LeukemiaPhase 3NCT00121303
Cytarabine and Daunorubicin With or Without Gemtuzumab Ozogamicin in Treating Older Patients With Acute Myeloid Leukemia or Myelodysplastic Syndromes
A Phase 3 study testing cytarabine, daunorubicin hydrochloride and gemtuzumab ozogamicin in people with Leukemia and Myelodysplastic Syndromes, run by Stichting Hemato-Oncologie voor Volwassenen Nederland at 6 sites in United Kingdom.
Trial summary
RATIONALE: Drugs used in chemotherapy, such as cytarabine and daunorubicin, 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 ozogamicin, can block cancer growth in different ways. Read more about this study
- Who is it for?
- Ages 61 to 120 years
- Conditions the study is for
- Leukemia, Myelodysplastic Syndromes
- What is being tested?
- cytarabine, daunorubicin hydrochloride and gemtuzumab ozogamicin
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 600 participants
- Where
- 6 sitesUnited Kingdom
- Study dates
- Jan 2005to Jun 2016
- Phase
- Phase 3
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 61 to 120 years
- All sexes
- No healthy volunteers
- Adult, Older adult
DISEASE CHARACTERISTICS:
- Histologically or cytologically confirmed diagnosis of 1 of the following:
- Acute myeloid leukemia (AML)
- M0-M2 or M4-M7 FAB subtype
- No AML with cytogenetic abnormality t(15;17) (M3)
- Patients with secondary AML progressing from prior myelodysplasia* or biphenotypic leukemia are eligible
- Refractory anemia with excess blasts (RAEB) or RAEB in transformation
- International Prognostic Scoring System score ≥ 1.5 NOTE: *Any prior hematological disease of ≥ 4 months duration
- No chronic myelogenous leukemia in blastic crisis
- No prior polycythemia rubra vera
- No primary myelofibrosis
PATIENT CHARACTERISTICS:
Age
- 61 and over
Performance status
- WHO 0-2
Life expectancy
- Not specified
Hematopoietic
- Not specified
Hepatic
- ALT and/or AST ≤ 2.5 times upper limit of normal (ULN)*
- Bilirubin ≤ 2 times ULN* NOTE: *Unless elevation is caused by organ infiltration by AML
Renal
- Creatinine ≤ 2 times ULN* NOTE: *Unless elevation is caused by organ infiltration by AML
Cardiovascular
- No myocardial infarction within the past 6 months
- LVEF > 50% by MUGA, echocardiogram, or other methods
- No unstable angina
- No unstable cardiac arrhythmia
- No severe and/or uncontrolled hypertension
Other
- No uncontrolled diabetes
- No severe and/or uncontrolled infection
- No other severe and/or uncontrolled medical condition
PRIOR CONCURRENT THERAPY:
Biologic therapy
- Not specified
Chemotherapy
- More than 6 months since prior chemotherapy
Endocrine therapy
- Not specified
Radiotherapy
- Not specified
Surgery
- Not specified
Other
- No prior induction therapy for AML or myelodysplastic syndromes
Trial locations and contacts
6 sites in 1 country.
6 sites in 1 country
United Kingdom6 sites
North Hampshire Hospital
Basingstoke, England, RG24 9NA
Kent and Canterbury Hospital
Canterbury, England, CT2 7NR
University Hospital of Wales
Cardiff, Wales, CF14 4XW
Medway Maritime Hospital
Gillingham Kent, England, ME7 5NY
Maidstone Hospital
Maidstone, England, ME16 9QQ
Royal Cornwall Hospital
Truro, Cornwall, England, TR1 3LJ
About this study
Official title: Randomised Induction and Post Induction Therapy in Older Patients (≥61 Years of Age) With Acute Myeloid Leukemia (AML) and Refractory Anemia With Excess Blasts (RAEB, RAEB-t)
RATIONALE: Drugs used in chemotherapy, such as cytarabine and daunorubicin, 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 ozogamicin, 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. It is not yet known whether cytarabine and daunorubicin followed by gemtuzumab ozogamicin is more effective than cytarabine and daunorubicin in treating acute myeloid leukemia or myelodysplastic syndromes.
