Combination Chemotherapy Followed By Donor Bone Marrow or Umbilical Cord Blood Transplant in Treating Children With Newly Diagnosed Juvenile Myelomonocytic Leukemia

NCT ID: NCT00025038

Last Updated: 2013-04-11

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

100 participants

Study Classification

INTERVENTIONAL

Study Start Date

2001-06-30

Brief Summary

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Giving chemotherapy drugs, such as R115777, isotretinoin, cytarabine, and fludarabine, before a donor bone marrow transplant or an umbilical cord transplant helps stop the growth of cancer cells. It also helps stop the patient's immune system from rejecting the donor's stem cells. When the healthy stem cells from a donor are infused into the patient they may help the patient's bone marrow make stem cells, red blood cells, white blood cells, and platelets. This phase II trial is studying how well giving combination chemotherapy together with donor bone marrow or umbilical cord blood transplant works in treating children with newly diagnosed juvenile myelomonocytic leukemia

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Detailed Description

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PRIMARY OBJECTIVES:

I. Determine the response rate of children with newly diagnosed juvenile myelomonocytic leukemia treated with R115777, isotretinoin, cytarabine, and fludarabine followed by allogeneic bone marrow or umbilical cord blood transplantation.

II. Determine the safety and toxicity of this regimen in these patients. III. Determine the tolerability of this regimen in these patients. IV. Determine the rate of 2-year event-free survival of patients treated with this regimen.

V. Determine whether prognostic subsets of these patients can be identified based on expression of clinical, genetic (NFI, monosomy 7, RAS gene), or hematopoietic characteristics.

OUTLINE: This is a multicenter study.

Patients may choose to receive upfront window induction therapy with oral R115777 twice daily on days 1-21. Treatment repeats every 28 days for 2 courses in the absence of disease progression or unacceptable toxicity.

Patients with progressive disease or stable disease with unacceptable hematopoietic recovery after 1 course proceed to induction chemotherapy. (R11577 portion of the study closed to accrual as of 08/2005)

All patients receive induction chemotherapy comprising oral isotretinoin once daily beginning on day 1 and fludarabine IV over 30 minutes and cytarabine IV over 4 hours on days 1-5. Treatment with fludarabine and cytarabine repeats every 28 days for 2 courses. Treatment with isotretinoin continues until allogeneic bone marrow or umbilical cord blood transplantation. Patients with progressive disease after 1 course proceed to transplantation.

After completion of isotretinoin, patients receive a preparative regimen comprising total body irradiation twice daily on days -7 to -4, cyclophosphamide IV over 2 hours on days -3 and -2, and anti-thymocyte globulin IV over 4-6 hours every 12 hours on days -3 to -1. Patients undergo allogeneic bone marrow or umbilical cord blood transplantation on day 0. Patients receive oral isotretinoin daily beginning on approximately day 60 and continuing for 1 year.

Patients are followed every 6 months for 5 years and then annually thereafter.

PROJECTED ACCRUAL: A maximum of 100 patients (18-46 receiving R115777 with induction chemotherapy \[R11577 portion of the study closed to accrual as of 08/2005\] and 27-54 receiving induction chemotherapy only) will be accrued for this study within 3.2 years.

Conditions

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Juvenile Myelomonocytic Leukemia

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Treatment (tipifarnib, bone marrow/umbilical cord transplant)

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Group Type EXPERIMENTAL

tipifarnib

Intervention Type DRUG

Given orally

isotretinoin

Intervention Type DRUG

Given orally

fludarabine phosphate

Intervention Type DRUG

Given IV

cytarabine

Intervention Type DRUG

Given IV

radiation therapy

Intervention Type RADIATION

Undergo total body irradiation

cyclophosphamide

Intervention Type DRUG

Given IV

anti-thymocyte globulin

Intervention Type BIOLOGICAL

Given IV

allogeneic bone marrow transplantation

Intervention Type PROCEDURE

Undergo allogeneic bone marrow transplant

double-unit umbilical cord blood transplantation

Intervention Type PROCEDURE

umbilical cord blood transplantation

Intervention Type PROCEDURE

Undergo allogeneic cord blood transplant

laboratory biomarker analysis

Intervention Type OTHER

Correlative studies

Interventions

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tipifarnib

Given orally

Intervention Type DRUG

isotretinoin

Given orally

Intervention Type DRUG

fludarabine phosphate

Given IV

Intervention Type DRUG

cytarabine

Given IV

Intervention Type DRUG

radiation therapy

Undergo total body irradiation

Intervention Type RADIATION

cyclophosphamide

Given IV

Intervention Type DRUG

anti-thymocyte globulin

Given IV

Intervention Type BIOLOGICAL

allogeneic bone marrow transplantation

Undergo allogeneic bone marrow transplant

Intervention Type PROCEDURE

double-unit umbilical cord blood transplantation

Intervention Type PROCEDURE

umbilical cord blood transplantation

Undergo allogeneic cord blood transplant

Intervention Type PROCEDURE

laboratory biomarker analysis

Correlative studies

Intervention Type OTHER

Other Intervention Names

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R115777 Zarnestra 13-CRA Amnesteem Cistane Claravis Sotret 2-F-ara-AMP Beneflur Fludara ARA-C arabinofuranosylcytosine arabinosylcytosine Cytosar-U cytosine arabinoside irradiation radiotherapy therapy, radiation CPM CTX Cytoxan Endoxan Endoxana ATG ATGAM lymphocyte immune globulin Thymoglobulin bone marrow therapy, allogeneic bone marrow therapy, allogenic transplantation, allogeneic bone marrow transplantation, allogenic bone marrow cord blood transplantation transplantation, umbilical cord blood UCB transplantation

Eligibility Criteria

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Inclusion Criteria

* Newly diagnosed, previously untreated juvenile myelomonocytic leukemia
* Presenting with all of the following:

* Absence of t(9;22) or bcr/abl by PCR
* Absolute monocyte count greater than 1,000/mm\^3
* Less than 20% bone marrow blasts
* Presenting with at least 2 of the following:

* Elevated F hemoglobin
* Myeloid precursors in peripheral blood
* WBC greater than 10,000/mm\^3
* Sargramostim (GM-CSF) hypersensitivity
* See Disease Characteristics
* Bilirubin no greater than 2.0 mg/dL
* ALT no greater than 3 times normal
* Creatinine no greater than 2 times normal
* No concurrent sargramostim (GM-CSF)
* No concurrent proton pump inhibitors
Maximum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Cancer Institute (NCI)

NIH

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Robert Castleberry

Role: PRINCIPAL_INVESTIGATOR

Children's Oncology Group

Locations

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Children's Oncology Group

Arcadia, California, United States

Site Status

Countries

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United States

References

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Stieglitz E, Gu CJ, Richardson M, Kita R, Santaguida MT, Ali KA, Strachan DC, Dhar A, Yam G, Anderson W, Anderson E, Hubner J, Tasian SK, Loh ML, Lacher MD. Tretinoin Enhances the Effects of Chemotherapy in Juvenile Myelomonocytic Leukemia Using an Ex Vivo Drug Sensitivity Assay. JCO Precis Oncol. 2023 Sep;7:e2300302. doi: 10.1200/PO.23.00302.

Reference Type DERIVED
PMID: 37944074 (View on PubMed)

Other Identifiers

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AAML0122

Identifier Type: -

Identifier Source: secondary_id

U10CA098543

Identifier Type: NIH

Identifier Source: secondary_id

View Link

CDR0000068788

Identifier Type: REGISTRY

Identifier Source: secondary_id

NCI-2012-01861

Identifier Type: -

Identifier Source: org_study_id

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