. Patients
with residual disease or those who do not achieve an aplastic bone marrow on day
12-14 (i.e., < 5% blasts and < 20% cellularity or markedly/moderately
hypocellular) may receive a second course of induction therapy beginning no sooner
than day 14.

- Arm II: Patients receive clofarabine IV over 1 hour on days 1-5. Patients with
residual disease or those who do not achieve an aplastic bone marrow on day 12-14
(i.e., < 5% blasts and < 20% cellularity or markedly/moderately hypocellular) may
receive a second course of induction therapy beginning no sooner than day 21 and
no later than day 56.

Patients who achieve a complete remission (CR) or CR incomplete (CRi) after induction
therapy proceed to consolidation therapy. Patients who are 60-69 years of age who achieve a
"morphologic leukemia-free state" after induction therapy and who have an HLA-identical
donor proceed to allogeneic stem cell transplantation. Patients undergoing second induction
who do not achieve CR by day 56 of the start of re-induction are taken off protocol.

- Consolidation therapy: Beginning within 60 days after documentation of CR or CRi,
patients receive consolidation therapy in the same arm they were randomized to for
induction therapy.

- Arm I (standard therapy): Patients receive cytarabine IV over 1 hour once or twice
daily on days 1-6. Treatment repeats every 4-6 weeks for 2 courses.

- Arm II: Patients receive clofarabine IV over 1 hour on days 1-5. Treatment repeats
every 4-6 weeks for 2 courses.

Patients who remain in CR after completion of consolidation therapy proceed to maintenance
therapy.

- Maintenance therapy: Beginning within 60 days after completion of consolidation
therapy, patients receive maintenance therapy and are randomized to 1 of 2 arms.

- Arm I: Patients undergo observation monthly for 12 months.

- Arm II: Patients receive decitabine IV over 1 hour on days 1-3. Treatment repeats
every 4 weeks for 12 months the absence of unacceptable toxicity.

- Allogeneic stem cell transplantation with reduced-intensity conditioning regimen:
Patients begin reduced-intensity conditioning 30-90 days after the initiation of
induction therapy.

- Conditioning regimen: Patients receive fludarabine phosphate IV over 30 minutes on
days -7 to -3, busulfan IV over 2 hours every 6 hours on days -4 and -3 (for a
total of 8 doses), and anti-thymocyte globulin IV over 4-6 hours on days -4 to -2.

- Transplantation: Patients undergo allogeneic peripheral blood stem cell
transplantation on day 0.

Patients complete quality-of-life questionnaires periodically, including health-related
quality of life, physical and functional well-being, and fatigue questionnaires.

Peripheral blood, bone marrow, and karyotype samples are collected periodically for
cytogenetic analysis and other correlative laboratory studies.

After completion of study treatment, patients are followed up periodically for ≥ 5 years.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Newly diagnosed acute myeloid leukemia (AML)

- Considered candidates for intensive chemotherapy based on examination of peripheral
blood or bone marrow aspirate specimens or touch preparations of the bone marrow
biopsy obtained within the past 2 weeks

- Bone marrow aspirate is required for enrollment, however, if there is
discordance between percentage of myeloblasts on the differential of the
peripheral blood or aspirate, the peripheral blood criteria are sufficient for
diagnosis

- Patients with secondary AML (defined as AML that has developed in a person with a
history of antecedent blood count abnormalities, myelodysplastic syndromes [MDS], or
a myeloproliferative disorder [excluding chronic myeloid leukemia], or a history of
prior chemotherapy or radiotherapy for a disease other than AML) are eligible

- Patients with acute promyelocytic leukemia (APL) confirmed either by the presence of
t(15;17)(q22;q21) or PML/RAR transcripts will be excluded

- No blastic transformation of chronic myelogenous leukemia

- No documented CNS involvement

- Concurrent registration on ECOG-E3903 (Ancillary Laboratory Protocol for the
Collecting of Diagnostic Samples from Patients With Leukemia or Related Hematologic
Disorders Being Considered for ECOG Treatment Clinical Trials) required (except for
patients participating at CTSU institutions; these patients are exempt from this
requirement)

- Cytogenetic analysis must be performed from diagnostic bone marrow (preferred)
or if adequate number of circulating blasts (>10^9/L) from peripheral blood

- Diagnostic bone marrow and peripheral blood specimens must be submitted for
immunophenotyping and selected molecular testing

- Peripheral blood stem cell donor meeting 1 of the following criteria:

- HLA-identical sibling (6/6)

