Clofarabine Salvage Therapy in Patients With Relapsed or Refractory Acute Myeloid Leukemia (AML) (BRIDGE)
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In relapsed or refractory AML allogeneic HCT is considered to be the only treatment by which long-term disease-free survival can be achieved. Despite this favorable prospect, even in younger patients with relapsed AML only about 40% of the patients reach allogeneic HCT. A number of factors contribute to this low rate of transplantation, among them moderate activity of the salvage regimens and accumulating toxicities which prevent from transplantation; Prospective clinical trials in this indication usually focus either on the rate of CR achieved after a defined number of cycles of salvage therapy or on transplantation modalities. The consequent integration of salvage therapy into a transplant strategy accounting for the time-dependent process of donor search has not been studied so far.
The objective of this study is to evaluate the safety and efficacy of clofarabine salvage therapy prior to allogeneic HCT.
Condition | Intervention | Phase |
---|---|---|
Acute Myeloid Leukemia |
Drug: Clofarabine |
Phase 2 |
Study Type: | Interventional |
Study Design: | Endpoint Classification: Safety/Efficacy Study Intervention Model: Single Group Assignment Masking: Open Label Primary Purpose: Treatment |
Official Title: | Clofarabine Salvage Therapy in Patients With Relapsed or Refractory Acute Myeloid Leukemia |
- Rate of treatment success [ Time Frame: To be evaluated 42 days after start of last cycle of chemotherapy containing clofarabine ] [ Designated as safety issue: No ]Treatment success is defined as a complete remission (CR, CRi or CRchim) at final response assessment after having completed the study treatment. CR and CRi are defined according to standard criteria (ELN). Complete remission by chimerism (CR chim) is defined as a >95% overall donor chimerism assessed by STR-PCR in bone marrow and absence of extramedullary disease together with an absolute neutrophil count >0.5 /nL (500/μL).
- Rate of transplantation [ Time Frame: see evaluation of primary endpoint ] [ Designated as safety issue: No ]Rate of patients who finally proceeded to allogeneic HCT after bridging therapy with Clofarabine
- Adverse drug reactions [ Time Frame: see evaluation of primary endpoint ] [ Designated as safety issue: Yes ]Rate of adverse drug reactions.
- Treatment failure [ Time Frame: see evaluation of primary endpoint ] [ Designated as safety issue: Yes ]Cause specific analysis of treatment failure
Estimated Enrollment: | 84 |
Study Start Date: | March 2011 |
Estimated Study Completion Date: | July 2013 |
Estimated Primary Completion Date: | July 2013 (Final data collection date for primary outcome measure) |
Arms | Assigned Interventions |
---|---|
Experimental: Single Arm
Induction therapy with clofarabine/cytarabine. Post-remission therapy with either allogeneic HCT after conditioning with clofarabine/melphalan if a donor is available, or clofarabine/cytarabine if no donor is available
|
Drug: Clofarabine
Induction and consolidation therapy / conditioning therapy with Clofarabine
|
Detailed Description:
All patients are scheduled for at least one cycle of induction therapy with CLARA. CLARA contains clofarabine 40 mg/m2 (1 hr infusion) days 1-5 followed 3 hours after the end of infusion by intermediate dose cytarabine 1 g/m2 (2 hrs infusion) days 1-5. Patients with moderate early response (reduced marrow blast count but ≥10% at day 15) or patients with progressive disease during delayed hematologic recovery (beyond day 42) may receive re-induction therapy similar to the first cycle induction therapy.
Study treatment comprises up to two cycles of induction therapy and one to two cycles of consolidation chemotherapy for patients without a donor. Consolidation therapy is reduced by 25% and consists of clofarabine 40 mg/m2 (1 hr infusion) days 1-4 followed 3 hours after the end of infusion by intermediate dose cytarabine 1 g/m2 (2 hrs infusion) days 1-4.
