This phase II trial studies how well CPX-351 or the CLAG-M regimen (consisting of the drugs cladribine, cytarabine, G-CSF, and mitoxantrone) works in treating medically less-fit patients with acute myeloid leukemia or other high-grade myeloid neoplasms. Drugs used in chemotherapy, such as CPX-351, cladribine, cytarabine, G-CSF, and mitoxantrone, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving CPX-351 or the CLAG-M regimen at doses typically used for medically-fit patients with acute myeloid leukemia may work better than reduced doses of CPX-351 in treating medically less-fit patients with acute myeloid leukemia or other high-grade myeloid neoplasms.
OUTLINE: Patients are randomized to 1 of 2 arms in a 1:1 fashion. ARM I = CPX-351; ARM II = CLAG-M. ARM I (INDUCTION): Patients receive CPX-351 intravenously (IV) over 90 minutes on days 1, 3, and 5 in the absence of disease progression or unacceptable toxicity. Patients who achieve a response other than an MRDneg CR receive a second course of CPX-351 intravenously IV over 90 minutes on days 1, 3, and 5 in the absence of disease progression or unacceptable toxicity. ARM I (POST-REMISSION): Patients who achieve a CR or CR with incomplete hematologic recovery (CRi) receive a reduced dose of CPX-351 IV over 90 minutes on days 1, 3, and 5 for up to 4 additional courses in the absence of disease progression or unacceptable toxicity. ARM II (INDUCTION): Patients receive cladribine IV over 2 hours on days 1-5, cytarabine IV over 2 hours on days 1-5, G-CSF subcutaneously (SC) on days 0-5, and mitoxantrone IV over 60 minutes on days 1-3 in the absence of disease progression or unacceptable toxicity. Patients who achieve a response other than an MRDneg CR receive a second course of cladribine IV over 2 hours on days 1-5, cytarabine IV over 2 hours on days 1-5, G-CSF SC on days 0-5, and mitoxantrone IV over 60 minutes on days 1-3 in the absence of disease progression or unacceptable toxicity. ARM II (POST-REMISSION): Patients who achieve a CR/CRi receive an intermediate dose of cytarabine IV over 2 hours on days 1-6 for up to 4 additional courses in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up periodically for up to 5 years.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
60
Given IV
Given IV
Given IV
Given SC
Given IV
Ancillary studies
Ancillary studies
Fred Hutch/University of Washington Cancer Consortium
Seattle, Washington, United States
3-month Overall Survival (OS)
Will evaluate whether CPX-351 or cladribine, cytarabine, granulocyte colony-stimulating factor (G-CSF), and mitoxantrone (CLAG-M), at doses typically used for medically-fit adults with AML, improve 3-month overall survival in medically-unfit adults with AML compared to attenuated dose CPX-351 as used in our previous institutional trial (32 units/m2 per dose).
Time frame: Up to 3 months from date of start of protocol therapy
Complete Remission (CR) Rates
Will compare CR rates between the study arms.
Time frame: Up to 5 years post treatment
MRDneg CR Rates
Will compare MRDneg CR rates between the study arms.
Time frame: Up to 5 years post treatment
Response Duration
Will compare response duration between the study arms.
Time frame: Up to 5 years post treatment
Relapse-free Survival
Will compare RFS between the study arms.
Time frame: Up to 5 years post treatment
Incidence of Adverse Events
Will use the CTCAE (National Cancer Institute \[NCI\] Common Terminology Criteria for Adverse Events) version 5.0 for toxicity and adverse event reporting. Will describe the toxicity profile and infectious complications of each study treatment.
Time frame: AEs were recorded from the time of first exposure to the therapy (start of the first drug administration infusion on day 1) until 4 weeks after the last dose. All-Cause Mortality was monitored from study start to data cut-off dates 5/27/2020 to 9/18/2025
30-day Mortality Rate
30-day mortality rate from start of treatment
Time frame: At 30 days
60-day Mortality
60-day mortality rate from start of treatment
Time frame: At 60 days
Quality of Life (QOL): Questionnaire
QOL of patients will be assessed longitudinally using the European Organization for Research and Treatment of Cancer (EORTC) core QOL questionnaire (QLQ-C30) and the newly developed acute myeloid leukemia-specific QOL instrument. QOL measures for Global Health Status (GHS), Functional Score, and Symptom Score were scored on a 0-100 scale with lower scores indicating worse outcomes.
Time frame: Up to 5 years post treatment
Patient Use of Medical Resources (e.g. Transfusions)
Electronic medical chart review to enumerate the number of platelet and red blood cell transfusions administered.
Time frame: Up to 5 years post treatment
Patient Use of Medical Resources (e.g. Transfusions)
Electronic medical chart review to enumerate the number of days spent on IV antimicrobial therapy and the number of days spent in the ICU.
Time frame: Up to 5 years post treatment
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.