Standard Idarubicin and Cytarabine for the Treatment of Acute Myeloid Leukemia (AML)
Study Details
Study Description
Brief Summary
The goal of this clinical research study is to find out if standard chemotherapy given with idarubicin and Cytarabine (ara-C) can help to control AML.
Objectives:
To determine the complete response (CR) rate, event-free survival (EFS) and overall survival (OS) of patients with newly diagnosed acute myeloid leukemia (AML) receiving standard combination chemotherapy with Idarubicin and cytarabine.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
| Phase 2 |
Detailed Description
Ara-C and idarubicin are designed to interfere with DNA's (the genetic material of cells) ability to repair itself, causing cancer cells to die.
If you are found to be eligible to take part in this study, you will receive treatment with idarubicin and ara-C for up to 8 cycles. One cycle lasts about 4-5 weeks. Cycles 1 and 2 are called induction therapy, which is used to help induce (cause) a remission. Cycles 3 to 8 are called consolidation therapy, which is a type of high-dose chemotherapy often given as the second phase of a cancer treatment.
After Cycle 1, you will have a brief rest period of a few days, before you move on to Cycle 2. On Day 1 of Cycle 1, you will receive cytarabine by vein as a continuous infusion over 4 days. It will only be 3 days if you are age 60 or older. On Days 1-3 of Cycle 1, you will receive idarubicin by vein over 1 hour once a day.
The dose of the study drugs you receive may be changed to help manage side effects (such as nausea and diarrhea) that you may experience. Medications (given by mouth or by vein), such as Tylenol (acetaminophen), may be given before and during treatment to help decrease the risk of such side effects. The study doctor will specify what these medications are.
You will have blood drawn (about 2 teaspoons) for routine tests about once a week during treatment. Starting on Days 21-28, you will have bone marrow collected every 1-2 weeks to check the status of the disease. Blood (about 2 tablespoons) will also be drawn at least twice a week after each cycle of therapy (beginning about 4-6 weeks from the start of treatment each cycle) to check your blood counts.
Cycle 2 will begin after your blood counts have recovered. If at the end of Cycle 1 you have not achieved a remission (disease has decreased), you may receive Cycle 2, which will be similar to Cycle 1.
If the disease is responding to treatment after Cycle 2 (after completion of induction therapy), you will receive up to 6 more cycles of therapy. These cycles are called consolidation therapy. Consolidation therapy is a type of high-dose chemotherapy often given as the second phase to treat cancer. For consolidation therapy, you will receive ara-C as a continuous infusion over 3 days starting on Day 1 of Cycle 3. On Days 1 and 2 of Cycles 3 and 4, you will receive idarubicin by vein over 1 hour. Your blood (about 2 tablespoons) will be drawn at least twice a week after each cycle to check your blood counts. Cycle 3 will begin after your blood counts have recovered.
After completion of consolidation therapy, you may receive what is called maintenance therapy. Maintenance therapy will start after completion of consolidation therapy. Maintenance therapy is often given to help keep cancer in remission. It is treatment that is given to help the original treatment keep working. You will be told if you will have maintenance therapy as well as the drugs and drug schedule you will be on.
During consolidation and/or maintenance therapy, blood (about 2 teaspoons) will be drawn for routine tests every 1-2 weeks. You will have bone marrow collected every 3-6 months to check the status of the disease.
You may have treatment on this study for up to 8 cycles (induction and consolidation therapy) or more (for maintenance therapy), depending on disease response to the study drugs. If the disease gets worse or you experience any intolerable side effects, you will be taken off this study, and your study doctor will discuss other treatment options with you.
Once your participation is over on this study, you will be followed-up with a phone call by the study doctor or study nurse to check on how you are doing and if you have experienced any intolerable side effects. The call should last about 10-15 minutes.
This is an investigational study. Idarubicin and ara-C are both FDA approved and commercially available. Up to 200 patients will take part in this study. All will be enrolled at MD Anderson.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Idarubicin + Cytarabine Idarubicin 12 mg/m2 IV over 1 hour daily x 3 (days 1-3). Cytarabine 1.5 g/m2 IV over 24 hours daily on day 1-4 (age <60 years) or days 1-3 (age > 60 years). |
Drug: Cytarabine
1.5 g/m2 IV over 24 hours daily on day 1-4 (age <60 years) or days 1-3 (age > 60 years).
