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ALFA-0703 Study in Older Patients With Acute Myeloblastic Leukemia (AML) (ALFA-0703)

Primary Purpose

Acute Myeloid Leukemia

Status
Withdrawn
Phase
Phase 3
Locations
France
Study Type
Interventional
Intervention
Vesanoid (ATRA)
AZACITIDINE (VIDAZA)
CYTARABINE
Sponsored by
Acute Leukemia French Association
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Acute Myeloid Leukemia focused on measuring Acute Myeloid Leukemia, Aged of 65 to 79 years, Older Patients with Acute Myeloblastic Leukemia

Eligibility Criteria

65 Years - 79 Years (Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Aged of 65 to 79 years
  2. With a morphologically proven diagnosis of AML according to WHO classification either de novo or AML with "myelodysplasia related changes"
  3. Not previously treated for AML
  4. Signed informed consent.

Exclusion Criteria:

  1. APL in the WHO classification.
  2. Ph1-positive AML or prior Ph1-positive disease
  3. AML evolving from a prior MPN in the WHO 2008 classification.
  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. Prior advanced malignant hepatic tumor
  7. ECOG Performance Status Score > 2
  8. Creatinine level more than 2x's the upper limit of the normal range (ULN) at the laboratory where the analysis was performed, except if AML-related.
  9. Total serum bilirubin more than 2x's the ULN at the laboratory where the analysis was performed, except if AML-related.
  10. AST (SGOT) or ALT (SGPT) more than 2.5x's the ULN at the laboratory where the analysis was performed, except if AML-related
  11. LVEF less than.55 or equivalent by doppler echocardiography
  12. Known intolerance to Azacitidine, mannitol, retinoids
  13. Positive serum test for HIV and HTLV-1
  14. NYHA Grade 3/4 cardiac disease .
  15. Severe infection at inclusion time.
  16. Psychiatric disease or an history of non-compliance to medical regimens or patients considered potentially unreliable.
  17. Absence of health care insurance (affiliation à un régime de Sécurité Sociale)
  18. Participation to any study requiring informed consent

Sites / Locations

  • Chu Amiens Sud
  • CH
  • Hopital Avicenne
  • Chu Boulogne Sur Mer
  • CH
  • Hopital Percy
  • Ch Sud Francilien
  • Hopital Henri Mondor
  • Ch Dunkerque
  • CH
  • CHU
  • CH
  • Hopital Edouard Herriot
  • CH
  • Centre Antoine Lacassagne
  • Necker Hospital
  • St Antoine Hospital
  • Hopital Pitie-Salpetriere
  • Hopital Saint-Louis
  • Ch Rene Dubos
  • CH
  • CHU
  • CNLCC
  • CH
  • CH
  • IGR

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm 6

Arm Type

Experimental

No Intervention

Experimental

Experimental

Experimental

Experimental

Arm Label

R1 Arm A : ATRA

R1 Arm B : no ATRA

R2 Arm 1A : AZACITIDINE and ATRA

R2 Arm 1B : AZACITIDINE and No ATRA

R2 Arm 2A : ATRA

R2 Arm 2B : no ATRA

Arm Description

Idarubicin: 9 mg/m2/d D1 to D4 Cytarabine : 200 mg/m2/d Continuous IV from D1 to D7 Peg-filgrastim : 6 mg SC D9 or filgrastim 5ug/kg/d SC or lenograstim 263ug/d IV 30mn, both from D9 to myeloid recovery(PMN >1G/l over 2 days at minimum All-trans retinoic acid (ATRA): 45mg/m2/day in two divided doses from D8 to D28

Idarubicin: 9 mg/m2/d D1 to D4 Cytarabine : 200 mg/m2/d Continuous IV from D1 to D7 Peg-filgrastim : 6 mg SC D9 or filgrastim 5ug/kg/d SC or lenograstim 263ug/d IV 30mn, both from D9 to myeloid recovery(PMN >1G/l over 2 days at minimum

