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Acute Promyelocytic LeukemiaPhase 2NCT04793919

Treatment Study for Children and Adolescents With Acute Promyelocytic Leukemia

A Phase 2 study testing Mylotarg, Arsenic Trioxide and All-trans retinoic acid in people with Acute Promyelocytic Leukemia, run by Associazione Italiana Ematologia Oncologia Pediatrica at 31 sites in 12 countries.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
Search all trials

Trial summary

The trial is open to all patients with a diagnosis of acute promyelocytic leukemia (APL) who are PCR-positive for the PML-RARα transcript and less than 18 years of age. Read more about this study

Who is it for?
Ages Up to 18 years
Conditions the study is for
Acute Promyelocytic Leukemia
What is being tested?
Mylotarg, Arsenic Trioxide and All-trans retinoic acid
Could I receive a placebo?
No, everyone receives an active treatment
How many people
89 participants
Where
31 sitesin 12 countries
Study dates
9 Oct 2019to 10 Oct 2027
Phase
Phase 2
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages Up to 18 years
  • All sexes
  • No healthy volunteers
  • Child, Adult

Who may be able to join

  • Newly diagnosed APL confirmed by the presence of PML/RARα fusion gene
  • Age <18 years
  • Written informed consent by parents or legal guardians

Who cannot join

  • Patients with a clinical diagnosis of APL but subsequently found to lack PML/RARα rearrangement should be withdrawn from the study and treated on an alternative protocol
  • Significant liver dysfunction (bilirubin serum levels >3 mg/dL, ALT/AST serum levels greater than 5 times the normal values)
  • Creatinine serum levels >2 times the normal value for age
  • Significant arrhythmias, EKG abnormalities (*see below), other cardiac contraindications (L-FEV <50% or LV-FS <28%)
  • Neuropathy
  • Concurrent active malignancy
Show all 9Show fewer
  • Uncontrolled life-threatening infections
  • Pregnant or lactating female
  • Patients who had received alternative therapy (APL not initially suspected; ATRA and/or ATO not available

Trial locations and contacts

31 sites in 12 countries. Contact the study team or a site near you to ask about taking part.

31 sites in 12 countries

Italy18 sites, 18 recruiting
  • AOU Policlinico Dipartimento di Pediatria

    Bari, 70124

    Not yet recruiting
  • Ospedale Papa Giovanni XXIII - USS Oncoematologia Pediatrica

    Bergamo, 24100

    Massimo Provenzi, Dr

    Not yet recruiting
  • AOU Policlinico Sant'Orsola-Malpighi - Oncologia ed Ematologia Pediatrica

    Bologna, 40138

    Andrea Pession, Prof

    Recruiting
  • Ospedale Pediatrico Microcitemico "A.Cau", Az.Ospedaliera Brotzu - SC Oncoematologia Ped. e Patologia della coagulazione

    Cagliari, 09121

    Rosamaria Mura, Dr

    Recruiting
  • AOU Policlinico Vittorio Emanuele - UOC Ematologia ed Oncologia Pediatrica con TNO

    Catania, 95123

    Luca Lo Nigro, Dr

    Recruiting
  • A.O. Universitaria Meyer - DAI Oncoematologia Pediatrica

    Florence, 50139

    Tommaso Casini, Dr

    Not yet recruiting
  • IRCCS Istituto Gannina Gaslini - Dipartimento di Oncoematologia

    Genova, 16147

    Concetta Micalizzi, Dr

    Recruiting
  • Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM) - Ospedale San Gerardo

    Monza, 20900

    Carmelo Rizzari, Dr

    Recruiting
  • AORN Santobono-Pausilipon

    Naples, 80123

    Giuseppe Menna, Dr

    Recruiting
  • Univerità degli Studi della Campania- Luigi Vanvitelli - Sevizio di Oncologia Pediatrica

    Naples, 80138

    Francesca Rossi, Prof

    Recruiting
  • Azienda Ospedaliera di Padova - Oncoematologia Pediatrica

    Padova, 35128

    Alessandra Biffi, Prof

    Not yet recruiting
  • ARNAS Civico di Cristina e Benfratelli - UOC Oncoematologia Pediatrica

