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Clinical Trial Details — Status: Recruiting

Administrative data

NCT number NCT02115295
Other study ID # 2012-0648
Secondary ID NCI-2014-0110320
Status Recruiting
Phase Phase 2
First received
Last updated
Start date May 19, 2014
Est. completion date May 31, 2026

Study information

Verified date April 2024
Source M.D. Anderson Cancer Center
Contact Tapan Kadia
Phone 713-792-7305
Email tkadia@mdanderson.org
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

This phase II trial studies how well cladribine, idarubicin, cytarabine, and venetoclax work in patients with acute myeloid leukemia, high-risk myelodysplastic syndrome, or blastic phase chronic myeloid leukemia. Drugs used in chemotherapy, such as cladribine, idarubicin, cytarabine, and venetoclax, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading.


Description:

Primary Objectives: I. To determine the complete response rate (CR) of cladribine in combination with idarubicin and cytarabine (araC) in patients with acute myeloid leukemia (AML), high risk (HR) myelodysplastic syndrome (MDS), or myeloid blast phase of chronic myeloid leukemia (CML). Secondary Objectives: I. To determine the overall response rate (ORR) of cladribine in combination with idarubicin and araC in patients with AML, HR MDS, or myeloid blast phase of CML. II. To assess overall survival (OS) and event free survival (EFS) of patients treated with cladribine, idarubicin, and araC (cytarabine). III. To assess the duration of response to the combination in patients with AML, HR MDS, or myeloid blast phase of CML. IV. To determine the safety and tolerability of the combination in patients with AML, HR MDS, or myeloid blast phase of CML. Exploratory Objectives: I. To study and describe the relationship between pretreatment patient/disease characteristics (including AML-associated molecular abnormalities) and outcome. II. To identify molecular biomarkers predictive of response to therapy. III. To study and describe the relationship between patient/disease characteristics, use of intrathecal prophylaxis, and incidence of leptomeningeal disease. IV. To study the trajectories of leukemia mutations and molecular minimal residual disease (MRD) during the therapy. OUTLINE: INDUCTION: Patients receive cladribine intravenously (IV) and cytarabine IV over 1-2 hours on days 1-5 and idarubicin IV over 30-60 minutes on days 1-3. Patients with untreated AML and MDS also receive venetoclax orally (PO) on days 2-8. AML patients with known FLT3-ITD or FLT3 kinase domain mutations may receive midostaurin PO twice daily (BID) on days 6-19 or gilteritinib PO once daily (QD) on days 1-14. Treatment repeats every 28 days for up to 2 cycles in the absence of disease progression or unacceptable toxicity. CONSOLIDATION: Patients receive cladribine IV and cytarabine IV over 1-2 hours on days 1-3 and idarubicin IV over 30-60 minutes on days 1-2. Patients with untreated AML and MDS also receive venetoclax PO on days 2-8. AML patients with known FLT3-ITD or FLT3 kinase domain mutations may receive midostaurin PO BID on days 6-19 or gilteritinib PO QD. Treatment repeats every 28 days for up to 5 cycles in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 6-12 months.