PURPOSE: This randomized phase III trial is studying cytarabine and two different doses of daunorubicin to see how well they work compared to cytarabine and daunorubicin followed by gemtuzumab ozogamicin in treating older patients with acute myeloid leukemia or myelodysplastic syndromes.
Read the detailed description
OBJECTIVES:
Primary
- Compare the event-free and disease-free survival of older patients with acute myeloid leukemia, refractory anemia with excess blasts (RAEB), or RAEB in transformation treated with induction therapy comprising cytarabine in combination with two different doses of daunorubicin followed by cytarabine alone with or without post-induction therapy comprising gemtuzumab ozogamicin.
Secondary
- Compare the complete remission rate in patients treated with these regimens.
- Compare the overall survival of patients treated with these regimens.
- Compare the toxicity of these regimens in these patients.
- Determine the probability of relapse and death during first complete remission in patients treated with post-induction gemtuzumab ozogamicin.
- Correlate prognostic factors (e.g., CD33 positivity, multidrug resistance phenotype, or cytogenetics) with probability of complete remission and overall, event-free, and disease-free survival of patients treated with these regimens.
OUTLINE: This is a randomized, multicenter study. Patients are stratified according to participating center and diagnosis (acute myeloid leukemia [AML] vs myelodysplastic syndromes [MDS]) for induction therapy. Patients are stratified according to participating center, diagnosis (AML vs MDS), induction treatment arm (I vs II), and response to induction therapy (complete remission [CR] vs no CR) for post-induction therapy.
- Induction therapy (course 1): Patients are randomized to 1 of 2 induction treatment arms.
- Arm I: Patients receive cytarabine IV continuously on days 1-7 and daunorubicin IV over 3 hours on days 1-3.
- Arm II: Patients receive cytarabine as in arm I and daunorubicin as in arm I but at a higher dose.
Approximately 28-35 days after the start of course 1 (or sooner if the bone marrow shows evidence of resistant disease), patients in both arms proceed to course 2 of induction therapy.
- Induction therapy (course 2): All patients receive cytarabine IV over 6 hours twice daily on days 1-6.
After completion of course 2, patients undergo assessment of remission status. Patients who do not achieve CR are removed from the study. Patients achieving CR proceed to post-induction therapy and undergo a second randomization.
- Post-induction therapy: Patients are randomized to 1 of 2 post-induction treatment arms.
- Arm I: Patients receive no further chemotherapy.
- Arm II: Patients receive gemtuzumab ozogamicin IV over 2 hours on days 1, 29, and 57 in the absence of disease relapse or unacceptable toxicity.
After completion of study treatment, patients are followed monthly for 1 year, every 3 months for 2 years, every 4-6 months for 2 years, and then periodically thereafter.
PROJECTED ACCRUAL: A total of 600 patients will be accrued for this study within 4-5 years.
- Conditions
- Leukemia, Myelodysplastic Syndromes
- Being tested
- cytarabine, daunorubicin hydrochloride, gemtuzumab ozogamicin
- Keywords
- adult acute monocytic leukemia (M5b), adult erythroleukemia (M6a), adult pure erythroid leukemia (M6b), adult acute megakaryoblastic leukemia (M7), adult acute myeloblastic leukemia with maturation (M2), adult acute myeloblastic leukemia without maturation (M1), adult acute myelomonocytic leukemia (M4), adult acute monoblastic leukemia (M5a), refractory anemia with excess blasts in transformation, refractory anemia with excess blasts, secondary acute myeloid leukemia, untreated adult acute myeloid leukemia, de novo myelodysplastic syndromes, adult acute minimally differentiated myeloid leukemia (M0), adult acute myeloid leukemia with 11q23 (MLL) abnormalities, 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), secondary myelodysplastic syndromes
- Medical subject headings
- Leukemia, Myelodysplastic Syndromes, Leukemia, Monocytic, Acute, Leukemia, Erythroblastic, Acute, Leukemia, Megakaryoblastic, Acute, Leukemia, Myeloid, Acute, Leukemia, Myelomonocytic, Acute, Anemia, Refractory, with Excess of Blasts
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
cytarabineDrug
daunorubicin hydrochlorideDrug
gemtuzumab ozogamicinDrug
| Study group | Role | What they receive |
|---|---|---|
| Arm A low dose Dauno | Active comparator | Induction 45 mg Dauno Receives: Drug: cytarabine; Drug: daunorubicin hydrochloride |
| ARM B high dose Dauno | Experimental | Induction 90 mg Dauno Receives: Drug: cytarabine; Drug: daunorubicin hydrochloride |
| Arm 1 no further treatment | No intervention | Not described |
| Arm 2 Mylotarg | Experimental | Post induction treatment with Mylotarg Receives: Drug: gemtuzumab ozogamicin |
What is being measured
The primary outcome is the main question the study is designed to answer.
