MDS, Myelodysplastic Syndrome
Conditions
Brief summary
The purpose of this research is to evaluate the use of lenalidomide and prednisone in people with Myelodysplastic Syndrome (MDS). Lenalidomide is a drug that alters the immune system and it may also interfere with the development of tiny blood vessels that help support tumor growth. Therefore, in theory, it may reduce or prevent the growth of cancer cells. Lenalidomide is approved by the U.S. Food and Drug Administration (FDA) for the treatment of specific types of myelodysplastic syndrome (MDS) and in combination with dexamethasone for people with multiple myeloma (MM) who have received at least 1 prior therapy. MDS and MM are cancers of the blood. It is currently being tested in a variety of cancer conditions. As it is being used in this study it is considered an investigational use. An investigational use is a use that is being tested and is not approved by the FDA. Prednisone is approved by the FDA to treat numerous conditions. In addition, prednisone is approved by the FDA to treat Low or Intermediate-1 IPSS Risk, non-del (5q) MDS. Study drug refers to the combination of lenalidomide and prednisone.
Detailed description
10 mg/day of lenalidomide will be taken by mouth on days 1 - 28 of cycles 1-6. Dosing will be in the morning at approximately the same time each day. Planned prednisone dose: * 30 mg by mouth daily, days 1-28 of cycle 1 * 20 mg by mouth daily, days 1-28 of cycle 2 * 10 mg by mouth daily, days 1-28 of cycle 3 * 10 mg by mouth every other day on days 1-28 of cycles 4-6 * 5 mg by mouth every other day for responders beyond cycle 6
Interventions
DRUGPrednisone
Prednisone therapy for 6 cycles (24 weeks).
DRUGLenalidomide
Lenalidomide therapy for 6 cycles (24 weeks).
Sponsors
Celgene Corporation
H. Lee Moffitt Cancer Center and Research Institute
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
* Understand and voluntarily sign an informed consent form * Age ≥ 18 years at the time of signing the informed consent form * Able to adhere to the study visit schedule and other protocol requirements * Documented diagnosis of MDS according Word Health Organization (WHO) that meets International Prognostic Scoring System (IPSS) criteria for Low- to Intermediate-1-risk disease or non-proliferative (white blood count \[WBC\] \< 13,000/uL) chronic myelomonocytic leukemia (CMML) and MDS/myeloproliferative neoplasms (MPN). * Absence of a chromosome 5q deletion by metaphase cytogenetics or fluorescent in situ hybridization (FISH) analysis * Red blood cell (RBC) transfusion-dependent anemia defined as having received ≥4 transfusions of RBCs for hemoglobin (Hgb) ≤ 9.0 g/dl within 56 days of randomization or symptomatic anemia (Hgb ≤ 9.0 g/dl) * No response or progression on prior treatment with epoetin alpha (\> 40,000 U/wk x 6), darbepoetin alpha (≥ 500 mcg q 3 wk x 2) or serum erythropoietin (EPO) concentration ≥ 500 mU/ml * All previous cancer therapy, including radiation, hormonal therapy and surgery, must have been discontinued at least 4 weeks prior to treatment in this study. * Eastern Cooperative Oncology Group (ECOG) performance status of ≤ 2 at study entry * Laboratory test results within these ranges: Absolute neutrophil count ≥ 500 /mm³; Platelet count ≥ 50,000 /mm³; Creatinine Clearance \> 60 mL/min by Cockcroft-Gault formula; Total bilirubin ≤ 1.5 mg/dl; aspartic transaminase (AST)and alanine transaminase (ALT) ≤ 2 x upper limit of normal (ULN). * Disease free of prior malignancies for ≥ 3 years with exception of currently treated basal cell, squamous cell carcinoma of the skin, or carcinoma insitu of the cervix or breast * Must be registered into the mandatory RevAssist® program, and be willing and able to comply with the requirements of RevAssist®. * Females of childbearing potential (FCBP)† must have a negative serum or urine pregnancy test with a sensitivity of at least 50 milli-international units per milliliter (mIU/mL) within 10 - 14 days prior to and again within 24 hours of prescribing lenalidomide (prescriptions must be filled within 7 days) and must either commit to continued abstinence from heterosexual intercourse or begin TWO acceptable methods of birth control, one highly effective method and one additional effective method AT THE SAME TIME, at least 28 days before she starts taking lenalidomide. FCBP must also agree to ongoing pregnancy testing. Men must agree to use a latex condom during sexual contact with a FCBP even if they have had a successful vasectomy.
