Azacitidine in Patients Undergoing Matched Unrelated Stem Cell Transplantation

Phase I/II Trial of Intravenous Azacitidine in Patients Undergoing Matched Unrelated Stem Cell Transplantation

Status

Terminated

Phases

Phase 1Phase 2

Study type

Interventional

Source

ClinicalTrials.gov

Registry ID

NCT01747499

Enrollment

Registered

2012-12-11

Start date

2013-04-15

Completion date

2018-12-24

Last updated

2019-10-16

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Leukemia, Myeloid, Acute, Myelodysplastic Syndromes, Precursor Cell Lymphoblastic Leukemia-Lymphoma

Brief summary

The purpose of this phase I/II study is to define the maximum tolerated dose of 5-AzaC and the effect on grade II-IV GvHD when given after matched unrelated donor transplant (MUD).

Interventions

DRUGAzacitidine

Study design

Allocation

NON_RANDOMIZED

Intervention model

PARALLEL

Primary purpose

TREATMENT

Masking

NONE

Eligibility

Sex/Gender

ALL

Age

18 Years to 70 Years

Healthy volunteers

Inclusion criteria

Patients must meet the following criteria within 30 days prior to Day 0 unless otherwise noted. * Phase I: Diagnosis of any hematological malignancy listed below (excluding myelofibrosis) in remission or with stable minimal residual disease * Acute myelogenous leukemia (AML) in 1st or subsequent remission or in relapse after any remission * Acute lymphoblastic leukemia (ALL) in 1st or subsequent remission or in relapse after any remission * Myelodysplastic syndrome either intermediate 1 or 2, or high risk by the International Prognostic Scoring System * Chronic myelogenous leukemia (CML) in accelerated or second chronic phase * Non-Hodgkin's lymphoma (NHL) or Hodgkin's disease (HD) in 2nd or greater complete remission, partial remission, or refractory relapse * Chronic lymphocytic leukemia (CLL), Rai Stage 2-4, failing at least 2 prior regimens * Multiple myeloma (MM), Stage 2-3 * Myeloproliferative disorder or neoplasm * Phase II: Diagnosis of AML in remission 1 or 2 or a diagnosis of myelodysplastic syndrome either intermediate 1 or 2, or high risk by the International Prognostic Scoring System. * Patients with MDS must be transplant candidates by current clinical standards. * Patients who have been treated with hypomethylating agents prior to entering the study are eligible. * Must have matched unrelated donor (8 of 8 HLA match at A, B, C, and DR loci) by high resolution DNA typing * Must have donor peripheral blood stem cells mobilized by NMDP standards. No bone marrow donors. * Must have 2-8 x 10\^6 CD34+ cells/kg (recipient weight) infused on Day 0. * Must have at least one additional aliquot of \>=1 x 10\^6 CD34/kg cryopreserved cells stored at the time of transplant. * Must receive a myeloablative or reduced intensity conditioning regimen for SCT as defined by the CIBMTR * Cyclophosphamide and single dose total body irradiation * Fludarabine and busulfan * Fractionated TBI and cyclophosphamide * Busulfan and cyclophosphamide * Must be able to receive GVHD prophylaxis with tacrolimus and methotrexate. * Must be ≥ 18 yrs old and ≤ 70 yrs old. Azacitidine is not approved by the FDA for use in children. * Must have an Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2. * Must have laboratory results indicating: * Total bilirubin \< 2.0 mg/dl, unless a diagnosis of Gilbert's disease * AST/ALT ≤ 3 X the upper limit of institutional normal * Serum creatinine ≤ 2.0 mg/dl * Patient must have ability to understand and willingness to provide written informed consent prior to participation in the study and any related procedures being performed. * The effects of azacitidine on the developing human fetus at the recommended therapeutic dose are unknown. For this reason and because category D agents as well as other therapeutic agents used in this trial are known to be teratogenic, women of childbearing age must have a negative serum pregnancy test (ß-human chorionic gonadotropin) within 72 hours prior to initiating the conditioning regimen and be willing to not become pregnant by using effective contraception while undergoing treatment and for at least 3 months after the last dose of azacitidine. * Men must be willing not to father a new child while receiving therapy. They must use an effective barrier method of contraception during the study and for 3 months following the last dose.

