Risk-adapted Therapy for Primary Acute Myeloid Leukemia
- Conditions
- Leukemia, Myeloid, Acute
- Interventions
- Procedure: Allogeneic matched or unrelated donor transplant.Procedure: Autologous peripheral blood stem cell transplantProcedure: Measurable residual disease
- Registration Number
- NCT04687098
- Brief Summary
The AML-12 study investigates the efficacy and toxicity of standard induction chemotherapy with idarubicin and cytarabine (IC) with G-CSF priming followed by a risk-adapted post remission therapy for patients up to the age of 70 diagnosed with de novo acute myeloid leukemia (AML).
Modifications from the previous protocol AML-03 (NCT01723657) include removal of etoposide in induction, limitation of the GCSF priming to the induction phase and categorization of post remission therapy (stem cell transplant or 2 high dose cytarabine consolidations) according to diagnostic genetics as well as post-remission clearance of measurable residual disease.
The aims of these modifications are to improve the overall survival and leukemia free survival of acute myeloid leukemia patients with a risk-adapted approach.
- Detailed Description
Induction chemotherapy: Idarubicin (12mg/m2/day intravenous, days 1-3), Low-dose cytarabine (200mg/m2/day, intravenous in continuous infusion, days 1-7) and G-CSF priming 150mcg/m2/day, subcutaneous from day 0 to the last day of chemotherapy if white blood cell count (WBC) \<30x10E9/L.
This induction chemotherapy can be repeated twice in the case of partial response (PR) to achieve complete response (CR).
Once CR is achieved (with one or two induction cycles), all patients receive a consolidation course with high-dose cytarabine (3000mg/m2/12h days 1, 3 and 5) and pegfilgrastim 6mg on day 6.
After this, patients will be allocated to the different risk groups as follows:
* Favorable risk group \[patients with t(8;21)(q22;q22)/RUNX1/RUNX1T1, inv(16)(p12;q22) or t(16;16)/CBFB/MYH11; Intermediate risk cytogenetics (MRC 2010) and NPM1 mutation with FLT3 wild type or low ratio of FLT3 internal tandem duplication (ITD)/wild type (\<0.5); or CEBPA biallelic mutation\]. Patients in this group will receive 2 additional courses of consolidation therapy
* Intermediate risk group \[Intermediate risk cytogenetics (MRC 2010) without NPM1 mutations, FLT3-ITD, or CEBPA biallelic mutation\]. Patients in this group receive an allogeneic stem cell transplant in first CR. Patients without an available donor can be autografted per center decision
* Adverse risk group \[Adverse risk cytogenetics (MRC 2010), intermediate cytogenetics with FLT3-ITD without NPM1 mutation or NPM1-FLT3-ITD high ratio or MLL rearrangement; any favorable or intermediate risk patients with positive MRD following 1 (intermediate) or 2 (favorable) consolidation courses\]. Intention to treat of those patients is allogeneic stem cell transplant from any source.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 1034
- Patients with newly diagnosed AML, classified using the World Health Organization (WHO) 2017 criteria.
- Patients with 70 years old or younger.
- Patients previously treated for the AML with chemotherapy different from hydroxyurea.
- Acute promyelocytic leukemia with t(15;17).
- Chronic myeloid leukemia in blastic phase.
- Secondary AML or therapy related AML.
- Presence of concomitant active neoplastic disease.
- Abnormal renal and hepatic functions with creatinin and/or bilirubin 2 times higher than the normal threshold, except when the alteration should be attributed to the leukemia.
- Patients with a cardiac ejection fraction below 45%, symptomatic cardiac deficiency or both.
- Patients with neurological or concomitant psychiatric disease.
- HIV infection.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Risk-adapted postremission treatment. Allogeneic matched or unrelated donor transplant. Induction (idarubicin, cytarabine), first consolidation (high dose cytarabine), risk- stratification: allogeneic matched related or unrelated donor transplant vs. consolidation courses. Risk-adapted postremission treatment. Autologous peripheral blood stem cell transplant Induction (idarubicin, cytarabine), first consolidation (high dose cytarabine), risk- stratification: allogeneic matched related or unrelated donor transplant vs. consolidation courses. Risk-adapted postremission treatment. Measurable residual disease Induction (idarubicin, cytarabine), first consolidation (high dose cytarabine), risk- stratification: allogeneic matched related or unrelated donor transplant vs. consolidation courses. Risk-adapted postremission treatment. Idarubicin Induction (idarubicin, cytarabine), first consolidation (high dose cytarabine), risk- stratification: allogeneic matched related or unrelated donor transplant vs. consolidation courses. Risk-adapted postremission treatment. Ara-C Induction (idarubicin, cytarabine), first consolidation (high dose cytarabine), risk- stratification: allogeneic matched related or unrelated donor transplant vs. consolidation courses. Risk-adapted postremission treatment. G-CSF Induction (idarubicin, cytarabine), first consolidation (high dose cytarabine), risk- stratification: allogeneic matched related or unrelated donor transplant vs. consolidation courses.
- Primary Outcome Measures
Name Time Method Complete remission rate (CRR) 2 months Analyze the efficacy and toxicity of the current doses of IC (Idarubicin and cytarabine) with G-CSF priming to achieve complete remission in patients tih AML up to 70yo.
Disease free survival (DFS) 4 years Analyze the disease free survival in the whole cohort of AML patients.
Relapse rate (RR) 4 years Analyze the relapse rate of all patients achieving remission with intensive induction followed by risk-adapted consolidation strategies.
- Secondary Outcome Measures
Name Time Method Feasibility of centralized monitoring of measurable residual disease (MRD) 4 years Survival outcomes in positive vs negative MRD patients. Number of patients with modified risk due to positive MRD.
Comparison of global outcomes with previous protocol (AML-03) and other published protocols. 4 years Comparison of CRR, OS, RR and DFS
Feasibility of treatment completion 4 years Increase the number of patients who complete all treatment phases
Survival outcome analysis of the 3 risk-adapted categories (favourable, intermediate and adverse) 4 years Evaluate the feasibility of the consolidation treatments in the different risk groups by comparison of overall survival (OS), RR and DFS.
Trial Locations
- Locations (15)
ICO Hospital Universitari de Bellvitge
🇪🇸Hospitalet de Llobregat, Barcelona, Spain
Hospital Universitari Son Espases
🇪🇸Palma de Mallorca, Mallorca, Spain
Hospital Universitari Son Llatzer
🇪🇸Palma de Mallorca, Mallorca, Spain
Hospital Vall d'Hebron
🇪🇸Barcelona, Spain
Hospital Clinic Barcelona
🇪🇸Barcelona, Spain
Hospital del Mar
🇪🇸Barcelona, Spain
Hospital de la Santa Creu i Sant Pau
🇪🇸Barcelona, Spain
ICO-Girona Hopital Universitari de Girona Dr. Josep Trueta
🇪🇸Girona, Spain
Hospital Universitario Virgen de la Victoria
🇪🇸Malaga, Spain
Hospital Universitari Arnau de Vilanova
🇪🇸Lleida, Spain
ICO Tarragona-Hospital Universitari Joan XXIII
🇪🇸Tarragona, Spain
Mutua de Terrassa
🇪🇸Terrassa, Spain
Hospital Clínico Universitario de Valencia
🇪🇸Valencia, Spain
ICO Badalona-Hospital Universitari Germans Trias i Pujol
🇪🇸Badalona, Barcelona, Spain
Hospital Verge de la Cinta
🇪🇸Tortosa, Tarragona, Spain