Clofarabine Plus Low-Dose Cytarabine Induction Followed by Consolidation of Clofarabine Plus Low-Dose Cytarabine Alternating With Decitabine in Frontline AML and High-Risk MDS
The Study Drugs:
Clofarabine is designed to interfere with the growth and development of cancer cells.
Cytarabine is designed to insert itself into DNA (the genetic material of cells) of cancer
cells and stop the DNA from repairing itself.
Decitabine is designed to damage the DNA of cells, which may cause cancer cells to die.
Study Drug Administration:
If you are found eligible to take part in this study, on Days 1-5, you will receive
clofarabine through a needle in your vein over 1-2 hours.
On Days 1-10, you will receive cytarabine by injection twice a day.
You may receive up to 2 cycles at this dose and schedule. There are 10 days in each cycle.
If you show a response to the treatment, you can then continue with up to a total of 17 more
cycles of therapy, which will be called "consolidation cycles". Not every participant may
be able to receive all 17 consolidation cycles. The actual number that you will receive
depends on whether or not you maintain the response and how you are able to tolerate ongoing
therapy. There will be 4-7 weeks in between each consolidation cycle depending on any side
effects you may be having and your blood counts.
For consolidation cycles 1, 2, 6, 7, 8, 12, 13, and 14, you will receive clofarabine and
cytarabine, but the schedule will be different. On Days 1-3 you will receive clofarabine by
vein. On Days 1-7, you will receive cytarabine by vein. On the days when you receive both
clofarabine and cytarabine (Days 1-3), the clofarabine will be given about 3-6 hours before
the cytarabine injections. You can be taught to give cytarabine injections to yourself. In
this case, you can leave the clinic after receiving clofarabine. You will be required to
record the injections of cytarabine in a diary unless you receive the treatments while you
are in the hospital.
During consolidation cycles 3-5, 9-11, and 15-17, you will receive decitabine only.
Decitabine will be given through a needle in your vein over 1-2 hours on Days 1-5. During
the decitabine cycles, you may be treated at home, but must return to MD Anderson for study
visits before the start of each cycle.
If you do not achieve a response after the first 2 cycles of treatment with clofarabine and
cytarabine, you can stay on study and receive 3 cycles of decitabine alone (same dose and
schedule as the consolidation course). If you achieve a response after the 3 decitabine
cycles, you can continue with the consolidation cycles. If there is no evidence of response
after the 3 decitabine cycles, you may be taken off study.
On Day 1 of every cycle, the following tests and procedures will be performed:
- You will have a physical exam, including measurement of your weight and vital signs.
- You will have a performance status evaluation.
- Blood (about 1-2 teaspoons) will be drawn for routine tests.
About 3 weeks after your first course, you may have a bone marrow aspirate to check the
status of the disease. To collect a bone marrow aspirate, an area of the hip is numbed with
anesthetic, and a small amount of bone marrow is withdrawn through a large needle. After
that, you will have a bone marrow aspirate every 2 weeks (or more often if your doctor feels
it is necessary). If your routine blood tests indicate that there is still leukemia, you
may not need to have the bone marrow samples collected.
You will need to stay in Houston for up to the first 5 weeks of treatment. After that, you
will need to return to Houston before each cycle and to receive the clofarabine treatments.
Decitabine-only consolidation cycles can be given by your local oncologist. In either case,
you can have check-up visits and blood tests with your local doctor between treatments.
Length of Study:
You can stay on study for up to 19 cycles. You will be taken off study early if you
experience any intolerable side effects. You may be taken off study early if the disease
Once you are off active treatment but as long as you are still part of the study, every 3-6
months you will have blood (1 tablespoon) drawn to check the status of the disease and your
This is an investigational study. Clofarabine is FDA approved and commercially available
for use in pediatric patients with ALL. Its use in patients with AML is experimental.
Cytarabine is FDA approved and commercially available for use in patients with AML.
Decitabine is FDA approved and commercially available for use in patients with MDS, but its
use for patients with AML is investigational.
Up to 120 patients will take part in this study. All will be enrolled at M. D. Anderson.
Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Disease-free (DFS) time and overall survival (OS)
Disease-free survival (DFS): Time from date of treatment start until the date of first objective documentation of disease-relapse; and Overall survival (OS): Time from date of treatment start until date of death due to any cause.
Bone marrow aspirate and/or biopsy starting on day 21 (+/- 7 days) of therapy and then every 2 weeks (+/- 7 days) as required by leukemia evolution until remission or non-response.
Stefan F. Faderl, M.D.
M.D. Anderson Cancer Center
United States: Food and Drug Administration
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