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Treatment of Newly Diagnosed Patients With Acute Promyelocytic Leukemia (PETHEMA LPA 2005)

This study is currently recruiting participants.
Verified by PETHEMA Foundation, March 2008

Sponsored by: PETHEMA Foundation
Information provided by: PETHEMA Foundation
ClinicalTrials.gov Identifier: NCT00408278
  Purpose

Primary objectives

  • To evaluate the efficacy and toxicity of a risk-adapted protocol that use idarubicin for induction and consolidation therapy in patients with APL.
  • To evaluate the impact of mitoxantrone reduction on the event-free, disease-free, and overall survival, as well as on the duration of remission and cumulative incidence of relapse in low- and intermediate-risk patients with APL.
  • To evaluate the impact of the addition of ara-C to idarubicin courses of consolidation for high-risk patients (administered as in the original GIMEMA protocols) on the event-free, disease-free, and overall survival, as well as on the duration of remission and cumulative incidence of relapse.
  • To evaluate the toxicity of the induction, consolidation, and maintenance chemotherapy in the whole series and in each treatment group in patients with APL.

Secondary objectives

• To compare all outcomes with those achieved with the PETHEMA LPA99 protocol.


Condition Intervention Phase
Acute Promyelocytic Leukemia
Drug: ATRA
Drug: Idarubicina
Drug: Mitoxantrone
Drug: ARA-C
Phase IV

MedlinePlus related topics:   Leukemia, Adult Acute    Leukemia, Adult Chronic    Leukemia, Childhood   

Drug Information available for:   Cytarabine    Cytarabine hydrochloride    Idarubicin    Idarubicin hydrochloride    Mercaptopurine    6-Mercaptopurine    Methotrexate    Mitoxantrone hydrochloride    Mitoxantrone   

U.S. FDA Resources

Study Type:   Interventional
Study Design:   Treatment, Non-Randomized, Open Label, Uncontrolled, Single Group Assignment, Efficacy Study
Official Title:   Treatment of Newly Diagnosed Patients With Acute Promyelocytic Leukemia (PETHEMA LPA 2005): Remission Induction With ATRA + Idarubicin. Risk-Adapted Consolidation With ATRA and Anthracycline-Based Chemotherapy (Idarubicin/Mitoxantrone) With Addition of Ara-C for High-Risk Patients. Maintenance Therapy With ATRA + Low Dose Chemotherapy (Methotrexate + Mercaptopurine).

Further study details as provided by PETHEMA Foundation:

Primary Outcome Measures:
  • To evaluate the efficacy and toxicity of a risk-adapted protocol that use idarubicin for induction and consolidation therapy in patients with APL. [ Time Frame: 1 year ] [ Designated as safety issue: Yes ]
  • To evaluate the impact of mitoxantrone reduction on the event-free, disease-free, and overall survival. [ Time Frame: 1 year ] [ Designated as safety issue: No ]
  • To evaluate the impact of the addition of ara-C to idarubicin courses of consolidation for high-risk patients on the event-free, disease-free, and overall survival [ Time Frame: 1 year ] [ Designated as safety issue: No ]
  • To evaluate the toxicity of the induction, consolidation, and maintenance chemotherapy in the whole series and in each treatment group in patients with APL. [ Time Frame: 1 year ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • To compare all outcomes with those achieved with the PETHEMA LPA99 protocol. [ Time Frame: 2 years ] [ Designated as safety issue: No ]

Estimated Enrollment:   300
Study Start Date:   July 2005
Estimated Study Completion Date:   December 2009
Estimated Primary Completion Date:   April 2009 (Final data collection date for primary outcome measure)

Intervention Details:
    Drug: ATRA
    45 mg/m2 day until CR Consolidation: 3 cycles (45 mg/m2 days 1-15) Maintenance:15 days every 3 months
    Drug: Idarubicina
    Induction: 12 mg/m2 days 2, 4, 6 and 8 Consolidation: 5 mg/m2 days 1-4 in cycle 1 and 12 mg/m2 day 1 in cycle 3.
    Drug: Mitoxantrone
    Consolidation: Mitoxantrone 10 mg/m2 days 1-3 in cycle 2
    Drug: ARA-C
    In high risk patients, consolidation with ara-C in cycles 1 and 3.
Detailed Description:

