search
Back to results

The CLARA Study From the Acute Leukemia French Association (ALFA 0702 Trial) (CLARA)

Primary Purpose

Acute Myeloid Leukemia

Status
Completed
Phase
Phase 2
Locations
France
Study Type
Interventional
Intervention
CLARA
HDAc
Sponsored by
Hospices Civils de Lyon
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Acute Myeloid Leukemia focused on measuring Younger Patients with Newly-Diagnosed Acute Myeloid Leukemia (AML).

Eligibility Criteria

18 Years - 60 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria at registration:

  1. Age 18 years or more and less than 60 years
  2. With:

    A morphologically proven diagnosis of AML according to the WHO classification, cytogenetically (standard karyotype, FISH-MLL) and molecularly (FLT3, CEBPA, NMP1) defined.

  3. ECOG (Eastern Cooperative Oncology Group) performance status 0 to 2.
  4. Have adequate renal and hepatic function as indicated by the following laboratory values:

    • Creatinine clearance (calculated by the cockcroft and Gault method) ≥ 40mL/min;
    • AST (Aspartate amino transférase) and ALT (Alanine Amino Transférase ) < or = 2.5N; total bilirubin < or = 2N (unless related to the underlying disease).
  5. Cardiac function determined by radionuclide or echography within normal limits.
  6. Women of child-bearing potential (i.e. women who are pre-menopausal or not surgically sterile) must use acceptable contraceptive methods, and must have a negative serum or urine pregnancy test within 2 weeks prior the beginning treatment on this trial.
  7. Must be able and willing to give written informed consent.
  8. The subject must be covered by a social security system.

Exclusion Criteria at registration:

  1. Patients with AML with favorable risk cytogenetics: M3-AML; CBF-AML including t(8:21), inv(16), or t(16;16) AML.
  2. Ph-positive AML.
  3. AML following diagnosed myeloproliferation or patient with prior history of MDS known for more than 3 months
  4. Prior treatment with chemotherapy or radiotherapy for another tumor.
  5. Prior tumor, if not stable for at least two years, except in-situ carcinoma and skin carcinoma
  6. Compromised organ function judged to be lifethreatening by the Investigator.
  7. Positive serology for HIV (Human Immunodeficiency Virus), HBV (Hepatitis B Virus) and HBC (Hepatitis C Virus)(except post vaccination)
  8. Uncontrolled active infection of any kind or bleeding. Patients with infections who are under active treatment with antibiotics and whose infections are controlled may be entered to the study.
  9. Other active malignancy.
  10. Patients concurrently receiving any other standard or investigational treatment for their leukemia, with the exception of hydroxyurea.

INCLUSION CRITERIA AT RANDOMIZATION

  1. Patients with either in first CR/CRp after the first induction course or in first CR/CRp after salvage therapy.
  2. ECOG performance status 0 to 2.
  3. AST and ALT < or = 2.5N; total bilirubin < or = 2N.
  4. Creatinine clearance ≥40mL/min (calculated by the cockcroft and Gault method or by MDRD (see http://nephron.org/cgi-bin/MDRD_GFR/cgi)
  5. Patient without HLA identical donor.

    EXCLUSION CRITERIA AT RANDOMIZATION

  6. Patients belonging to the intermediate 1 risk group (CEBPA+ or NPM1+ without Flt3-ITD) in CR/CRp after the first induction course. These patients will go out of the study and receive consolidation cycles based on HD-AraC (Aracytine).
  7. Known central nervous system involvement with AML.
  8. Uncontrolled active infection of any kind or bleeding.
  9. Compromized organ function judged to be lifethreatening by the Investigator.
  10. Patient with HLA identical donor identified.

Sites / Locations

  • Hôpital Sud - CHU Amiens
  • Centre Hospitalier Regional et Universitaire d'Angers
  • Hôpital Victor Dupouy
  • Hôpital Avicenne - bobigny
  • Centre Hospitalier Boulogne/Mer
  • Hôpital Clemenceau - chu Caen
  • Centre Hospitalier René Dubos
  • HIA Percy
  • Hôpital de Corbeil
  • Hôpital Mondor
  • Hôpital Dubocage
  • Centre Hospitalier Dunkerque
  • Hôpital Michallon
  • Centre Hospitalier Versailles
  • Centre Hospitalier Schaffner
  • Hôpital Huriez
  • CHU Dupuytren
  • Institut Paoli-Calmette
  • Centre Hospitalier Meaux
  • CHU - Hôtel Dieu
  • Centre A. Lacassagne
  • Hôpital Archet 1
  • Hôpital St Louis
  • Pitié-Salpetrière
  • Paris Necker
  • Hôpital Haut Lévêque
  • Hospices Civils de Lyon - Centre Hospitalier Lyon Sud
  • Hôpital V. Provo
  • Centre Henri Becquerel - CHRU ROUEN
  • Centre Hospitalier Huguenin
  • Hôpital Purpan
  • Centre Hospitalier Valenciennes
  • CHU de Brabois
  • Institut Gustave Roussy