Azacitidine: 75 mg/m2/12h SC from D1 to D5 Idarubicine: 9 mg/m2/d IV on D5 All-trans retinoic acid (ATRA): 45mg/m2/d in two divided doses from D8 to D21

Azacitidine: 75 mg/m2/12h SC from D1 to D5 Idarubicine: 9 mg/m2/d IV on D5

Idarubicine : 9 mg/m2/d IV on D1 Cytarabine : 60 mg/m2/12h SC from D1 to D5 All-trans retinoic acid (ATRA): 45mg/ m2/d in two divided doses from D8 to D21

Idarubicine : 9 mg/m2/d IV on D1 Cytarabine : 60 mg/m2/12h SC from D1 to D5

Outcomes

Primary Outcome Measures

For randomization R1, the primary endpoint is Event-free Survival (EFS)
For randomization R2, the primary endpoint is disease free survival (DFS)

Secondary Outcome Measures

Complete Response (CR) rate
Overall survival
Response rate to azacitidine idarubicin +/-ATRA combination after intensive chemotherapy failure and identification of possible predictors of response to this therapy
Assess the safety of combination ATRA + chemotherapy or idarubicin-azacitidine courses and of maintenance with azacitidine
Effects on relapse rates of ATRA and maintenance, with respect to cytogenetics risk groups, subtypes of AML and mutational status (FLT3, MLL), and biomarkers

Full Information

First Posted
February 10, 2010
Last Updated
December 29, 2015
Sponsor
Acute Leukemia French Association
Collaborators
Assistance Publique - Hôpitaux de Paris
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1. Study Identification

Unique Protocol Identification Number
NCT01067274
Brief Title
ALFA-0703 Study in Older Patients With Acute Myeloblastic Leukemia (AML)
Acronym
ALFA-0703
Official Title
A Randomized Multicenter Phase III Study to Evaluate the Role of All-trans Retinoic Acid (ATRA) in Combination With Induction Chemotherapy, or Azacitidine and Idarubicin as Salvage Therapy and Idarubicin With Cytarabine or Azacitidine as Maintenance Therapy in Older Patients With Acute Myeloblastic Leukemia (AML)
Study Type
Interventional

2. Study Status

Record Verification Date
February 2010
Overall Recruitment Status
Withdrawn
Why Stopped
Study abandoned
Study Start Date
April 2010 (undefined)
Primary Completion Date
April 2016 (Anticipated)
Study Completion Date
undefined (undefined)

3. Sponsor/Collaborators

Name of the Sponsor
Acute Leukemia French Association
Collaborators
Assistance Publique - Hôpitaux de Paris

4. Oversight

5. Study Description

Brief Summary
A Randomized Multicenter Phase III Study to Evaluate the Role of All-trans Retinoic Acid (ATRA) in Combination with Induction Chemotherapy, or Azacitidine and Idarubicin as salvage therapy and Idarubicin with Cytarabine or Azacitidine as Maintenance Therapy in Older Patients with Acute Myeloblastic Leukemia (AML). To compare the outcome of elderly patients with newly-diagnosed AML treated with standard induction chemotherapy and post-remission therapy, in only patients in CR, with either azacitidine or cytarabine combined to idarubicin +/- ATRA and salvage therapy with azacitidine combined to idarubicin +/- ATRA.
Detailed Description
Induction therapy : First randomization (R1) at baseline : ATRA versus no ATRA. Salvage therapy : No conventional salvage therapy is planned. Patients who will not achieve CR, according to IWG criteria after induction will be treated with 3 courses of azacitidine and idarubicin +/- ATRA combination, if eligible for further treatment. Followed by 3 identical courses and 6 courses of maintenance by azacitidine alone to be delivered every 28 days, in those patients reaching CR or PR after 3 courses (evaluation of response from 28 to 56 days from course 3). Randomization R2: type of maintenance: Response to induction will be evaluated 2 weeks after myeloid recovery, just before first consolidation course, due use of to pegfilgrastim, lenograstim or filgrastim during induction. Responses will be classified according to the Revised Recommendations of the IWG for AML. Patients in CR only will be subjected to a second randomization R2 as follows 6 courses of combined chemotherapy, will be delivered as outpatients, ATRA according to R1 randomization.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Myeloid Leukemia
Keywords
Acute Myeloid Leukemia, Aged of 65 to 79 years, Older Patients with Acute Myeloblastic Leukemia