    Palermo, 90127

    Paolo D'Angelo, Dr

    Not yet recruiting
  • Fondazione IRCCS Policlinico San Matteo - Oncoematologia Pediatrica

    Pavia, 27100

    Marco Zecca, Dr

    Recruiting
  • Ospedale santa Chiara - AOU Pisana, UO Oncoematologia Pediatrica

    Pisa, 56126

    Gabriella Casazza, Dr

    Not yet recruiting
  • Policlinico Umberto I Università "LA Sapienza" - Dip. Biotecnologie cellulari ed ematologia UOS Ematologia Pediatrica

    Roma, 00161

    Anna Maria Testi, Dr

    Not yet recruiting
  • Dipartimento di Onco-Ematologia e Terapia Cellulare e Genica - Ospedale Pediatrico "Bambino Gesù"

    Roma, 00165

    Valentina Cirillo, Dr

    Franco Locatelli, Prof

    Recruiting
  • Ospedale "Casa Sollievo della Sofferenza" - UO Oncoematologia Pediatrica

    San Giovanni Rotondo, Foggia, 71013

    Saverio Ladogana, Dr

    Recruiting
  • AOU Città della Salute e della Scienza di Torino - Presidio Infantile Regina Margherita

    Torino, 10126

    Franca Fagioli, Prof

    Recruiting

Other trials in Italy

Portugal3 sites, 3 recruiting
  • Centro Hospitalar Universitário de Coimbra - Hospital Pediátrico de Coimbra

    Coimbra, 3000-602

    Manuel Brito, Dr.

    Not yet recruiting
  • Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE

    Lisbon, 1099-023

    Ximo Duarte, Dr.

    Not yet recruiting
  • Instituto Português de Oncologia do Porto Francisco Gentil, E. P. E.

    Porto, 4200-072

    Vítor Costa, Dr.

    Not yet recruiting

Other trials in Portugal

Belgium1 site, 1 recruiting
  • Hôpital Universitaire des Enfants Reine Fabiola (Huderf)

    Brussels, 1020

    Laurence Dedeken, MD, +324772678, laurence.dedeken@huderf.be

    Not yet recruiting

Other trials in Belgium

Czechia1 site, 1 recruiting
  • University Hospital Motol

    Prague, 15006

    Lucie Sramkova, MD, 22443 6401 ext. +420, lucie.sramkova@fnmotol.cz

    Not yet recruiting

Other trials in Czechia

Denmark1 site, 1 recruiting
  • Pediatrics and Adolescent Medicine Aarhus University Hospital

    Aarhus N, 8200

    Henrik Hasle, Prof.

    Not yet recruiting

Other trials in Denmark

France1 site, 1 recruiting
  • CHU de Bordeaux - Hôpital des Enfants

    Bordeaux, 33076

    Stéphane Ducassou, MD PhD, 0557820440, stephane.ducassou@chu-bordeaux.fr

    Aurore Capelli, 0557820877, aurore.capelli@chu-bordeaux.fr

    Recruiting

Other trials in France

Germany1 site, 1 recruiting
  • Universitätsklinikum Essen (AöR) Zentrum für Kinder-und Jugendmedizin Klinik für Kinderheilkunde III

    Essen, 45147

    Dirk Reinhardt, Prof, 49-(0)201 1723-3784, Dirk.Reinhardt@uk-essen.de

    Not yet recruiting

Other trials in Germany

Ireland1 site, 1 recruiting
  • Our Lady's Children's Hospital Crumlin

    Dublin, 12

    Owen P. Smith, Prof, 003531-4096720, owen.smith@olchc.ie

    Not yet recruiting

Other trials in Ireland

Israel1 site, 1 recruiting
  • Rappaport Children'S Hospital, Rambam Health Care Campus

    Haifa

    NIRA ARAD-COHEN, MD, +972-50-206-1181, n_arad-cohen@rambam.health.gov.il

    Not yet recruiting

Other trials in Israel

Netherlands1 site, 1 recruiting
  • VU medisch centrum

    Amsterdam

    Gertjan Kasper, Prof. dr.

