VIDAZA-DLI Pre-emptive Azacitidine and Donor Lymphocyte Infusions Following Allogeneic Hematopoietic Stem Cell Transplantation for High Risk Acute Myeloid Leukemia and Myelodysplastic Syndrome

This study is currently recruiting participants. (see Contacts and Locations)
Verified March 2012 by Nantes University Hospital
Sponsor:
Information provided by (Responsible Party):
Nantes University Hospital
ClinicalTrials.gov Identifier:
NCT01541280
First received: December 13, 2011
Last updated: March 26, 2012
Last verified: March 2012
  Purpose

Patients included in the study with high risk acute myeloid leukemia or myelodysplastic syndrome as defined will receive an allogeneic transplantation conditioned by either myeloablative or reduced regimen. Following allogeneic transplantation, patients will receive a maintenance regimen combining chemotherapy with azacitidine (aza) and immunotherapy with donor lymphocyte infusion.


Condition Intervention Phase
Acute Myeloid Leukemia
Myelodysplastic Syndrome
Drug: Azacitidine
Other: DLI
Phase 2

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Pre-emptive Azacitidine and Donor Lymphocyte Infusions Following Allogeneic Hematopoietic Stem Cell Transplantation for High Risk Acute Myeloid Leukemia and Myelodysplastic Syndrome

Resource links provided by NLM:


Further study details as provided by Nantes University Hospital:

Primary Outcome Measures:
  • Evaluation of the cumulative incidence of relapse rate [ Time Frame: 2 years ] [ Designated as safety issue: Yes ]
    An A'Hern procedure will be used (cf. 11.1): If the number of patients not relapsed at two year will be 18 or more out of 24 patients, the null hypothesis will be rejected and the relapse rate will be considered acceptable.


Secondary Outcome Measures:
  • Evaluation of disease-free survival (DFS) at 2 years from transplantation [ Time Frame: 2 years ] [ Designated as safety issue: Yes ]
    Kaplan-Meier method

  • Measure the overall survival rate at 2 years [ Time Frame: 2 years ] [ Designated as safety issue: Yes ]
    Kaplan-Meier method

  • Cumulative incidence death from leukemia, and non relapse mortality (NRM) [ Time Frame: 2 years ] [ Designated as safety issue: Yes ]
    cumulative incidence function for disease free survival at 2 years from transplantation, GVHD, death from leukaemia and non-relapse mortality will be estimated (patients are at risk not only for relapse but can also be "removed" from possible relapse because of competing events such as death in remission (due to infection or GVHD)).

  • Feasibility and safety of administrating maintenance azacitidine following allogenic transplantaton [ Time Frame: 2 years ] [ Designated as safety issue: Yes ]
    To evaluate toxicity induced by the azacitidine and DLI, different parameters will be studied:Cell Blood Count with differential, liver function tests, serum creatinine, BUN and total protein will be performed weekly from the time of initiation of azacitidine administration until completion of the last DLI. Performance Status,Acute GVHD,Bone marrow aspiration with evaluation of morphological response as well as chimerism from peripheral blood will be performed prior starting azacitidine, following 3 cycles of azacitidine and after the seventh cycle and twelfth cycle of azacitidine.

  • Feasibility and safety of performing prophylactic donor lymphocytes infusion [ Time Frame: 2 years ] [ Designated as safety issue: Yes ]

    The relatedness of observed toxicity to DLI will be evaluated and documented:

    • Maximum toxicity with respect to mucositis, liver, kidney, lung, heart, neurological system according to CTC criteria (cf. appendices).
    • Infections (bacteremia, fungemia, invasive fungal infection, CMV reactivation and disease, other viral reactivation or infection).
    • Grade of acute and chronic GVHD (cf. appendices); GVHD is classified according to clinical symptoms, irrespective to the time interval to DLI.
    • Bone marrow aspiration, as well as chimerism in PB.

  • Incidence and severity of acute and chronic graft-versus-host disease [ Time Frame: 2 years ] [ Designated as safety issue: Yes ]

    Symptoms related to GVHD should be reported within the GVHD section of the case reporting files. AE and SAE are documented in the patient's chart

    • on a daily basis, as long as the patient is on ward, and
    • on a weekly to two-monthly basis during outpatient follow up, depending on the frequency of outpatient visits on the respective patient.


Estimated Enrollment: 30
Study Start Date: November 2011
Estimated Study Completion Date: November 2015
Estimated Primary Completion Date: November 2015 (Final data collection date for primary outcome measure)
Intervention Details:
    Drug: Azacitidine
    Azacitidine (AZA) is to be administered every 28 days beginning day +56 to 100 posttransplant for one year provided the patients has a platelet count of >15 x 109/L without transfusion for at least 2 successive days, and an absolute neutrophil count of >1 x 109/L without growth factor for at least 2 successive days, and no acute GVHD greater than grade I and no clinical evidence of life-threatening infection. AZA is given 32 mg /m²/day subcutaneously for 5 days every 28 days (
    Other: DLI

    Donor lymphocyte infusion (DLI) is to be given from day +126 (week 18) in patients without immunosuppressive therapy for at least one month and following 3 cycles of AZA, and without clinical signs of GVHD, and without uncontrolled infection and without a recent history of >grade 2 acute GVHD. DLI are schedules every 8 weeks. There are 3 DLI scheduled.

