NCT01390311已完成1 期
A Phase I Study of the Safety and Feasibility of Azacitidine After Donor Lymphocyte Infusion for Patients With Relapsed Acute Myeloid Leukemia or Myelodysplastic Syndrome After Allogeneic Stem Cell Transplantation
适应症
干预措施
相关药物
试验速览
- 阶段
- 1 期
- 状态
- 已完成
- 入组人数
- 14
- 试验地点
- 1
- 主要终点
- MTD and DLT of azacitidine when given after DLI
研究概览
简要总结
This phase I trial studies the effects and safety of adding azacitidine (5-AzaC) to the standard of care (Soc) for patients with relapsed acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) after being treated with donor stem cell transplant. SoC includes giving an infusion of the donor's white blood cells (donor lymphocyte infusion or DLI) to boost the anticancer effects of the transplant. Giving 5-AzaC after DLI may alter the function of T-cells resulting in reduced incidence of graft versus host disease (GVHD) while maintaining the anticancer effects.
详细描述
PRIMARY OBJECTIVES:
-To determine the Maximum Tolerated Dose (MTD) of 5-AzaC (azacitidine) when given after chemotherapy and DLI in patients with AML/MDS who relapse after allogeneic stem cell transplant.
SECONDARY OBJECTIVES:
- To determine the rate of Grades II-IV and III-IV acute GVHD (aGVHD) in first 100 days after DLI.
- To determine the rates of complete remission (CR), partial remission, (PR) and complete remission with incomplete count recovery (CRi), and overall response rate (CR+ CRi + PR).
- To determine overall survival 100 days after DLI.
- To determine the effects of increasing dose of 5-AzaC on frequency and absolute number of resting regulatory T-cells (rTregs) and activated Tregs (aTregs) at baseline, 7 days, 14 days, 21 days, and ~60 days after first dose of 5-AzaC.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Must have a diagnosis of AML/MDS based on 2008 World Health Organization (WHO) classification of myeloid malignancies
- •Must have laboratory, histologic, or cytogenetic evidence of disease relapse after allogeneic hematopoietic stem cell transplant (HSCT) and require salvage therapy followed by DLI
- •Must have original donor
- •Must have life expectancy >= 2 months
- •Must be ≥ 18 years old. Azacitidine is not approved by the FDA for use in children
- •Must have an Eastern Cooperative Oncology Group (ECOG) performance status =< 3
- •Must have laboratory results indicating:
- •Total bilirubin < 2.0 mg/dL
- •Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) =< 3 X the upper limit of institutional normal
- •Serum creatinine =< 2.0 mg/dL
- •Patient must have ability to understand and willingness to provide written informed consent prior to participation in the study and any related procedures being performed
- •The effects of 5-AzaC on the developing human fetus at the recommended therapeutic dose are unknown; for this reason and because category D agents as well as other therapeutic agents used in this trial are known to be teratogenic, women of childbearing age must have a negative serum pregnancy test (Beta [B]-human chorionic gonadotropin) within 72 hours prior to initiating therapy and be willing to not become pregnant by using effective contraception while undergoing treatment and for at least 3 months afterwards; azacitidine is a pregnancy category D drug and could be harmful to or cause loss of a fetus; should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately
- •Men must be willing not to father a new child while receiving therapy; they must use an effective barrier method of contraception during the study and for 3 months following the last dose
- •Both men and women and members of all races and ethnic groups are eligible for this trial
- •DONOR Inclusion Criteria:
- •Must be the original donor for the allogeneic bone marrow transplant patient
- •Must have signed the standard informed consent form; if sufficient cryopreserved cells remain from a previous donation, no additional donation or consent is required
- •Must be eligible according to Washington University "Guidelines for Eligibility of Normal Donors" or per National Marrow Donor Program (NMDP) standards if unrelated donor
- •Both men and women and members of all races and ethnic groups are eligible for this trial
排除标准
- •Must not have Grade III-IV GVHD
- •Must not have an advanced malignant hepatic tumor
- •Must not receive anti-thymocyte globulin, campath (alemtuzumab) or daclizumab within 4 weeks of DLI
- •Must not receive any other forms of chemotherapy after cell infusion during the treatment protocol
- •Must not be receiving any other investigational agents within 14 days of first dose of study drug
- •Must not have uncontrolled intercurrent illness including ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, or psychiatric illness/social situations that would limit compliance with study requirements
- •Must not be pregnant or breastfeeding; pregnant women are excluded from this study because azacitidine is a Category D agent with the potential for teratogenic or abortifacient effects; because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with azacitidine, breastfeeding should be discontinued if the mother is treated with azacitidine; these potential risks may also apply to other agents used in this study
- •Must not have a history of allergic reactions attributed to compounds of similar chemical or biologic composition to azacitidine or other agents used in the study
- •Must not have a known or suspected hypersensitivity to azacitidine or mannitol.