    Not yet recruiting

Other trials in Netherlands

Spain1 site, 1 recruiting
  • Valencia University Medical School University Hospital La Fe

    Valencia, 46026

    Miguel A. Sanz, MD, domingo_joa@gva.es

    Not yet recruiting

Other trials in Spain

Sweden1 site, 1 recruiting
  • Childrens hematology and oncology Uppsala University

    Uppsala, .O. Box 256, SE-751 05

    Josefine Palle, MD, josefine.palle@akademiska.se

    Not yet recruiting

Other trials in Sweden

About this study

The trial is open to all patients with a diagnosis of acute promyelocytic leukemia (APL) who are PCR-positive for the PML-RARα transcript and less than 18 years of age.

Read the detailed description

Acute promyelocytic leukemia (APL) in children has become a highly curable disease with the combination of all-trans retinoic acid (ATRA) and anthracycline-based chemotherapy with an overall remission rates equal to or higher than 98% and cure rates now exceeding 80% 1-9.

Based on data coming from adults indicating that at least standard-risk APL patients may be cured without chemotherapy (i.e., with a treatment combining arsenic trioxide (ATO) and ATRA only) 10-12, this ICC APL 02 study was designed with the aim of validating the efficacy of a treatment combining:

  • ATO and ATRA in newly diagnosed APL standard-risk (SR) children and adolescents and
  • ATO, ATRA and gemtuzumab ozogamicin (GO) in newly diagnosed APL high-risk (HR) children and adolescents.

Following one induction course of treatment combining ATO and ATRA +/- GO depending on risk stratification, patients will receive 4 ATO/ATRA based consolidation blocks. This is the first pediatric trial delivering a non-chemotherapy-based treatment for children with APL, being the whole treatment based on the use of ATRA, ATO (and GO in HR patients). The aim of the study is to demonstrate at least an equivalent efficacy and safety of this treatment not containing cytostatic agents compared to the standard protocols combining ATRA and chemotherapy (i.e. ICC APL Study 01).

The trial is open to all patients with a diagnosis of acute promyelocytic leukemia (APL) who are PCR-positive for the PML-RARα transcript and less than 18 years of age.

This will be an international study, comprising the most important pediatric European groups, expecting to recruit 46 and 43 patients in SR and HR arms, respectively, in 3 years. The duration of study recruitment will be 36 months with a minimum follow-up per patient of 2 years.

The evaluation of morphological CR will be carried out after induction therapy, prior to the first block of consolidation therapy. MRD results after induction will not have an impact on subsequent therapy. By contrast, MRD results after the third consolidation course will influence the subsequent treatment, MRD-positive patients being eligible to rescue treatment, including hematopoietic stem cell transplantation (HSCT). BM aspirates will be repeated after the end of therapy, and 3 months, 6 months, 9 months and 12 months after treatment discontinuation.

This is a collaborative international study in APL in children and adolescents aimed at providing information about procedures for the entry, treatment and follow-up of pediatric patients with APL. It is not intended that this document be used as an aide-memoir or guide for the treatment of other patients. Every care has been taken in its drafting, but corrections and amendments may be necessary. Before entering patients into the study, clinicians must ensure that the study has received clearance from their Local Research Ethics Committee and any other necessary body.

Being tested
Mylotarg, Arsenic Trioxide, All-trans retinoic acid
Medical subject headings
Leukemia, Promyelocytic, Acute

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • MylotargDrug

    Also called GO

    See the protocol

  • Arsenic TrioxideDrug

    Also called ATO

    See the protocol

  • All-trans retinoic acidDrug

    Also called ATRA

    See the protocol

Study groups in NCT04793919
Study groupRoleWhat they receive
Standard Risk (SR)Active comparatorPatient with APL and WBC less than 10x10e9/L at presentation before start treatment
Receives: Drug: Arsenic Trioxide; Drug: All-trans retinoic acid
High Risk (HR)ExperimentalPatient with APL, with the highest pre-treatment WBC count equal to or greater than 10x10e9/L at presentation
Receives: Drug: Mylotarg; Drug: Arsenic Trioxide; Drug: All-trans retinoic acid

