A multicenter, randomized study of decitabine as epigenetic priming with induction chemotherapy in children with AML

Lia Gore, Timothy J. Triche, Jason E. Farrar, Daniel Wai, Christophe Legendre, Gerald C. Gooden, Winnie S. Liang, John Carpten, David Lee, Frank Alvaro, Margaret E. Macy, Carola A.S. Arndt, Philip Barnette, Todd Cooper, Laura Martin, Aru Narendran, Jessica Pollard, Soheil Meshinchi, Jessica Boklan, Robert J. Arceci & 1 others Bodour Salhia

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Decitabine is a deoxycytidine nucleoside derivative inhibitor of DNA-methyltransferases, which has been studied extensively and is approved for myelodysplastic syndrome in adults but with less focus in children. Accordingly, we conducted a phase 1 multicenter, randomized, open-label study to evaluate decitabine pre-treatment before standard induction therapy in children with newly diagnosed AML to assess safety and tolerability and explore a number of biologic endpoints. Results: Twenty-four patients were fully assessable for all study objectives per protocol (10 in Arm A = epigenetic priming induction, 14 in Arm B = standard induction). All patients experienced neutropenia and thrombocytopenia. The most common grade 3 and 4 non-hematologic adverse events observed were gastrointestinal toxicities and hypophosphatemia. Plasma decitabine PK were similar to previously reported adult data. Overall CR/CRi was similar for the two arms. MRD negativity at end-induction was 85% in Arm A versus 67% in Arm B patients. DNA methylation measured in peripheral blood over the course of treatment tracked with blast clearance and matched marrow aspirates at day 0 and day 21. Unlike end-induction marrow analyses, promoter methylation in blood identified an apparent reversal of response in the lone treatment failure, 1 week prior to the patient's marrow aspirate confirming non-response. Decitabine-induced effects on end-induction (day 35-43 following initiation of treatment) marrows in Arm A were reflected by changes in DNA methylation in matched paired marrow diagnostic aspirates. Conclusions: This first-in-pediatrics trial demonstrates that decitabine prior to standard combination chemotherapy is feasible and well tolerated in children with newly diagnosed AML. Pre-treatment with decitabine may represent a newer therapeutic option for pediatric AML, especially as it appears to induce important epigenetic alterations. The novel biological correlates studied in this trial offer a clinically relevant window into disease progression and remission. Additional studies are needed to definitively assess whether decitabine can enhance durability responses in children with AML. Trial registration:NCT01177540.

Original languageEnglish (US)
Article number108
JournalClinical Epigenetics
Volume9
Issue number1
DOIs
StatePublished - Oct 5 2017

Fingerprint

decitabine
Induction Chemotherapy
Epigenomics
Multicenter Studies
Bone Marrow
DNA Methylation
Therapeutics
Pediatrics
Hypophosphatemia
Deoxycytidine
Myelodysplastic Syndromes
Methyltransferases
Combination Drug Therapy
Neutropenia
Treatment Failure
Nucleosides
Thrombocytopenia
Methylation
Disease Progression

Keywords

  • AML
  • DNA methylation
  • Epigenetics
  • Pediatrics
  • Pharmacodynamics
  • Pharmacokinetics

ASJC Scopus subject areas

  • Molecular Biology
  • Genetics
  • Developmental Biology
  • Genetics(clinical)

Cite this

Gore, L., Triche, T. J., Farrar, J. E., Wai, D., Legendre, C., Gooden, G. C., ... Salhia, B. (2017). A multicenter, randomized study of decitabine as epigenetic priming with induction chemotherapy in children with AML. Clinical Epigenetics, 9(1), [108]. https://doi.org/10.1186/s13148-017-0411-x

A multicenter, randomized study of decitabine as epigenetic priming with induction chemotherapy in children with AML. / Gore, Lia; Triche, Timothy J.; Farrar, Jason E.; Wai, Daniel; Legendre, Christophe; Gooden, Gerald C.; Liang, Winnie S.; Carpten, John; Lee, David; Alvaro, Frank; Macy, Margaret E.; Arndt, Carola A.S.; Barnette, Philip; Cooper, Todd; Martin, Laura; Narendran, Aru; Pollard, Jessica; Meshinchi, Soheil; Boklan, Jessica; Arceci, Robert J.; Salhia, Bodour.

In: Clinical Epigenetics, Vol. 9, No. 1, 108, 05.10.2017.

Research output: Contribution to journalArticle

Gore, L, Triche, TJ, Farrar, JE, Wai, D, Legendre, C, Gooden, GC, Liang, WS, Carpten, J, Lee, D, Alvaro, F, Macy, ME, Arndt, CAS, Barnette, P, Cooper, T, Martin, L, Narendran, A, Pollard, J, Meshinchi, S, Boklan, J, Arceci, RJ & Salhia, B 2017, 'A multicenter, randomized study of decitabine as epigenetic priming with induction chemotherapy in children with AML', Clinical Epigenetics, vol. 9, no. 1, 108. https://doi.org/10.1186/s13148-017-0411-x
Gore, Lia ; Triche, Timothy J. ; Farrar, Jason E. ; Wai, Daniel ; Legendre, Christophe ; Gooden, Gerald C. ; Liang, Winnie S. ; Carpten, John ; Lee, David ; Alvaro, Frank ; Macy, Margaret E. ; Arndt, Carola A.S. ; Barnette, Philip ; Cooper, Todd ; Martin, Laura ; Narendran, Aru ; Pollard, Jessica ; Meshinchi, Soheil ; Boklan, Jessica ; Arceci, Robert J. ; Salhia, Bodour. / A multicenter, randomized study of decitabine as epigenetic priming with induction chemotherapy in children with AML. In: Clinical Epigenetics. 2017 ; Vol. 9, No. 1.
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T1 - A multicenter, randomized study of decitabine as epigenetic priming with induction chemotherapy in children with AML

AU - Gore, Lia

AU - Triche, Timothy J.

