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Phase II Study of Azacitidine and Sargramostim as Maintenance Treatment for Poor-Risk AML or MDS

Primary Purpose

Acute Myeloid Leukemia, Myelodysplastic Syndrome

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Azacitidine
Sargramostim
Sponsored by
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Acute Myeloid Leukemia focused on measuring maintenance treatment, stem cell transplant, cytarabine-based chemotherapy

Eligibility Criteria

6 Months - undefined (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Age > 6 months
  2. Initial diagnosis of poor -risk AML or MDS (defined in section 3.2), treated with either stem cell transplant or cytarabine-based consolidation chemotherapy, within the past 60-185 days
  3. ECOG performance status 0-2
  4. No morphologic evidence of leukemia or active MDS as determined by JHH Hematopathologist independent review of a bone marrow aspirate and biopsy done following the completion of therapy and within 14 days prior to enrollment
  5. Peripheral blood count recovery: Neutrophil count ≥ 1000 /µL, platelet count ≥ 50x 109 /µL without platelet transfusions, and adequate hematocrit independent of red cell transfusions .
  6. No evidence of extramedullary leukemia, such as CNS or soft tissue involvement
  7. Adequate end organ function as measured by the following: AST and ALT < 4 x normal, total serum bilirubin < 2 x upper limit normal (unless due to hemolysis, Gilbert's syndrome, or ineffective erythropoiesis), creatinine < 2 x upper limit of normal
  8. Ability to give informed consent
  9. In agreement to use an effective barrier method of birth control to avoid pregnancy during the study and for a minimum of 30 days after study treatment, for all male and female patients who are fertile

Exclusion Criteria:

  1. Patients with untreated or uncontrolled infections
  2. Patients with untreated or uncontrolled grade 3 or 4 GVHD
  3. Pregnancy and lactation
  4. Concurrent use of any other investigational agents.
  5. Known HIV-positive patients.
  6. Known hypersensitivity to 5AC or GM-CSF

Sites / Locations

  • The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

Myeloablative BMT

Non-myeloablative BMT

Standard consolidation

Arm Description

Azacitidine and sargramostim after myeloablative stem cell transplant

Azacitidine and sargramostim after non-myeloablative stem cell transplant

Azacitidine and sargramostim after standard consolidation

Outcomes

Primary Outcome Measures

Two-year Relapse Free Survival of Patients
To evaluate the two-year relapse-free survival (RFS) of patients with poor-risk Acute Myeloid Leukemia (AML) or Myelodysplasia (MDS), who receive maintenance treatment with 5-Azacytidine (5AC) in combination with sargramostim (GM-CSF) during remission, following definitive therapy with either a stem cell transplant (SCT) or cytarabine-based consolidation chemotherapy.

Secondary Outcome Measures

Hematologic Toxicity as Determined by Anemia
Percentage of patients with anemia, the most commonly reported hematologic toxicity, after receiving the combination of Azacitidine and sargramostim
One-year RFS
We will report the number of participants with one year RFS
Overall Survival
Percentage of participants with overall survival at 2 years.

Full Information

First Posted
October 2, 2012
Last Updated
September 23, 2022
Sponsor
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT01700673
Brief Title
Phase II Study of Azacitidine and Sargramostim as Maintenance Treatment for Poor-Risk AML or MDS
Official Title
A Phase II Study of 5-Azacitidine (5AC) in Combination With Sargramostim (GM-CSF) as Maintenance Treatment, After Definitive Therapy With Either Stem Cell Transplant (SCT) or Cytarabine-based Chemotherapy, in Patients With Poor-risk Acute Myeloid Leukemia (AML) or Myelodysplastic Syndrome (MDS)
Study Type
Interventional

2. Study Status

Record Verification Date
August 2021
Overall Recruitment Status
Completed
Study Start Date
June 2013 (Actual)
Primary Completion Date
June 2020 (Actual)
Study Completion Date
June 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Collaborators
National Cancer Institute (NCI)

