Last year in the UK over 60,000 cancer patients enrolled on clinical trials aimed at improving cancer treatments and making them available to all.
A trial looking at different treatments for acute myeloid leukaemia and high risk myelodysplastic syndrome (AML 19)
This trial is looking at different treatments for acute myeloid leukaemia (AML) and high risk myelodysplastic syndrome (MDS). It is for people who are fit enough to have intensive treatment. This trial is supported by Cancer Research UK.
More about this trial
Myelodysplastic syndromes (MDS) are blood disorders. High risk MDS means there is more chance it might develop into AML over time. MDS is classed as high risk if more than 10% of your bone marrow is made up of immature cells called blasts. High risk MDS is treated in a similar way to AML.
Doctors usually treat AML with chemotherapy and other drugs to get rid of the leukaemia cells (getting it into
If induction treatment is successful, you usually have treatment to lower the chances of the leukaemia coming back. This is called consolidation treatment. Some people may then have a transplant using the stem cells or bone marrow of a donor.
This trial is trying to answer a number of questions about the treatment of AML and high risk MDS. These include trying to find out
- Which combination of chemotherapy works best in induction treatment
- If 1 or 2 courses of consolidation chemotherapy improve treatment for AML
- Whether adding a targeted drug can further reduce the risk of the leukaemia coming back
- Whether extra monitoring of some people is useful in trying to work out who has a higher chance of their leukaemia coming back
If you have a type of AML called acute promyelocytic leukaemia (APL) you have different treatment. This is described in A trial looking at treatment for acute promyelocytic leukaemia (AML 19)
Who can enter
The following bullet points list the entry conditions for this trial. If you are unsure about any of these speak with your doctor or the trial team. They will be able to advise you.
You may be able to join this trial if you have one of the following
- Acute myeloid leukaemia
- High risk myelodysplastic syndrome (MDS) - this means that more than 10% of your bone marrow is made up of immature cells called blasts)
- MDS where 5 to 9% of your bone marrow is made up of blasts and other features of your disease mean that it scores intermediate, high or very high on a scoring system called the IPSS-R
As well as the above all of the following apply. You
- Are well enough to be up and about for at least half the day (performance status 0, 1 or 2)
- Are suitable for intensive treatment
- Have satisfactory blood test results
- Are willing to use reliable contraception during treatment and for 1 month afterwards if there is any chance that you or your partner could become pregnant
- Are aged between 16 and 60 years, older people may be able to take part if your doctor thinks you can have intensive treatment
Your blood tests include tests to check whether your liver is working normally. If these results are abnormal, you might still be able to take part in the trial. But you might not be able to have one of the drugs used this trial called mylotarg (gemtuzumab ozogamicin).
You cannot join this trial if any of these apply. You
- Have already had chemotherapy to treat your AML, you can still take part if you have had hydroxycarbamide, or a similar low dose treatment to control you white blood cells
- Have had treatment with a hypomethylating agent such as azacitidine or decitabine, you can still take part if you had this treatment for low risk MDS, which has transformed into AML
- Are in the blast phase of chronic myeloid leukeamia
- Have any other cancer that needs treatment
- Are HIV (Human Immunodeficiency Virus) positive
- Are pregnant or breastfeeding
This is a phase 3 trial. The researchers need 3000 people to join.
There are a number of different treatments described in this trial summary, not all are relevant to your situation.
Your treatment depends on
- The type of leukaemia you have
- How well your first induction chemotherapy works
- Certain features of your leukaemia
You have most of your treatment through a drip into a vein. Your medical team will explain your individual treatment in more detail and how and when you have your drugs.
At different points in the trial, people with AML are put into groups by computer. Neither you, nor your doctors can decide which group you are in. This is called randomisation.
Doctors look closely at the chromosomes in leukaemia cells. This is called
Treatment for AML that has a chromosomal abnormality
Doctors know that people with an abnormal chromosome will probably need further chemotherapy after induction, followed by a stem cell or bone marrow transplant.
To try to improve induction treatment in this group of people, the trial team will compare the standard treatment of
with a new combination of
- daunorubicin and cytarabine called CPX-351
Twice as many people will be in the group having CPX-351.
You have 2 courses of FLAG-Ida or CPX-351 about 4 weeks apart. A course of chemotherapy is also sometimes called a cycle of treatment.
Your doctor may then recommend that you go on to have a transplant using the stem cells or bone marrow of a donor. If there are delays or difficulties in finding you a donor, you have further chemotherapy.
If you had FLAG-Ida for your first 2 courses, you have
If you had CPX-351 for your first 2 courses, you have 2 further courses of this treatment.