Other Names:
Drug: Idarubicin
12 mg/m2 IV over 1 hour daily x 3 (days 1-3)
Other Names:
|
Outcome Measures
Primary Outcome Measures
- Complete Response (CR) Rate [Up to 2 months]
Complete Response (CR): Normalization of marrow (< 5% blasts; >10% cellularity) and of peripheral blood counts (no circulating blasts, neutrophil count > 109/L, platelet count > 100 x 109/L).
Secondary Outcome Measures
- Event-Free Survival (EFS) [from treatment initiation until treatment failure, relapse, or death]
Event -Free Survival (EFS) EFS was calculated with Kaplan-Meier estimates. Event-free survival (EFS), defined as the time to no response to intensive induction therapy, relapse, or death of any cause, whichever comes first.
- Overall Survival (OS) [Until death or loss of follow-up]
Overall Survival (OS) was calculated with Kaplan-Meier estimates. OS was calculated from the time of treatment initiation until death.
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Diagnosis of 1) AML (WHO classification definition of >/= 20% blasts). Patients with M6 AML with less than 20% blasts are eligible.
-
Patients aged 15 to 75 years are eligible. Patients must be chemo-naïve, i.e. not have received any prior chemotherapy (except hydrea) for AML. They could have received transfusions, hematopoietic growth factors or vitamins. Temporary measures such as pheresis or hydrea (0.5 to 5g daily or more for up to 3 days) are allowed .
-
Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0, 1, 2, or 3 at screening.
-
Serum biochemical values with the following limits: - creatinine </= 2.0 mg/dl - total bilirubin </= 2.0 mg/dL, unless increase is due to hemolysis - transaminases (SG PT) </= 3x upper limit of normal (ULN)
-
Ability to understand and provide signed informed consent.
Exclusion Criteria:
-
Subjects with Acute Promyelocytic Leukemia (APL).
-
Presence of active systemic infection.
-
Any coexisting medical condition that in the judgment of the treating physician is likely to interfere with study procedures or results.
-
Nursing women, women of childbearing potential with positive urine pregnancy test, or women of childbearing potential who are not willing to maintain adequate contraception (such as birth control pills, intrauterine device (IUD), diaphragm, abstinence, or condoms by their partner) over the entire course of the study.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | University of Texas MD Anderson Cancer Center | Houston | Texas | United States | 77030 |
Sponsors and Collaborators
- M.D. Anderson Cancer Center
Investigators
- Principal Investigator: Farhad Ravandi-Kashani, MD, M.D. Anderson Cancer Center
Study Documents (Full-Text)
None provided.More Information
Additional Information:
Publications
None provided.- 2006-0813
- NCI-2012-01412
Study Results
Participant Flow
| Recruitment Details | Recruitment Period: 12/2006 to 01/2017 |
|---|---|
| Pre-assignment Detail | Of the 175 participants registered, six were never treated. |
| Arm/Group Title | Idarubicin + Cytarabine |
|---|---|
| Arm/Group Description | Idarubicin 12 mg/m2 intravenously (IV) over 1 hour daily days 1-3. Cytarabine 1.5 g/m2 IV over 24 hours daily on day 1-4 (age <60 years) or days 1-3 (age > 60 years). |
| Period Title: Overall Study | |
| STARTED | 175 |
| COMPLETED | 169 |
| NOT COMPLETED | 6 |
Baseline Characteristics
| Arm/Group Title | Idarubicin + Cytarabine |
|---|---|