Exclusion criteria

* Must not have myelofibrosis or other disease known to prolong neutrophil engraftment to \> 28 days after transplant. * Must not be receiving any other investigational agents within 14 days of first dose of azacitidine (Day 7). * Must not have myeloablative conditioning as defined below: * TBI \< or = Gy +/- purine analog * Flu + Cy +/- ATG * Flu + AraC + Ida * Cladribine + AraC * Total Lymphoid Irradiation + ATG * Must not receive antithymocyte globulin as part of pre-transplant conditioning regimens. Antithymocyte globulin is excluded due to its potential impact on modulating the incidence of GvHD or GvL. * Must not have uncontrolled intercurrent illness including ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, or psychiatric illness/social situations that would limit compliance with study requirements. * Must not be pregnant or breastfeeding. Pregnant women are excluded from this study because azacitidine is a Category D agent with the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with azacitidine, breastfeeding should be discontinued if the mother is treated azacitidine. These potential risks may also apply to other agents used in this study. * Must not have a known or suspected hypersensitivity to azacitidine, mannitol, or compounds of similar composition to azacitidine.. * Must not have an advanced malignant hepatic tumor. * Must not be HIV, HBV, or HCV positive.

Design outcomes

Primary

Measure	Time frame	Description
Phase I: to Determine the Maximum Tolerated Dose (MTD) of Azacitidine in Patients Undergoing Matched (8 Out of 8) Unrelated Donor Transplant for Any Hematological Malignancy in Remission or With Stable Disease.	28 days	The MTD is defined as the dose level immediately below the dose level at which patients of a cohort (of 2 to 6 patients) experience dose-limiting toxicity.
Phase II: Number of Participants With Grades II-IV Acute GvHD	Day +180	GVHD rate and severity will be assessed based on modified Glucksberg criteria. Grade II-IV and III-IV aGVHD in first 180 days after transplant will be assessed.

Secondary

Measure	Time frame	Description
Treatment-related Mortality	Day +140	Death that results from a transplant procedure-related complication (e.g. infection, organ failure, hemorrhage, GVHD) rather than from relapse of the underlying disease or an unrelated cause.
Rate of Grades III-IV aGVHD at Day +180.	Day +180	GVHD rate and severity will be assessed based on modified Glucksberg criteria.
Rate of Chronic GvHD	One year after transplant	—
Number of Participants Who Relapsed Within the First Year of Transplant	Within the first year of transplant	Recurrence of the original malignant disease after transplantation. The time to relapse is the time to the first observation of hematologic, radiographic, or cytogenetic changes, which result in characterization as relapse.
Overall Survival as Measured by Number of Participants Alive at 1 Year After Transplant	One year after transplant	Date of transplant to the date of death from any cause.

Countries

United States

Participant flow

Participants by arm

Arm	Count
Cohort 1 Conditioning treatment Transplant on Day 0 15 mg/m\^2 azacitidine Days 7-11 15 mg/m\^2 azacitidine Days 35-39 15 mg/m\^2 azacitidine Days 63-67 15 mg/m\^2 azacitidine Days 91-95	3
Cohort 2 Conditioning treatment Transplant on Day 0 30 mg/m\^2 azacitidine Days 7-11 30 mg/m\^2 azacitidine Days 35-39 30 mg/m\^2 azacitidine Days 63-67 30 mg/m\^2 azacitidine Days 91-95	3
Cohort 3 Conditioning treatment Transplant on Day 0 37.5 mg/m\^2 azacitidine Days 7-11 37.5 mg/m\^2 azacitidine Days 35-39 37.5 mg/m\^2 azacitidine Days 63-67 37.5 mg/m\^2 azacitidine Days 91-95	3
Cohort 4 Conditioning treatment Transplant on Day 0 45 mg/m\^2 azacitidine Days 7-11 45 mg/m\^2 azacitidine Days 35-39 45 mg/m\^2 azacitidine Days 63-67 45 mg/m\^2 azacitidine Days 91-95	6
Phase II Cohort Conditioning treatment Transplant on Day 0 Dose determined in Phase I - 45 mg/m\^2 azacitidine Days 7-11 Dose determined in Phase I - 45 mg/m\^2 azacitidine Days 35-39 Dose determined in Phase I - 45 mg/m\^2 azacitidine Days 63-67 Dose determined in Phase I - 45 mg/m\^2 attitudinize Days 91-95	39
Total	54

