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Clinical picture: AML (Acute Myeloide Leukemia)

Trial: HOVON 155 AML


News
1. Overview
Study details
2. Patient eligibility criteria
3. Registration (& randomization) of patients
4. Participating parties
5. Participating sites
6. Instruction videos
7. Download documentation / forms


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1. Overview



Summary

A randomized phase II multicenter study to assess the tolerability and efficacy of the addition of midostaurin to 10-day decitabine in unfit (i.e. HCT-CI ≥ 3) adult AML and high risk myelodysplasia (MDS) (IPSS-R > 4.5) patients.

A study in the frame of the masterprotocol of parallel randomized phase II studies in UNFIT- AML/high-risk MDS patients.


Status

planned


Members

Participating groups; HOVON, SAKK



Study details



Type of study

Prospective randomized Phase II study


Echelon level

Limited site selection


Type of monitoring for this study

Site evaluation visits


Target number of patients

140


Date of first EC&CA submission

28-Nov-2018


Study objectives

Primary objectives:
To assess in a randomized comparison the effect of midostaurin added to 10-day decitabine treatment on the cumulative CR/CRi rate during 3 cycles.

Secondary objectives:

To assess the safety and tolerability of midostaurin added to 10-day decitabine treatment for AML (frequency and severity of toxicities and the durations of neutropenia and thrombocytopenia) as regards to the selected dose level of the study.

To determine the efficacy profile: response rate (CRMRD-, CR, CRi, MLFS, PR), event free survival (EFS) and overall survival (OS) associated with the two therapy regimens.

To measure MRD by immunophenotyping and PCR in relation to clinical response parameters.

To identify gene mutations as potential biomarkers predictive of response, EFS and OS by exploratory analysis.

To evaluate the prognostic value of baseline physical and functional conditions using comprehensive geriatric assessment tools (short physical performance battery (SPPB) and activities of daily living (ADL)) on treatment outcome.


2. Patient eligibility criteria



Inclusion criteria

•Patients with:
a diagnosis of AML and related precursor neoplasms according to WHO 2016 classification (excluding acute promyelocytic leukemia) including secondary AML (after an antecedent hematological disease (e.g. MDS) and therapy-related AML, or
a diagnosis of myelodysplastic syndrome with excess of blasts (MDS) and IPSS-R > 4.5
•Patients 18 years and older.
•Patients NOT eligible for standard chemotherapy, defined as HCT-CI ≥ 3. (Appendix G)
OR
Patients NOT eligible for standard chemotherapy for other reasons (wish of patient).
•WBC ≤ 30 x109/L (prior hydroxyurea allowed for a maximum of 5 days, stop 2 days before start decitabine treatment)
•Adequate renal and hepatic functions unless clearly disease related as indicated by the following laboratory values:
Serum creatinine ≤ 221.7 µmol/L (≤ 2.5 mg/dL ), unless considered AML-related
Serum bilirubin ≤ 2.5 x upper limit of normal (ULN), unless considered AML-related or due to Gilbert’s syndrome
Alanine transaminase (ALT) ≤ 2.5 x ULN, unless considered AML-related
• WHO performance status 0, 1 or 2 (see Appendix D).
• Patient is willing and able to use adequate contraception during and until 5 months after the last protocol treatment.
• Written informed consent.
•Patient is capable of giving informed consent.


Exclusion criteria

• Acute promyelocytic leukemia.
• Acute leukemia's of ambiguous lineage according to WHO 2016
• Patient has symptomatic central nervous system (CNS) leukemia (NO routinely lumbar puncture required to investigate CNS involvement)
• Blast crisis of chronic myeloid leukemia.
• Diagnosis of any previous or concomitant malignancy is an exclusion criterion:
• except when the patient completed successfully treatment (chemotherapy and/or surgery and/or radiotherapy) with curative intent for this malignancy at least 6 months prior to randomization. OR
• except for basal and squamous cell carcinoma of the skin or in situ carcinoma of the cervix
• Patients previously treated for AML (any antileukemic therapy including investigational agents), a short treatment period ( ≤ 5 days) with Hydroxyurea is allowed
• Current concomitant chemotherapy, radiation therapy, or immunotherapy; other than hydroxyurea
• Concurrent severe and/or uncontrolled medical condition (e.g. uncontrolled diabetes, infection, hypertension, pulmonary disease etc.)
• Cardiac dysfunction as defined by:
Myocardial infarction within the last 3 months of study entry, or
Reduced left ventricular function with an ejection fraction < 40% as measured by MUGA scan or echocardiogram or
Unstable angina or
New York Heart Association (NYHA) grade IV congestive heart failure (see Appendix I) or
Unstable cardiac arrhythmias.
• History of stroke or intracranial hemorrhage within 6 months prior to randomization.
• Patient has a history of human immunodeficiency virus (HIV) or active infection with Hepatitis C or B.
• Patients known to be pregnant
• Patients with a history of non-compliance to medical regimens or who are considered unreliable with respect to compliance.
• Patients with any serious concomitant medical condition which could, in the opinion of the investigator, compromise participation in the study.
• Patients who have senile dementia, mental impairment or any other psychiatric disorder that prohibits the patient from understanding and giving informed consent.
• Any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule


3. Registration (& randomization) of patients



4. Participating parties



5. Participating sites



Site
Included patients *

* Please note that if TOP is not used to register patients for a study, the number of patients shown is zero.

6. Instruction videos



7. Download documentation / forms




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