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

CLARA

HDAC

Arm Description

Clofarabine / Intermediate-Dose Cytarabine (CLARA) with G-CSF given during each sequence of chemotherapy in order to increase the blast priming.

High-Dose Cytarabine (HDAC) with G-CSF given during each sequence of chemotherapy in order to increase the blast priming.

Outcomes

Primary Outcome Measures

DFS (disease free survival) following first remission achievement (CR : Complete Remission or CRp : Complete Remission but platelet count < 100 x109/L) in younger patients with intermediate-risk or unfavorable-risk AML.
As all these patients are eligible for allogenic stem cell transplantation in first remission if they have a donor and the comparison of interest primarily concerns non-transplanted patients, it is planned: 1) to exclude patients with an identified donor; 2) to adjust Relapse Free survival (RFS) comparison on the interaction with stem cell transplantation in first remission; and 3) to censure at transplant time the patients allografted before disease progression after randomization (late donor identification) as sensitivity analysis.

Secondary Outcome Measures

• Safety profile of CLARA versus HDAC consolidation courses
All toxicity encountered during therapy will be evaluated according to the CTC expanded Common Toxicity Criteria and causal relationship to investigational products will be reported. Serious Adverse Events encountered 3 MONTHS after the last cycle of study chemotherapy (induction/salvage/CLARA/HDAC), whether or not ascribed to the study, will be recorded in the Serious Adverse Event form.
• Possible predictors to response
Possible predictors to response: with respect to cytogenetics risk groups and mutational status: FLT3 (Fms-like tyrosine kinase 3), MLL (myeloid/ lymphoid or mixed-lineage leukemia), CEBPA (CCAAT / enhancer binding protein α) and NPM(Nucleophosmin))
• MRD (Minimal Residual Disease) level
Evaluation of MRD in patients with AML in clinical remission is a potentially useful tool for assessing the risk of relapse and guiding further therapeutic decisions. Once an aberrant pattern is identified at diagnosis, it will serve as a "patient-specific probe" to be used, with standard triple/quadruple labelling, to track residual disease longitudinally. Bone marrow and peripheral blood samples for MRD evaluation will be collected at fixed time points: End of induction in patients achieving CR/CRp. End of consolidation 3. Every 6 months during follow-up for 2 years.
• Overall cumulative incidence of relapse
• Overall survival (OS)
OS will be defined as the time from diagnosis to death or last contact with the patient

Full Information

First Posted
July 2, 2009
Last Updated
September 20, 2016
Sponsor
Hospices Civils de Lyon
search

1. Study Identification

Unique Protocol Identification Number
NCT00932412
Brief Title
The CLARA Study From the Acute Leukemia French Association (ALFA 0702 Trial)
Acronym
CLARA
Official Title
A Randomized Phase II Study of Clofarabine / Intermediate-Dose Cytarabine (CLARA)Versus High-Dose Cytarabine (HDAC) as Consolidation in Younger Patients With Newly-Diagnosed Acute Myeloid Leukemia (AML).
Study Type
Interventional

2. Study Status

Record Verification Date
September 2016
Overall Recruitment Status
Completed
Study Start Date
March 2009 (undefined)
Primary Completion Date
April 2016 (Actual)
Study Completion Date
April 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Hospices Civils de Lyon

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study is a phase II randomized multicenter study. Patients will be enrolled at time of diagnosis and will receive one or two cycles of induction chemotherapy. Patients, without indication of intensification by allogeneic stem cell transplantation and/or without HLA (Human Leukocyte Antigen)-compatible donor, who attain a CR after one or two cycles of induction chemotherapy, will be eligible for the study Clofarabine / Intermediate-Dose Cytarabine (CLARA)versus High-Dose Cytarabine (HDAC)and will be randomized between 3 courses of CLARA chemotherapy and 3 courses of HDAC chemotherapy as consolidation. We will compare efficacy and toxicity among the two arms.
Detailed Description
Because of the results of our former trial (ALFA-9802) [Thomas, 2005], chemotherapy will be combined in each arm with G-CSF (Granulocyte Colony-Stimulating Factor) given during each sequence of chemotherapy in order to increase the blast priming.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Myeloid Leukemia
Keywords
Younger Patients with Newly-Diagnosed Acute Myeloid Leukemia (AML).

