The purpose of this study is to learn the effects of treatment with an investigational drug, CPX-351 in patients with secondary myeloid neoplasms (SMNs).
Primary Objective * Determine the composite complete remission (CR) and complete remission with incomplete peripheral blood recovery (CRi) rates, safety and tolerability in patients under 22 years of age with SMN treated with one or two courses of CPX-351 before HSCT. Secondary Objectives * Describe the toxicity profile of patients with SMN treated with one or two courses of CPX-351. * Describe the biologic correlates of response in patients with SMN after one or two courses of CPX-351. * Estimate the 3-year overall survival of patients who received one or two courses of CPX-351 followed by HSCT. Participants who meet the inclusion criteria and consent will receive up to 2 cycles of CPX-351 for remission induction, and then will proceed to allogeneic HSCT or other therapies as per institutional practice. If a patient attains remission and has negative MRD after the first course of CPX-351, and HSCT can occur within 3 to 4 weeks from the evaluation date of the first course, the patient can proceed to HSCT without receiving the second course of CPX-351.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
25
St. Jude Children's Research Hospital
Memphis, Tennessee, United States
Composite complete remission (CR) rates after one or two courses of CPX-351
The Simon's two-stage minimax design with be used. Complete morphologic remission response (CR) is defined as less than 5% blasts without Auer rods by morphological evaluation of the bone marrow (M1 marrow).
Time frame: After one or 2 course of CPX-351, no later than day 42 from the start of each course of chemotherapy
Complete remission with incomplete peripheral blood recovery (CRi) rates after one or two courses of CPX-351
The Simon's two-stage minimax design with be used. Complete remission with incomplete peripheral blood recovery (CRi) is defined as hematologic recovery hematological (white cell blood count ≥ 1.0 x 109/L, unsupported platelet count ≥ 30.0 x 109/L and absolute neutrophil count ≥ 0.3 x 109/L).
Time frame: After one or 2 course of CPX-351, no later than day 42 from the start of each course of chemotherapy
Safety and tolerability in patients under 22 years of age with SMN treated with one or two courses of CPX-351 before HSCT
The exact three-stage binomial design will be used to monitor tolerability. We define a tolerability success as a patient completing two courses of therapy without experiencing a grade 4 or 5 non-hematologic toxicity.
Time frame: After one or 2 course of CPX-351, prior to hematopoietic stem cell transplantation (HSCT), three to four weeks from the hematologic recovery
Toxicity profile of patients with SMN treated with one or two courses of CPX-351
We will define categories for toxicity events and for each category we will determine the highest grade experienced by each patient. We will then report the number of patients with each grade in each category.
Time frame: 30 days after completion of one or two courses of chemotherapy
Biologic correlates of response in patients with SMN after one or two courses of CPX-351
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We will use logistic regression modeling explore biologic correlates as predictors of response. For genomic associations, we will use false discovery rate methods to address multiple testing.
Time frame: Day 22 for the first cycle and day 36-42 after the second cycle
Overall (OS) survival of patients who received one or two courses of CPX-351 followed by HSCT
We will use the Kaplan-Meier method to estimate overall survival. We define OS as the time elapsed from protocol enrollment to death and censor times of living patients at last follow-up.
Time frame: 3 years from study entry
Event-free survival (EFS) of patients who received one or two courses of CPX-351 followed by HSCT
We will use the Kaplan-Meier method to estimate event-free survival. We define EFS as the time elapsed from protocol enrollment to death, relapse, discontinuation of therapy due to excessive toxicity or resistant disease, or development of an additional malignancy and censor times for patients free of these events at last follow-up.
Time frame: 3 years from study entry
The impact of transplant on patients who received one or two courses of CPX-351 followed by HSCT
To explore the impact of transplant, we will fit Cox models with transplant as a time-dependent covariate.
Time frame: 3 years from study entry