Exclusion criteria
* Any serious medical condition, laboratory abnormality, or psychiatric illness that would prevent the patient from signing the informed consent form. * Pregnant or breast feeding. (Lactating females must agree not to breast feed while taking lenalidomide). * Any condition, including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study or confounds the ability to interpret data from the study. * Use of any other experimental drug or therapy within 28 days of baseline * Known hypersensitivity to thalidomide * The development of erythema nodosum if characterized by a desquamating rash while taking thalidomide or similar drugs or history of desquamating (blistering) rash while taking thalidomide * Any prior use of lenalidomide * Concurrent use of other anti-cancer agents or treatments * Known positive for human immunodeficiency virus (HIV) or infectious hepatitis, type B or C * Proliferative CMML (WBC ≥13,000/μL) * MDS secondary to treatment with radiotherapy, chemotherapy, and/or immunotherapy for malignant or autoimmune diseases * Prior ≥ grade-2 National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) allergic reaction to thalidomide * Clinically significant anemia due to factors such as iron, B12 or folate deficiencies, autoimmune or hereditary hemolysis or gastrointestinal bleeding * Known HIV-1 positivity * Chromosome 5q deletion * Documented thromboembolic event within the past 3 years
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Erythroid Response | Up to 7 months | The rate of erythroid response to treatment with the lenalidomide/prednisone combination in non-del (5q) low and int-1 risk Myelodysplastic Syndrome (MDS) with symptomatic anemia. Hematological improvement erythroid response (HI-E) according to International Working Group (IWG) 2006 criteria. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Grade 3 or 4 Adverse Events Possibly Related to Treatment | Up to 54 months | Grade 3 or 4 events Related/Possibly Related/Probably Related to study treatment. Number of participants with events specified in the study protocol: Neutropenia, Thrombocytopenia, Febrile Neutropenia, Infection, Sepsis, Venous Thromboembolic Events. Evaluations according to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) V4.0. |
Countries
United States
Participant flow
Recruitment details
Participants were recruited at Moffitt Cancer Center and Shands Cancer Hospital at the University of Florida from 4/28/2010 through 8/13/2013.
Participants by arm
| Arm | Count |
|---|---|
| Lenalidomide and Prednisone Therapy Lenalidomide and prednisone therapy for 6 cycles (24 weeks). Each cycle is 28 days (4 weeks). | 28 |
| Total | 28 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Cerebrovascular accident (CVA) | 1 |
| Overall Study | Withdrawal by Subject | 1 |
Baseline characteristics
| Characteristic | Lenalidomide and Prednisone Therapy |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 20 Participants |
| Age, Categorical Between 18 and 65 years | 8 Participants |
| Age, Continuous | 68.64 years |
| Region of Enrollment United States | 28 participants |
| Sex: Female, Male Female | 10 Participants |
| Sex: Female, Male Male | 18 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 27 / 28 |
| serious Total, serious adverse events | 8 / 28 |
Outcome results
Primary
Number of Participants With Erythroid Response
The rate of erythroid response to treatment with the lenalidomide/prednisone combination in non-del (5q) low and int-1 risk Myelodysplastic Syndrome (MDS) with symptomatic anemia. Hematological improvement erythroid response (HI-E) according to International Working Group (IWG) 2006 criteria.
Time frame: Up to 7 months
Population: All evaluable participants
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Lenalidomide and Prednisone Therapy | Number of Participants With Erythroid Response | 5 participants |
Secondary
Number of Participants With Grade 3 or 4 Adverse Events Possibly Related to Treatment
Grade 3 or 4 events Related/Possibly Related/Probably Related to study treatment. Number of participants with events specified in the study protocol: Neutropenia, Thrombocytopenia, Febrile Neutropenia, Infection, Sepsis, Venous Thromboembolic Events. Evaluations according to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) V4.0.
Time frame: Up to 54 months
Population: All participants
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Lenalidomide and Prednisone Therapy | Number of Participants With Grade 3 or 4 Adverse Events Possibly Related to Treatment | Infection and Sepsis | 0 participants |
| Lenalidomide and Prednisone Therapy | Number of Participants With Grade 3 or 4 Adverse Events Possibly Related to Treatment | Neutropenia | 8 participants |
| Lenalidomide and Prednisone Therapy | Number of Participants With Grade 3 or 4 Adverse Events Possibly Related to Treatment | Thrombocytopenia | 4 participants |
| Lenalidomide and Prednisone Therapy | Number of Participants With Grade 3 or 4 Adverse Events Possibly Related to Treatment | Febrile Neutropenia | 0 participants |
| Lenalidomide and Prednisone Therapy | Number of Participants With Grade 3 or 4 Adverse Events Possibly Related to Treatment | Venous Thromboembolic Events | 0 participants |