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
735 (Actual)

8. Arms, Groups, and Interventions

Arm Title
CLARA
Arm Type
Experimental
Arm Description
Clofarabine / Intermediate-Dose Cytarabine (CLARA) with G-CSF given during each sequence of chemotherapy in order to increase the blast priming.
Arm Title
HDAC
Arm Type
Active Comparator
Arm Description
High-Dose Cytarabine (HDAC) with G-CSF given during each sequence of chemotherapy in order to increase the blast priming.
Intervention Type
Drug
Intervention Name(s)
CLARA
Intervention Description
Clofarabine 30 mg/m2/day IV (2h) on days 2 to 6 (administered as a 2h infusion in 250 ml of 0.9% normal saline solution) Cytarabine 1 g/m2/day intravenous (2h) 4 hours later on days 1 to 5 (administered as a 2h infusion in 250 ml of 5% dextrose in water) G-CSF 5 microg/kg/day intravenous from day 1 to day 6 (administered as a 30 mn infusion in 20 ml of dextrose 5% in water)
Intervention Type
Drug
Intervention Name(s)
HDAc
Intervention Description
Cytarabine 3 g/m2/12h intravenous (3h) on days 1, 3, 5 (administered as a 3h infusion in 250 ml of 5% dextrose in water) G-CSF 5 microg/kg/day intravenous from day 1 to day 5 (administered as a 30 mn infusion in 20 ml of dextrose 5% in water)
Primary Outcome Measure Information:
Title
DFS (disease free survival) following first remission achievement (CR : Complete Remission or CRp : Complete Remission but platelet count < 100 x109/L) in younger patients with intermediate-risk or unfavorable-risk AML.
Description
As all these patients are eligible for allogenic stem cell transplantation in first remission if they have a donor and the comparison of interest primarily concerns non-transplanted patients, it is planned: 1) to exclude patients with an identified donor; 2) to adjust Relapse Free survival (RFS) comparison on the interaction with stem cell transplantation in first remission; and 3) to censure at transplant time the patients allografted before disease progression after randomization (late donor identification) as sensitivity analysis.
Time Frame
2 years
Secondary Outcome Measure Information:
Title
• Safety profile of CLARA versus HDAC consolidation courses
Description
All toxicity encountered during therapy will be evaluated according to the CTC expanded Common Toxicity Criteria and causal relationship to investigational products will be reported. Serious Adverse Events encountered 3 MONTHS after the last cycle of study chemotherapy (induction/salvage/CLARA/HDAC), whether or not ascribed to the study, will be recorded in the Serious Adverse Event form.
Time Frame
2 years
Title
• Possible predictors to response
Description
Possible predictors to response: with respect to cytogenetics risk groups and mutational status: FLT3 (Fms-like tyrosine kinase 3), MLL (myeloid/ lymphoid or mixed-lineage leukemia), CEBPA (CCAAT / enhancer binding protein α) and NPM(Nucleophosmin))
Time Frame
2 years
Title
• MRD (Minimal Residual Disease) level
Description
Evaluation of MRD in patients with AML in clinical remission is a potentially useful tool for assessing the risk of relapse and guiding further therapeutic decisions. Once an aberrant pattern is identified at diagnosis, it will serve as a "patient-specific probe" to be used, with standard triple/quadruple labelling, to track residual disease longitudinally. Bone marrow and peripheral blood samples for MRD evaluation will be collected at fixed time points: End of induction in patients achieving CR/CRp. End of consolidation 3. Every 6 months during follow-up for 2 years.
Time Frame
2 years
Title
• Overall cumulative incidence of relapse
Time Frame
120 days
Title
• Overall survival (OS)
Description
OS will be defined as the time from diagnosis to death or last contact with the patient
Time Frame
2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria at registration: Age 18 years or more and less than 60 years With: A morphologically proven diagnosis of AML according to the WHO classification, cytogenetically (standard karyotype, FISH-MLL) and molecularly (FLT3, CEBPA, NMP1) defined. ECOG (Eastern Cooperative Oncology Group) performance status 0 to 2. Have adequate renal and hepatic function as indicated by the following laboratory values: Creatinine clearance (calculated by the cockcroft and Gault method) ≥ 40mL/min; AST (Aspartate amino transférase) and ALT (Alanine Amino Transférase ) < or = 2.5N; total bilirubin < or = 2N (unless related to the underlying disease). Cardiac function determined by radionuclide or echography within normal limits. Women of child-bearing potential (i.e. women who are pre-menopausal or not surgically sterile) must use acceptable contraceptive methods, and must have a negative serum or urine pregnancy test within 2 weeks prior the beginning treatment on this trial. Must be able and willing to give written informed consent. The subject must be covered by a social security system. Exclusion Criteria at registration: Patients with AML with favorable risk cytogenetics: