A Phase 3 interventional study of Busulfan and Fludarabine in Myelodysplastic Syndrome, Leukemia and Acute Myeloid Leukemia, sponsored by M.D. Anderson Cancer Center. Completed at 1 site in United States. Open to participants aged Up to 65 Years. Per ClinicalTrials.gov, last updated 2021-01-19.
Sponsored by M.D. Anderson Cancer Center · Phase 3, Interventional, and Treatment
The goal of this clinical research study is to learn if giving busulfan in a dose based on blood levels, along with a fixed (unchanging) dose of fludarabine, is more effective and causes fewer side effects for AML or myelodysplastic syndrome patients than the standard method of giving a fixed busulfan dose based on body size, along with a fixed dose of fludarabine. The safety of dosing based on blood levels will also be studied.
Busulfan is a chemotherapy drug that kills cancer cells by binding to DNA, and is commonly used in stem cell transplantation. Fludarabine is an antimetabolite drug which has anti-leukemia and immunosuppressive effects.
If you are eligible to take part in this study, you will be randomly assigned (as in the toss of a coin) to 1 of 2 study groups. One group will receive a fixed dose of busulfan, while the other group will receive an adjusted dose of busulfan based on blood levels of the drug. Both groups will receive fludarabine treatment as well as a stem cell transplant.
Patients in the adjusted-dose group will first receive a low-level "test" dose of busulfan to check how their blood levels change over time; this information will be used to decide the next dose needed to reach the target blood level that matches your body size. Patients in the fixed-dose group will receive a fixed dose of busulfan without the test dose. If you are assigned to the fixed-dose group, this measurement will only affect your dose level if you have an unusually high or low drug level in your blood. Patients in both groups will have a total of about 20 teaspoons (less than 7 tablespoons) of blood drawn over time to check their busulfan blood levels following one or more of the busulfan treatments.
About 11 samples of blood will be drawn to check your blood levels of busulfan over time following the test dose and the first high-dose busulfan treatment; each sample is about 1 teaspoon of blood. A heparin lock will be placed in your vein to lower the number of needle sticks needed for these draws. If it is not possible for these blood level tests to be performed for technical or scheduling reasons, you will receive the standard fixed dose.
Both groups of patients receive fludarabine through a central venous catheter (CVC--a small tube inserted into one of your major veins, usually in the chest or shoulder blade) over 1 hour, once a day, for 4 days. After each dose of fludarabine, the high-dose Busulfan will be infused through the CVC over 3 hours. These drugs are given to try to kill malignant cells and suppress your immune system in order to reduce the risk of stem cell transplant rejection. If you are going to be receiving a transplant from an HLA-type-nonidentical or unrelated donor, you will also receive Thymoglobulin (ATG) over 4 hours on the 3 days prior to the transplant to further suppress your immune system.
After 2 days of rest, the allogeneic stem cells (bone marrow or peripheral blood stem cells) will then be given intravenously (IV--through a needle in your vein). You will receive the drug G-CSF (Neupogen) as an injection under the skin daily starting 1 week after the transplant until your blood cell levels return to normal.
Patients usually remain in the hospital for about 4 weeks after stem cell transplantation. After you are released from the hospital, you will continue as an outpatient in the hospital area to be monitored for infections and transplant-related complications for a minimum of 100 days after the transplant.
Patients who previously had leukemia involvement in the nervous system may need to receive spinal taps, with injection of cytosine arabinoside and hydrocortisone, several times over the year after transplantation to try to keep the leukemia from coming back.
You will undergo blood tests and bone marrow biopsies at 3, 6, and 12 months after the transplant, to check if the disease is in remission. Your health status will be followed along with their local physician to find out if the leukemia or myelodysplastic syndrome comes back, as well as to check the length of your survival.
This is an investigational study. All of the drugs used in this study are approved by the FDA for treatment of cancer. Up to 230 patients will take part in this study. All will be enrolled at MD Anderson.
5,441 studies on the registry are indexed under Leukemia; 636 are open to participants now.
This study's enrollment of 233 is above the median of 38 across 4,247 interventional studies indexed under Leukemia.
Browse Leukemia studies →M.D. Anderson Cancer Center is the lead sponsor of 2,999 studies on the registry; 581 are open to participants now.
Of its 599 completed or terminated interventional studies of FDA-regulated products, 402 (67%) have results posted.
Counted across the registry records on this site, refreshed daily.
Exclusion Criteria:
Busulfan Fixed Dose = 130 mg/m\^2 IV Daily Over Three Hours x 4 Days. Fludarabine 40 mg/m\^2 IV Daily Over 1 Hour x 4 Days.
Drug: Busulfan · Drug: Fludarabine
Busulfan Adjusted Dose = 32 mg/m\^2 IV Over 2 Hours Test Dose x 1 Day. Fludarabine 40 mg/m\^2 IV Daily Over 1 Hour x 4 Days.
Drug: Busulfan · Drug: Fludarabine
Fixed Dose = 130 mg/m\^2 IV Daily Over Three Hours x 4 Days. Adjusted Dose = 32 mg/m\^2 IV Over 2 Hours Test Dose x 1 Day. Proceeding dosage level determined by pharmacokinetic studies to achieve a daily area under curve (AUC) of 6,000 microMol-min ± 10%.
40 mg/m\^2 IV Daily Over 1 Hour x 4 Days
Treatment-related Mortality (TRM)
Time to failure (TTF) defined as either disease recurrence or death, from the time of bone marrow transplant (BMT) and reported as TRM at 100 days and 1 year. Treatment period defined as BMT Day -9 for patients treated on the PK-guided treatment arm, and day -7 for patients receiving the fixed-dose busulfan treatment through BMT Day +28. The post study surveillance period is defined as BMT Day +29 through BMT Day +100. Bone marrow aspirate with cytogenetics at approximately one (1) month and three (3) months, or as clinically indicated. Response Criteria is measured by the bone marrow aspirate to determine it has leukemic blast. Bone marrow blast less than 5% is considered to be a complete response.