Event-free survival after induction therapy
Disease-free survival after maintenance therapy
Secondary outcomes (6)
Complete remission (CR) rate after induction therapy
Overall survival after induction therapy
Toxicity after induction therapy
Toxicity after maintenance therapy
Probability of relapse and death in first CR after maintenance therapy
Overall survival after maintenance therapy
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted21 Jul 2005 (estimated)
- Study startJan 2005
- Primary completionJan 2009
- Study completionJun 2016
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for LeukemiaStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 3
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 600 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Stichting Hemato-Oncologie voor Volwassenen Nederland
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Jonathan Kell, MRCPath, Study chair, University Hospital of Wales
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT00121303
- Sponsor's protocol ID
- CDR0000433422
- Other IDs
- SAKK-AML-43, EU-20514, HOVON-AML-43
- Status last verified
- Sep 2016
- First submitted
- 19 Jul 2005
- Last updated
- 20 Sep 2016
- Results posted
- No
Study at a glance
From the registry record, last updated by the sponsor on 20 Sep 2016. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Randomised Induction and Post Induction Therapy in Older Patients (≥61 Years of Age) With Acute Myeloid Leukemia (AML) and Refractory Anemia With Excess Blasts (RAEB, RAEB-t)
- ClinicalTrials.gov ID
- NCT00121303
- Acronym / sponsor ID
- CDR0000433422
- Conditions
- Leukemia, Myelodysplastic Syndromes
- Keywords
- adult acute monocytic leukemia (M5b), adult erythroleukemia (M6a), adult pure erythroid leukemia (M6b), adult acute megakaryoblastic leukemia (M7), adult acute myeloblastic leukemia with maturation (M2), adult acute myeloblastic leukemia without maturation (M1), adult acute myelomonocytic leukemia (M4), adult acute monoblastic leukemia (M5a)
- Phase
- Phase 3
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 600 participants (estimated)
- Lead sponsor
- Stichting Hemato-Oncologie voor Volwassenen NederlandUniversity, hospital or other
- Study start
- Jan 2005
- Primary completion
- Jan 2009 (actual)
- Study completion
- Jun 2016 (actual)
- First posted
- 21 Jul 2005 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
RATIONALE: Drugs used in chemotherapy, such as cytarabine and daunorubicin, 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 ozogamicin, 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. It is not yet known whether cytarabine and daunorubicin followed by gemtuzumab ozogamicin is more effective than cytarabine and daunorubicin in treating acute myeloid leukemia or myelodysplastic syndromes.
PURPOSE: This randomized phase III trial is studying cytarabine and two different doses of daunorubicin to see how well they work compared to cytarabine and daunorubicin followed by gemtuzumab ozogamicin in treating older patients with acute myeloid leukemia or myelodysplastic syndromes.
Detailed description
OBJECTIVES:
Primary
- Compare the event-free and disease-free survival of older patients with acute myeloid leukemia, refractory anemia with excess blasts (RAEB), or RAEB in transformation treated with induction therapy comprising cytarabine in combination with two different doses of daunorubicin followed by cytarabine alone with or without post-induction therapy comprising gemtuzumab ozogamicin.