M3-AML; CBF-AML including t(8:21), inv(16), or t(16;16) AML. Ph-positive AML. AML following diagnosed myeloproliferation or patient with prior history of MDS known for more than 3 months Prior treatment with chemotherapy or radiotherapy for another tumor. Prior tumor, if not stable for at least two years, except in-situ carcinoma and skin carcinoma Compromised organ function judged to be lifethreatening by the Investigator. Positive serology for HIV (Human Immunodeficiency Virus), HBV (Hepatitis B Virus) and HBC (Hepatitis C Virus)(except post vaccination) Uncontrolled active infection of any kind or bleeding. Patients with infections who are under active treatment with antibiotics and whose infections are controlled may be entered to the study. Other active malignancy. Patients concurrently receiving any other standard or investigational treatment for their leukemia, with the exception of hydroxyurea. INCLUSION CRITERIA AT RANDOMIZATION Patients with either in first CR/CRp after the first induction course or in first CR/CRp after salvage therapy. ECOG performance status 0 to 2. AST and ALT < or = 2.5N; total bilirubin < or = 2N. Creatinine clearance ≥40mL/min (calculated by the cockcroft and Gault method or by MDRD (see http://nephron.org/cgi-bin/MDRD_GFR/cgi) Patient without HLA identical donor. EXCLUSION CRITERIA AT RANDOMIZATION Patients belonging to the intermediate 1 risk group (CEBPA+ or NPM1+ without Flt3-ITD) in CR/CRp after the first induction course. These patients will go out of the study and receive consolidation cycles based on HD-AraC (Aracytine). Known central nervous system involvement with AML. Uncontrolled active infection of any kind or bleeding. Compromized organ function judged to be lifethreatening by the Investigator. Patient with HLA identical donor identified.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Xavier THOMAS, MD
Organizational Affiliation
Hospices Civils de Lyon
Official's Role
Principal Investigator
Facility Information:
Facility Name
Hôpital Sud - CHU Amiens
City
Amiens
ZIP/Postal Code
80054
Country
France
Facility Name
Centre Hospitalier Regional et Universitaire d'Angers
City
Angers
ZIP/Postal Code
49033
Country
France
Facility Name
Hôpital Victor Dupouy
City
Argenteuil
ZIP/Postal Code
95107
Country
France
Facility Name
Hôpital Avicenne - bobigny
City
Bobigny
ZIP/Postal Code
93009
Country
France
Facility Name
Centre Hospitalier Boulogne/Mer
City
Boulogne / Mer
ZIP/Postal Code
62280
Country
France
Facility Name
Hôpital Clemenceau - chu Caen
City
Caen
ZIP/Postal Code
14033
Country
France
Facility Name
Centre Hospitalier René Dubos
City
Cergy Pontoise
ZIP/Postal Code
95303
Country
France
Facility Name
HIA Percy
City
Clamart
ZIP/Postal Code
92141
Country
France
Facility Name
Hôpital de Corbeil
City
Corbeil
ZIP/Postal Code
91100
Country
France
Facility Name
Hôpital Mondor
City
Créteil
ZIP/Postal Code
94010
Country
France
Facility Name
Hôpital Dubocage
City
Dijon
ZIP/Postal Code
21000
Country
France
Facility Name
Centre Hospitalier Dunkerque
City
Dunkerque
ZIP/Postal Code
59395
Country
France
Facility Name
Hôpital Michallon
City
Grenoble
ZIP/Postal Code
38043
Country
France
Facility Name
Centre Hospitalier Versailles
City
Le Chesnay
ZIP/Postal Code
78150
Country
France
Facility Name
Centre Hospitalier Schaffner
City
Lens
ZIP/Postal Code
62307
Country
France
Facility Name
Hôpital Huriez
City
Lille
ZIP/Postal Code
59037
Country
France
Facility Name
CHU Dupuytren
City
Limoges
ZIP/Postal Code
87042
Country
France
Facility Name
Institut Paoli-Calmette
City
Marseille
ZIP/Postal Code
13273
Country
France
Facility Name
Centre Hospitalier Meaux
City
Meaux
ZIP/Postal Code
77104
Country
France
Facility Name
CHU - Hôtel Dieu
City
Nantes
ZIP/Postal Code
44093
Country
France
Facility Name
Centre A. Lacassagne
City
Nice
ZIP/Postal Code
06100
Country
France
Facility Name
Hôpital Archet 1
City
Nice
ZIP/Postal Code
06202
Country
France
Facility Name
Hôpital St Louis
City
Paris
ZIP/Postal Code
75010
Country
France
Facility Name
Pitié-Salpetrière
City
Paris
ZIP/Postal Code
75013
Country
France
Facility Name
Paris Necker
City
Paris
ZIP/Postal Code
75743
Country
France
Facility Name
Hôpital Haut Lévêque
City
Pessac
ZIP/Postal Code
33604
Country
France
Facility Name
Hospices Civils de Lyon - Centre Hospitalier Lyon Sud
City
Pierre-benite
ZIP/Postal Code
69495
Country
France
Facility Name
Hôpital V. Provo
City
Roubaix
ZIP/Postal Code
59056
Country
France
Facility Name
Centre Henri Becquerel - CHRU ROUEN
City
Rouen
ZIP/Postal Code
76038
Country
France
Facility Name
Centre Hospitalier Huguenin
City
Saint Cloud
ZIP/Postal Code
92210
Country
France
Facility Name
Hôpital Purpan
City
Toulouse
ZIP/Postal Code
31059
Country
France
Facility Name
Centre Hospitalier Valenciennes
City
Valenciennes
ZIP/Postal Code
59322
Country
France
Facility Name
CHU de Brabois
City
Vandoeuvre Les Nancy
ZIP/Postal Code
54511
Country
France
Facility Name
Institut Gustave Roussy
City
Villejuif
ZIP/Postal Code
94800
Country
France