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Event Free Survival (EFS) probability

    SR patients: To evaluate the efficacy in terms of event-free survival of a treatment combining arsenic trioxide (ATO) and all-trans retinoic acid (ATRA) in newly diagnosed APL standard-risk children and adolescents HR patients: To evaluate the efficacy in terms of event-free survival of a treatment combining arsenic trioxide (ATO), all-trans retinoic acid (ATRA) and gemtuzumab ozogamicin (GO) in newly diagnosed APL high-risk children and adolescents

    Measured: 3 years

Secondary outcomes (10)
  1. Rate of hematological CR/CRi after induction

    To evaluate the rate of hematological Complete Remission (CR) (defined as bone marrow regenerating normal hematopoietic cells and containing < 5% blast cells by morphology, with ANC in peripheral blood > 1.0 x 10^9/L and platelet count > 100 x 10^9/L) and Complete Remission with incomplete hematologic recovery (CRi) (defined as CR except that peripheral blood neutrophils and/or platelets do not meet the criteria as defined above) after induction therapy.

    Measured: 5 years

  2. Rate of molecular CR/CRi after induction

    To evaluate the rate of molecular CR/CRi (defined as the absence of PML/RARα fusion transcript in bone marrow assessed by RQ-PCR, with an assay sensitivity of at least 10^-4).

    Measured: 5 years

  3. Rate of early death during induction

    To evaluate the rate of early death during induction (defined as any death occurring within 14 days from diagnosis from any cause).

    Measured: 5 years

  4. Probability of overall survival (OS) at 3 years

    To evaluate the rate of overall survival

    Measured: 3 years

  5. Cumulative incidence of relapse (CIR) at 3 years

    To evaluate the cumulative incidence of hematological relapse (defined as reappearance of promyeloblasts/abnormal promyelocytes > 5% in the bone marrow) and molecular relapse (defined as reappearance of PML/RARα fusion transcript in two successive samples taken at least 2 weeks apart in patients previously in molecular remission).

    Measured: 3 years

  6. Incidence of hematological and non-hematological toxicity

    Incidence of treatment-related hematological and non-hematological toxicity assessed by CTCAE v4.0

    Measured: 5 years

  7. Rate of molecular remission after 3 consolidation cycles

    To evaluate the rate of molecular remission (defined as the absence of PML/RARα fusion transcript in bone marrow assessed by RQ-PCR, with an assay sensitivity of at least 10^-4) after 3 consolidation cycles.

    Measured: 5 years

  8. Assessment of PML/RARα transcription level reduction during treatment

    To evaluate the reduction of PML/RARα fusion transcript in bone marrow by means of RQ-PCR during treatment.

    Measured: 5 years

  9. Pediatric Quality of Life assessment

    Pediatric Quality of life assessed by PedsQoL questionnaire, in the questionnaire there is a list of things that might be a problem for the child. The minimum value is 0 (never a problem) - maximum value 4 (almost always problem)

    Measured: 5 years

  10. Total hospitalization days during therapy

    Number of total hospitalization days during the treatment.

    Measured: 5 years

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted11 Mar 2021
  2. Study start9 Oct 2019
  3. Primary completion9 Oct 2025 (estimated)
  4. Study completion10 Oct 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Non-randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
89 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04793919
Sponsor's protocol ID
ICC APL STUDY 02
Other IDs
2017-002383-40, 2017
Status last verified
Apr 2024
First submitted
13 Nov 2019
Last updated
15 Apr 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Mylotarg, Arsenic Trioxide and All-trans retinoic acid in people with Acute Promyelocytic Leukemia, run by Associazione Italiana Ematologia Oncologia Pediatrica at 31 sites in 12 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 15 Apr 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 31 sites in Italy, Portugal, Belgium, Czechia, Denmark and 7 more countries. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact AIEOP (0039 051 2144667, studiclinici@aieop.org), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Event Free Survival (EFS) probability (time frame: 3 years). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 15 Apr 2024.

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