Acute Myeloid Leukemia Clinical Trial

Levofloxacin in Preventing Infection in Young Patients With Acute Leukemia Receiving Chemotherapy or Undergoing Stem Cell Transplantation

Summary

This randomized phase III trial studies how well levofloxacin works in preventing infection in young patients with acute leukemia receiving chemotherapy or undergoing stem cell transplant. Giving antibiotics may be effective in preventing or controlling early infection in patients receiving chemotherapy or undergoing stem cell transplant for acute leukemia. It is not yet known whether levofloxacin is effective in preventing infection.

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Full Description

PRIMARY OBJECTIVES:

I. To determine whether levofloxacin given prophylactically during periods of neutropenia to patients being treated with chemotherapy for acute leukemia (AL) or undergoing hematopoietic stem cell transplantation (HSCT) will decrease the incidence of bacteremia.

SECONDARY OBJECTIVES:

I. To determine the effect of prophylactic levofloxacin on resistance patterns of bacterial isolates from all sterile site cultures, and the evolution of antimicrobial resistance from peri-rectal swab isolates of Enterobacteriaceae, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Streptococcus mitis.

II. To determine the effect of levofloxacin prophylaxis on total number of days of antibiotic administration (prophylactic, empiric, and treatment) in children undergoing therapy for AL or HSCT.

III. To determine whether levofloxacin prophylaxis reduces the incidence of fever with neutropenia, severe infection, and death from bacterial infection.

IV. To assess the safety of levofloxacin prophylaxis, with specific attention to musculoskeletal disorders including tendinopathy and tendon rupture.

V. To assess the impact of prophylactic levofloxacin on the incidence of Clostridium difficile-associated diarrhea (CDAD), and the incidence of microbiologically documented invasive fungal infections (IFI).

OUTLINE: Patients are randomized to 1 of 2 treatment arms.

ARM I: Patients receive levofloxacin orally (PO) or intravenously (IV) over 60-90 minutes once daily (QD) or twice daily (BID) beginning on day 3 during 2 consecutive courses of chemotherapy or beginning on day -2 during HSCT and continuing until blood counts recover.

ARM II: Patients receive established standard of care and receive chemotherapy or HSCT as patients in Arm I.

After completion of study therapy, patients are followed up for 1 year.

View Eligibility Criteria

Eligibility Criteria

Inclusion Criteria:

Patient must fit 1 of the following 2 categories:

Chemotherapy patients

Planned to receive at least 2 consecutive cycles (not required to be the first 2 cycles) of intensive chemotherapy for either:

De novo, relapsed or secondary acute myeloid leukemia (AML), or acute leukemia of ambiguous lineage treated with standard AML therapy
Relapsed acute lymphoblastic leukemia (ALL)
For the purposes of this study, "intensive chemotherapy" is defined as regimens that are predicted by the local investigator to cause neutropenia for > 7 days; examples include, but are not limited to, treatment with "4-drug induction" (anthracycline, vincristine, asparaginase, and steroid), high dose cytarabine, anthracycline/cytarabine, ifosfamide/etoposide, and clofarabine-containing regimens

Stem cell transplantation patients

Planned to receive at least 1 myeloablative autologous or allogeneic HSCT
For the purposes of this study, myeloablative autologous and allogeneic HSCT are those in which the conditioning regimen is predicted by the local Investigator to cause neutropenia for > 7 days

Creatinine clearance or radioisotope glomerular filtration rate (GFR) > 70 mL/min/1.73 m^2 OR serum creatinine based on age/gender as follows:

0.5 mg/dL (6 months to < 1 year of age)
0.6 mg/dL (1 to < 2 years of age)
0.8 mg/dL (2 to < 6 years of age)
1.0 mg/dL (6 to < 10 years of age)
1.2 mg/dL (10 to < 13 years of age)
1.5 mg/dL (male)/1.4 mg/dL (female) (13 to < 16 years of age)
1.7 mg/dL (male)/1.4 mg/dL (female) (>= 16 years of age)
Patients must have a performance status corresponding to Eastern Cooperative Oncology Group (ECOG) scores of 0, 1, or 2; use Karnofsky for patients > 16 years of age and Lansky for patients =< 16 years of age
All patients and/or their parents or legal guardians must sign a written informed consent
All institutional, Food and Drug Administration (FDA), and National Cancer Institute (NCI) requirements for human studies must be met