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
To determine the impact of maintenance therapy in patients with MDS/AML in remission.
Detailed Description
We propose a phase II study to determine the impact of maintenance therapy with 5-azacytidine and GM-CSF in patients with poor-risk AML or MDS, who are in remission after definitive treatment with either stem cell transplant or cytarabine-based consolidation chemotherapy. In order to precede relapse and to avoid lead time bias, treatment would need to commence within 185 days of definitive therapy. Furthermore, approximately 50% of relapses occur within the first year and up to 80% within two years after SCT, therefore we would limit the duration of maintenance therapy to one year, followed by two years of follow-up.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Myeloid Leukemia, Myelodysplastic Syndrome
Keywords
maintenance treatment, stem cell transplant, cytarabine-based chemotherapy

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Myeloablative BMT
Arm Type
Experimental
Arm Description
Azacitidine and sargramostim after myeloablative stem cell transplant
Arm Title
Non-myeloablative BMT
Arm Type
Experimental
Arm Description
Azacitidine and sargramostim after non-myeloablative stem cell transplant
Arm Title
Standard consolidation
Arm Type
Experimental
Arm Description
Azacitidine and sargramostim after standard consolidation
Intervention Type
Drug
Intervention Name(s)
Azacitidine
Other Intervention Name(s)
Vidaza, 5-azacytidine, Azacytidine
Intervention Description
Azacitidine will be administered days 1-5 of a 28 day cycle. Treatment is planned for a total of 12 cycles.
Intervention Type
Biological
Intervention Name(s)
Sargramostim
Other Intervention Name(s)
GM-CSF
Intervention Description
Sargramostim will be administered days 1-10 of a 28 day cycle. Treatment is planned for a total of 12 cycles.
Primary Outcome Measure Information:
Title
Two-year Relapse Free Survival of Patients
Description
To evaluate the two-year relapse-free survival (RFS) of patients with poor-risk Acute Myeloid Leukemia (AML) or Myelodysplasia (MDS), who receive maintenance treatment with 5-Azacytidine (5AC) in combination with sargramostim (GM-CSF) during remission, following definitive therapy with either a stem cell transplant (SCT) or cytarabine-based consolidation chemotherapy.
Time Frame
2 year
Secondary Outcome Measure Information:
Title
Hematologic Toxicity as Determined by Anemia
Description
Percentage of patients with anemia, the most commonly reported hematologic toxicity, after receiving the combination of Azacitidine and sargramostim
Time Frame
1 year
Title
One-year RFS
Description
We will report the number of participants with one year RFS
Time Frame
1 year
Title
Overall Survival
Description
Percentage of participants with overall survival at 2 years.
Time Frame
2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
6 Months
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age > 6 months Initial diagnosis of poor -risk AML or MDS (defined in section 3.2), treated with either stem cell transplant or cytarabine-based consolidation chemotherapy, within the past 60-185 days ECOG performance status 0-2 No morphologic evidence of leukemia or active MDS as determined by JHH Hematopathologist independent review of a bone marrow aspirate and biopsy done following the completion of therapy and within 14 days prior to enrollment Peripheral blood count recovery: Neutrophil count ≥ 1000 /µL, platelet count ≥ 50x 109 /µL without platelet transfusions, and adequate hematocrit independent of red cell transfusions . No evidence of extramedullary leukemia, such as CNS or soft tissue involvement Adequate end organ function as measured by the following: AST and ALT < 4 x normal, total serum bilirubin < 2 x upper limit normal (unless due to hemolysis, Gilbert's syndrome, or ineffective erythropoiesis), creatinine < 2 x upper limit of normal Ability to give informed consent In agreement to use an effective barrier method of birth control to avoid pregnancy during the study and for a minimum of 30 days after study treatment, for all male and female patients who are fertile Exclusion Criteria: Patients with untreated or uncontrolled infections Patients with untreated or uncontrolled grade 3 or 4 GVHD Pregnancy and lactation Concurrent use of any other investigational agents. Known HIV-positive patients. Known hypersensitivity to 5AC or GM-CSF
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Margaret Showel, MD
Organizational Affiliation
JHU
Official's Role
Study Chair
Facility Information:
Facility Name
The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21287
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Phase II Study of Azacitidine and Sargramostim as Maintenance Treatment for Poor-Risk AML or MDS

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