Allo vs Hypomethylating/Best Supportive Care in MDS (BMT CTN 1102)

Study Description

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Brief Summary:

This study is designed as a multicenter trial, with biological assignment to one of two study arms; Arm 1: Reduced intensity conditioning allogeneic hematopoietic cell transplantation (RIC-alloHCT), Arm 2: Non-Transplant Therapy/Best Supportive Care.

Condition or disease	Intervention/treatment	Phase
MDS	Procedure: Allogeneic Hematopoietic Cell Transplant; Procedure: Hypomethylating Therapy / Best Supportive Care	Phase 2

Detailed Description:

Background: MDS is a clonal disorder of hematopoietic precursors and stem cells, which may evolve to a terminal phase resembling acute leukemia. A subject of clinical urgency for researchers, clinicians, patients, and health care underwriters such as Medicare, is the role of allogeneic hematopoietic cell transplantation (alloHCT) in the treatment of older patients with higher risk myelodysplastic syndromes (MDS). The use of reduced intensity conditioning (RIC) regimens has extended HCT to the care of older patients with acute myelogenous leukemia (AML) and lymphoma and a number of retrospective and phase II trials for patients with MDS now show the curative potential of RIC alloHCT in selected patients.

This protocol is designed to evaluate the relative benefits of RIC alloHCT compared to non-transplant therapies focusing on overall survival. This will be done by having patients biologically assigned to the alloHCT arm or the hypomethylating therapy/best supportive care arm and following them for survival at 3 years.

Study Design

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Study Type :	Interventional (Clinical Trial)
Estimated Enrollment :	400 participants
Allocation:	Non-Randomized
Intervention Model:	Parallel Assignment
Intervention Model Description:	Two arms will enroll and have data collected on them simultaneously.
Masking:	None (Open Label)
Primary Purpose:	Treatment
Official Title:	A Multi-Center Biologic Assignment Trial Comparing Allogeneic Hematopoietic Cell Transplant to Hypomethylating Therapy or Best Supportive Care in Patients w/Intermediate-2 & High Risk Myelodysplastic Syndrome (BMT CTN #1102)
Actual Study Start Date :	December 2013
Estimated Primary Completion Date :	December 2021
Estimated Study Completion Date :	December 2021

Arms and Interventions

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Arm	Intervention/treatment
Active Comparator: Transplant; Reduced intensity conditioning allogeneic hematopoietic cell transplantation (RIC-alloHCT)	Procedure: Allogeneic Hematopoietic Cell Transplant; Bone marrow or peripheral blood stem cell transplant.from a fully matched related (6/6) or unrelated (8/8) donor. The specific transplant treatment regimen will be at the discretion of the treating physician but is required to be reduced-intensity.; Other Name: RIC alloHCT
Active Comparator: Hypomethylating Therapy / Best Supportive Care; The specific non-transplant treatment regimen will be at the discretion of the treating physician.	Procedure: Hypomethylating Therapy / Best Supportive Care; The specific non-transplant treatment regimen will be at the discretion of the treating physician.; Other Name: Non-transplant

Outcome Measures

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Primary Outcome Measures :

1. Overall survival [ Time Frame: 3 years ]
   Overall survival is calculated for all patients from date of patient consent until death from any cause. Observation is censored at the date of last follow-up for patients last known to be alive.

Secondary Outcome Measures :

1. Leukemia-free survival (LFS) [ Time Frame: 3 years ]
   LFS is defined as the time from the date of patient consent to the date of progression to AML or death from any cause, whichever comes first. Observation is censored at the date of last follow-up for patients known to be alive without leukemia. Progression to AML is defined as > 20% leukemic blasts in bone marrow or in the peripheral blood.
2. Number of participants on HCT arm with disease relapse [ Time Frame: 3 years ]
   Disease relapse for patients with MDS is defined as: Satisfying criteria for evolution into acute leukemia; or reappearance of pre-transplant morphologic abnormalities, detected in bone marrow specimens; or reappearance of pre-transplant cytogenetic abnormality in at least one metaphase on each of two separate consecutive examinations at least one month apart, regardless of the number of metaphases analyzed; or institution of any therapy to treat relapsed disease (institution of any therapy not meant for maintenance or prevention), including withdrawal of immunosuppressive therapy or DLI.
3. Cost-Effectiveness Analysis (CEA) [ Time Frame: 3 years ]

   The primary endpoint for the CEA will be the cost per quality-adjusted life year (QALY) from the third party payer perspective with two time horizons: (1) within trial (at 3 years post-enrollment), and (2) lifetime using simulating modeling.

   The secondary endpoint for the CEA is the cost per QALY from the societal perspective, a broader measure that captures health insurer direct medical care costs and patient out-of-pocket direct medical and direct non-medical costs. Patient productivity costs (captured as part of QALY calculations) will be reported separately.

4. QOL using the EQ-5D [ Time Frame: 3 years ]
   Patient reported state of health will be compared between the 2 arms.
5. QOL using the FACT-BMT [ Time Frame: 3 years ]
   Patient reported well-being will be compared between the 2 arms.
6. QOL using the MOS SF-36 [ Time Frame: 3 years ]
   Patient reported health status will be compared between the 2 arms.

Eligibility Criteria

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Ages Eligible for Study:	50 Years to 75 Years (Adult, Older Adult)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

• Patients fulfilling the following criteria will be eligible for entry into this study:

  1. Patients with de novo MDS who have, or have previously had, Intermediate-2 or High risk disease as determined by the International Prognostic Scoring System (IPSS). Current Intermediate-2 or High risk disease is NOT a requirement.