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
0 (Actual)

8. Arms, Groups, and Interventions

Arm Title
R1 Arm A : ATRA
Arm Type
Experimental
Arm Description
Idarubicin: 9 mg/m2/d D1 to D4 Cytarabine : 200 mg/m2/d Continuous IV from D1 to D7 Peg-filgrastim : 6 mg SC D9 or filgrastim 5ug/kg/d SC or lenograstim 263ug/d IV 30mn, both from D9 to myeloid recovery(PMN >1G/l over 2 days at minimum All-trans retinoic acid (ATRA): 45mg/m2/day in two divided doses from D8 to D28
Arm Title
R1 Arm B : no ATRA
Arm Type
No Intervention
Arm Description
Idarubicin: 9 mg/m2/d D1 to D4 Cytarabine : 200 mg/m2/d Continuous IV from D1 to D7 Peg-filgrastim : 6 mg SC D9 or filgrastim 5ug/kg/d SC or lenograstim 263ug/d IV 30mn, both from D9 to myeloid recovery(PMN >1G/l over 2 days at minimum
Arm Title
R2 Arm 1A : AZACITIDINE and ATRA
Arm Type
Experimental
Arm Description
Azacitidine: 75 mg/m2/12h SC from D1 to D5 Idarubicine: 9 mg/m2/d IV on D5 All-trans retinoic acid (ATRA): 45mg/m2/d in two divided doses from D8 to D21
Arm Title
R2 Arm 1B : AZACITIDINE and No ATRA
Arm Type
Experimental
Arm Description
Azacitidine: 75 mg/m2/12h SC from D1 to D5 Idarubicine: 9 mg/m2/d IV on D5
Arm Title
R2 Arm 2A : ATRA
Arm Type
Experimental
Arm Description
Idarubicine : 9 mg/m2/d IV on D1 Cytarabine : 60 mg/m2/12h SC from D1 to D5 All-trans retinoic acid (ATRA): 45mg/ m2/d in two divided doses from D8 to D21
Arm Title
R2 Arm 2B : no ATRA
Arm Type
Experimental
Arm Description
Idarubicine : 9 mg/m2/d IV on D1 Cytarabine : 60 mg/m2/12h SC from D1 to D5
Intervention Type
Drug
Intervention Name(s)
Vesanoid (ATRA)
Other Intervention Name(s)
VEZANOIDE
Intervention Description
45 mg/m2/day in two divided doses from D8 to D28
Intervention Type
Drug
Intervention Name(s)
AZACITIDINE (VIDAZA)
Intervention Description
75 mg/m2/12h SC from D1 to D5
Intervention Type
Drug
Intervention Name(s)
CYTARABINE
Intervention Description
Cytarabine : 60 mg/m2/12h SC from D1 to D5
Primary Outcome Measure Information:
Title
For randomization R1, the primary endpoint is Event-free Survival (EFS)
Time Frame
2-year EFS
Title
For randomization R2, the primary endpoint is disease free survival (DFS)
Time Frame
2-year DFS
Secondary Outcome Measure Information:
Title
Complete Response (CR) rate
Time Frame
2 years
Title
Overall survival
Time Frame
2 years
Title
Response rate to azacitidine idarubicin +/-ATRA combination after intensive chemotherapy failure and identification of possible predictors of response to this therapy
Time Frame
2 years
Title
Assess the safety of combination ATRA + chemotherapy or idarubicin-azacitidine courses and of maintenance with azacitidine
Time Frame
2 years
Title
Effects on relapse rates of ATRA and maintenance, with respect to cytogenetics risk groups, subtypes of AML and mutational status (FLT3, MLL), and biomarkers
Time Frame
2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
65 Years
Maximum Age & Unit of Time