Patients for whom a donor can be identified may proceed to allogeneic HCT after CLARA I adopting the concept of allogeneic HCT in aplasia. Patients for whom donor search is more time consuming should proceed to allogeneic HCT once a donor has been identified.
Patients who have achieved a response after the last cycle of CLARA will receive clofarabine as part of the conditioning regimen. Clofarabine and melphalan may only be given as conditioning therapy to patients with HLA-compatible donors with a maximum of one mismatch refering to the HLA-loci A, -B, -C and -DRB1. Conditioning therapy then contains clofarabine 30 mg/m2 (1 hr IV infusion) days -6 to -3 and melphalan 140 mg/m2 (1 hour IV infusion) on day -2.
Ages Eligible for Study: | 40 Years and older |
Genders Eligible for Study: | Both |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Diagnosis of AML according to WHO criteria.
Untreated relapse or refractory disease after a minimum of one standard induction therapy. Treatment of relapse with leukocyte-apheresis or up to 5 days with low dose cytarabine or hydroxyurea is allowed.
- Refractory disease is defined as ≥5% blasts after the second cycle of induction therapy or no reduction in marrow blasts at early treatment assessment (day +15) after the first cycle of induction therapy.
- Relapse is defined as an increase in bone marrow blast count ≥5%, re-appearance of blasts in the peripheral blood or extramedullary disease.
- Age above 40 years.
Have adequate renal and hepatic functions as indicated by the following laboratory values:
- Serum creatinine <=1.0 mg/dL; if serum creatinine >1.0 mg/dL, then the estimated glomerular filtration rate (GFR) must be >60 mL/min/1.73 m2 (see reference below*)
- Serum bilirubin <=1.5× upper limit of normal (ULN)
- Aspartate transaminase (AST)/alanine transaminase (ALT) <=2.5× ULN
- Alkaline phosphatase <=2.5× ULN
- Eligibility for intensive chemotherapy
- Patient needs to be capable to understand the clinical trial as an investigational approach to bridge the time to potential allogeneic HCT, potential risks and benefits of the study.
- Signed written informed consent.
- Female patients of childbearing potential must have a negative serum
- Male and female patients must use an effective contraceptive method during the study and for a minimum of 6 months after study treatment.
Exclusion Criteria:
- For refractory disease, more than two prior induction chemotherapies or more than one prior salvage chemotherapy containing high-dose cytarabine (cumulative dose of cytarabine ≥ 5 g/m2).
- Second or higher relapse. Patients who received hypomethylating agents like azacytidine or decitabine as a treatment of first relapse, respond and relapse later on may be included.
- Acute promyelocytic leukemia with t(15;17)(q22;q12) molecular detection or (PML/RARα).
- Central nervous system involvement (i.e. WBC ≥ 5/µL in cerebrospinal fluid with blasts present on cytospin).
- Prior allogeneic HCT
- Autologous transplantation within 100 days prior to start of study treatment
- Use of investigational agents or anticancer therapy within 10 days before study entry with the exception of hydroxyurea or low-dose cytarabine.
- Have any other severe concurrent disease, or have a history of serious organ dysfunction or disease involving the heart, kidney, liver, or other organ system that may place the patient at undue risk to undergo transplantation.
- Patients with known refractoriness to platelet support.
- Patients with a systemic fungal, bacterial, viral, or other infection not controlled (defined as exhibiting ongoing signs/symptoms related to the infection and without improvement, despite appropriate antibiotics or other treatment).
- Pregnant or lactating patients.
- Any significant concurrent disease, illness, or psychiatric disorder that would compromise patient safety or compliance, interfere with consent, study participation, follow up, or interpretation of study results.
