PETHEMA LAM07: Prospective, Multicenter, Uncontrolled Cohort Study to Analyze the Efficacy of a Risk Adapted Treatment Strategy, Including Gemtuzumab Ozogamicin (GO) During Consolidation, for Patients With Acute Myeloid Leukemia (AML)
Patients will be stratified according to age in a first step, with a cut-point of 65 years
old. For patients younger than 65 years old who achieve complete response, a second
stratification will be made before first consolidation treatment. This second stratification
will be performed according to the follow parameters: MDR at the end of induction, karyotype
and molecular findings, including FLT3 internal tandem duplication (ITD) and NPM1 mutations.
The following groups can be identified according to these parameters:
Group A:
Patients aged 65 or younger who are candidates for intensive chemotherapy.
Group A1:
Patients who are in first CR with negative MRD (less than 0.1%), good prognosis karyotype
and, in the case of t(8;21) or inv(16), absence of mutations in the exon 17 of c-kit.
Group A2:
Patients who are in first CR with negative MRD (less than 0.1%), intermediate-risk
karyotype, NPM1 positive and FLT3 negative.
Group A3:
Patients who are in first CR with negative MRD (less than 0.1%), intermediate-risk
karyotype, absence of NPM1 mutations and who are negative for FLT3-ITD or FLT3-ITD positive
with a ratio less than 0.8, regardless NPM1 status.
Group A4:
Patients who are in first CR with positive MRD (greater than 0.1%), t(8;21) or inv(16) with
mutations in the exon 17 of c-kit, intermediate risk karyotype with positive FLT3-ITD and
ratio greater or equal to 0.8 or high-risk karyotype.
Group B:
Patients over 65 years who are able to receive intensive chemotherapy.
TREATMENT SCHEDULE:
Treatment is tailored for each of the previously defined groups:
Group A:
Induction with Idarubicin and ARA-C in "3 +7" schedule (IDA 12 mg/m2 x 3 days and ARA-C 200
mg/m2 x 7 days).
Group A1:
Two consolidation cycles with ARA-C at a dose of 3 g/m2 on days 1, 3 and 5. Collection of
peripheral blood stem cells (PBSC) after the first consolidation. Autologous stem cell
transplantation (ASCT) with Busulphan 1 mg/kg/6 VO or 0,8 mg/kg/6 h IV (Busilvex®) from day
-8 to -5; Etoposide 20 mg/kg/d from day -4 to -3 and ARA-C 3 g/m2/12 h from on days -3 and
-2 (see criteria for HiDAC modification); and G-CSF 10 µg/kg/d from day -9 to -2 (BEA
schedule). Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is not recommended
in first CR in this group of patients.
Group A2:
First consolidation with Idarubicin and ARA-C at the same dose than induction plus GO 3
mg/m2 at day 1. Collection of PBSC after first consolidation. Second consolidation with
ARA-C 3 g/m2 on days 1, 3 and 5 followed by ASCT with BEA conditioning. It is not
recommended to perform Allo-HSCT, especially from alternative donors, in first CR.
Group A3:
First consolidation with Ida and ARA-C at the same dose than induction plus GO 3 mg/m2 at
day 1. Collection of PBSC after first consolidation. Second consolidation with ARA-C 3 g/m2
on days 1, 3 and 5 followed by ASCT with BEA schedule if no HLA-identical sibling is
available. Patients in this group are candidates for allo-HSCT in first CR if HLA-identical
sibling is available. Allo-HSCT will be performed after first consolidation.
Group A4:
First consolidation with Ida and ARA-C at the same dose than induction plus GO 3 mg/m2 at
day 1. Collection of PBSC after first consolidation. Second consolidation with ARA-C 3 g/m2
on days 1, 3 and 5 followed by ASCT with BEA schedule if no donor is available. Patients in
this group are candidates for allo-HSCT in first CR, including alternative donors. Allo-HSCT
will be performed after first consolidation or later if no donor is available at this time.
Group C:
Induction with Idarubicin and ARA-C "2 + 5" (IDA 12 mg/m2 x 2 days and ARA-C 200 mg/m2 x 5
days). Two consolidations with GO 3 mg/m2 day 1 and ARA-C 100 mg/m2 continuous infusion days
1 to 5.
AML CHARACTERIZATION AND SAMPLES COLLECTION:
To achieve a complete characterization of AML, inmunophenotype analysis (defining the
pattern for MRD studies), cytogenetics, FISH for inv(16), t(8;21) and t(15;17), and
molecular study for AML1/ETO, CBFβ/MYH11, NPM1 and FLT3-ITD will be performed in all cases.
For FLT3-ITD, the ratio between the mutated and not mutated allele will be calculated.
During the phase of samples collection, DNA, RNA and viable cells will be stored.
Interventional
Allocation: Non-Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
To provide prognosis stratification of AML patients at the end of the induction treatment, based on minimal residual disease (MRD), cytogenetics and molecular findings.
No
Sanz Miguel Angel, Dr
Study Chair
PETHEMA Foundation
Spain: Ministry of Health
PETHEMA-LAM07
NCT01041040
October 2007
January 2012
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