Treatment of induction with the simultaneous administration of ATRA (45 mg/m2 day until the RC) and idarubicine (12 mg/m2 days 2, 4, 6 and 8), 3 monthly cycles of consolidation with ATRA (45 mg/m2 days 1-15) and idarubicine (5 mg/m2 days 1-4) in the cycle #1, mitoxantrone (10 mg/m2 days 1-3) in the cycle #2 and idarubicine (12 mg/m2 day 1) in the cycle #3. The consolidation was reinforced for the group of patients with intermediate risk by means of an increase of the idarubicine to 7 mg in the cycle #1 and to 2 days in the cycle #3. In the patients of high risk, the consolidation was reinforced with the addition of altar-c in the cycles #1 and #3. For the maintenance treatment, one will administer to intermittent ATRA (15 days every 3 months) and chemotherapy low doses with methotrexate and 6-mercaptopurina during two years

  Eligibility
Ages Eligible for Study:   up to 75 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No

Criteria

Inclusion Criteria:

  • Age ≤ 75 years.
  • ECOG ≤ 3.
  • Morphologic Diagnosis of LPA (FAB M3 or variant M3). Those cases without typical morphology but with PML-RARα reordering also must be including.
  • Genetic Diagnosis: t (15; 17) demonstrated by cariotipo conventional, FISH, PML-RARα reordering detected by RT-PCR or a pattern microspeckled demonstrated with antibody anti-PML (positive PGM3). Obvious, it will be had the result of these tests once initiated the treatment on the basis of a suspicion diagnoses morphologic

Exclusion Criteria:

  • Age >75 years (the treatment with this protocol can be considered individually)
  • Absence of PML-Rare reordering.
  • To have received previously some type of treatment for LPA, including chemotherapy or retinoides. The previous treatment with corticoids, hidroxiurea or leucoaféresis is not reason for exclusion.
  • To have received chemotherapy or x-ray for the treatment of a disease vitiates previous.
  • Associate Neoplasia.
  • Serious psychiatric Disease.
  • Seropositividad for VIH.
  • Contraindication to receive intensive chemotherapy, specially antraciclinas.
  • Sérica Creatinina ≥ 2,5 mg/dL (≥ 250 μmol/l).
  • Bilirrubina, fosfatasa alkaline, or GOT > 3 times the normal limit
  • Test of positive pregnancy.
  Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00408278

Contacts
Contact: Sanz Miguel Angel, Dr     +34 96 197 3057     msanz@uv.es    
Contact: Vellenga Edo, Dr     +31 (50) 3612354     e.vellenga@int.azg.nl    