Contact: Johannes Schetelig, MD | +49 (0)351 458-0 ext -15604 | johannes.schetelig@uniklinikum-dresden.de |
Contact: Moritz Middeke | +49 (0)351 458-0 | moritz.middeke@uniklinikum-dresden.de |
Germany | |
HELIOS Klinikum Bad Saarow | Recruiting |
Bad Saarow, Germany | |
Contact: Peter Reichardt, PD Dr. med. peter.reichardt@helios-kliniken.de | |
Principal Investigator: Peter Reichardt, PD Dr. med. | |
Klinikum Bayreuth GmbH | Withdrawn |
Bayreuth, Germany | |
Klinikum Chemnitz gGmbH | Recruiting |
Chemnitz, Germany | |
Contact: Mathias Hänel, PD Dr. m.haenel@skc.de | |
Principal Investigator: Mathias Hänel, PD Dr. | |
University Hospital Carl Gustav Carus | Recruiting |
Dresden, Germany, 01307 | |
Contact: Johannes Schetelig, MD +49 (0)351 458-0 ext -15604 johannes.schetelig@uniklinikum-dresden.de | |
Contact: Moritz J. Middeke moritz.middeke@uniklinikum-dresden.de | |
Principal Investigator: Johannes Schetelig, MD | |
Universitätsklinikum Erlangen | Recruiting |
Erlangen, Germany | |
Contact: Wolf Rösler, Dr. med. wolf.roesler@uk-erlangen.de | |
Principal Investigator: Wolf Rösler, Dr. med. | |
Klinikum der J. W. Goethe-Universität | Not yet recruiting |
Frankfurt am Main, Germany | |
Contact: Gesine Bug, PD Dr. g.bug@em.uni-frankfurt.de | |
Principal Investigator: Gesine Bug, PD Dr. | |
Klinikum Mannheim GmbH | Not yet recruiting |
Mannheim, Germany | |
Contact: Stefan AL Klein, PD Dr. med. stefan.klein@umm.de | |
Principal Investigator: Stefan AL Klein, PD Dr. med. | |
Universitätsklinikum Münster | Not yet recruiting |
Münster, Germany | |
Contact: Steffen Koschmieder, PD Dr. steffen.koschmieder@ukmuenster.de | |
Principal Investigator: Steffen Koschmieder, PD Dr. | |
Klinikum Nürnberg Nord | Recruiting |
Nürnberg, Germany | |
Contact: Kerstin Schäfer-Eckart, Dr. schaefer@klinikum-nuernberg.de | |
Principal Investigator: Kerstin Schäfer-Eckart, Dr. | |
Universitätsklinikum Tübingen | Recruiting |
Tübingen, Germany | |
Contact: Wolfgang Bethge, Prof.Dr.med. wolfgang.bethge@med.uni-tuebingen.de | |
Principal Investigator: Wolfgang Bethge, PD Dr.med. | |
Universitätsklinikum Würzburg | Recruiting |
Würzburg, Germany | |
Contact: Gernot Stuhler, PD Dr. Stuhler_G@medizin.uni-wuerzburg.de | |
Principal Investigator: Gernot Stuhler, PD Dr. |
Principal Investigator: | Johannes Schetelig, MD | Universitätsklinikum Dresden, Med. Klinik und Poliklinik I, Study Alliance Leukemia |
No publications provided
Responsible Party: | Schetelig Johannes, PD Dr. med. Johannes Schetelig, Dresden University of Technology |
ClinicalTrials.gov Identifier: | NCT01295307 History of Changes |
Other Study ID Numbers: | TUD-BRIDGE-046, 2010-022584-35 |
Study First Received: | February 4, 2011 |
Last Updated: | July 23, 2012 |
Health Authority: | Germany: Federal Institute for Drugs and Medical Devices |
Keywords provided by Dresden University of Technology:
acute myeloid leukemia relapsed refractory Relapsed or refractory AML |
Additional relevant MeSH terms:
Leukemia Leukemia, Myeloid, Acute Leukemia, Myeloid Neoplasms by Histologic Type Neoplasms |
Clofarabine Antineoplastic Agents Therapeutic Uses Pharmacologic Actions |
ClinicalTrials.gov processed this record on September 30, 2012