A Phase 1 interventional study of Bone Marrow Aspiration and Biopsy and Cytarabine in Acute Myeloid Leukemia, sponsored by Wake Forest University Health Sciences. Completed at 1 site in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-08-03.
Sponsored by Wake Forest University Health Sciences · Phase 1, Interventional, and Treatment
This pilot clinical trial studies the side effects of cytarabine and daunorubicin hydrochloride and to see how well they work in treating patients with newly diagnosed acute myeloid leukemia. Drugs used in chemotherapy, such as cytarabine and daunorubicin hydrochloride, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading, and may be safer for the heart.
PRIMARY OBJECTIVES:
I. To assess the safety (at 3 months) and feasibility of administering daunorubicin hydrochloride (daunorubicin) as continuous infusion under the proposed treatment regimen.
SECONDARY OBJECTIVES:
I. To assess the safety (at 6 months) of administering daunorubicin as continuous infusion under the proposed treatment regimen.
II. To assess treatment outcomes (including complete remission [CR] and complete remission with incomplete recovery [CRi]) in patients with acute myeloid leukemia (AML) under the proposed treatment regimen.
III. To compare the concordance between magnetic resonance imaging (MRI) and echocardiogram (ECHO) in identifying cardiac toxicity, ie a reduction in left ventricular ejection fraction (LVEF) of >= 10% and ejection fraction (EF) =\< 50% compared to baseline LVEF.
OUTLINE:
INDUCTION: Patients receive cytarabine intravenously (IV) continuously over 24 hours on days 1-7 and daunorubicin hydrochloride IV continuously over 24 hours on days 1-3 in the absence of disease progression or unacceptable toxicity. Patients then undergo bone marrow aspirate and biopsy on day 14. Patients with bone marrow cellularity >= 10% and > 5% leukemic blasts, may receive a second induction of cytarabine IV continuously over 24 hours on days 1-5 and daunorubicin hydrochloride IV continuously over 24 hours on days 1-2 in the absence of disease progression or unacceptable toxicity.
CONSOLIDATION: Patients achieving remission receive cytarabine IV over 3 hours every 12 hours on days 1, 3, and 5. Treatment repeats every 28 days for up to 3 courses in the absence of disease progression or unacceptable toxicity. Patients with core-binding factor (CBF) AML may receive 4 courses of therapy.
After completion of study treatment, patients are followed up for a minimum of 30 days, at 3 and 6 months, and then every 3 months thereafter.
2,971 studies on the registry are indexed under Leukemia, Myeloid, Acute; 745 are open to participants now.
This study's enrollment of 40 is close to the median of 41 across 2,509 interventional studies indexed under Leukemia, Myeloid, Acute.
Browse Leukemia, Myeloid, Acute studies →Wake Forest University Health Sciences is the lead sponsor of 1,320 studies on the registry; 199 are open to participants now.
Of its 323 completed or terminated interventional studies of FDA-regulated products, 243 (75%) have results posted.
Counted across the registry records on this site, refreshed daily.
Exclusion Criteria:
Patients not suitable for cardiac MRI; contraindications include:
Patients who are known to be human immunodeficiency virus (HIV) positive (+) may be eligible providing they meet all of the following additional criteria within 28 days prior to registration:
INDUCTION: Patients receive cytarabine IV continuously over 24 hours on days 1-7 and daunorubicin hydrochloride IV continuously over 24 hours on days 1-3 in the absence of disease progression or unacceptable toxicity. Patients then undergo bone marrow aspirate and biopsy on day 14. Patients with bone marrow cellularity \>= 10% and \> 5% leukemic blasts, may receive a second induction of cytarabine IV continuously over 24 hours on days 1-5 and daunorubicin hydrochloride IV continuously over 24 hours on days 1-2 in the absence of disease progression or unacceptable toxicity. CONSOLIDATION: Patients achieving remission receive cytarabine IV over 3 hours every 12 hours on days 1, 3, and 5. Treatment repeats every 28 days for up to 3 courses in the absence of disease progression or unacceptable toxicity. Patients with CBF AML may receive 4 courses of therapy.