Withdrawals & dropouts

Period	Reason	FG000	FG001	FG003	FG004
Overall Study	Death	0	0	1	1
Overall Study	Determined not to be eligible	0	0	0	1
Overall Study	Developed AML and death	0	0	0	1
Overall Study	Physician Decision	0	1	0	2
Overall Study	Steroid refractory aGvHD	1	0	1	4
Overall Study	Withdrawal by Subject	0	0	0	6

Baseline characteristics

Characteristic	Cohort 1	Total	Phase II Cohort	Cohort 4	Cohort 3	Cohort 2
Age, Continuous	46 years	59 years	59 years	58.5 years	63 years	57 years
Ethnicity (NIH/OMB) Hispanic or Latino	0 Participants	0 Participants	0 Participants	0 Participants	0 Participants	0 Participants
Ethnicity (NIH/OMB) Not Hispanic or Latino	3 Participants	54 Participants	39 Participants	6 Participants	3 Participants	3 Participants
Ethnicity (NIH/OMB) Unknown or Not Reported	0 Participants	0 Participants	0 Participants	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) American Indian or Alaska Native	0 Participants	0 Participants	0 Participants	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) Asian	0 Participants	2 Participants	1 Participants	1 Participants	0 Participants	0 Participants
Race (NIH/OMB) Black or African American	0 Participants	1 Participants	1 Participants	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) More than one race	0 Participants	0 Participants	0 Participants	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) Native Hawaiian or Other Pacific Islander	0 Participants	0 Participants	0 Participants	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) Unknown or Not Reported	0 Participants	0 Participants	0 Participants	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) White	3 Participants	51 Participants	37 Participants	5 Participants	3 Participants	3 Participants
Region of Enrollment United States	3 participants	54 participants	39 participants	6 participants	3 participants	3 participants
Sex: Female, Male Female	1 Participants	22 Participants	17 Participants	2 Participants	0 Participants	2 Participants
Sex: Female, Male Male	2 Participants	32 Participants	22 Participants	4 Participants	3 Participants	1 Participants

Adverse events

Event type	EG000 affected / at risk	EG001 affected / at risk	EG002 affected / at risk	EG003 affected / at risk	EG004 affected / at risk
deaths Total, all-cause mortality	1 / 3	1 / 3	1 / 3	2 / 6	12 / 39
other Total, other adverse events	3 / 3	3 / 3	3 / 3	6 / 6	39 / 39
serious Total, serious adverse events	2 / 3	2 / 3	2 / 3	3 / 6	23 / 39

Outcome results

Primary

Phase II: Number of Participants With Grades II-IV Acute GvHD

GVHD rate and severity will be assessed based on modified Glucksberg criteria. Grade II-IV and III-IV aGVHD in first 180 days after transplant will be assessed.

Time frame: Day +180

Population: One patient was enrolled and treated with 1 cycle but was ultimately ineligible following a laboratory error and is not evaluable for this outcome measure.

Arm	Measure	Value (COUNT_OF_PARTICIPANTS)
Phase I	Phase II: Number of Participants With Grades II-IV Acute GvHD	16 Participants

Primary

Phase I: to Determine the Maximum Tolerated Dose (MTD) of Azacitidine in Patients Undergoing Matched (8 Out of 8) Unrelated Donor Transplant for Any Hematological Malignancy in Remission or With Stable Disease.

The MTD is defined as the dose level immediately below the dose level at which patients of a cohort (of 2 to 6 patients) experience dose-limiting toxicity.

Time frame: 28 days

Arm	Measure	Value (NUMBER)
Phase I	Phase I: to Determine the Maximum Tolerated Dose (MTD) of Azacitidine in Patients Undergoing Matched (8 Out of 8) Unrelated Donor Transplant for Any Hematological Malignancy in Remission or With Stable Disease.	45 mg/m^2

Secondary

Number of Participants Who Relapsed Within the First Year of Transplant

Recurrence of the original malignant disease after transplantation. The time to relapse is the time to the first observation of hematologic, radiographic, or cytogenetic changes, which result in characterization as relapse.

Time frame: Within the first year of transplant