Study of Molecular and Genetic Abnormalities in Patients With Myeloid Neoplasms

Study Overview
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Brief Summary
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The objective of this study is to describe the prevalence and prognostic impact of the most common genetic abnormalities in patients with Myeloid Neoplasms, including Acute Myeloid Leukemia (AML), Myeloproliferative Neoplasms (MPN), Myelodysplastic Syndromes (MDS) and Myeloproliferative/Myelodysplastic Neoplasms. Patients will have samples of blood and/or bone marrow collected and sent to Hospital Israelita Albert Einstein for analysis and storage. Patients with a diagnosis of Acute Myeloid Leukemia will be treated according to an uniform protocol.

Official Title
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Evaluation of the Incidence and Prognostic Impact of Molecular and Genetic Abnormalities in Patients With Acute Myeloid Leukemia, Myelodysplastic Syndrome and Myeloproliferative Neoplasms

Conditions
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Myelodysplastic Syndromes, Myeloproliferative/Myelodysplastic Neoplasm, Acute Myeloid Leukemia, Myeloproliferative Neoplasms

Intervention / Treatment
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* Drug: Induction Chemotherapy
* Drug: Consolidation Chemotherapy
* Drug: Autologous Stem Cell Transplantation
* Drug: Allogeneic Stem Cell Transplantation
* Drug: Low Dose Cytarabine
* Drug: Decitabine


Participation Criteria
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Eligibility Criteria
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Acute Myeloid Leukemia-Intensive Chemotherapy Inclusion Criteria: Diagnosis of AML according to WHO criteria Age greater than 18 years Performance status (ECOG) between 0-2 Adequate liver and kidney function Signed Informed Consent form No prior therapy for AML, except use of hydroxyurea for control of elevated white blood cell counts Adequate contraception for fertile men and women Eligible for intensive chemotherapy (as judged by the treating physician) Exclusion Criteria: Acute myeloid leukemia with retinoic acid receptor alpha (RARA) translocations (APL, acute promyelocytic leukemia) Pregnant women HIV-positivity New York Heart Association class III and IV congestive heart failure Patient refuses to use adequate contraception History of hypersensibility to any of the used chemotherapy drugs Patient refuses to sign informed consent form Acute Myeloid Leukemia-Non-Intensive Chemotherapy Inclusion Criteria: Diagnosis of AML according to WHO criteria Age greater than 18 years Signed Informed Consent form No prior therapy for AML, except use of hydroxyurea for control of elevated white blood cell counts Adequate contraception for fertile men and women Non-eligible for intensive chemotherapy (as judged by the treating physician) Exclusion Criteria: Acute myeloid leukemia with RARA translocations (APL, acute promyelocytic leukemia) Pregnant women HIV-positivity Patient refuses to use adequate contraception History of hypersensibility to any of the used chemotherapy drugs Patient refuses to sign informed consent form Chronic Myeloid Disorders: Inclusion Criteria: Diagnosis of Myeloproliferative Neoplasm or Myelodysplastic Syndrome or Myeloproliferative/Myelodysplastic Neoplasm according to WHO criteria Age greater than 18 years Signed Informed Consent form Exclusion Criteria: Patient refuses to sign informed consent form

