A Randomized Trial of Recombinant Humanized Anti-IL-2 Receptor Antibody (Daclizumab) Versus Antithymocyte Globulin (ATG) to Treat the Cytopenia of Myelodysplastic Syndrome (MDS)
N/A
N/A
Both
Myelodysplastic Syndromes
Trial Information
A Randomized Trial of Recombinant Humanized Anti-IL-2 Receptor Antibody (Daclizumab) Versus Antithymocyte Globulin (ATG) to Treat the Cytopenia of Myelodysplastic Syndrome (MDS)
Many bone marrow failure syndromes in humans are now recognized to result from immunological
mechanisms. These diseases include aplastic anemia, pure red cell aplasia, and some types of
myelodysplasia. Patients with these conditions, who may suffer variable degrees of anemia,
leukocytopenia, and thrombocytopenia, alone or in combination, have been shown to respond to
a wide variety of immunosuppressive agents, ranging from corticosteroids to cyclosporine
(CSA) and antithymocyte globulin (ATG), however, nonresponse and relapse continues to be a
problem. Why some patients do not respond initially or others respond and then relapse is
unclear. Autoreactive T cells may be resistant to the effect of ATG/CsA (nonresponders),
while in others residual autoreactive T cells expand post-treatment leading to hematopoietic
stem cell destruction and recurrent pancytopenia (relapse). Therefore, novel, less toxic
immunosuppressive regimens that increase response rates and hematologic recovery and
decrease relapse rates are needed.
One such novel therapy, Daclizumab, a humanized anti-interleukin-2 receptor (lL-2R)
monoclonal antibody (mAb), acts against activated lymphocytes, thus sharing an important
mechanism of action with ATG. The mAb is much less toxic than ATG and may be administered
to outpatients at relatively infrequent intervals (every 2 weeks). Treatments with ATG
alone and CsA alone have demonstrated varying degrees of success in alleviating the
cytopenia of MDS. Our experience suggests that ATG rather than CSA is the more effective
agent inducing hematological responses in susceptible MDS patients and that certain
variables including the patient's age, whether or not they were HLA DR15, and days of red
cell transfusion dependence prior to treatment were predictive of response.
We therefore propose this randomized phase II study to evaluate and compare a new
immunosuppressive therapy, Daclizumab, with antithymocyte globulin (ATG) to treat the
cytopenia of MDS in a population of subjects with intermediate or high predicted probability
of response.
Inclusion Criteria
INCLUSION CRITERIA:
MDS of RA, RARS & RAEB sub-types including those previously treated with chemotherapy or
experimental agents such as retinoids, Vitamin D, and growth factors
Anemia requiring transfusion support with at least one unit of packed red blood cells per
month for greater than or equal to 2 months
OR
thrombocytopenia (platelet count less than 50000/ul)
OR
neutropenia (absolute neutrophil count less than 500/ul).
Off all other treatments (except G-CSF, and transfusion support and related medications)
for at least four weeks. G-CSF can be used before, during and after the protocol
treatment for patients with documented neutropenia (less than 500/Ul) as long as they meet
the criteria for anemia and/or thrombocytopenia as stated above.
ECOG performance status less than or equal to 2
High or intermediate predicted probability of response
EXCLUSION CRITERIA:
MDS of FAB sub-group chronic myelomonocytic leukemia (CMML)
Transformation to acute leukemia (FAB sub-group RAEB-T, ie, greater than 20% blasts in
marrow aspirate)
Hypoplastic marrow without one major or two minor criteria
Treatment with growth factors (except for G-CSF) or cyclosporine within 4 weeks prior to
entry to protocol
Recent or current treatment (24 hours wash out period) with the herbal supplement
Echinacea purpurea or Usnea barbata (Old Man's Beard)
ECOG performance status of greater than 2
Active uncontrolled infection (chronic or current clinically significant infection,
including hepatitis B or C virus infection)
Current pregnancy, or unwilling to take oral contraceptives or refrain from pregnancy if
of childbearing potential
Patients for whom bone marrow transplant is indicated as standard therapy (age less than
fifty-five with a fully-matched sibling donor)
Age less than 18 years
Not able to understand the investigational nature of the study or give informed consent
HIV positive patients
Active malignant disease (excluding basal cell carcinoma)
Serum creatinine greater than 2mg/dl
Patients who are moribund or patients with concurrent hepatic, renal, cardiac, metabolic,
or any disease of such severity that death within 3 months is likely
Low predicted probability of response
Type of Study:
Interventional
Study Design:
Endpoint Classification: Safety/Efficacy Study, Primary Purpose: Treatment
Authority:
United States: Federal Government
Study ID:
040026
NCT ID:
NCT00072969
Start Date:
November 2003
Completion Date:
August 2005
Related Keywords:
- Myelodysplastic Syndromes
- Immunosuppression
- Myelodysplastic Syndrome
- MDS
- Myelodysplastic Syndromes
- Preleukemia
Name | Location |
|---|---|
| National Heart, Lung and Blood Institute (NHLBI) | Bethesda, Maryland 20892 |