79 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Aged of 65 to 79 years With a morphologically proven diagnosis of AML according to WHO classification either de novo or AML with "myelodysplasia related changes" Not previously treated for AML Signed informed consent. Exclusion Criteria: APL in the WHO classification. Ph1-positive AML or prior Ph1-positive disease AML evolving from a prior MPN in the WHO 2008 classification. 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 Prior advanced malignant hepatic tumor ECOG Performance Status Score > 2 Creatinine level more than 2x's the upper limit of the normal range (ULN) at the laboratory where the analysis was performed, except if AML-related. Total serum bilirubin more than 2x's the ULN at the laboratory where the analysis was performed, except if AML-related. AST (SGOT) or ALT (SGPT) more than 2.5x's the ULN at the laboratory where the analysis was performed, except if AML-related LVEF less than.55 or equivalent by doppler echocardiography Known intolerance to Azacitidine, mannitol, retinoids Positive serum test for HIV and HTLV-1 NYHA Grade 3/4 cardiac disease . Severe infection at inclusion time. Psychiatric disease or an history of non-compliance to medical regimens or patients considered potentially unreliable. Absence of health care insurance (affiliation à un régime de Sécurité Sociale) Participation to any study requiring informed consent
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
GARDIN CLAUDE, MD
Organizational Affiliation
Acute Leukemia French Association
Official's Role
Principal Investigator
Facility Information:
Facility Name
Chu Amiens Sud
City
Amiens
ZIP/Postal Code
80054
Country
France
Facility Name
CH
City
Argenteuil
ZIP/Postal Code
95107
Country
France
Facility Name
Hopital Avicenne
City
Bobigny
Country
France
Facility Name
Chu Boulogne Sur Mer
City
Boulogne Sur Mer
ZIP/Postal Code
62321
Country
France
Facility Name
CH
City
Caen
ZIP/Postal Code
14033
Country
France
Facility Name
Hopital Percy
City
Clamart
ZIP/Postal Code
92141
Country
France
Facility Name
Ch Sud Francilien
City
Corbeil Essonnes
ZIP/Postal Code
94010
Country
France
Facility Name
Hopital Henri Mondor
City
Creteil
Country
France
Facility Name
Ch Dunkerque
City
Dunkerque
ZIP/Postal Code
59385
Country
France
Facility Name
CH
City
Lens
ZIP/Postal Code
62307
Country
France
Facility Name
CHU
City
Lille
ZIP/Postal Code
59037
Country
France
Facility Name
CH
City
Limoges
ZIP/Postal Code
87042
Country
France
Facility Name
Hopital Edouard Herriot
City
Lyon
Country
France
Facility Name
CH
City
Meaux
ZIP/Postal Code
77104
Country
France
Facility Name
Centre Antoine Lacassagne
City
Nice
ZIP/Postal Code
06189
Country
France
Facility Name
Necker Hospital
City
Paris 15
ZIP/Postal Code
75015
Country
France
Facility Name
St Antoine Hospital
City
Paris
ZIP/Postal Code
75012
Country
France
Facility Name
Hopital Pitie-Salpetriere
City
Paris
ZIP/Postal Code
75651
Country
France
Facility Name
Hopital Saint-Louis
City
Paris
Country
France
Facility Name
Ch Rene Dubos
City
Pontoise
ZIP/Postal Code
95303
Country
France
Facility Name
CH
City
Roubaix
ZIP/Postal Code
59100
Country
France
Facility Name
CHU
City
Rouen
ZIP/Postal Code
76038
Country
France
Facility Name
CNLCC
City
Saint-Cloud
ZIP/Postal Code
92210
Country
France
Facility Name
CH
City
Valenciennes
ZIP/Postal Code
59322
Country
France
Facility Name
CH
City
Versailles
Country
France
Facility Name
IGR
City
Villejuif
Country
France

12. IPD Sharing Statement

Learn more about this trial

ALFA-0703 Study in Older Patients With Acute Myeloblastic Leukemia (AML)

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