| Arm/Group Description | Idarubicin 12 mg/m2 intravenously (IV) over 1 hour daily days 1-3. Cytarabine 1.5 g/m2 IV over 24 hours daily on day 1-4 (age <60 years) or days 1-3 (age > 60 years). |
| Overall Participants | 175 |
| Age (Count of Participants) | |
| <=18 years |
0
0%
|
| Between 18 and 65 years |
156
89.1%
|
| >=65 years |
19
10.9%
|
| Age (years) [Median (Full Range) ] | |
| Median (Full Range) [years] |
55
|
| Sex: Female, Male (Count of Participants) | |
| Female |
77
44%
|
| Male |
98
56%
|
| Region of Enrollment (participants) [Number] | |
| United States |
175
100%
|
Outcome Measures
| Title | Complete Response (CR) Rate |
|---|---|
| Description | Complete Response (CR): Normalization of marrow (< 5% blasts; >10% cellularity) and of peripheral blood counts (no circulating blasts, neutrophil count > 109/L, platelet count > 100 x 109/L). |
| Time Frame | Up to 2 months |
Outcome Measure Data
| Analysis Population Description |
|---|
| [Not Specified] |
| Arm/Group Title | Idarubicin + Cytarabine |
|---|---|
| Arm/Group Description | Idarubicin 12 mg/m2 intravenously (IV) over 1 hour daily days 1-3. Cytarabine 1.5 g/m2 IV over 24 hours daily on day 1-4 (age <60 years) or days 1-3 (age > 60 years). |
| Measure Participants | 169 |
| Complete Response |
98
56%
|
| Partial Response |
4
2.3%
|
| Complete Response w/o Platelet Recovery |
9
5.1%
|
| Death |
7
4%
|
| No Response |
51
29.1%
|
| Title | Event-Free Survival (EFS) |
|---|---|
| Description | Event -Free Survival (EFS) EFS was calculated with Kaplan-Meier estimates. Event-free survival (EFS), defined as the time to no response to intensive induction therapy, relapse, or death of any cause, whichever comes first. |
| Time Frame | from treatment initiation until treatment failure, relapse, or death |
Outcome Measure Data
| Analysis Population Description |
|---|
| [Not Specified] |
| Arm/Group Title | Idarubicin + Cytarabine |
|---|---|
| Arm/Group Description | Idarubicin 12 mg/m2 intravenously (IV) over 1 hour daily days 1-3. Cytarabine 1.5 g/m2 IV over 24 hours daily on day 1-4 (age <60 years) or days 1-3 (age > 60 years). |
| Measure Participants | 169 |
| Median (95% Confidence Interval) [Months] |
4.7
|
| Title | Overall Survival (OS) |
|---|---|
| Description | Overall Survival (OS) was calculated with Kaplan-Meier estimates. OS was calculated from the time of treatment initiation until death. |
| Time Frame | Until death or loss of follow-up |
Outcome Measure Data
| Analysis Population Description |
|---|
| [Not Specified] |
| Arm/Group Title | Idarubicin + Cytarabine |
|---|---|
| Arm/Group Description | Idarubicin 12 mg/m2 intravenously (IV) over 1 hour daily days 1-3. Cytarabine 1.5 g/m2 IV over 24 hours daily on day 1-4 (age <60 years) or days 1-3 (age > 60 years). |
| Measure Participants | 169 |
| Median (Full Range) [Months] |
11.3
|
Adverse Events
| Time Frame | Adverse events captured from the time of participant consent and will be followed to resolution or stabilization; up to 1 year. | |
|---|---|---|
| Adverse Event Reporting Description | ||
| Arm/Group Title | Idarubicin + Cytarabine | |
| Arm/Group Description | Idarubicin 12 mg/m2 intravenously (IV) over 1 hour daily days 1-3. Cytarabine 1.5 g/m2 IV over 24 hours daily on day 1-4 (age <60 years) or days 1-3 (age > 60 years). | |
All Cause Mortality |
||
| Idarubicin + Cytarabine | ||
| Affected / at Risk (%) | # Events | |
| Total | 10/169 (5.9%) | |
Serious Adverse Events |
||
| Idarubicin + Cytarabine | ||