12. IPD Sharing Statement

Citations:
PubMed Identifier
34895843
Citation
Michallet M, Sobh M, Morisset S, Deloire A, Raffoux E, de Botton S, Caillot D, Chantepie S, Girault S, Berthon C, Bertoli S, Lepretre S, Leguay T, Castaigne S, Marolleau JP, Pautas C, Malfuson JV, Veyn N, Braun T, Gastaud L, Suarez F, Schmidt A, Gressin R, Bonmati C, Celli-Lebras K, El-Hamri M, Ribaud P, Dombret H, Thomas X, Bergeron A. Antifungal Prophylaxis in AML Patients Receiving Intensive Induction Chemotherapy: A Prospective Observational Study From the Acute Leukaemia French Association (ALFA) Group. Clin Lymphoma Myeloma Leuk. 2022 May;22(5):311-318. doi: 10.1016/j.clml.2021.10.011. Epub 2021 Oct 25.
Results Reference
derived
PubMed Identifier
32871585
Citation
Fenwarth L, Thomas X, de Botton S, Duployez N, Bourhis JH, Lesieur A, Fortin G, Meslin PA, Yakoub-Agha I, Sujobert P, Dumas PY, Recher C, Lebon D, Berthon C, Michallet M, Pigneux A, Nguyen S, Chantepie S, Vey N, Raffoux E, Celli-Lebras K, Gardin C, Lambert J, Malfuson JV, Caillot D, Maury S, Ducourneau B, Turlure P, Lemasle E, Pautas C, Chevret S, Terre C, Boissel N, Socie G, Dombret H, Preudhomme C, Itzykson R. A personalized approach to guide allogeneic stem cell transplantation in younger adults with acute myeloid leukemia. Blood. 2021 Jan 28;137(4):524-532. doi: 10.1182/blood.2020005524.
Results Reference
derived

Learn more about this trial

The CLARA Study From the Acute Leukemia French Association (ALFA 0702 Trial)

We'll reach out to this number within 24 hrs