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The Primary objective is to assess the non-inferiority of the experimental arm (arm B) compared to the control arm (arm A) in terms of Major Molecular Response (MMolR) after the 4th cycle (MRD4) in patients aged 18-59 years old with de novo Philadelphia positive (Ph+) acute lymphoblastic leukemia (ALL)
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intensive Arm (A) | Active Comparator | 4 cycles + 2 interphases +Hematopoietic Stem Cell Transplantation (SCT) + Post-SCT Maintenance |
|
| Light Arm (B) | Experimental | 4 cycles + 2 interphases +Hematopoietic Stem Cell Transplantation (SCT) + Post-SCT Maintenance |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Nilotinib | Drug | 400 mg/12h per os D1 to D28 cycles 1-4 300 mg/12h per os D1-D14 interphase |
|
| Measure | Description | Time Frame |
|---|---|---|
| Major Molecular Response (MMolR) | defined as a breakpoint cluster region (BCR)-Abelson (ABL) ratio < 0.1% in the bone marrow sample of MRD4 | 4 cycles (4 months) |
| Measure | Description | Time Frame |
|---|---|---|
| Complete remission after cycle 1 | day 28 | |
| Cumulative incidence of treatment- and transplantation-related mortality | 2 years | |
| Cumulative incidence of relapse |
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Inclusion Criteria:
Patient
Note 1: Secondary ALL (antecedent of chemo- or radio-therapy) can be included Note 2: In case of high vascular risk (see section "study management") the patient will not be able to receive nilotinib unless an ultra sound Doppler of the neck and lower limbs has been performed during the pre-phase and treatment validated by the medical coordinators of the protocol via the secretariat.
Exclusion Criteria:
Patient:
Previously treated with Tyrosine Kinase Inhibitor (TKI)
With another active malignancy
With general or visceral contra-indication to intensive therapy (except if considered related to the ALL):
With heart failure, including at least one of the following criteria:
Active uncontrolled infection, any other concurrent disease deemed to interfere with the conduct of the study as judged by the investigator
Severe evolving infection, or known HIV or Human T-Lymphotropic Virus type I (HTLV1) seropositivity, or active infection by hepatitis B or C virus
Pregnant (beta-HCG) or nursing woman
Women of childbearing potential not willing to use an effective form of contraception during participation in the study and at least three months thereafter. Patient not willing to ensure not to beget a child during participation in the study and at least three months thereafter.
Having received an investigational treatment or participation in another trial within 30 days prior to entering this study.
Not able to bear with the procedures or the frequency of visits planned in the trial.
Unable to consent, under tutelage or curators, or judiciary safeguard
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Hervé Dombret, MDPhD | Contact | +33 (0)1 57 27 68 47 | herve.dombret@aphp.fr | |
| Véronique Lhéritier | Contact | +33(0)4 78 86 22 39 | veronique.lheritier@chu-lyon.fr |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hopital Saint Louis | Recruiting | Paris | 75010 | France |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 38452207 | Derived | Chalandon Y, Rousselot P, Chevret S, Cayuela JM, Kim R, Huguet F, Chevallier P, Graux C, Thiebaut-Bertrand A, Chantepie S, Thomas X, Vincent L, Berthon C, Hicheri Y, Raffoux E, Escoffre-Barbe M, Plantier I, Joris M, Turlure P, Pasquier F, Belhabri A, Guepin GR, Blum S, Gregor M, Lafage-Pochitaloff M, Quessada J, Lheritier V, Clappier E, Boissel N, Dombret H. Nilotinib with or without cytarabine for Philadelphia-positive acute lymphoblastic leukemia. Blood. 2024 Jun 6;143(23):2363-2372. doi: 10.1182/blood.2023023502. |
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| Methotrexate | Drug | 1 g/m2 continuous Intravenous Infusion (CIV) D1 cycles 2 and 4 25 mg/m2 per os D1, D8 interphase |
|
| Aracytine (Ara C) | Drug | Age<45 years: 3 mg/m2/12h D2, D3 cycles 2 and 4 Age>=45 years: 1.5 mg/m2/12h D2, D3 cycles 2 and 4 |
|
| Granulocyte Colony-Stimulating Factor (G-CSF) | Drug | 5µg/kg/d (SC) D6 until neutrophils > 1 G/L D15 cycles 1 and 3; D6 cycles 2 and 4 |
|
| Depomedrol | Drug | 40 mg + methotrexate 15 mg + Aracytine (AraC) 40mg IT cycle 1: D1, D8, D15 IT cycles 2 and 4: D9 IT cycle 3: D1 |
|
| Dexamethasone | Drug | 40 mg per os, D1-D2, D8-D9, D15-D16, D22-D23, cycles 1 and 3 |
|
| Vincristine | Drug | 2 mg total dose IV, D1 D8 D15 D22 cycles 1 and 3 |
|
| Imatinib | Drug | 300 mg/12h per os in post-SCT maintenance therapy for during at least 2 years |
|
| 6 Mercaptopurine (6MP) | Drug | 60 mg/m2 per os, D1 to D14, interphase |
|
| 10 years |
| Relapse free survival | 10 years |
| Event-free survival | 10 years |
| overall survival | 10 years |
| T315I mutation | mutations will be assessed by Reverse transcription Quantitative Polymerase Chain Reaction (RQ-PCR) sequencing in case of progression or relapse | 10 years |
| Toxicity | 12 months |
| ID | Term |
|---|---|
| C498826 | nilotinib |
| D008727 | Methotrexate |
| D003561 | Cytarabine |
| D016179 | Granulocyte Colony-Stimulating Factor |
| D003907 | Dexamethasone |
| D014750 | Vincristine |
| D000068877 | Imatinib Mesylate |
| D015122 | Mercaptopurine |
| ID | Term |
|---|---|
| D000630 | Aminopterin |
| D011622 | Pterins |
| D011621 | Pteridines |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D006571 | Heterocyclic Compounds |
| D003562 | Cytidine |
| D011741 | Pyrimidine Nucleosides |
| D011743 | Pyrimidines |
| D006573 | Heterocyclic Compounds, 1-Ring |
| 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 |
| D011246 | Pregnadienetriols |
| D011245 | Pregnadienes |
| D011278 | Pregnanes |
| D013256 | Steroids |
| D000072473 | Fused-Ring Compounds |
| D011083 | Polycyclic Compounds |
| D013259 | Steroids, Fluorinated |
| D014748 | Vinca Alkaloids |
| D046948 | Secologanin Tryptamine Alkaloids |
| D026121 | Indole Alkaloids |
| D000470 | Alkaloids |
| D007211 | Indoles |
| D054836 | Indolizidines |
| D007212 | Indolizines |
| D001549 | Benzamides |
| D000577 | Amides |
| D009930 | Organic Chemicals |
| D001565 | Benzoates |
| D000146 | Acids, Carbocyclic |
| D002264 | Carboxylic Acids |
| D001555 | Benzene Derivatives |
| D006841 | Hydrocarbons, Aromatic |
| D006844 | Hydrocarbons, Cyclic |
| D006838 | Hydrocarbons |
| D010879 | Piperazines |
| D013438 | Sulfhydryl Compounds |
| D013457 | Sulfur Compounds |
| D011687 | Purines |
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