Cladribine, Idarubicin, Cytarabine, and Venetoclax in Treating Patients With Acute Myeloid Leukemia, High-Risk Myelodysplastic Syndrome, or Blastic Phase Chronic Myeloid Leukemia

Acute Myeloid Leukemia Clinical Trial

Official title:

Phase II Study of Cladribine Plus Idarubicin Plus Cytarabine (ARAC) in Patients With AML, HR MDS, or Myeloid Blast Phase of CML

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
• 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
• 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.

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

External Links

•   University of Texas MD Anderson Cancer Center Website