    If first cycle of AZA is postponed beyond day 56 (maximum to Day 100), all subsequent cycles and DLI will be post poned too.

  Eligibility

Ages Eligible for Study:   18 Years to 70 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients with high risk acute myeloid leukemia undergoing allogeneic transplantation with either a familial or an unrelated donor.

High risk AML is defined as :

  • AML in CR1 with unfavorable cytogenetics defined by complex caryotype, autosomal monosomy combined or not with other cytogenetics abnormalities inv(3)/t(3,3), t(6;9), t(6;11), t(11;19), del(5q), del(7q).
  • AML in CR2 or greater remission prior allogeneic transplantation
  • AML in PR or relapse prior allogeneic transplantation
  • Or Patients with high risk myelodysplastic syndrome undergoing allogeneic transplantation with either a familial or an unrelated donor.

High risk MDS is defined as :

  • MDS with intermediate-2 group and higher risk group according to IPSS criteria
  • Age 18 - 70 years.
  • Availability of an HLA identical family donor or unrelated donor with matching in 10/10 alleles (HLA-A, B, C, DRB1, DQB1) or maximum of 1 allele or antigen mismatch OR family donor with maximum 1 allele mismatch.
  • Conditioning regimen to allogeneic transplantation may be either myeloablative or reduced.
  • Be able to understand and sign informed consent.
  • Affiliation number to National Health Care System
  • Men and women of childbearing potential must use effective contraception during and up to 3 months after treatment.

Exclusion Criteria:

  • The presence of any one exclusion criteria renders the patient ineligible:
  • Patient in full relapse post-transplant (>20% blasts in the bone marrow) following allogeneic transplant
  • Documented leukemic infiltration of CNS/cerebrospinal fluid.
  • Karnofsky performance score below 60%.
  • Acute and chronic heart failure (NYHA Class III or IV) or symptomatic ischemic heart disease.

following allogeneic transplant

  • Severe liver failure (bilirubin >30 μmoles/L, SGPT > 4 X upper limit of normal).
  • Hepatic malignancy in advanced stage.
  • Severe neurological or psychiatric disorders
  • Acute GVHD grade II-III. Patient with grade I GVHD may be included (see annex 1 for GHVD grade definition).
  • Active uncontrolled infection.
  • Denied informed consent.
  • Treatment with other investigational drugs following allogeneic transplantation.
  • No effective contraception
  • Lactating females
  • Pregnant woman
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01541280

Contacts
Contact: Guillaume Thierry, Doctor 02 40 08 32 71 thierry.guillaume@chu-nantes.fr

Locations
France
University Hospital of Nantes Recruiting
Nantes, France, 44000
Contact: Dr Guillaume Thierry, Doctor    02 40 0832 71    thierry.guillaume@chu-nantes.fr   
Sponsors and Collaborators
Nantes University Hospital
Investigators
Principal Investigator: Milpied Noel, Professor CHU BORDEAUX
Principal Investigator: Guillaume Thierry, Doctor CHU Nantes
Principal Investigator: Yakoub-Agha Ibrahim, Professor CHU Lille
Principal Investigator: Huynh Anne, Doctor CHU Toulouse
Principal Investigator: Blaise Didier, Professor Institut-Paoli Calmettes Marseille
Study Director: Mohamad Mothy, Professor chu Nantes
  More Information

No publications provided

Responsible Party: Nantes University Hospital
ClinicalTrials.gov Identifier: NCT01541280     History of Changes
Other Study ID Numbers: BRD 10/07-H
Study First Received: December 13, 2011
Last Updated: March 26, 2012
Health Authority: France: Afssaps - Agence française de sécurité sanitaire des produits de santé (Saint-Denis)

Keywords provided by Nantes University Hospital:
Allogreffe, LAM , MDS
Azacitidine (VidazaÒ)
Injection de lymphocytes de donneur (DLI)

Additional relevant MeSH terms:
Leukemia
Leukemia, Myeloid
Leukemia, Myeloid, Acute
Myelodysplastic Syndromes
Preleukemia
Syndrome
Bone Marrow Diseases
Disease
Hematologic Diseases
Neoplasms
Neoplasms by Histologic Type
Pathologic Processes
Precancerous Conditions
Azacitidine
Antimetabolites
Antimetabolites, Antineoplastic
Antineoplastic Agents
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Therapeutic Uses

ClinicalTrials.gov processed this record on October 20, 2014