Secondary
- Compare the complete remission rate in patients treated with these regimens.
- Compare the overall survival of patients treated with these regimens.
- Compare the toxicity of these regimens in these patients.
- Determine the probability of relapse and death during first complete remission in patients treated with post-induction gemtuzumab ozogamicin.
- Correlate prognostic factors (e.g., CD33 positivity, multidrug resistance phenotype, or cytogenetics) with probability of complete remission and overall, event-free, and disease-free survival of patients treated with these regimens.
OUTLINE: This is a randomized, multicenter study. Patients are stratified according to participating center and diagnosis (acute myeloid leukemia [AML] vs myelodysplastic syndromes [MDS]) for induction therapy. Patients are stratified according to participating center, diagnosis (AML vs MDS), induction treatment arm (I vs II), and response to induction therapy (complete remission [CR] vs no CR) for post-induction therapy.
- Induction therapy (course 1): Patients are randomized to 1 of 2 induction treatment arms.
- Arm I: Patients receive cytarabine IV continuously on days 1-7 and daunorubicin IV over 3 hours on days 1-3.
- Arm II: Patients receive cytarabine as in arm I and daunorubicin as in arm I but at a higher dose.
Approximately 28-35 days after the start of course 1 (or sooner if the bone marrow shows evidence of resistant disease), patients in both arms proceed to course 2 of induction therapy.
- Induction therapy (course 2): All patients receive cytarabine IV over 6 hours twice daily on days 1-6.
After completion of course 2, patients undergo assessment of remission status. Patients who do not achieve CR are removed from the study. Patients achieving CR proceed to post-induction therapy and undergo a second randomization.
- Post-induction therapy: Patients are randomized to 1 of 2 post-induction treatment arms.
- Arm I: Patients receive no further chemotherapy.
- Arm II: Patients receive gemtuzumab ozogamicin IV over 2 hours on days 1, 29, and 57 in the absence of disease relapse or unacceptable toxicity.
After completion of study treatment, patients are followed monthly for 1 year, every 3 months for 2 years, every 4-6 months for 2 years, and then periodically thereafter.
PROJECTED ACCRUAL: A total of 600 patients will be accrued for this study within 4-5 years.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 4
| Arm | Type | Receives |
|---|---|---|
| Arm A low dose Dauno | Active comparator | Drug: cytarabine, Drug: daunorubicin hydrochlorideInduction 45 mg Dauno |
| ARM B high dose Dauno | Experimental | Drug: cytarabine, Drug: daunorubicin hydrochlorideInduction 90 mg Dauno |
| Arm 1 no further treatment | No intervention | – |
| Arm 2 Mylotarg | Experimental | Drug: gemtuzumab ozogamicinPost induction treatment with Mylotarg |
Who may qualify
- Ages
- 61 to 120 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| cytarabine | Drug | ARM B high dose Dauno, Arm A low dose Dauno |
| daunorubicin hydrochloride | Drug | ARM B high dose Dauno, Arm A low dose Dauno |
| gemtuzumab ozogamicin | Drug | Arm 2 Mylotarg |
Primary outcome
Event-free survival after induction therapy
Disease-free survival after maintenance therapy
6 secondary outcomes
Complete remission (CR) rate after induction therapy
Overall survival after induction therapy
Toxicity after induction therapy
Toxicity after maintenance therapy
Probability of relapse and death in first CR after maintenance therapy
Overall survival after maintenance therapy
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 20 Sep 2016.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Jonathan Kell, MRCPath study chair
University Hospital of Wales
6 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 3 study testing cytarabine, daunorubicin hydrochloride and gemtuzumab ozogamicin in people with Leukemia and Myelodysplastic Syndromes, run by Stichting Hemato-Oncologie voor Volwassenen Nederland at 6 sites in United Kingdom.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 20 Sep 2016. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 6 sites in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Event-free survival after induction therapy. The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 20 Sep 2016.