- Low-resolution HLA typing (A,B,DR) allowed

- Matched unrelated donor (10/10)

- High-resolution class I and II typing (A,B,C,DRB1 and DQ) should be matched
at all 10 loci

PATIENT CHARACTERISTICS:

- ECOG performance status (PS) 0-3 (ECOG PS 0-2 if ≥ 70 years of age)

- AST and ALT ≤ grade 1

- Total serum bilirubin ≤ 1.5 times upper limit of normal (ULN) (≤ grade 1)

- Serum creatinine ≤ 1 mg/dL (≤ grade 1)

- Cardiac ejection fraction ≥ 45% by MUGA or 2-D ECHO

- Fertile patients must use effective contraception

- No concurrent active malignancy requiring treatment (other than MDS)

- No active, uncontrolled infection

- No known HIV infection

PRIOR CONCURRENT THERAPY:

- See Disease Characteristics

- No prior chemotherapy for AML (except for hydroxyurea for increased blast count or
leukapheresis for leukocytes)

- No prior treatment with azacitidine, decitabine, or low-dose cytarabine

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Overall survival

Safety Issue:

No

Principal Investigator

James M. Foran, MD, FRCPC

Investigator Role:

Principal Investigator

Investigator Affiliation:

Mayo Clinic

Authority:

Unspecified

Study ID:

CDR0000659585

NCT ID:

NCT01041703

Start Date:

January 2011

Completion Date:

Related Keywords:

  • Leukemia
  • untreated adult acute myeloid leukemia
  • secondary acute myeloid leukemia
  • adult acute minimally differentiated myeloid leukemia (M0)
  • adult acute myeloblastic leukemia without maturation (M1)
  • adult acute myeloblastic leukemia with maturation (M2)
  • adult acute myelomonocytic leukemia (M4)
  • adult acute monoblastic leukemia (M5a)
  • adult acute monocytic leukemia (M5b)
  • adult erythroleukemia (M6a)
  • adult pure erythroid leukemia (M6b)
  • adult acute megakaryoblastic leukemia (M7)
  • adult acute myeloid leukemia with 11q23 (MLL) abnormalities
  • adult acute myeloid leukemia with del(5q)
  • adult acute myeloid leukemia with inv(16)(p13;q22)
  • adult acute myeloid leukemia with t(16;16)(p13;q22)
  • adult acute myeloid leukemia with t(8;21)(q22;q22)
  • Leukemia
  • Leukemia, Myeloid, Acute
  • Leukemia, Myeloid

