Darbepoetin Alpha in Myelodysplastic Syndromes (MDS)

Groupe Francophone des Myelodysplasies

Status and phase

Unknown

Phase 2

Conditions

Myelodysplastic Syndromes

Treatments

Drug: Darbepoetin

Study type

Interventional

Funder types

Other

Identifiers

NCT00443339

GFM-DAR500-2006-01

Details and patient eligibility

About

This is an evaluation of the effectiveness of darbepoetin alpha in treating anemia of MDS patients with an International Prognostic Scoring System (IPSS) score of low or intermediate 1.

Full description

Inclusion of MDS with IPSS low or int-1 and hemoglobin < 10/dL.

Study drug: Darbepoetin alfa (Aranesp) 500 microg every two weeks subcutaneously during 12 weeks, combined to filgrastim 300 microg twice weekly for an additional 12 weeks in non responders.

Response will be evaluated at 12 weeks. Patients with major or minor erythroid response (HI-E major or minor according to IWG 2000 criteria) will be continued on Aranesp. In non-responders, an additional 12 weeks of Aranesp at the same dosing, combined to Filgrastim (300 ug twice weekly, then adjusted to maintain WBC between 5000 and 10000/mm3) will be proposed. In case of response, the treatment will be continued for a total duration of 24 months. If Hb level reaches levels > 13 g/dl at any time, Aranesp should be discontinued until Hb levels are less than 12 g/dl. Aranesp should then be resumed at 500 µg/injection every 3 weeks. Intervals between injections should be further increased by one week every time they lead to Hb levels > 13 g/dl. The purpose of this dose adjustment is to reach the Aranesp schedule allowing a maintenance Hb level between 11 and 12 g/dl.

Enrollment

99 estimated patients

Sex

All

Ages

18+ years old

Volunteers

No Healthy Volunteers

Inclusion criteria

MDS of the following subtypes:
- RA, RAS, RAEB with marrow blasts < 10% (according to FAB),
- RA, RARS, RCMD, RAEB 1, CMML 1 with ≤ 10% WBC counts < 13000/mm3 (according to WHO classification)
Anemia, defined by Hb < 10 g/dl or RBC transfusion requirement in the absence of other causes of anemia (especially renal failure, iron, or folate deficiency)
IPSS ≤ 1(ie IPSS low or intermediate 1)
EPO level < 500 UI/L
Ability to perform physical tests of exercise tolerance
No renal failure (creatinine ≤ 120% normal upper value for the center)
No underlying severe condition
ECOG performance status score of 0, 1, or 2
Must be 18 years of age or older at the time of screening
Written informed consent

Exclusion criteria

Therapy related MDS
MDS with IPSS > 1 (int 2 or high score)
Chronic myelomonocytic leukemia with > 10% marrow blasts or WBC > 13000/mm3
Uncontrolled systemic hypertension
Cardiac condition: uncontrolled angina, congestive heart failure, or uncontrolled cardiac arrhythmia
Creatinine level > 120% upper normal value for the center.
Clinically significant systemic infection or chronic inflammatory disease (eg, rheumatoid arthritis) present at the time of screening
Serum folate ≤ 2.0 ng/mL or vitamin B12 ≤ 200 pg/mL (anemia related to nutritional deficiencies)
Other causes of anemia (eg, hemolysis, bleeding, sickle cell anemia, renal disease)
Pregnant (ie, positive βhCG test) or breast feeding female subjects
Women of childbearing potential and not using adequate contraceptives
Known positive antibody response to an erythropoietic growth factor
Known hypersensitivity to darbepoetin alpha or any of its excipients, or to recombinant erythropoietins
Patient unable to understand the protocol or to be adequately followed up.
History of seizures
Previous history of thrombotic events
Concomitant treatment with thalidomide