- •Must not be human immunodeficiency virus (HIV)-positive and on combination antiretroviral therapy; these patients are ineligible because of the potential for pharmacokinetic interactions with azacitidine; in addition, these patients are at increased risk of lethal infections when treated with marrow-suppressive therapy; appropriate studies will be undertaken in patients receiving combination antiretroviral therapy when indicated
- •DONOR Exclusion Criteria:
- •Must not have any underlying conditions which would contra-indicate apheresis
- •Must not be pregnant
研究组 & 干预措施
Control Cohort
Active Comparator
- Pre-DLI Salvage Chemotherapy (at the discretion of the treating physician)
- DLI will be administered 2 +/- 1 weeks after pre-DLI chemotherapy. The minimum CD3+ cell counts in DLI product should be 1 x 107 cells/kg for sibling and ~1 x 106/kg for match unrelated donors based on recipient weight
- No Azacitidine will be given
干预措施: Pre-DLI Salvage Chemotherapy (Drug)
Control Cohort
Active Comparator
- Pre-DLI Salvage Chemotherapy (at the discretion of the treating physician)
- DLI will be administered 2 +/- 1 weeks after pre-DLI chemotherapy. The minimum CD3+ cell counts in DLI product should be 1 x 107 cells/kg for sibling and ~1 x 106/kg for match unrelated donors based on recipient weight
- No Azacitidine will be given
干预措施: Donor Leukocyte Infusion (DLI) (Biological)
Cohort 1 (Starting Dose)
Experimental
- Pre-DLI Salvage Chemotherapy (at the discretion of the treating physician)
- DLI will be administered 2 +/- 1 weeks after pre-DLI chemotherapy. The minimum CD3+ cell counts in DLI product should be 1 x 107 cells/kg for sibling and ~1 x 106/kg for match unrelated donors based on recipient weight
- Azacitidine 45 mg/m2 IV on Days 4, 6, 8, and 10 post-DLI.
干预措施: Azacitidine (Drug)
Cohort 1 (Starting Dose)
Experimental
- Pre-DLI Salvage Chemotherapy (at the discretion of the treating physician)
- DLI will be administered 2 +/- 1 weeks after pre-DLI chemotherapy. The minimum CD3+ cell counts in DLI product should be 1 x 107 cells/kg for sibling and ~1 x 106/kg for match unrelated donors based on recipient weight
- Azacitidine 45 mg/m2 IV on Days 4, 6, 8, and 10 post-DLI.
干预措施: Pre-DLI Salvage Chemotherapy (Drug)
Cohort 1 (Starting Dose)
Experimental
- Pre-DLI Salvage Chemotherapy (at the discretion of the treating physician)
- DLI will be administered 2 +/- 1 weeks after pre-DLI chemotherapy. The minimum CD3+ cell counts in DLI product should be 1 x 107 cells/kg for sibling and ~1 x 106/kg for match unrelated donors based on recipient weight
- Azacitidine 45 mg/m2 IV on Days 4, 6, 8, and 10 post-DLI.
