GOELAMS SA4 Study: the Role of Fludarabine in the Treatment of Acute Myeloid Leukemia in the Elderly
Condition: Acute Myeloid Leukemia
MeSH terms: Leukemia; Leukemia, Myeloid; Leukemia, Myeloid, Acute
Study type: Interventional
Phase: Phase 3

Summary: 
      In this study, patients were randomly assigned to either receive fludarabine or not (20
      mg/m2/d) in addition to induction chemotherapy, consolidation chemotherapy and the 3
      subsequent re-induction courses during maintenance.
    

Detailed description: 
      Eligibility for enrollment in the study was limited to patients aged 60 to 75 years old with
      previously untreated de novo AML as defined morphologically by the French-American-British
      (FAB) classification with the exception of M3 and M7 subtypes.10,11 The bone marrow aspirate
      had to show at least 30 percent of nonerythroid blast cells. Patients were not eligible if
      they had a performance status before diagnosis of 2 or more according to the World Health
      Organization (WHO) grading system, congestive heart failure or abnormal left ventricular
      ejection fraction, severe hepatic or renal disturbances if not related to leukemia (hepatic
      enzymes levels over four times the normal values, serum bilirubin over 35 micromol/L,
      creatinine over 150 micromol/L). Patients with previous unexplained cytopenia were eligible
      for the study. Conversely, patients with a history of documented myelodysplastic or
      myeloproliferative syndrome or previously treated with chemotherapy or radiation could not
      enter the study. The study received in June 1996 approval from the ethics' board of the Nancy
      Hospital and written informed consent was given by all eligible patients before entering the
      study, in accordance with the Declaration of Helsinki. The enrollment period was open from
      November 1996 to April 2000.
    

Intervention name(s): Active comparator (no fludarabine); Experimental (fludarabine)
Intervention type(s): Drug; Drug
Intervention description(s): Ara-C (100 mg/m2/d by continuous IV infusion 7 days), idarubicin (8 mg/m2/d (IV) for 5 days), GM-CSF a dose of 5 mg/kg/d on day 1. (Novartis Laboratory, Rueil-Malmaison, France).
The consolidation course: intermediate-dose Ara-C (1g/m2 g 3-hour infusion twice a day 1 through 3) and idarubicin (10 mg/m2 on days 4 through 5). In the allocated arm
Maintenance therapy for one year with 6-thioguanine (100 mg/m2/d orally on days 1 through 4 every week, Ara-C (60 mg/m2 SC on day 5 weekly) interrupted every 3 months with a reinduction course including CCNU (40 mg orally on day 1), mitoguazone (350 mg/m2 on day 1) and Ara-C (40 mg/m2 sc twice daily day 1 to 5); The same regimen with addition of fludarabine in every treatment sequence
Induction course: Fludarabine (20 mg/m2/d, IV for 30 minutes) was started in the assigned group on day 2 and continued until the end of cytarabine treatment on day 7.
Consolidation course: In the allocated arm, fludarabine (20 mg/m2/d, IV) was administered on days 2 through 3, 4 hours prior to cytarabine infusion.
Reinduction courses: Ara-C associated in the allocated group with fludarabine (20 mg/m2/d, IV) on days 1 through 2.
Other intervention name(s): Arm A; Arm B
Intervention MeSH terms: Vidarabine; Fludarabine; Fludarabine phosphate
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Fludarabine; AML; elderly patients