Procedure: Bone Marrow Aspiration and Biopsy · Drug: Cytarabine · Drug: Daunorubicin Hydrochloride · Other: Laboratory Biomarker Analysis
Undergo bone marrow aspiration and biopsy
Given IV
Also known as: .beta.-Cytosine arabinoside, 1-.beta.-D-Arabinofuranosyl-4-amino-2(1H)pyrimidinone, 1-.beta.-D-Arabinofuranosylcytosine, 1-Beta-D-arabinofuranosyl-4-amino-2(1H)pyrimidinone, 1-Beta-D-arabinofuranosylcytosine, 1.beta.-D-Arabinofuranosylcytosine, 2(1H)-Pyrimidinone, 4-Amino-1-beta-D-arabinofuranosyl-, 2(1H)-Pyrimidinone, 4-amino-1.beta.-D-arabinofuranosyl-, Alexan, Ara-C, ARA-cell, Arabine, Arabinofuranosylcytosine, Arabinosylcytosine, Aracytidine, Aracytin, Aracytine, Beta-Cytosine Arabinoside, CHX-3311, Cytarabinum, Cytarbel, Cytosar, Cytosar-U, Cytosine Arabinoside, Cytosine-.beta.-arabinoside, Cytosine-beta-arabinoside, Erpalfa, Starasid, Tarabine PFS, U 19920, U-19920, Udicil, WR-28453
Given IV
Also known as: Cerubidin, Cerubidine, Cloridrato de Daunorubicina, Daunoblastin, Daunoblastina, Daunoblastine, Daunomycin Hydrochloride, Daunomycin, hydrochloride, Daunorubicin.HCl, Daunorubicini Hydrochloridum, FI-6339, Ondena, RP-13057, Rubidomycin Hydrochloride, Rubilem
Correlative studies
Number of Participants With Cardiac Toxicity, Defined as Reduction in LVEF of >= 10% Compared to Baseline LVEF and EF =< 50% on the Follow-up Scan, Assessed Using MRI
Incidence of cardiac toxicity, defined as reduction in LVEF of \>= 10% compared to baseline LVEF and EF =\< 50% on the follow-up scan, assessed using MRI.
Time frame: Baseline up to 3 months
Unexpected Toxicities (Exclude Hematologic and Infectious) ≥ Grade 3, as Measured by CTCAE v 4.0
Unexpected toxicities (exclude hematologic and infectious) ≥ grade 3, as measured by CTCAE v 4.0
Time frame: Up to 30 days after last dose of study drug
Proportion of Patients Who Complete the Infusion Therapy
Will report these proportions with 95% confidence intervals.
Time frame: 72 hours
Proportion of Patients With Study-related Deviations
Will report these proportions with 95% confidence intervals.
Time frame: Approximately 1 year, 5 months
Incidence of Cardiac Toxicity, Defined as Reduction in LVEF of >= 10% Compared to Baseline LVEF and EF =< 50% on the Follow-up Scan, Assessed Using ECHO
Incidence of cardiac toxicity, defined as reduction in LVEF of \>= 10% compared to baseline LVEF and EF =\< 50% on the follow-up scan, assessed using ECHO.
Time frame: Baseline up to 3 months after last dose of study drug
EF, Assessed by MRI and ECHO
Ejection Fraction at baseline, 3 months, and change from baseline to 3 months
Time frame: Baseline and 3 months
Incidence of Cardiac Toxicity, Defined as Reduction in LVEF of >= 10% Compared to Baseline LVEF and EF =< 50% on the Follow-up Scan, Assessed Using MRI
Incidence of cardiac toxicity, defined as reduction in LVEF of \>= 10% compared to baseline LVEF and EF =\< 50% on the follow-up scan, assessed using MRI.
Time frame: Baseline up to 6 months after last dose of study drug
Change in Left Ventricular End Diastolic Volume, Assessed by MRI and ECHO
Left ventricular end diastolic volume assessed by MRI and ECHO at baseline, 3 months, and change from baseline to 3 months.
Time frame: Baseline up to 6 months after last dose of study drug
Left Ventricular End Systolic Volume, Assessed by MRI and ECHO
Left ventricular end systolic volume assessed by MRI and ECHO at baseline, 3 months, and change from baseline to 3 months.
Time frame: Baseline, 3 months
Myocardial Strain, Assessed by MRI and ECHO
Myocardial strain (Global Longitudinal Strain %) assessed by ECHO at baseline, 3 months, and change from baseline to 3 months. GLS was not measured with MRI.
Time frame: Baseline and 3 months
Disease-free Survival for Those Patients Who Achieve Remission
Disease-free survival is calculated for patients who achieve CR and measured from the date of CR until relapse from CR or death. Observation is censored at the date of last follow-up for patients last known to be alive without report of relapse.
Time frame: From the date of CR until relapse from CR or death, approximately 1 year, 9 months
Induction Death Rate
Number of patients who had an induction death
Time frame: Up to 28 days
Overall Response Rate, Defined as CR + CRi
Overall response rate, defined as CR + CRi. Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR.", or similar definition that is accurate and appropriate.
