Chronic Myeloid Leukemia
Conditions
Keywords
CML
Brief summary
To investigate whether patients with chronic-phase chronic myeloid leukemia (CP-CML) who have achieved a complete cytogenetic response (CCyR) on imatinib (IM) or nilotinib (N) can then be treated with a combination of the tyrosine kinase inhibitor (TKI) and interferon-α2b (PEG-IFN-a2b, \[IFN\]) for 2 years, subsequently have their therapy discontinued, and then maintain a durable molecular response off all therapy. Relapse-free survival (RFS) rate 1 year after discontinuation of the TKI and IFN will be the measurement of this objective.
Interventions
DRUGPEG-IFN-a2b
Patients will receive pegylated interferon α-2b (Pegintron®) (PEG-IFN-α2b) 150 µg subcutaneously, once a week. Patients and/or caregivers identified by the patient will be taught how to perform subcutaneous injections of the PEG-IFN-α2b by trained nurses in the chemotherapy infusion center at the University of Michigan Comprehensive Cancer Center. Those patients who do not feel comfortable receiving the injections outside of the cancer center, or are deemed unreliable in administering injections per the training nurse, will return to the cancer center infusion room on a weekly basis to receive subsequent injections.
Sponsors
University of Michigan Rogel Cancer Center
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients must have a diagnosis of Philadelphia chromosome positive (Ph+) chronic myeloid leukemia in chronic phase by having met all of the following criteria at the time of their initial diagnosis: * Cytogenetic confirmation of Philadelphia chromosome or variants of the t(9;22) translocations. Patients may have secondary chromosomal abnormalities in addition to the Philadelphia chromosome. * Peripheral blood or bone marrow blast count \< 10%. * Peripheral blood basophil count \< 20%. * Platelet count ≥ 100,000 x 109/L. * If the peripheral blood counts are unavailable from the time of their original diagnosis, but there is no evidence of accelerated- or blast-phase disease from prior clinical or other medical records, then they will be allowed to participate. * Patients must be eighteen years of age or older. * Patients must be actively receiving treatment for their CML with a a tyrosine kinase inhibitor, either imatinib or nilotinib. * Patients may be receiving imatinib mesylate. Patients must be on imatinib mesylate for a minimum of 2 years, and be on a stable dose for at least one consecutive year leading up to enrollment. * Patients may be receiving nilotinib (Tasigna) as frontline therapy or as second line therapy if the reason for the switch from imatinib to nilotinib was intolerance to imatinib. Patients cannot have been switched from imatinib to nilotinib because of a concern or demonstration for resistance to frontline imatinib. Patients must be on nilotinib for a minimum of 2 years, and be on a stable does for at least one consecutive year leading up to enrollment. * Patients must have an ongoing complete hematologic response (CHR) on a a TKI (imatinib or nilotinib), defined as follows: * WBC ≤ 10 x 109/L. * Platelet count \< 450,000 x 109/L. * No blasts or promyelocytes in peripheral blood. * No evidence of disease-related symptoms and extramedullary disease, including the liver and spleen. * Patients must have a complete cytogenetic response (CCyR) on a TKI (imatinib or nilotinib) for a minimum of 1 year leading up to enrollment. Complete cytogenetic response is defined as 0% Ph+ cells in metaphase, in the bone marrow and/or a negative peripheral blood FISH analysis for the Bcr-Abl gene fusion, and an ongoing CCyR must be confirmed by bone marrow aspirate cytogenetics and/or peripheral blood FISH for Bcr-Abl within 4 weeks of starting treatment. * Patients may have a negative quantitative RT-PCR (qPCR) for BCR-ABL at the time of enrollment, but if the qPCR is positive, patients cannot have greater than 1% bcr-ABl / Abl /ABL transcript, present in 2 consecutive qPCR analyses, performed at least 3 months apart, in the 6 to 12 months leading up to enrollment. * Patients must have an ECOG performance status of 0-2 (Appendix 13.1). * All patients must be informed of the investigational nature of this study and standard alternative therapy. All patients must sign and give written informed consent in accordance with institutional and federal guidelines.