  2. Patients must have an acceptable MDS subtype:

     • Refractory cytopenia with unilineage dysplasia (RCUD) (includes refractory anemia (RA))
     • Refractory anemia with ringed sideroblasts (RARS)
     • Refractory anemia with excess blasts (RAEB-1)
     • Refractory anemia with excess blasts (RAEB-2)
     • Refractory cytopenia with multilineage dysplasia (RCMD)
     • Myelodysplastic syndrome with isolated del(5q) (5q-syndrome)
     • Myelodysplastic syndrome (MDS), unclassifiable
  3. Patients must have fewer than 20% marrow blasts within 60 days of consent.
  4. Patients may have received prior therapy for the treatment of MDS, including but not limited to: growth factor, transfusion support, immunomodulatory (IMID) therapy, DNA hypomethylating therapy, or cytotoxic chemotherapy prior to enrollment.
  5. Age 50.0-75.0 years.
  6. Karnofsky performance status > 70 or Eastern Cooperative Oncology Group (ECOG) ≤ 1.
  7. Patients are eligible if no formal unrelated donor search has been activated prior to date of consent. A formal unrelated donor search begins at the time at which samples are requested from potential National Marrow Donor Program (NMDP) donors. Patients who have started a sibling donor search or who have found a matched sibling donor are eligible.

  8. Patients and physicians must be willing to comply with treatment assignment:

     1. No intent to proceed with alloHCT using donor sources not specified in this protocol, including human leukocyte antigen (HLA)-mismatched related or unrelated donors (< 6/6 HLA related matched or < 8/8 HLA unrelated matched) or umbilical cord blood unit(s).
     2. No intent to use myeloablative conditioning regimens.
     3. Intent to proceed with RIC alloHCT if a matched sibling or matched unrelated donor is identified. There is no requirement as to the timing of the transplantation.
  9. Patients must be considered to be suitable RIC alloHCT candidates at the time of enrollment based on medical history, physical examination, and available laboratory tests. Specific testing for organ function is not required for eligibility but, if available, these tests should be used to judge eligibility.
  10. Signed informed consent

Exclusion Criteria:

• Patients with the following will be ineligible for registration onto this study:

  1. Therapy-related MDS (defined as the occurrence of MDS due to prior exposure to systemic chemotherapy and/or radiation for malignancy)
  2. Current or prior diagnosis of AML
  3. Chronic myelomonocytic leukemia or myelodysplastic/myeloproliferative neoplasm (unacceptable MDS subtypes); uncontrolled bacterial, viral or fungal infection (currently taking medication and with progression or no clinical improvement) at time of enrollment.
  4. Patients with prior malignancies, except treated non-melanoma skin cancer or treated cervical carcinoma in situ. Cancer treated with curative surgery without chemotherapy/radiation therapy > 5 years previously will be allowed. Cancer treated with curative surgery < 5 years previously will not be allowed unless approved by the Protocol Officer or one of the Protocol Chairs.
  5. Prior autologous or allogeneic HCT
  6. Human Immunodeficiency Virus (HIV) infection
  7. Patients of childbearing potential unwilling to use contraceptive techniques
  8. Patients with psychosocial conditions that would prevent study compliance

Contacts and Locations

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Contacts

Contact: Alyssa Ramirez		aramirez@emmes.com
Contact: Adam Mendizabal, PhD		amendizabal@emmes.com

  Show 36 Study Locations

Sponsors and Collaborators

Medical College of Wisconsin

National Heart, Lung, and Blood Institute (NHLBI)

National Cancer Institute (NCI)

Blood and Marrow Transplant Clinical Trials Network

National Marrow Donor Program

Investigators

Study Director:	Mary Horowitz, MD, MS	Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin

More Information

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Additional Information:

Blood and Marrow Transplant Clinical Trials Network Website 

National Marrow Donor Program 

Publications:

Saber W, Le Rademacher J, Sekeres M, Logan B, Lewis M, Mendizabal A, Leifer E, Appelbaum FR, Horowitz MM, Nakamura R, Cutler CS. Multicenter biologic assignment trial comparing reduced-intensity allogeneic hematopoietic cell transplant to hypomethylating therapy or best supportive care in patients aged 50 to 75 with intermediate-2 and high-risk myelodysplastic syndrome: Blood and Marrow Transplant Clinical Trials Network #1102 study rationale, design, and methods. Biol Blood Marrow Transplant. 2014 Oct;20(10):1566-72. doi: 10.1016/j.bbmt.2014.06.010. Epub 2014 Jun 24.

Responsible Party:	Medical College of Wisconsin
ClinicalTrials.gov Identifier:	NCT02016781 History of Changes
Other Study ID Numbers:	BMTCTN1102; 2U10HL069294-11 ( U.S. NIH Grant/Contract ); 5U24CA076518 ( U.S. NIH Grant/Contract )
First Posted:	December 20, 2013
Last Update Posted:	October 4, 2018
Last Verified:	October 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD:	Yes
Plan Description:	Results will be published in a manuscript and supporting information submitted to NIH BioLINCC (including data dictionaries, case report forms, data submission documentation, documentation for outcomes dataset, etc where indicated).
Supporting Materials:	Study Protocol; Informed Consent Form (ICF)
Time Frame:	Within 6 months of official study closure at participating sites.
Access Criteria:	Available to the public
URL:	https://biolincc.nhlbi.nih.gov/home/

Studies a U.S. FDA-regulated Drug Product:		No
Studies a U.S. FDA-regulated Device Product:		No

Keywords provided by Medical College of Wisconsin:

Myelodysplastic Syndrome

Additional relevant MeSH terms:

Myelodysplastic Syndromes; Bone Marrow Diseases; Hematologic Diseases