Name

Location

Mayo Clinic Scottsdale Scottsdale, Arizona  85259
Mayo Clinic - Jacksonville Jacksonville, Florida  32224
Mayo Clinic Cancer Center Rochester, Minnesota  55905
Cardinal Bernardin Cancer Center at Loyola University Medical Center Maywood, Illinois  60153-5500
CCOP - Christiana Care Health Services Wilmington, Delaware  19899
CCOP - Illinois Oncology Research Association Peoria, Illinois  61602
George Bray Cancer Center at the Hospital of Central Connecticut - New Britain Campus New Britain, Connecticut  06050
Mercy Medical Center - Sioux City Sioux City, Iowa  51104
Siouxland Hematology-Oncology Associates, LLP Sioux City, Iowa  51101
St. Luke's Regional Medical Center Sioux City, Iowa  51104
Baystate Regional Cancer Program at D'Amour Center for Cancer Care Springfield, Massachusetts  01199
Bronson Methodist Hospital Kalamazoo, Michigan  49007
West Michigan Cancer Center Kalamazoo, Michigan  49007-3731
Borgess Medical Center Kalamazooaa, Michigan  49001
MeritCare Bemidji Bemidji, Minnesota  56601
Duluth Clinic Cancer Center - Duluth Duluth, Minnesota  55805-1983
CCOP - Duluth Duluth, Minnesota  55805
Miller - Dwan Medical Center Duluth, Minnesota  55805
MeritCare Broadway Fargo, North Dakota  58122
CCOP - MeritCare Hospital Fargo, North Dakota  58122
Aultman Cancer Center at Aultman Hospital Canton, Ohio  44710-1799
Jewish Hospital Cancer Center Cincinnati, Ohio  45236
St. Rita's Medical Center Lima, Ohio  45801
Abramson Cancer Center of the University of Pennsylvania Philadelphia, Pennsylvania  19104-4283
Geisinger Medical Group - Scenery Park State College, Pennsylvania  16801
Frank M. and Dorothea Henry Cancer Center at Geisinger Wyoming Valley Medical Center Wilkes-Barre, Pennsylvania  18711
Vanderbilt-Ingram Cancer Center Nashville, Tennessee  37232-6838
University of Wisconsin Paul P. Carbone Comprehensive Cancer Center Madison, Wisconsin  53792-6164
Medical College of Wisconsin Cancer Center Milwaukee, Wisconsin  53226
Methodist Medical Center of Illinois Peoria, Illinois  61636
CCOP - Montana Cancer Consortium Billings, Montana  59101
CCOP - Dayton Kettering, Ohio  45429
CCOP - Grand Rapids Grand Rapids, Michigan  49503
CCOP - St. Louis-Cape Girardeau Saint Louis, Missouri  63141
Waukesha Memorial Hospital Regional Cancer Center Waukesha, Wisconsin  53188
Florida Hospital Cancer Institute at Florida Hospital Orlando Orlando, Florida  32803-1273
Mary Babb Randolph Cancer Center at West Virginia University Hospitals Morgantown, West Virginia  26506
Lewistown Hospital Lewistown, Pennsylvania  17044
Mount Nittany Medical Center State College, Pennsylvania  16803
Saint Anthony's Hospital at Saint Anthony's Health Center Alton, Illinois  62002
Good Samaritan Regional Health Center Mt. Vernon, Illinois  62864
Battle Creek Health System Cancer Care Center Battle Creek, Michigan  49017
Munson Medical Center Traverse City, Michigan  49684
David C. Pratt Cancer Center at St. John's Mercy St. Louis, Missouri  63141
Hematology-Oncology Centers of the Northern Rockies - Billings Billings, Montana  59101
St. Peter's Hospital Helena, Montana  59601
Kalispell Regional Medical Center Kalispell, Montana  59901
Glacier Oncology, PLLC Kalispell, Montana  59901
Montana Cancer Center at St. Patrick Hospital and Health Sciences Center Missoula, Montana  59802
MBCCOP - Medical College of Georgia Cancer Center Augusta, Georgia  30912-3730
Swedish-American Regional Cancer Center Rockford, Illinois  61104-2315
Butterworth Hospital at Spectrum Health Grand Rapids, Michigan  49503-2560
CCOP - Nevada Cancer Research Foundation Las Vegas, Nevada  89109-2306
Oklahoma University Cancer Institute Oklahoma City, Oklahoma  73104
Geisinger Cancer Institute at Geisinger Health Danville, Pennsylvania  17822-0001
West Virginia University Health Sciences Center - Charleston Charleston, West Virginia  25302
Gundersen Lutheran Center for Cancer and Blood La Crosse, Wisconsin  54601
Robert H. Lurie Comprehensive Cancer Center at Northwestern University Chicago, Illinois  60611
Decatur Memorial Hospital Cancer Care Institute Decatur, Illinois  62526
Hematology Oncology Associates - Skokie Skokie, Illinois  60076
Joan Karnell Cancer Center at Pennsylvania Hospital Philadelphia, Pennsylvania  19107
St. Joseph Medical Center Bloomington, Illinois  61701
Graham Hospital Canton, Illinois  61520
Memorial Hospital Carthage, Illinois  62321
Hematology and Oncology Associates Chicago, Illinois  60611
Eureka Community Hospital Eureka, Illinois  61530
Mason District Hospital Havana, Illinois  62644
North Shore Oncology and Hematology Associates, Limited - Libertyville Libertyville, Illinois  60048
McDonough District Hospital Macomb, Illinois  61455