| Affected / at Risk (%) | # Events | |
| Total | 77/169 (45.6%) | |
| Blood and lymphatic system disorders | ||
| Anemia | 1/169 (0.6%) | 1 |
| Edema - leg | 1/169 (0.6%) | 1 |
| Leukocytosis | 1/169 (0.6%) | 1 |
| Hemorrhage Gastrointestinal | 1/169 (0.6%) | 1 |
| Hyperbilirubinemia | 1/169 (0.6%) | 1 |
| Intracerebral Hemorrhage | 1/169 (0.6%) | 1 |
| Neutropenia | 1/169 (0.6%) | 1 |
| Thrombocytopenia | 1/169 (0.6%) | 1 |
| Cardiac disorders | ||
| Arrythmia | 1/169 (0.6%) | 1 |
| Atrial Fibrillation | 2/169 (1.2%) | 2 |
| Cardiac Arrest | 1/169 (0.6%) | 1 |
| Cardiac Infarction | 1/169 (0.6%) | 1 |
| Hypotension | 1/169 (0.6%) | 2 |
| Pain Cardiovascular | 1/169 (0.6%) | 1 |
| Sinus Bradycarida | 1/169 (0.6%) | 1 |
| Supraventricular arrhythmia | 1/169 (0.6%) | 1 |
| Ventricular Arrhythmia | 1/169 (0.6%) | 1 |
| Gastrointestinal disorders | ||
| Diarrhea | 4/169 (2.4%) | 4 |
| Vomiting | 1/169 (0.6%) | 1 |
| General disorders | ||
| Abdominal Pain | 3/169 (1.8%) | 3 |
| Death | 10/169 (5.9%) | 10 |
| Fever | 6/169 (3.6%) | 7 |
| Pain Head/Neck | 1/169 (0.6%) | 1 |
| Hepatobiliary disorders | ||
| Pancreatitis | 1/169 (0.6%) | 1 |
| Immune system disorders | ||
| Myelosupression | 2/169 (1.2%) | 2 |
| Infections and infestations | ||
| Catheter Related Infection | 1/169 (0.6%) | 1 |
| Cellulitis | 2/169 (1.2%) | 2 |
| Cholecystitis | 2/169 (1.2%) | 3 |
| Clostridium Difficile Colitis | 1/169 (0.6%) | 1 |
| Colitis | 1/169 (0.6%) | 1 |
| Infection | 14/169 (8.3%) | 18 |
| Infection Abcess | 1/169 (0.6%) | 1 |
| Neutropenic Fever | 27/169 (16%) | 34 |
| Pneumonia | 9/169 (5.3%) | 10 |
| Pneumonitis | 1/169 (0.6%) | 1 |
| Sepsis | 1/169 (0.6%) | 1 |
| Wound Infection | 1/169 (0.6%) | 1 |
| Musculoskeletal and connective tissue disorders | ||
| Arthritis Knee | 1/169 (0.6%) | 1 |
| Nervous system disorders | ||
| Neuropathy | 1/169 (0.6%) | 1 |
| Seizure | 1/169 (0.6%) | 1 |
| Syncope | 2/169 (1.2%) | 2 |
| Renal and urinary disorders | ||
| Renal Failure | 2/169 (1.2%) | 2 |
| Respiratory, thoracic and mediastinal disorders | ||
| Dyspnea | 1/169 (0.6%) | 1 |
| Hypoxia | 1/169 (0.6%) | 1 |
| Lung Injury | 1/169 (0.6%) | 1 |
| Skin and subcutaneous tissue disorders | ||
| Abscess Left Groin | 1/169 (0.6%) | 1 |
| Rash | 1/169 (0.6%) | 1 |
| Surgical and medical procedures | ||
| Cholecyctectomy | 1/169 (0.6%) | 1 |
Other (Not Including Serious) Adverse Events |
||
| Idarubicin + Cytarabine | ||
| Affected / at Risk (%) | # Events | |
| Total | 87/169 (51.5%) | |
| Gastrointestinal disorders | ||
| Diarrhea | 26/169 (15.4%) | 26 |
| Nausea | 10/169 (5.9%) | 12 |
| General disorders | ||
| Pain | 8/169 (4.7%) | 8 |
| Infections and infestations | ||
| Febrile Neutropenia | 47/169 (27.8%) | 65 |
| Infection/unknown ANC | 20/169 (11.8%) | 28 |
| Infection other | 10/169 (5.9%) | 10 |
| Opportunistic Infection | 18/169 (10.7%) | 19 |
| Metabolism and nutrition disorders | ||
| Hyperbilirubinemia | 10/169 (5.9%) | 10 |
| Skin and subcutaneous tissue disorders | ||
| Rash | 20/169 (11.8%) | 20 |
Limitations/Caveats
More Information
Certain Agreements
All Principal Investigators ARE employed by the organization sponsoring the study.
There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.
Results Point of Contact
| Name/Title | Farhad Ravandi-Kashani, MD |
|---|---|
| Organization | UT MD Anderson Cancer Center |
| Phone | 713-792-7734 |
| CR_Study_Registration@mdanderson.org |
- 2006-0813
- NCI-2012-01412