干预措施: Donor Leukocyte Infusion (DLI) (Biological)
Cohort 2
Experimental
- Pre-DLI Salvage Chemotherapy (at the discretion of the treating physician)
- DLI will be administered 2 +/- 1 weeks after pre-DLI chemotherapy. The minimum CD3+ cell counts in DLI product should be 1 x 107 cells/kg for sibling and ~1 x 106/kg for match unrelated donors based on recipient weight
- Azacitidine 75 mg/m2 IV on Days 4, 6, 8, and 10 post-DLI.
干预措施: Azacitidine (Drug)
Cohort 2
Experimental
- Pre-DLI Salvage Chemotherapy (at the discretion of the treating physician)
- DLI will be administered 2 +/- 1 weeks after pre-DLI chemotherapy. The minimum CD3+ cell counts in DLI product should be 1 x 107 cells/kg for sibling and ~1 x 106/kg for match unrelated donors based on recipient weight
- Azacitidine 75 mg/m2 IV on Days 4, 6, 8, and 10 post-DLI.
干预措施: Pre-DLI Salvage Chemotherapy (Drug)
Cohort 2
Experimental
- Pre-DLI Salvage Chemotherapy (at the discretion of the treating physician)
- DLI will be administered 2 +/- 1 weeks after pre-DLI chemotherapy. The minimum CD3+ cell counts in DLI product should be 1 x 107 cells/kg for sibling and ~1 x 106/kg for match unrelated donors based on recipient weight
- Azacitidine 75 mg/m2 IV on Days 4, 6, 8, and 10 post-DLI.
干预措施: Donor Leukocyte Infusion (DLI) (Biological)
结局指标
主要结局
MTD and DLT of azacitidine when given after DLI
时间窗: 40 days (after DLI)
MTD is defined as the maximum dose level immediately below the dose level at which 2 patients of a cohort (3 to 6 patients) experience dose-limiting toxicity during the first cycle.
次要结局
- Rate of Grade II-IV and III-IV acute GVHD based on Glucksberg criteria(100 days (after DLI))
- Overall survival(100 days (after DLI))
- Rates of CR, CRi, PR, and overall response (CR+CRi+PR = overall response)(1 year (after DLI))
- Effects of increasing dose of azacitidine on frequency and absolute number of (resting T-cells) rTregs and (T-cells)Tregs(64 days (Baseline, 7 days, 14 days, 21 days, and ~60 days after first dose of azacitidine)
研究者
研究点 (1)
Loading locations...
相似试验
终止
1 期
Azacitidine in Patients Undergoing Matched Unrelated Stem Cell TransplantationLeukemia, Myeloid, AcuteMyelodysplastic SyndromesPrecursor Cell Lymphoblastic Leukemia-LymphomaNCT01747499Washington University School of Medicine54
已完成
1 期
A Phase I Study of 5-Azacytidine in Combination With Chemotherapy for Children With Relapsed or Refractory ALL or AMLLymphoblastic Leukemia, Acute, ChildhoodMyelogenous Leukemia, Acute, ChildhoodNCT01861002Therapeutic Advances in Childhood Leukemia Consortium15
Unknown
1 期
Repurposing 5-Azacytidine for the Treatment of Muscle Contractures in Children With Cerebral PalsyContractureCerebral PalsyNCT06377085Shirley Ryan AbilityLab27
已完成
2 期
Efficacy of 5-azacytidine Added to Standard Primary Therapy in Elderly Patients With Newly Diagnosed Acute Myeloid Leukemia (AML)Acute Myeloid LeukemiaNCT00915252University Hospital Muenster214
已完成
4 期
Study of Azacitidine in Adult Taiwanese Subjects With Higher-Risk Myelodysplastic Syndromes (MDS)Myelodysplastic SyndromesNCT01201811Celgene44