01.04.2004 | Ongoing Clinical Studies
Imatinib and beyond—the new CML study IV
A randomized controlled comparison of imatinib vs imatinib/interferon-alpha vs imatinib/low-dose AraC vs imatinib after interferon-alpha failure in newly diagnosed chronic phase chronic myeloid leukemia
Erschienen in: Annals of Hematology | Ausgabe 4/2004
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Synopsis of CML-study IV
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Objectives
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1. Primary imatinib-based vs imatinib after interferon-alpha (IFN) failure
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2. Imatinib vs imatinib/IFN vs imatinib/low-dose AraC
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3. Allografting vs imatinib-based therapy in patients eligible for transplantation
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4. Age-adjusted standard intensity vs reduced intensity conditioning in patients older than 45 years of age
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Additional objectives:
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1. Time of first appearance and duration of hematologic, cytogenetic, and molecular responses
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2. Correlation of quality of responses with survival
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3. Comparison of short- and long-term adverse effects of imatinib-based mono- and combination therapies and of imatinib after IFN failure
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4. Duration of blastic phase and immunophenotype of blasts in dependence of treatment
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5. Survival and outcome of high-risk patients (new CML score) after early allografting
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6. Hematologic, cytogenetic, and molecular responses of imatinib as salvage therapy after IFN failure
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7. Validation of the new CML score or development of a new prognostic score adapted for imatinib-based therapies
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8. Impact of normal or subnormal WBC counts during the course of treatment for the duration of chronic phase and effect on survival
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9. Novel treatment approaches for refractory CML
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10. Influence of pretransplant therapies on the outcome of allografting
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11. Analysis of complete cytogenetic responders within the different treatment groups
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Study endpoints
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Primary: overall survival, time to progression, risk group-dependent survival, hematologic, cytogenetic, and molecular response
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Secondary: toxicity, quality of life
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Trial design
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Randomization into four treatment strategies: imatinib, imatinib/IFN, imatinib/low-dose AraC, or imatinib after failure of IFN ± hydroxyurea (HU) (± low-dose AraC)
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High risk patients who do not profit from primary IFN will be randomized instead to receive primary imatinib 800 mg
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Study period
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July 2002 until 2012
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Sample size
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Total number of subjects to be enrolled n=1600
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Inclusion criteria
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Newly diagnosed BCR-ABL positive CML in chronic phase
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Pretreatment with HU or anagrelide is permitted
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No age limit
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Informed consent
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Exclusion criteria
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Pretreatment with chemotherapy, IFN, or irradiation
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Second malignancy, if it requires therapy and the estimated life expectancy is shorter than the median survival of CML
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Other serious diseases, pregnancy including lactation period, or other conditions which could prevent the required protocol-compliance
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Participation in another trial
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No informed consent
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Treatment plan
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Arm I: 400 mg (dose increased to 600 mg up to 800 mg, if no hematologic response after 2 or 6 months) imatinib p.o. qd.
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Arm II: 400 mg (dose increased to 600 mg up to 800 mg, if no hematologic response after 2 or 6 months) imatinib p.o. qd + IFN, initially 1.5–3.0×106 IU flat dose s.c. qd, later IFN dose to be adjusted according to WBC and tolerability
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Arm III: 400 mg (dose increased to 600 mg up to 800 mg, if no hematologic response after 2 or 6 months) imatinib p.o. qd + low-dose AraC, initially 10 mg flat dose up to 2×5 days/month, starting after 3 months, later AraC dose to be adjusted according to WBC and tolerability
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Arm IV: IFN, initially 3×106 IU s.c. qd, later IFN dose increase made according to CBC and attainment of hematologic response. Imatinib, 400 mg p.o. qd after IFN failure. High risk: primary imatinib 800 mg p.o. qd.
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Patients eligible for allogeneic SCT who failed imatinib are randomized genetically by the availability of a HLA-identical related or unrelated donor to undergo allografting or to continue any form of salvage therapy
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Patients older than 45 years of age will be further randomized to receive an age-adjusted standard conditioning regimen or reduced-intensity preparative regimen
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