Time frame: Approximately 1 year and 9 months
| Milestone | Treatment (Cytarabine, Daunorubicin Hydrochloride, Biopsy) |
|---|---|
| Started | 40 |
| Completed | 12 |
| Not completed | 28 |
| Withdrew: Lack of efficacy | 5 |
| Withdrew: Adverse event | 3 |
| Withdrew: Death | 7 |
| Withdrew: Withdrawal by subject | 1 |
| Withdrew: Physician decision | 12 |
Incidence of cardiac toxicity, defined as reduction in LVEF of \>= 10% compared to baseline LVEF and EF =\< 50% on the follow-up scan, assessed using MRI.
| Participants | Treatment (Cytarabine, Daunorubicin Hydrochloride, Biopsy) |
|---|---|
| Number of Participants With Cardiac Toxicity, Defined as Reduction in LVEF of >= 10% Compared to Baseline LVEF and EF =< 50% on the Follow-up Scan, Assessed Using MRI | 3 |
Unexpected toxicities (exclude hematologic and infectious) ≥ grade 3, as measured by CTCAE v 4.0
| events | Treatment (Cytarabine, Daunorubicin Hydrochloride, Biopsy) |
|---|---|
| Alkalosis | 3 |
| Anxiety | 2 |
| Atrial fibrillation | 3 |
| Atrial flutter | 1 |
| Bone pain | 2 |
| Cardiac arrest | 2 |
| Encephalopathy | 2 |
| Hyperglycemia | 14 |
| Hypertension | 25 |
| Hypoglycemia | 2 |
| Pain | 2 |
| Ventricular fibrillation | 1 |
| Ventricular tachycardia | 2 |
| Blood and lymphatic system disorders - Other: Acute blood loss | 1 |
Will report these proportions with 95% confidence intervals.
| Participants | Treatment (Cytarabine, Daunorubicin Hydrochloride, Biopsy) |
|---|---|
| Proportion of Patients Who Complete the Infusion Therapy | 40 |
Will report these proportions with 95% confidence intervals.
| Participants | Treatment (Cytarabine, Daunorubicin Hydrochloride, Biopsy) |
|---|---|
| Proportion of Patients With Study-related Deviations | 1 |
Incidence of cardiac toxicity, defined as reduction in LVEF of \>= 10% compared to baseline LVEF and EF =\< 50% on the follow-up scan, assessed using ECHO.
| Participants | Treatment (Cytarabine, Daunorubicin Hydrochloride, Biopsy) |
|---|---|
| Incidence of Cardiac Toxicity, Defined as Reduction in LVEF of >= 10% Compared to Baseline LVEF and EF =< 50% on the Follow-up Scan, Assessed Using ECHO | 4 |
Ejection Fraction at baseline, 3 months, and change from baseline to 3 months
| percentage of ejection fraction | Treatment (Cytarabine, Daunorubicin Hydrochloride, Biopsy) |
|---|---|
| Baseline MRI | 59.8 ± 6.3 |
| 3 months MRI | 56.7 ± 7.9 |
| Change from baseline to 3 months MRI | -4.0 ± 8.0 |
| Baseline ECHO | 56.3 ± 5.2 |
| 3 months ECHO | 53.6 ± 8.8 |
| Change from baseline to 3 months ECHO | -3.5 ± 8.6 |
Incidence of cardiac toxicity, defined as reduction in LVEF of \>= 10% compared to baseline LVEF and EF =\< 50% on the follow-up scan, assessed using MRI.
| Participants | Treatment (Cytarabine, Daunorubicin Hydrochloride, Biopsy) |
|---|---|
| Incidence of Cardiac Toxicity, Defined as Reduction in LVEF of >= 10% Compared to Baseline LVEF and EF =< 50% on the Follow-up Scan, Assessed Using MRI | 1 |
Left ventricular end diastolic volume assessed by MRI and ECHO at baseline, 3 months, and change from baseline to 3 months.
| ml | Treatment (Cytarabine, Daunorubicin Hydrochloride, Biopsy) |
|---|---|
| Baseline MRI | 140.4 ± 33.2 |
| 3 months MRI | 141.3 ± 46.5 |
| Change from baseline to 3 months MRI | 2.5 ± 28.4 |
| Baseline ECHO | 98.6 ± 31.2 |
| 3 month ECHO | 99.0 ± 35.6 |
| Change from baseline to 3 months ECHO | -5.2 ± 35.3 |
Left ventricular end systolic volume assessed by MRI and ECHO at baseline, 3 months, and change from baseline to 3 months.