AU - Farrar, Jason E.

AU - Wai, Daniel

AU - Legendre, Christophe

AU - Gooden, Gerald C.

AU - Liang, Winnie S.

AU - Carpten, John

AU - Lee, David

AU - Alvaro, Frank

AU - Macy, Margaret E.

AU - Arndt, Carola A.S.

AU - Barnette, Philip

AU - Cooper, Todd

AU - Martin, Laura

AU - Narendran, Aru

AU - Pollard, Jessica

AU - Meshinchi, Soheil

AU - Boklan, Jessica

AU - Arceci, Robert J.

AU - Salhia, Bodour

PY - 2017/10/5

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N2 - Background: Decitabine is a deoxycytidine nucleoside derivative inhibitor of DNA-methyltransferases, which has been studied extensively and is approved for myelodysplastic syndrome in adults but with less focus in children. Accordingly, we conducted a phase 1 multicenter, randomized, open-label study to evaluate decitabine pre-treatment before standard induction therapy in children with newly diagnosed AML to assess safety and tolerability and explore a number of biologic endpoints. Results: Twenty-four patients were fully assessable for all study objectives per protocol (10 in Arm A = epigenetic priming induction, 14 in Arm B = standard induction). All patients experienced neutropenia and thrombocytopenia. The most common grade 3 and 4 non-hematologic adverse events observed were gastrointestinal toxicities and hypophosphatemia. Plasma decitabine PK were similar to previously reported adult data. Overall CR/CRi was similar for the two arms. MRD negativity at end-induction was 85% in Arm A versus 67% in Arm B patients. DNA methylation measured in peripheral blood over the course of treatment tracked with blast clearance and matched marrow aspirates at day 0 and day 21. Unlike end-induction marrow analyses, promoter methylation in blood identified an apparent reversal of response in the lone treatment failure, 1 week prior to the patient's marrow aspirate confirming non-response. Decitabine-induced effects on end-induction (day 35-43 following initiation of treatment) marrows in Arm A were reflected by changes in DNA methylation in matched paired marrow diagnostic aspirates. Conclusions: This first-in-pediatrics trial demonstrates that decitabine prior to standard combination chemotherapy is feasible and well tolerated in children with newly diagnosed AML. Pre-treatment with decitabine may represent a newer therapeutic option for pediatric AML, especially as it appears to induce important epigenetic alterations. The novel biological correlates studied in this trial offer a clinically relevant window into disease progression and remission. Additional studies are needed to definitively assess whether decitabine can enhance durability responses in children with AML. Trial registration:NCT01177540.

AB - Background: Decitabine is a deoxycytidine nucleoside derivative inhibitor of DNA-methyltransferases, which has been studied extensively and is approved for myelodysplastic syndrome in adults but with less focus in children. Accordingly, we conducted a phase 1 multicenter, randomized, open-label study to evaluate decitabine pre-treatment before standard induction therapy in children with newly diagnosed AML to assess safety and tolerability and explore a number of biologic endpoints. Results: Twenty-four patients were fully assessable for all study objectives per protocol (10 in Arm A = epigenetic priming induction, 14 in Arm B = standard induction). All patients experienced neutropenia and thrombocytopenia. The most common grade 3 and 4 non-hematologic adverse events observed were gastrointestinal toxicities and hypophosphatemia. Plasma decitabine PK were similar to previously reported adult data. Overall CR/CRi was similar for the two arms. MRD negativity at end-induction was 85% in Arm A versus 67% in Arm B patients. DNA methylation measured in peripheral blood over the course of treatment tracked with blast clearance and matched marrow aspirates at day 0 and day 21. Unlike end-induction marrow analyses, promoter methylation in blood identified an apparent reversal of response in the lone treatment failure, 1 week prior to the patient's marrow aspirate confirming non-response. Decitabine-induced effects on end-induction (day 35-43 following initiation of treatment) marrows in Arm A were reflected by changes in DNA methylation in matched paired marrow diagnostic aspirates. Conclusions: This first-in-pediatrics trial demonstrates that decitabine prior to standard combination chemotherapy is feasible and well tolerated in children with newly diagnosed AML. Pre-treatment with decitabine may represent a newer therapeutic option for pediatric AML, especially as it appears to induce important epigenetic alterations. The novel biological correlates studied in this trial offer a clinically relevant window into disease progression and remission. Additional studies are needed to definitively assess whether decitabine can enhance durability responses in children with AML. Trial registration:NCT01177540.

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KW - Pharmacodynamics

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