Recruitment information / eligibility

Status Recruiting
Enrollment 508
Est. completion date May 31, 2026
Est. primary completion date May 31, 2025
Accepts healthy volunteers No
Gender All
Age group 18 Years to 65 Years
Eligibility Inclusion Criteria: 1. Patients with a diagnosis of AML, Acute Biphenotypic Leukemia, or high risk MDS (>/= 10% blasts or IPSS >/= intermediate-2) will be eligible. Patients with CML in Myeloid Blast Phase are also eligible. 2. For Frontline cohort (1 or 4): No prior potentially-curative therapy for leukemia. Prior therapy with hydroxyurea, hematopoietic growth factors, azacytidine, decitabine, ATRA, or a total dose of cytarabine up to 2g (for emergency use for stabilization) is allowed. Patients deemed able to receive venetoclax (ie. insurance clearance) will be assigned to Frontline cohort 4. Patients with secondary AMLwho have been treated for their antecedent myeloid neoplasm will be enrolled into the separate Secondary AML cohort. 3. For Salvage cohort: Patients with previously treated, relapsed or refractory AML, Acute Biphenotypic Leukemia, or CML in Myeloid Blast Phase are eligible. 4. Age </= 65 years. 5. Adequate organ function as defined below: - liver function (bilirubin < 2mg/dL, AST and/or ALT <3 x ULN - or <5 x ULN if related to leukemic involvement) - kidney function (creatinine < 1.5 x ULN ). - known cardiac ejection fraction of > or = 45% within the past 6 months 6. ECOG performance status of = 2. 7. A negative urine pregnancy test is required within 1 week for all women of childbearing potential prior to enrolling on this trial. 8. Patient must have the ability to understand the requirements of the study and signed informed consent. A signed informed consent by the patient is required prior to their enrollment on the protocol. Exclusion Criteria: 1. Pregnant women are excluded from this study because the agents used in this study have the potential for teratogenic or abortifacient effects. Because there is a potential risk for adverse events in nursing infants secondary to treatment of the mother with the chemotherapy agents, breastfeeding should also be avoided. 2. Uncontrolled intercurrent illness including, but not limited to active uncontrolled infection, symptomatic congestive heart failure (NYHA Class III or IV), unstable angina pectoris, clinically significant cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements. 3. Patient with documented hypersensitivity to any of the components of the chemotherapy program. 4. Men and women of childbearing potential who do not practice contraception. Women of childbearing potential and men must agree to use contraception prior to study entry and for the duration of study participation.

Study Design


Related Conditions & MeSH terms

  • Acute Biphenotypic Leukemia
  • Acute Myeloid Leukemia
  • Blast Crisis
  • Blast Phase Chronic Myelogenous Leukemia, BCR-ABL1 Positive
  • Blasts 10 Percent or More of Bone Marrow Nucleated Cells
  • Blasts 10 Percent or More of Peripheral Blood White Cells
  • de Novo Myelodysplastic Syndrome
  • Leukemia
  • Leukemia, Biphenotypic, Acute
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive
  • Leukemia, Myeloid
  • Leukemia, Myeloid, Acute
  • Myelodysplastic Syndrome
  • Myelodysplastic Syndromes
  • Preleukemia
  • Previously Treated Myelodysplastic Syndrome
  • Recurrence
  • Recurrent Acute Myeloid Leukemia
  • Recurrent Chronic Myelogenous Leukemia, BCR-ABL1 Positive
  • Refractory Acute Myeloid Leukemia
  • Refractory Chronic Myelogenous Leukemia, BCR-ABL1 Positive
  • Secondary Acute Myeloid Leukemia
  • Syndrome
  • Untreated Adult Acute Myeloid Leukemia

Intervention

Drug:
Cladribine
Given IV
Cytarabine
Given IV
Gilteritinib
Given PO
Idarubicin
Given IV
Other:
Laboratory Biomarker Analysis
Correlative studies
Drug:
Midostaurin
Given PO
Venetoclax
Given PO

Locations

Country Name City State
United States M D Anderson Cancer Center Houston Texas

Sponsors (2)

Lead Sponsor Collaborator
M.D. Anderson Cancer Center National Cancer Institute (NCI)

Country where clinical trial is conducted

United States, 

Outcome

Type Measure Description Time frame Safety issue
Other Use of intrathecal prophylaxis The relationship between patient/disease characteristics and use of intrathecal prophylaxis will be studied and described. Up to 12 months
Other Incidence of leptomeningeal disease The relationship between patient/disease characteristics and incidence of leptomeningeal disease will be studied and described. Up to 12 months
Primary Complete response (CR) rate CR rate will be determined. Up to 12 months
Secondary Overall response rate (ORR) ORR will be determined. Up to 12 months
Secondary Overall survival (OS) OS will be assessed. Up to 12 months
Secondary Event-free survival (EFS) EFS will be assessed. Up to 12 months
Secondary Duration of response Duration of response will be assessed. Up to 12 months
Secondary Incidence of toxicities Safety and tolerability of cladribine in combination with idarubicin and cytarabine will be determined. Up to 12 months
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