Locations
Poland
PALG     Recruiting
      Lodz, Poland
      Principal Investigator: Holowiecka Alexandra, Dr            
Spain
Basurtuko Ospitalea     Recruiting
      Bilbao, Spain
      Contact: Beltran de Heredia José Mª, Dr            
      Principal Investigator: Beltran de Heredia José Mª, Dr            
Complejo Hospitalario León     Recruiting
      Leon, Spain
      Principal Investigator: Ramos Fernando, Dr            
Complexo Hospitalario Xeral-Calde     Recruiting
      Lugo, Spain
      Principal Investigator: Arias Jesús, Dr            
H. Carlos Haya     Recruiting
      Málaga, Spain
      Principal Investigator: Negri Silvia, Dr            
H. Universitario Virgen de la Victoria     Recruiting
      Málaga, Spain
      Principal Investigator: Perez Inmaculada, Dr            
H.U. Virgen del Rocio     Recruiting
      Sevilla, Spain
      Principal Investigator: Parody Ricardo, Dr            
Hospital "Dr. Trueta"     Recruiting
      Gerona, Spain
      Principal Investigator: Guardia Ramón, Dr            
Hospital 12 de Octubre     Recruiting
      Madrid, Spain
      Principal Investigator: de la Serna Javier, Dr            
Hospital Central de Asturias     Recruiting
      Oviedo, Spain
      Principal Investigator: Rayón Consuelo, Dr            
Hospital General     Recruiting
      Albacete, Spain
      Principal Investigator: Romero Juan Ramón, Dr            
Hospital Clínico de Valladolid     Recruiting
      Valladolid, Spain
      Principal Investigator: Fernandez Calvo Francisco, Dr            
Hospital Clínico San Carlos     Recruiting
      Madrid, Spain
      Principal Investigator: Diaz Mediavilla Joaquín, Dr            
Hospital Clínico Universitario Lozano Blesa     Recruiting
      Zaragoza, Spain
      Principal Investigator: Palomera Luis, Dr            
Hospital de Cruces     Recruiting
      Santander, Spain
      Principal Investigator: Amutio Elena, Dr            
Hospital de Fuenlabrada     Recruiting
      Fuenlabrada, Spain
      Principal Investigator: Hernández José Angel, DR            
Hospital de Navarra     Recruiting
      Pamplona, Spain
      Principal Investigator: Gorosquieta Ana, Dr            
Hospital Joan XXIII     Recruiting
      Tarragona, Spain
      Principal Investigator: Escoda Lourdes, Dr            
Hospital Dr. Peset     Recruiting
      Valencia, Spain
      Principal Investigator: Sayas Mª José            
Hospital general     Recruiting
      Alicante, Spain
      Principal Investigator: Rivas Concha, Dr            
Hospital Clinic     Recruiting
      Barcelona, Spain
      Principal Investigator: Esteve Jordi, Dr            
Hospital general     Recruiting
      Castellon, Spain
      Principal Investigator: Cañigral Guillermo, Dr            
Hospital general     Recruiting
      Valencia, Spain
      Principal Investigator: Linares Mariano, Dr            
Hospital de Jerez de la Frontera     Recruiting
      Jerez de la Frontera, Spain
      Principal Investigator: León Angel, Dr            
Hospital Insular de las Palmas     Recruiting
      Las Palmas de Gran Canaria, Spain
      Principal Investigator: Gonzalez José David, Dr            
Hospital Juan Canalejo     Recruiting
      La Coruña, Spain
      Principal Investigator: Debén Guillermo            
Hospital de Montecelo     Recruiting
      Pontevedra, Spain
      Principal Investigator: Allegue Mª Jose, Dr            
Hospital Severo Ochoa     Recruiting
      Madrid, Spain
      Principal Investigator: Sanchez Godoy Pedro, Dr            
Hospital Reina Sofia     Recruiting
      Madrid, Spain
      Principal Investigator: Rojas Rafael, Dr            
Hospital San Pedro de Alcántara     Recruiting
      Madrid, Spain
      Principal Investigator: Bergua José Mª, Dr            
Hospital de Sant Pau     Recruiting
      Barcelona, Spain
      Principal Investigator: Brunet Salut, Dr            
Hospital Puerta de Hierro     Recruiting
      Madrid, Spain
      Principal Investigator: Kirsnik Isabel, Dr            
Hospital Sta. Maria del Rosell     Recruiting
      Murcia, Spain
      Principal Investigator: Ibañez Jerónima, Dr            
Hospital Txagorritxu     Recruiting
      Vitoria, Spain
      Principal Investigator: Guinea José´Mª, Dr            
Hospital germans Trias i Pujol     Recruiting
      Badalona, Spain
      Principal Investigator: Ribera José Mª, Dr            
Hospital La Fe     Recruiting
      Valencia, Spain
      Principal Investigator: Martinez Jesús, Dr            
Hospital Clínico Universitario     Recruiting
      Salamanca, Spain
      Principal Investigator: González Marcos, Dr            
Hospital Virgen de la Concha     Recruiting
      Zamora, Spain
      Principal Investigator: Martín Alejandro, Dr            
Hospital Dr Negrín     Recruiting
      Palma de Gran Canaria, Spain
      Principal Investigator: Molero Teresa, Dr            
Institut Català d'Oncologái     Recruiting
      Barcelona, Spain
      Principal Investigator: Berlanga Jose, Dr            
Hospital de Santiago de Compostela     Recruiting
      Santiago de Compostela, Spain
      Principal Investigator: Pérez Encina manuel, Dr            
Uruguay
Hospital Maciel     Recruiting
      Montevideo, Uruguay
      Principal Investigator: De Lisa Elena, Dr            

