Persistence Of Major Molecular Remission In Chronic Myeloid Leukemia After A Second Stop Of Tki Treatment In Patients Who Failed An Initial Stop Attempt: A Multicenter Prospective Trial
Overview
- Phase
- Phase 2
- Intervention
- Dasatinib
- Conditions
- CML, Relapsed
- Sponsor
- Amsterdam UMC, location VUmc
- Enrollment
- 134
- Locations
- 20
- Primary Endpoint
- successful MMR maintenance
- Last Updated
- 7 years ago
Overview
Brief Summary
This study will enroll CML patients who have failed a first TKI stopping attempt. After failure and at least a year of TKI treatment, patients will proceed to dasatinib treatment for another 2 years. If MR4 or better is re-achieved and maintained for at least one year, patients will be eligible for a second stop. After verification of MR4, TKI treatment will be stopped and patients followed in the same manner as after first stop. If MMR is lost (BCR-ABL >0.1% (IS)), TKI treatment will once again be restarted.
Detailed Description
The DASTOP2 study aims to retreat patients who relapse in the Euro-SKI study (or who stopped TKI treatment outside trials but according to EURO-SKI procedures), with TKI for at least another 3 years, out of last two years with dasatinib. If MR4 or better is re-achieved and maintained for at least one year, patients will be eligible for a second stop. After verification of MR4, TKI treatment will be stopped and patients followed in the same manner as after first stop. If MMR is lost (BCR-ABL \>0.1% (IS)), TKI treatment will once again be restarted. Patients exhibiting hematological relapse after first stop attempt will not be offered a second stop within this study. The same applies to patients in whom TKI was restarted prematurely (without loss of MMR).
Investigators
J.J.W.M. Janssen
Clinical Hematologist, Deputy Chief of Department of Hematology
Amsterdam UMC, location VUmc
Eligibility Criteria
Inclusion Criteria
- •CML in chronical phase (CP) under TKI treatment after failing a prior attempt to stop treatment within EURO-SKI or outside the study but according to EURO-SKI trial procedures. For the latter group this requires at least 3 years of TKI treatment (first line or second line due to intolerance to first line) before first stop, and MR4 for at least one year before stopping.
- •Treated with TKI for at least one year after having failed a prior attempt to stop TKI. Previous TKI can be any.
- •Typical BCR/ABL1 transcript (b3a2 and/or b2a2) must have been confirmed at diagnosis or later during the disease course.
- •18 years or older.
Exclusion Criteria
- •Previous hematological relapse after first stop of TKI.
- •Previous AP/BC at any time in the history of the disease.
- •Restart of TKI without loss of MMR after first stop
- •Current participation in another clinical study.
- •Previous or planned allogeneic stem cell transplantation.
- •Patients with contra-indications to dasatinib therapy due to comorbidities.
- •Subjects with acute hepatitis B virus (HBV) infections.
- •Uncontrolled or significant cardiovascular disease.
- •Pulmonary arterial hypertension.
- •Pleural or pericardial effusions of any grade at study entry are excluded
Arms & Interventions
dasatinib
2 years of dasatinib treatment before discontinuation if MR 4 is achieved for at least 1 year
Intervention: Dasatinib
Outcomes
Primary Outcomes
successful MMR maintenance
Time Frame: one year
The proportion of patients maintaining MMR at 12 months after discontinuing TKI a second time (survival without loss of major molecular response, MMR, defined as BCR-ABL1 \> 0.1% on IS at one time point).
Secondary Outcomes
- correlates with succesful stop(1 year)
- reachievement of MR4(1 year)
- Time to reachievement of MR4(1 year)
- Adverse events after TKI withdrawal(1 year)
- Overall survival(1 year)
- Progression-free survival(1 year)
- TKI restart without prior molecular relapse(1 year)