GOELAMS SA4 Study: the Role of Fludarabine in the Treatment of Acute Myeloid Leukemia in the Elderly

French Innovative Leukemia Organisation

Status and phase: Completed; Phase 3

Conditions: Acute Myeloid Leukemia

Treatments: Drug: Experimental (fludarabine); Drug: Active comparator (no fludarabine)

Study type: Interventional

Funder types: Other; Industry

Identifiers

NCT00925873

GOELAMS SA4

Details and patient eligibility

About

In this study, patients were randomly assigned to either receive fludarabine or not (20 mg/m2/d) in addition to induction chemotherapy, consolidation chemotherapy and the 3 subsequent re-induction courses during maintenance.

Full description

Eligibility for enrollment in the study was limited to patients aged 60 to 75 years old with previously untreated de novo AML as defined morphologically by the French-American-British (FAB) classification with the exception of M3 and M7 subtypes.10,11 The bone marrow aspirate had to show at least 30 percent of nonerythroid blast cells. Patients were not eligible if they had a performance status before diagnosis of 2 or more according to the World Health Organization (WHO) grading system, congestive heart failure or abnormal left ventricular ejection fraction, severe hepatic or renal disturbances if not related to leukemia (hepatic enzymes levels over four times the normal values, serum bilirubin over 35 micromol/L, creatinine over 150 micromol/L). Patients with previous unexplained cytopenia were eligible for the study. Conversely, patients with a history of documented myelodysplastic or myeloproliferative syndrome or previously treated with chemotherapy or radiation could not enter the study. The study received in June 1996 approval from the ethics' board of the Nancy Hospital and written informed consent was given by all eligible patients before entering the study, in accordance with the Declaration of Helsinki. The enrollment period was open from November 1996 to April 2000.

Enrollment: 303 patients

Sex: All

Ages: 60 to 75 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• patients aged 60 to 75 years old
• untreated de novo AML
• performance status less than 2

Exclusion criteria

• performance status more than 2
• congestive heart failure or abnormal left ventricular ejection fraction
• severe hepatic or renal disturbances
• history of documented myelodysplastic or myeloproliferative syndrome
• patients previously treated with chemotherapy or radiation

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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303 participants in 2 patient groups

1

Active Comparator group

Description:

Control arm without fludarabine 1. Induction course: Ara-C 100mg/m2 days 1-7, idarubicin 8mg/m2 days 1-5, GM-CSF (molgramostim, Novartis) 5 microg/kg days 1 to neutrophil recovery; 2. Consolidation course: Ara-C 1g/m2 q12h days 1-3, idarubicin 10mg/m2 days 2-3; 3. and 3 quarterly reinduction courses during maintenance including Ara-C 80mg/m2 days 1-5, CCNU 40mg and mitoguazone 350mg/m2 day 1, ± fludarabine days 1-2.

Treatment:

Drug: Active comparator (no fludarabine)

2

Experimental group

Description:

Fludarabine arm The same regimen with fludarabine 20 mg/m2/day IV for 30 minutes 1. induction course + fludarabine days 2-7; 2. consolidation course + fludarabine days 4-5; 3. during reinduction courses + fludarabine days 1-2.

Treatment:

Drug: Experimental (fludarabine)