Time frame: From transplant at Day 0 to Day 100 and 1 year following transplant
3 Year Progression Free Survival
PFS defined as length of time either due to disease recurrence or death, from the time of stem cell infusion (Bone marrow or PBPC) to 3 years. Response Criteria is measured by the bone marrow aspirate to determine it has leukemic blast. Bone marrow blast less than 5% is considered to be a complete response.
Time frame: 3 years
Recruitment Period: June 28, 2005 to May 12, 2011. All recruitment done at The University of Texas MD Anderson Cancer Center.
| Milestone | Fixed-Dose Busulfan + Fludarabine | Adjusted Dose Busulfan + Fludarabine |
|---|---|---|
| Started | 114 | 111 |
| Completed | 108 | 105 |
| Not completed | 6 | 6 |
| Withdrew: Death | 0 | 1 |
| Withdrew: No response | 5 | 5 |
| Withdrew: Progressive disease | 1 | 0 |
Time to failure (TTF) defined as either disease recurrence or death, from the time of bone marrow transplant (BMT) and reported as TRM at 100 days and 1 year. Treatment period defined as BMT Day -9 for patients treated on the PK-guided treatment arm, and day -7 for patients receiving the fixed-dose busulfan treatment through BMT Day +28. The post study surveillance period is defined as BMT Day +29 through BMT Day +100. Bone marrow aspirate with cytogenetics at approximately one (1) month and three (3) months, or as clinically indicated. Response Criteria is measured by the bone marrow aspirate to determine it has leukemic blast. Bone marrow blast less than 5% is considered to be a complete response.
| Percentage of Participants | Fixed-Dose: Participants in CR | Adjusted Dose: Participants in CR | Fixed Dose: Participants Not in CR | Adjusted Dose: Participants Not in CR |
|---|---|---|---|---|
| 100 Days | 3 (1 to 11) | 3 (1 to 11) | 7 (2 to 20) | 3 (0.5 to 17) |
| 1 Year | 19 (11 to 32) | 17 (10 to 29) | 18 (10 to 34) | 3 (0.5 to 17) |
PFS defined as length of time either due to disease recurrence or death, from the time of stem cell infusion (Bone marrow or PBPC) to 3 years. Response Criteria is measured by the bone marrow aspirate to determine it has leukemic blast. Bone marrow blast less than 5% is considered to be a complete response.
| Days | Fixed-Dose Busulfan + Fludarabine | Adjusted Dose Busulfan + Fludarabine |
|---|---|---|
| 3 Year Progression Free Survival | 42 (32 to 52) | 56 (45 to 66) |
Collected over Adverse events collected from BMT Day -7 through BMT Day +28 or the day of discharge from the in-patient unit and post-study surveillance from initial discharge to BMT Day +100. The end of active treatment is the day of the allogeneic stem cell infusion.. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Fixed-Dose Busulfan + Fludarabine | — | 2/114 (1.8%) | 29/114 (25.4%) |
| Adjusted Dose Busulfan + Fludarabine | — | 3/111 (2.7%) | 26/111 (23.4%) |
| Event | Fixed-Dose Busulfan + Fludarabine | Adjusted Dose Busulfan + Fludarabine |
|---|---|---|
| DeathGeneral disorders | 1/114 | 2/111 |
| Respiratory FailureRespiratory, thoracic and mediastinal disorders | 0/114 | 1/111 |
| Respiratory FailureRespiratory, thoracic and mediastinal disorders | 1/114 | 0/111 |
| EncephalopathyNervous system disorders | 1/114 | 0/111 |
| Event | Fixed-Dose Busulfan + Fludarabine | Adjusted Dose Busulfan + Fludarabine |
|---|---|---|
| InfectionInfections and infestations | 10/114 | 5/111 |
| Skin GvHDSkin and subcutaneous tissue disorders | 6/114 | 1/111 |
| Chronic Skin GvHDSkin and subcutaneous tissue disorders | 1/114 | 3/111 |
| Ocular GvHDEye disorders | 1/114 | 3/111 |
| PneumoniaRespiratory, thoracic and mediastinal disorders | 0/114 | 3/111 |
| Chronic Ocular GvHDEye disorders | 3/114 | 1/111 |
| Liver GvHDHepatobiliary disorders | 3/114 | 2/111 |
| Respiratory Syncytial Virus Upper Respiratory InfectionInfections and infestations | 1/114 | 2/111 |
| CreatinineMetabolism and nutrition disorders | 1/114 | 2/111 |
| Oral GvHDGastrointestinal disorders | 2/114 | 2/111 |
| Age, Continuous(years) | Fixed-Dose Busulfan + Fludarabine | Adjusted Dose Busulfan + Fludarabine | Total |
|---|---|---|---|
| Median | 52 (14 to 66) | 50 (14 to 65) | 50 (14 to 66) |
| Sex: Female, Male(Participants) | Fixed-Dose Busulfan + Fludarabine | Adjusted Dose Busulfan + Fludarabine | Total |
|---|---|---|---|
| Female | 55 | 56 | 111 |
| Male | 59 | 55 | 114 |
| Region of Enrollment(participants) | Fixed-Dose Busulfan + Fludarabine | Adjusted Dose Busulfan + Fludarabine | Total |
|---|---|---|---|
| United States | 114 | 111 | 225 |
This study is completed, as verified in Jan 2021. You cannot join it, but the record below documents what was studied.
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M.D. Anderson Cancer Center