Exclusion criteria
* Patients who have had prior progression of their CML to accelerated phase or blast crisis. * Patients who have previously undergone hematopoietic stem cell transplantation. * Patients who have previously been treated with interferon-α. * Patients with an absolute neutrophil count (ANC) \< 1500/mm3 and/or a platelet count \< 100,000/mm3. * Patients with serum bilirubin, SGOT\[AST\], SGPT\[ALT\], or serum creatinine \> 1.5 x the upper limit of normal (ULN). * Patients with an INR or PTT \> 1.5 x ULN, with the exception of patients on treatment with oral anticoagulants. * Patients with uncontrolled medical diseases such as diabetes mellitus, neuropsychiatric disorders, infection, angina, severe hypertension, pulmonary disease (chronic obstructive pulmonary disease \[COPD\] with hypoxemia), major organ malfunction (liver, kidney) or class III or IV cardiac disease as defined by the New York Heart Association Criteria. * Patients who are (a) pregnant, (b) breast feeding, (c) of childbearing potential without a negative pregnancy test prior to Study Day 1, and (d) male or female of childbearing potential unwilling to use barrier contraceptive precautions throughout the trial (postmenopausal women must be amenorrheic for at least 12 months to be considered of non-childbearing potential). * Patients with a history of another active malignancy within the last five years, which required treatment with chemotherapy, hormonal therapy, or radiation therapy. Exceptions to this rule include basal cell and squamous cell skin carcinomas or cervical carcinoma in situ. * Patients with a history of non-compliance to medical regimens or who are considered potentially unreliable.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Relapse-free Survival (RFS) Rate 1 Year After Discontinuation of the TKI and IFN | 3 years (2 years of treatment with TKI and IFN + 1 year of follow-up) | To investigate whether patients with chronic-phase chronic myeloid leukemia (CP-CML) who have achieved a complete cytogenetic response (CCyR) on imatinib (IM) or nilotinib (N) can then be treated with a combination of the tyrosine kinase inhibitor (TKI) and interferon-α2b (PEG-IFN-a2b, \[IFN\]) for 2 years, subsequently have their therapy discontinued, and then maintain a durable molecular response off all therapy. Relapse-free survival (RFS) rate 1 year after discontinuation of the TKI and IFN will be the measurement of this objective. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Quantitative Reverse Transcriptase-polymerase Chain Reaction (qRT-PCR) for the Bcr-Abl Transcript. | 3 years (2 years of treatment with TKI and IFN + 1 year of follow-up) | To determine whether the addition of PEG-IFN-a2b to a TKI (imatinib or nilotinib) improves upon the quality of the molecular remission seen with TKI alone, as measured by quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) for the Bcr-Abl transcript. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| PEG-IFN-a2b PEG-IFN-a2b: Patients receive pegylated interferon α-2b (Pegintron®) (PEG-IFN-α2b) 150 µg subcutaneously, once a week. | 12 |
| Total | 12 |
Baseline characteristics
| Characteristic | PEG-IFN-a2b |
|---|---|
| Age, Continuous | 39 years |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 4 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 8 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 1 Participants |
| Race (NIH/OMB) White | 11 Participants |
| Sex: Female, Male Female | 5 Participants |
| Sex: Female, Male Male | 7 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 1 / 12 |
| other Total, other adverse events | 0 / 12 |
| serious Total, serious adverse events | 1 / 12 |
Outcome results
Primary
Relapse-free Survival (RFS) Rate 1 Year After Discontinuation of the TKI and IFN
To investigate whether patients with chronic-phase chronic myeloid leukemia (CP-CML) who have achieved a complete cytogenetic response (CCyR) on imatinib (IM) or nilotinib (N) can then be treated with a combination of the tyrosine kinase inhibitor (TKI) and interferon-α2b (PEG-IFN-a2b, \[IFN\]) for 2 years, subsequently have their therapy discontinued, and then maintain a durable molecular response off all therapy. Relapse-free survival (RFS) rate 1 year after discontinuation of the TKI and IFN will be the measurement of this objective.
Time frame: 3 years (2 years of treatment with TKI and IFN + 1 year of follow-up)
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| PEG-IFN-a2b | Relapse-free Survival (RFS) Rate 1 Year After Discontinuation of the TKI and IFN | 0 Participants |
Secondary
Quantitative Reverse Transcriptase-polymerase Chain Reaction (qRT-PCR) for the Bcr-Abl Transcript.
To determine whether the addition of PEG-IFN-a2b to a TKI (imatinib or nilotinib) improves upon the quality of the molecular remission seen with TKI alone, as measured by quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) for the Bcr-Abl transcript.
Time frame: 3 years (2 years of treatment with TKI and IFN + 1 year of follow-up)
Population: Because there were no molecular remissions at 1 year post treatment discontinuation (measure #1), there was no basis for this analysis. There is no data to summarize.