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: AML-Intensive Chemotherapy<br>Patients with Acute Myeloid Leukemia fit for intensive chemotherapy Patients will receive Induction Chemotherapy, and CR will be evaluated after 28 days. Patients who achieve CR post-induction chemotherapy will receive post-remission therapy according to risk: Low risk patients: Consolidation chemotherapy or Autologous stem cell transplantation Intermediate and high-risk patients: Allogeneic stem cell transplantation Patients who do not achieve CR may receive one second induction cycle, and if CR is achieved may proceed to post-remission therapy as per above. Patients who do not achieve CR after two cycles of induction will be deemed refractory and removed from the study. | Drug: Induction Chemotherapy<br>* Induction chemotherapy for patients with AML eligible for intensive chemotherapy: Cytarabine 200 mg/m2 IV continuous infusion days 1-7 Daunorubicin 90 mg/m2 intravenous piggyback days 1-3<br>* Other names: 3+7;Drug: Consolidation Chemotherapy<br>* Consolidation chemotherapy for patients eligible for intensive chemotherapy with low-risk AML or patients with intermediate-/high-risk AML who do not have matched donors: -Cytarabine 1.5 g/m2 IV in 3 hours days 1, 3 and 5 for 3 cycles<br>* Other names: Cytarabine;Drug: Autologous Stem Cell Transplantation<br>* Autologous Stem Cell Transplantation for consolidation of patients eligible for intensive chemotherapy with low-risk AML or patients with intermediate-/high-risk AML who do not have matched donors: Busulfan 1 mg/Kg PO q6h or 130 mg/m2 IV once daily days -7 to -4 Cyclophosphamide 60 mg/Kg IV once daily days -3 and -2<br>* Other names: ABMT;Drug: Allogeneic Stem Cell Transplantation<br>* Allogeneic Stem Cell Transplantation for consolidation of patients eligible for intensive chemotherapy with intermediate-/high-risk AML Conditioning regimen: Busulfan 1 mg/Kg PO q6h or 130 mg/m2 IV once daily days -7 to -4 Cyclophosphamide 60 mg/Kg IV once daily days -3 and -2 or Fludarabine 40 mg/m2 IV once daily days -7 to -4<br>* Other names: Allogeneic Bone Marrow Transplantation;|
| Other: AML-Non-intensive chemotherapy<br>Patients with acute myeloid leukemia not fit for intensive chemotherapy Patients will receive induction chemotherapy with either low dose cytarabine or decitabine. Assignment to each drug will depend on drug availability and physician discretion. No randomization will be done between the drugs. Cycles will be repeated every 28 days. Patients who achieve CR will continue to post-consolidation therapy with either cytarabine or decitabine, based on the induction therapy received. Patients will receive a maximum of 4 cycles until achieving CR, if no response is seen after 4 cycles patients will be deemed refractory. | Drug: Low Dose Cytarabine<br>* Chemotherapy for patients with AML who are not fit for intensive chemotherapy: Cytarabine 60 mg/m2 subcutaneous (SQ) bid days 1-5 (until CR or maximum 4 cycles) Cytarabine 40 mg/m2 SQ bid days 1-5 (after CR, until a maximum of 3 years of therapy or relapse, whichever comes first)<br>* Other names: LDAC;Drug: Decitabine<br>* Chemotherapy for patients with AML who are not fit for intensive chemotherapy: Decitabine 20 mg/m2 IV once daily days 1-10 (until CR or maximum 4 cycles) Decitabine 20 mg/m2 IV once daily days 1-5 (after CR, until a maximum of 3 years of therapy or relapse, whichever comes first)<br>* Other names: DAC;|
| No Intervention: Chronic Myeloid Disorders<br>Patients with Chronic Myeloid Disorders: Myeloproliferative Neoplasms Myelodysplastic Syndromes Myeloproliferative/Myelodysplastic Neoplasms | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Prevalence of molecular and cytogenetic abnormalities | As assessed by results of molecular and cytogenetic tests and frequency in the population studied | 2 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Overall survival | Evaluation of 5-years overall survival in patients with Acute Myeloid Leukemia, Myeloproliferative Neoplasms, Myelodysplastic Syndromes and Myeloproliferative/Myelodysplastic Neoplasms | 5 years | 
| Response rate | Evaluate complete remission (CR) rate at 1 month for patients with Acute Myeloid Leukemia who received induction chemotherapy. Complete remission was defined by the presence of < 5% blasts in the bone marrow (BM) with > 1 x 10^9/L neutrophils and >100x10^9/L platelets in the peripheral blood (PB) | 1 month | 
| Disease Free Survival | Evaluate rate of 5-years disease-free survival in patients with Acute Myeloid Leukemia who enter complete remission after induction chemotherapy | 5 years | 
| Cumulative incidence of relapse and non-relapse mortality | Evaluate 5-years cumulative incidence of relapse and non-relapse mortality in patients with Acute Myeloid Leukemia who achieve complete remission following induction chemotherapy | 5 years | 
| Number of participants with adverse events as a measure of safety and tolerability | Evaluate hematological and non-hematological toxicity in patients with Acute Myeloid Leukemia treated according to the protocol. Toxicity will be graded as per the National Cancer Institute Common Toxicity Criteria for Adverse Events v4.0.3 | 1 year | 
| Cumulative Incidence of Transformation to Acute Myeloid Leukemia | Evaluate 5-years incidence of transformation to Acute Myeloid Leukemia in patients with Myeloproliferative Neoplasms, Myelodysplastic Syndromes and Myeloproliferative/Myelodysplastic Neoplasms | 5 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Acute Myeloid Leukemia, Myeloproliferative Neoplasms, Myelodysplastic Syndromes, MPN, Essential Thrombocythemia (ET), Myelofibrosis (MF), Chronic myelomonocytic leukemia (CMML), Polycythemia Vera (PV), MDS, AML, Myeloproliferative/Myelodysplastic Neoplasm, Leukemia