BroMenn Regional Medical Center Normal, Illinois  61761
Community Cancer Center Normal, Illinois  61761
Community Hospital of Ottawa Ottawa, Illinois  61350
Oncology Hematology Associates of Central Illinois, PC - Ottawa Ottawa, Illinois  61350
Cancer Treatment Center at Pekin Hospital Pekin, Illinois  61554
Oncology Hematology Associates of Central Illinois, PC - Peoria Peoria, Illinois  61615
OSF St. Francis Medical Center Peoria, Illinois  61637
Proctor Hospital Peoria, Illinois  61614
Illinois Valley Community Hospital Peru, Illinois  61354
Perry Memorial Hospital Princeton, Illinois  61356
St. Francis Hospital and Health Centers - Beech Grove Campus Beech Grove, Indiana  46107
Fort Wayne Medical Oncology and Hematology Fort Wayne, Indiana  46815
Mecosta County Medical Center Big Rapids, Michigan  49307
St. Joseph's Medical Center Brainerd, Minnesota  56401
Saint Francis Medical Center Cape Girardeau, Missouri  63701
Cancer Institute of New Jersey at Cooper - Voorhees Voorhees, New Jersey  08043
Samaritan North Cancer Care Center Dayton, Ohio  45415
Grandview Hospital Dayton, Ohio  45405
David L. Rike Cancer Center at Miami Valley Hospital Dayton, Ohio  45409
Good Samaritan Hospital Dayton, Ohio  45406
Blanchard Valley Medical Associates Findlay, Ohio  45840
Charles F. Kettering Memorial Hospital Kettering, Ohio  45429
Middletown Regional Hospital Middletown, Ohio  45044
UVMC Cancer Care Center at Upper Valley Medical Center Troy, Ohio  45373-1300
Ruth G. McMillan Cancer Center at Greene Memorial Hospital Xenia, Ohio  45385
Welch Cancer Center at Sheridan Memorial Hospital Sheridan, Wyoming  82801
Tunnell Cancer Center at Beebe Medical Center Lewes, Delaware  19958
Kellogg Cancer Care Center Highland Park, Illinois  60035
Cancer Care and Hematology Specialists of Chicagoland - Niles Niles, Illinois  60714
Reid Hospital & Health Care Services Richmond, Indiana  47374
McFarland Clinic, PC Ames, Iowa  50010
Billings Clinic - Downtown Billings, Montana  59107-7000
Bozeman Deaconess Cancer Center Bozeman, Montana  59715
St. James Healthcare Cancer Care Butte, Montana  59701
Great Falls Clinic - Main Facility Great Falls, Montana  59405
Sletten Cancer Institute at Benefis Healthcare Great Falls, Montana  59405
Northern Montana Hospital Havre, Montana  59501
Kalispell Medical Oncology at KRMC Kalispell, Montana  59901
Summa Center for Cancer Care at Akron City Hospital Akron, Ohio  44309-2090
Barberton Citizens Hospital Barberton, Ohio  44203
Wayne Hospital Greenville, Ohio  45331
Geisinger Hazleton Cancer Center Hazleton, Pennsylvania  18201
Penn State Hershey Cancer Institute at Milton S. Hershey Medical Center Hershey, Pennsylvania  17033-0850
Hematology and Oncology Associates of Northeastern Pennsylvania Scranton, Pennsylvania  18510
York Cancer Center at Apple Hill Medical Center York, Pennsylvania  17405
Regional Cancer Center at Memorial Medical Center Springfield, Illinois  62781-0001
Regional Cancer Center at Oconomowoc Memorial Hospital Oconomowoc, Wisconsin  53066
Union Hospital of Cecil County Elkton MD, Maryland  21921
Kinston Medical Specialists Kinston, North Carolina  28501
West Tennessee Cancer Center at Jackson-Madison County General Hospital Jackson, Tennessee  38301
Lacks Cancer Center at Saint Mary's Health Care Grand Rapids, Michigan  49503
Galesburg Clinic, PC Galesburg, Illinois  61401
St. Vincent Healthcare Cancer Care Services Billings, Montana  59101
Midwest Hematology Oncology Group, Incorporated Saint Louis, Missouri  63109
Illinois CancerCare - Bloomington Bloomington%, Illinois  61701
Illinois CancerCare - Canton Canton, Illinois  61520
Illinois CancerCare - Carthage Carthage, Illinois  62321
Illinois CancerCare - Eureka Eureka, Illinois  61530
Illinois CancerCare - Galesburg Galesburg, Illinois  61401
Illinois CancerCare - Havana Havana, Illinois  62644
Illinois CancerCare - Kewanee Clinic Kewanee, Illinois  61443
Illinois CancerCare - Macomb Macomb, Illinois  61455
OSF Holy Family Medical Center Monmouth, Illinois  61462
Illinois CancerCare - Monmouth Monmouth, Illinois  61462
Illinois CancerCare - Community Cancer Center Normal, Illinois  61761
Illinois CancerCare - Pekin Pekin, Illinois  61603
Illinois CancerCare - Peru Peru, Illinois  61354
Illinois CancerCare - Princeton Princeton, Illinois  61356
Illinois CancerCare - Spring Valley Spring Valley, Illinois  61362
Mercy General Health Partners Muskegon, Michigan  49443
Provena St. Mary's Regional Cancer Center - Kankakee Kankakee, Illinois  60901
Tufts Medical Center Cancer Center Boston, Massachusetts  02111
Roger Maris Cancer Center at MeritCare Hospital Fargo, North Dakota  58122
D.N. Greenwald Center Mukwonago, Wisconsin  53149