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The AML-03 regimen investigates the addition of G-CSF priming to both induction and consolidation chemotherapies administrated in the previous AML-99 trial (NCT01716793) refines risk-stratification based on biological characterization also the AML-03 trial incorporates novel approaches for hematopoietic stem cell transplantation: such as Mylotarg™ "in vivo purging" in autografts, extends unrelated volunteers donors for allotransplants in high-risk patients, and introduces reduced intensity conditioning in patients with elder age (more than 50 years old).
The aims of these modifications are to analyse eficacy and toxicity of this induction and consolidation therapy and to analyse the disease free survival in patients who achieved complete response following a risk adjusted therapy.
Induction chemotherapy: idarubicin (12mg/m2/day intravenous, days 1, 3 and 5), intermediate-dose cytarabine (500mg/m2/12h, intravenous, days 1, 3 and 5) and etoposide (100mg/m2/day, intravenous, from day 1 to 3) as in AML-99 trial (NCT01716793), with the addition of subcutaneous G-CSF from day 0 to the last day of chemotherapy. This induction therapy is repeated if complete remission (CR) is not achieved after the first course of treatment.
Consolidation therapy (as in AML-99 trial): mitoxantrone (12mg/m2/day, intravenous, days 4 to 6) and intermediate-dose cytarabine (500mg/m2/12h from day 1 to 6).
Risk-stratification according to cytogenetics, courses to CR and availability of an HLA-identical sibling:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Risk-adapted postremission treatment. | Other | Ara-C, G-CSF, Autologous peripheral blood stem cell transplantation, Allogeneic matched related or unrelated donor transplant, G-CSF Priming, CD34+ selection, Myeloablative or reduced intensity conditioning, Mylotarg purging before autologous PBSC transplantation. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Ara-C | Drug |
|
|
| Measure | Description | Time Frame |
|---|---|---|
| Complete remission rate (CRR) | Analyze the efficacy and toxicity of IDICE-G (idarubicin, intermediate doses of ara-C and etoposide) and G-CSF to achieve complete remission. | 2 months. |
| Disease free survival (DFS). | Analyze the disease free suvival of patients in remission, with a therapeutic strategy adjusted to the prognostic factors. Mortality in remission after chemotherapy and/or peripheral blood stem cell tranplantation. | 4 years. |
| Measure | Description | Time Frame |
|---|---|---|
| Toxicity in patients over 60 years old. | Toxicity of the induction and intensification treatment in patients with more than 60 years old, in terms of unexpected adverse drug reaction, morbidity and mortality. | 4 years. |
| Evaluation of minimal residual disease (MRD) by flow cytometry and/or molecular markers during and after treatment. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Jorge Sierra, MD | Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau | Principal Investigator |
| Salut Brunet, MD | Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hospital Universitari Germans Trias i Pujol | Badalona | Barcelona | 08916 | Spain | ||
| Hospital del Mar |
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| Autologous peripheral blood stem cell transplantation. | Other |
|
|
| Allogeneic matched related or unrelated donor transplant. | Other | -Patients without favorable/intermediate characteristics. |
|
| G-CSF | Drug |
|
|
|
| CD34+ selection. | Other | -Patients with adverse prognosis with allogeneic peripheral blood stem cell (PBSC)tranplantation, CD34+ cell selection of the inoculum was performed. |
|
| Mylotarg purging before autologous PBSC transplantation | Other | Patients without favorable/intermediate characteristics and without matched related donor. |
|
Study the immunophenotype characteristics and/or molecular markers at diagnosis, and during the different treatment phases. |
| 4 years. |
| Feasibility of post-remission treatment in patients with 60 or more years old. | Study the effect of post-remission treatments in patients with more than 60 years to evaluate the success of consolidation treatments. | 4 years. |
| Barcelona |
| Barcelona |
| 08003 |
| Spain |
| Centro Medico Teknon | Barcelona | Barcelona | 08022 | Spain |
| Hospital de la Santa Creu i Sant Pau | Barcelona | Barcelona | 08025 | Spain |
| Hospital Vall d'Hebron | Barcelona | Barcelona | 08035 | Spain |
| Hospital Clínic de Barcelona | Barcelona | Barcelona | 08036 | Spain |
| ICO Hospital Universitari de Bellvitge | L'Hospitalet Del Llobregat | Barcelona | 08907 | Spain |
| Hospital A Coruña | A Coruña | Coruña | 15006 | Spain |
| Hopital Universitari de Girona Dr. Josep Trueta | Girona | Girona | 17007 | Spain |
| Hospital Universitari Arnau de Vilanova | Lleida | Lleida | 25006 | Spain |
| Hospital Universitario La Paz | Madrid | Madrid | 28046 | Spain |
| Hospital Universitario Virgen de la Victoria | Málaga | Malaga | 29010 | Spain |
| Hospital Universitari Son Espases | Palma de Mallorca | Mallorca | 07198 | Spain |
| Hospital Universitari Son Dureta | Palma de Mallorca | Mallorca | Spain |
| Hospital General Universitario de Murcia | Murcia | Murcia | 30008 | Spain |
| Hospital Universitario Virgen del Rocio | Seville | Sevilla | 41014 | Spain |
| Hospital Universitari Joan XXIII | Tarragona | Tarragona | 43007 | Spain |
| Hospital Verge de la Cinta | Tortosa | Tarragona | 43517 | Spain |
| Mutua de Terrassa | Terrassa | Terrassa | 08225 | Spain |
| Hospital Clinico Universitario de Valencia | Valencia | Valencia | 46010 | Spain |
| Hospital Universitario Rio Hortega | Valladolid | Valladolid | 41010 | Spain |
| ID | Term |
|---|---|
| D015470 | Leukemia, Myeloid, Acute |
| D007938 | Leukemia |
| ID | Term |
|---|---|
| D007951 | Leukemia, Myeloid |
| D009370 | Neoplasms by Histologic Type |
| D009369 | Neoplasms |
| D006402 | Hematologic Diseases |
| D006425 | Hemic and Lymphatic Diseases |
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| ID | Term |
|---|---|
| D003561 | Cytarabine |
| D016179 | Granulocyte Colony-Stimulating Factor |
| ID | Term |
|---|---|
| D003562 | Cytidine |
| D011741 | Pyrimidine Nucleosides |
| D011743 | Pyrimidines |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
| D001087 | Arabinonucleosides |
| D009705 | Nucleosides |
| D009706 | Nucleic Acids, Nucleotides, and Nucleosides |
| D003115 | Colony-Stimulating Factors |
| D006023 | Glycoproteins |
| D006001 | Glycoconjugates |
| D002241 | Carbohydrates |
| D016298 | Hematopoietic Cell Growth Factors |
| D016207 | Cytokines |
| D036341 | Intercellular Signaling Peptides and Proteins |
| D010455 | Peptides |
| D000602 | Amino Acids, Peptides, and Proteins |
| D011506 | Proteins |
| D001685 | Biological Factors |
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