| ml | Treatment (Cytarabine, Daunorubicin Hydrochloride, Biopsy) |
|---|---|
| Baseline MRI | 56.9 ± 17.7 |
| 3 month MRI | 60.7 ± 22.0 |
| Change from baseline to 3 months MRI | 6.0 ± 14.1 |
| Baseline ECHO | 40.1 ± 15.7 |
| 3 months ECHO | 40.5 ± 14.1 |
| Change from baseline to 3 months ECHO | -2.0 ± 17.1 |
Myocardial strain (Global Longitudinal Strain %) assessed by ECHO at baseline, 3 months, and change from baseline to 3 months. GLS was not measured with MRI.
| percentage of original length | Treatment (Cytarabine, Daunorubicin Hydrochloride, Biopsy) |
|---|---|
| Baseline | -20.2 ± 2.2 |
| 3 months | -18.5 ± 2.4 |
| Change: 3 months - baseline | 1.7 ± 3.2 |
Disease-free survival is calculated for patients who achieve CR and measured from the date of CR until relapse from CR or death. Observation is censored at the date of last follow-up for patients last known to be alive without report of relapse.
| months | Treatment (Cytarabine, Daunorubicin Hydrochloride, Biopsy) |
|---|---|
| Disease-free Survival for Those Patients Who Achieve Remission | 16.5 (2.4 to 24) |
Number of patients who had an induction death
| Participants | Treatment (Cytarabine, Daunorubicin Hydrochloride, Biopsy) |
|---|---|
| Induction Death Rate | 5 |
Overall response rate, defined as CR + CRi. Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR.", or similar definition that is accurate and appropriate.
| Participants | Treatment (Cytarabine, Daunorubicin Hydrochloride, Biopsy) |
|---|---|
| Overall Response Rate, Defined as CR + CRi | 23 |
Collected over From start of treatment until 30 days post treatment. Average time of 3.4 months with a maximum of 9.4 months.. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Treatment (Cytarabine, Daunorubicin Hydrochloride, Biopsy) | 9/40 (22.5%) | 40/40 (100%) | 40/40 (100%) |
| Event | Treatment (Cytarabine, Daunorubicin Hydrochloride, Biopsy) |
|---|---|
| Platelet count decreasedInvestigations | 40/40 |
| Neutrophil count decreasedInvestigations | 39/40 |
| White blood cell decreasedInvestigations | 37/40 |
| Lymphocyte count decreasedInvestigations | 32/40 |
| SepsisInfections and infestations | 8/40 |
| AnemiaBlood and lymphatic system disorders | 7/40 |
| Respiratory failureRespiratory, thoracic and mediastinal disorders | 4/40 |
| Cardiac arrestCardiac disorders | 3/40 |
| Lung infectionInfections and infestations | 3/40 |
| HyperkalemiaMetabolism and nutrition disorders | 3/40 |
| Event | Treatment (Cytarabine, Daunorubicin Hydrochloride, Biopsy) |
|---|---|
| HyperglycemiaMetabolism and nutrition disorders | 39/40 |
| HypoalbuminemiaMetabolism and nutrition disorders | 37/40 |
| AnorexiaMetabolism and nutrition disorders | 36/40 |
| HypomagnesemiaMetabolism and nutrition disorders | 36/40 |
| FatigueGeneral disorders and administration site conditions | 35/40 |
| HypokalemiaMetabolism and nutrition disorders | 35/40 |
| AnemiaBlood and lymphatic system disorders | 32/40 |
| HypocalcemiaMetabolism and nutrition disorders | 32/40 |
| DiarrheaGastrointestinal disorders | 31/40 |
| NauseaGastrointestinal disorders | 31/40 |
| Age, Continuous(years) | Treatment (Cytarabine, Daunorubicin Hydrochloride, Biopsy) |
|---|---|
| Mean | 60.1 ± 15.5 |
| Sex: Female, Male(Participants) | Treatment (Cytarabine, Daunorubicin Hydrochloride, Biopsy) |
|---|---|
| Female | 22 |
| Male | 18 |
| Ethnicity (NIH/OMB)(Participants) | Treatment (Cytarabine, Daunorubicin Hydrochloride, Biopsy) |
|---|---|
| Hispanic or Latino | 0 |
| Not Hispanic or Latino | 40 |
| Unknown or Not Reported | 0 |
| Race (NIH/OMB)(Participants) | Treatment (Cytarabine, Daunorubicin Hydrochloride, Biopsy) |
|---|---|
| American Indian or Alaska Native | 0 |
| Asian | 0 |
| Native Hawaiian or Other Pacific Islander | 0 |
| Black or African American | 7 |
| White | 33 |
| More than one race | 0 |
| Unknown or Not Reported | 0 |
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Wake Forest University Health Sciences