Sponsors and Collaborators
PETHEMA Foundation

Investigators
Study Chair:     San Miguel Miguel Angel, Dr     Hospital La Fe Valencia    
Study Director:     Vellenga Edo, Dr     HOVON    
Study Director:     Lowenberg Bob, Dr     HOVON    
  More Information


Pethema Foundation web  This link exits the ClinicalTrials.gov site
 
Spanish association of Haematology  This link exits the ClinicalTrials.gov site
 
Hovon Data Center  This link exits the ClinicalTrials.gov site
 

Publications:
Tallman MS, Nabhan C, Feusner JH, Rowe JM. Acute promyelocytic leukemia: evolving therapeutic strategies. Blood. 2002 Feb 1;99(3):759-67. Review.
 
Ohno R, Asou N, Ohnishi K. Treatment of acute promyelocytic leukemia: strategy toward further increase of cure rate. Leukemia. 2003 Aug;17(8):1454-63. Review.
 
Sanz MA, Martin G, Lo Coco F. Choice of chemotherapy in induction, consolidation and maintenance in acute promyelocytic leukaemia. Best Pract Res Clin Haematol. 2003 Sep;16(3):433-51. Review.
 
Asou N, Adachi K, Tamura J, Kanamaru A, Kageyama S, Hiraoka A, Omoto E, Akiyama H, Tsubaki K, Saito K, Kuriyama K, Oh H, Kitano K, Miyawaki S, Takeyama K, Yamada O, Nishikawa K, Takahashi M, Matsuda S, Ohtake S, Suzushima H, Emi N, Ohno R. Analysis of prognostic factors in newly diagnosed acute promyelocytic leukemia treated with all-trans retinoic acid and chemotherapy. Japan Adult Leukemia Study Group. J Clin Oncol. 1998 Jan;16(1):78-85.
 
Burnett AK, Grimwade D, Solomon E, Wheatley K, Goldstone AH. Presenting white blood cell count and kinetics of molecular remission predict prognosis in acute promyelocytic leukemia treated with all-trans retinoic acid: result of the Randomized MRC Trial. Blood. 1999 Jun 15;93(12):4131-43.
 
Fenaux P, Chastang C, Chevret S, Sanz M, Dombret H, Archimbaud E, Fey M, Rayon C, Huguet F, Sotto JJ, Gardin C, Makhoul PC, Travade P, Solary E, Fegueux N, Bordessoule D, Miguel JS, Link H, Desablens B, Stamatoullas A, Deconinck E, Maloisel F, Castaigne S, Preudhomme C, Degos L. A randomized comparison of all transretinoic acid (ATRA) followed by chemotherapy and ATRA plus chemotherapy and the role of maintenance therapy in newly diagnosed acute promyelocytic leukemia. The European APL Group. Blood. 1999 Aug 15;94(4):1192-200.
 
Lengfelder E, Reichert A, Schoch C, Haase D, Haferlach T, Loffler H, Staib P, Heyll A, Seifarth W, Saussele S, Fonatsch C, Gassmann W, Ludwig WD, Hochhaus A, Beelen D, Aul C, Sauerland MC, Heinecke A, Hehlmann R, Wormann B, Hiddemann W, Buchner T. Double induction strategy including high dose cytarabine in combination with all-trans retinoic acid: effects in patients with newly diagnosed acute promyelocytic leukemia. German AML Cooperative Group. Leukemia. 2000 Aug;14(8):1362-70.
 
Sanz MA, Lo Coco F, Martin G, Avvisati G, Rayon C, Barbui T, Diaz-Mediavilla J, Fioritoni G, Gonzalez JD, Liso V, Esteve J, Ferrara F, Bolufer P, Bernasconi C, Gonzalez M, Rodeghiero F, Colomer D, Petti MC, Ribera JM, Mandelli F. Definition of relapse risk and role of nonanthracycline drugs for consolidation in patients with acute promyelocytic leukemia: a joint study of the PETHEMA and GIMEMA cooperative groups. Blood. 2000 Aug 15;96(4):1247-53.
 