Treatment for AML that has no chromosomal abnormality
If your AML does not have a chromosomal abnormality you are put into 1 of 2 groups at random. You have 1 of the following
- DA (Daunorubicin and Ara-C) and 1 dose of mylotarg (also called gemtuzumab ozogamicin) twice in the first week, followed by treatment with DA alone
- DA and 1 dose of mylotarg on 3 different occasions over 2 weeks, followed by treatment DA and mylotarg (with mylotarg on day 1 only)
Mylotarg is a targeted drug and DA is a type of chemotherapy.
A few weeks after your first course of chemotherapy, your doctor will look at samples of your blood and bone marrow to see if there are any leukaemia cells left behind. They will also look at other factors, such as the cytogenetics of your leukaemia, to decide the risk of your leukaemia coming back (relapse).
If you have a higher than normal risk of your cancer coming back, this is called high risk disease. Your treatment will be different to those people who do not have high risk disease.
High risk AML
If you have high risk AML or MDS your doctor may recommend that you have a transplant using the stem cells or bone marrow of a donor.
Before your transplant, or while you are waiting for a donor to be found, you have further chemotherapy.
The trial team want to compare standard chemotherapy with CPX-351.
The standard treatment involves 3 different courses of chemotherapy, one after the other. These are
- 1 course of FLAG-Ida,
- 1 course of MACE (m-AMSA, Ara-C and etoposide)
- 1 course of MidAC (mitoxantrone and Ara-C)
Everyone in this part of the trial is put into 1 of 2 groups at random
- One group has FLAG-Ida, MACE and MidAC
- The other group has 3 courses of CPX-351
Twice as many people will be in the group having CPX-351.
You have each treatment about 4 weeks apart.
If you had FLAG-Ida as your induction treatment and your leukaemia did not go into remission, or has come back within the last 6 months you will have further chemotherapy. The standard drug used in this situation is fludarabine.
In this trial you have fludarabine and CPX-351. You have these drugs
- Over 5 days for your 1st course
- Then over 3 days for up to 2 more courses
Not high risk AML
If you do not have high risk disease, you have a second course of induction chemotherapy. This will be the same drugs as you had in course 1 (DA or Flag-Ida), but without Mylotarg.
If you had DA as your induction treatment and you are not at high risk you then have consolidation treatment. Your consolidation treatment is 2 courses of high dose Ara-C.
If you had FLAG-Ida as your induction treatment and you are not high risk, you then have consolidation treatment. This part is randomised. You have 1 of the following
- 2 courses of high dose Ara-C
- 1 course of high dose Ara-C
- No treatment with Ara-C
You have Ara-C treatment over 5 days.
If you have a 2nd course, you have this 4 to 6 weeks later.
Extra monitoring randomsation
Please note this part of the trial has now closed to recruitment. If you are already taking part in this randomisation, you continue with this.
- One group has extra monitoring
- The other group does not have any extra monitoring
Everyone has close monitoring and follow up appointments as part of their routine care. Those in the extra monitoring group have 8 extra bone marrow tests. Most of these take place in the first year of treatment.
Everyone taking part in the monitoring randomisation fills out a questionnaire on 8 different occasions over a period of 18 months. The questionnaires ask various questions about quality of life and the extra monitoring for those who have it.
You will see the doctors and have some tests before you start treatment. The tests include
- Blood tests
- Physical examination
- Bone marrow test
You have the above tests again during and after your treatment.
Your treatment is very intensive and so you will spend a lot of time at hospital. You usually stay in hospital to have your chemotherapy, for at least 1 to 2 weeks each time, sometimes longer.
If you are able to have your treatment as an outpatient, you will need to go to hospital quite often (for example 2 to 3 times a week) to have blood tests and to check how you are.
Your doctor or nurse will explain how often you need to visit hospital during and after your treatment
The most common side effects of chemotherapy include
- A drop in blood cells causing an increased risk of infection, bleeding problems, tiredness and breathlessness
- Feeling or being sick
- Sore mouth
- Loss of appetite
- Hair loss
The most common side effects of Mylotarg include
- A change to the way your liver works. You will have regular blood tests to monitor this
- A drop in the white blood cells causing an increased risk of infection
- Fever and chills
- Feeling or being sick
High blood sugar
- High blood pressure or low blood pressure
The possible side effects of ganetespib include
- High temperature
- Lung infection
- Tiredness (fatigue)
- Feeling sick
- A drop in the number of red blood cells (
- Loss of appetite
If you have any diarrhoea tell, your doctor or nurse straight away as this may need treating.
How to join a clinical trial
Professor Nigel Russell
Cancer Research UK
Experimental Cancer Medicine Centre (ECMC)
NIHR Clinical Research Network: Cancer
This is Cancer Research UK trial number CRUK/13/35