Acute Myeloid Leukemia, Childhood
Conditions
Keywords
AML, MRD, stem cell transplantation, pediatric, leukemia, haploidentical, TcRab-depletion, young adult
Brief summary
Minimal-residual disease (MRD) will be measured either by flow cytometry, or polymerase chain reaction (PCR) methods, in 3 check-points and it will be one of the decision-making control parameter for the optimal therapy tactics. Patients with initially high-risk group and those with high MRD after 2 initial courses of chemotherapy will be assigned to the allogenic transplantation of the hematopoietic stem cells from Human Leucocyte Antigen (HLA) matched or haploidentical family donors.
Detailed description
Genetic alterations in acute myeloid leukemia (AML) clone are well known prognostic risk factors of AML relapse. Standard risk group includes favorable t (15;17) (q22; q21) and inv (16)/t (16;16). High-risk patients have a complex karyotype rearrangement (3 and more), inversion of the long arm in 3rd chromosome and EVI1 gene rearrangement, monosomy 5 and 7, translocations involving KMT2A gene and several rare translocations. All other genotype alterations attributed to the moderate risk group. Besides genetic factors, detection of the minimal residual disease (MRD) after initial chemotherapy and its decrease rate after 1st postremission chemotherapy with high dose Cytarabine and anthracyclines, plays a crucial role in the development of the morphologic relapse. Patients with PCR-MRD\<0,1% after 2 courses of chemotherapy have a 30% or less risk of relapse, while PCR-MRD\>0,1% - over 70%. In the clinical trial investigators are planning to measure MRD either by immune-phenotype, or PCR methods, in 3 check-points and it will be one of decision-making control parameter for the optimal therapy tactics. Patients with initially high-risk group and those with high MRD after 2 initial courses of chemotherapy will be assigned to the allogenic transplantation of the hematopoietic stem cells from HLA- matched or haploidentical family donors.
Interventions
OTHERHSCT
allogenic HSCT from 5-8 HLA-MM family donor as a first choice for patients with initial high risk of relapse and for patients with MRD2\>0,1% and initial intermediate risk
Sponsors
Physicians, Innovations, Science for Children Fund
Federal Research Institute of Pediatric Hematology, Oncology and Immunology
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
No minimum to 18 Years
Healthy volunteers
No
Inclusion criteria
1. de novo acute myeloid leukemia 2. signed informed consent
Exclusion criteria
diagnosis of: Fanconi anemia, acute promyelocytic leukemia, MDS, JMML, AML as secondary malignancy, Dawn syndrome.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| relapse-free survival (RFS) | 1 year | relapse-free survival from date of diagnosis till date of relapse, or date of death (whichever comes first) or date of last follow up |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| event-free survival (EFS) | 2 years | Event=relapse/nonresponse, death or second malignancy |
| The proportion of of patients with severe adverse effects | 6 months | The proportion of of patients with severe adverse effects of therapy according to CTCAE (ver 4.3) |
| The proportion of of patients with severe infections | 1 month | The proportion of of patients with severe infections: number of episodes, grade, after each course of chemotherapy |
| The proportion of of patients with severe cardiotoxicity | 1 year | The proportion of of patients with severe cardiotoxicity: number of episodes and %EF by echocardiogam |
| MRD dynamic | 1 months | MRD (IFT and/or PCR) dynamic between check-points |
| overall survival (OS) | 1 year | — |
| Cumulative incidence of relapse | 6 months, 1 year | competing event - death in CR |
| Cumulative incidence of transplant-related mortality | 6 months after HSCT | for transplanted patients |
| Cumulative incidence of aGvHD II-IV grade | 100 days after HSCT | for transplanted patients |
| Cumulative incidence of cGvHD | 1 year after HSCT | for transplanted patients |
| MRD specificity and sensitivity | 1, 2, 3 months | MRD specificity and sensitivity in relapse prognosis |
Countries
Russia
Contacts
Primary ContactIrina Kalinina
Backup ContactZhanna Shekhovtsova
Outcome results
None listed