Sanz MA, Martin G, Gonzalez M, Leon A, Rayon C, Rivas C, Colomer D, Amutio E, Capote FJ, Milone GA, De La Serna J, Roman J, Barragan E, Bergua J, Escoda L, Parody R, Negri S, Calasanz MJ, Bolufer P; Programa de Estudio y Traitmiento de las Hemopatias Malignas. Risk-adapted treatment of acute promyelocytic leukemia with all-trans-retinoic acid and anthracycline monochemotherapy: a multicenter study by the PETHEMA group. Blood. 2004 Feb 15;103(4):1237-43. Epub 2003 Oct 23.
 
Sanz MA, Lo Coco F, Martin G, Avvisati G, Rayon C, Barbui T, Diaz-Mediavilla J, Fioritoni G, Gonzalez JD, Liso V, Esteve J, Ferrara F, Bolufer P, Bernasconi C, Gonzalez M, Rodeghiero F, Colomer D, Petti MC, Ribera JM, Mandelli F. Definition of relapse risk and role of nonanthracycline drugs for consolidation in patients with acute promyelocytic leukemia: a joint study of the PETHEMA and GIMEMA cooperative groups. Blood. 2000 Aug 15;96(4):1247-53.
 
Grimwade D, Gorman P, Duprez E, Howe K, Langabeer S, Oliver F, Walker H, Culligan D, Waters J, Pomfret M, Goldstone A, Burnett A, Freemont P, Sheer D, Solomon E. Characterization of cryptic rearrangements and variant translocations in acute promyelocytic leukemia. Blood. 1997 Dec 15;90(12):4876-85.
 
van Dongen JJ, Macintyre EA, Gabert JA, Delabesse E, Rossi V, Saglio G, Gottardi E, Rambaldi A, Dotti G, Griesinger F, Parreira A, Gameiro P, Diaz MG, Malec M, Langerak AW, San Miguel JF, Biondi A. Standardized RT-PCR analysis of fusion gene transcripts from chromosome aberrations in acute leukemia for detection of minimal residual disease. Report of the BIOMED-1 Concerted Action: investigation of minimal residual disease in acute leukemia. Leukemia. 1999 Dec;13(12):1901-28. Review.
 
Falini B, Flenghi L, Fagioli M, Lo Coco F, Cordone I, Diverio D, Pasqualucci L, Biondi A, Riganelli D, Orleth A, Liso A, Martelli MF, Pelicci PG, Pileri S. Immunocytochemical diagnosis of acute promyelocytic leukemia (M3) with the monoclonal antibody PG-M3 (anti-PML). Blood. 1997 Nov 15;90(10):4046-53.
 
Gomis F, Sanz J, Sempere A, Plume G, Senent ML, Perez ML, Cervera J, Moscardo F, Bolufer P, Barragan E, Martin G, Sanz MA. Immunofluorescent analysis with the anti-PML monoclonal antibody PG-M3 for rapid and accurate genetic diagnosis of acute promyelocytic leukemia. Ann Hematol. 2004 Nov;83(11):687-90. Epub 2004 Jul 24.
 

Responsible Party:   Pethema ( Pethema )
Study ID Numbers:   LPA 2005
First Received:   December 5, 2006
Last Updated:   July 9, 2008
ClinicalTrials.gov Identifier:   NCT00408278
Health Authority:   Spain: Ministry of Health

Keywords provided by PETHEMA Foundation:
Acute Promyelocytic Leukemia  

Study placed in the following topic categories:
Leukemia
Idarubicin
Acute promyelocytic leukemia
Leukemia, Promyelocytic, Acute
Methotrexate
Mitoxantrone
6-Mercaptopurine
Leukemia, Myeloid
Leukemia, Myeloid, Acute
Cytarabine

Additional relevant MeSH terms:
Neoplasms
Neoplasms by Histologic Type
Sensory System Agents
Antineoplastic Agents
Therapeutic Uses
Physiological Effects of Drugs
Peripheral Nervous System Agents
Analgesics
Central Nervous System Agents
Pharmacologic Actions

ClinicalTrials.gov processed this record on October 22, 2008




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