Exclusion Criteria:

Patients previously enrolled on the trial are not eligible; therefore, patients with AL who were on study during intensive chemotherapy are not eligible to be enrolled during the HSCT
Patients with an allergy to quinolones
Patients with chronic active arthritis
Patients with a known pathologic prolongation of the corrected QT (QTc)
Females who are pregnant or breast feeding

Patients being treated with antibacterial agents, other than any of the following:

Cotrimoxazole or other agents including dapsone, atovaquone, and pentamidine administered for Pneumocystitis jiroveci (PCP) prophylaxis
Topical antibiotics
Central venous catheter antibiotic lock therapy
Note: prophylactic antifungal therapy is NOT an exclusion criterion
Patients currently enrolled on the ACCL1034 study are not eligible until they have completed the 90 day observation period of that study

Study is for people with:

Acute Myeloid Leukemia

Phase:

Phase 3

Estimated Enrollment:

624

Study ID:

NCT01371656

Recruitment Status:

Completed

Sponsor:

Children's Oncology Group

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There are 83 Locations for this study

See Locations Near You

Arkansas Children's Hospital
Little Rock Arkansas, 72202, United States
Southern California Permanente Medical Group
Downey California, 90242, United States
City of Hope Medical Center
Duarte California, 91010, United States
Loma Linda University Medical Center
Loma Linda California, 92354, United States
Miller Children's Hospital
Long Beach California, 90806, United States
Children's Hospital Los Angeles
Los Angeles California, 90027, United States
Cedars-Sinai Medical Center
Los Angeles California, 90048, United States
Rady Children's Hospital - San Diego
San Diego California, 92123, United States
University of California San Francisco Medical Center-Parnassus
San Francisco California, 94143, United States
Connecticut Children's Medical Center
Hartford Connecticut, 06106, United States
Alfred I duPont Hospital for Children
Wilmington Delaware, 19803, United States
Children's National Medical Center
Washington District of Columbia, 20010, United States
Lombardi Comprehensive Cancer Center at Georgetown University
Washington District of Columbia, 20057, United States
Golisano Children's Hospital of Southwest Florida
Fort Myers Florida, 33908, United States
Nemours Children's Clinic - Jacksonville
Jacksonville Florida, 32207, United States
Nemours Children's Hospital
Orlando Florida, 32827, United States
Nemours Children's Clinic - Pensacola
Pensacola Florida, 32504, United States
All Children's Hospital
Saint Petersburg Florida, 33701, United States
Saint Mary's Hospital
West Palm Beach Florida, 33407, United States
Children's Healthcare of Atlanta - Egleston
Atlanta Georgia, 30322, United States
Georgia Regents University
Augusta Georgia, 30912, United States
University of Illinois
Chicago Illinois, 60612, United States
Advocate Children's Hospital-Oak Lawn
Oak Lawn Illinois, 60453, United States
Riley Hospital for Children
Indianapolis Indiana, 46202, United States
Saint Vincent Hospital and Health Services
Indianapolis Indiana, 46260, United States
Blank Children's Hospital
Des Moines Iowa, 50309, United States
University of Kentucky
Lexington Kentucky, 40536, United States
Kosair Children's Hospital
Louisville Kentucky, 40202, United States
Tulane University Health Sciences Center
New Orleans Louisiana, 70112, United States
Children's Hospital-Main Campus
New Orleans Louisiana, 70118, United States
Ochsner Medical Center
New Orleans Louisiana, 70121, United States
Sinai Hospital of Baltimore
Baltimore Maryland, 21215, United States
Floating Hospital for Children at Tufts Medical Center
Boston Massachusetts, 02111, United States
Dana-Farber Cancer Institute
Boston Massachusetts, 02115, United States
C S Mott Children's Hospital
Ann Arbor Michigan, 48109, United States
Helen DeVos Children's Hospital at Spectrum Health
Grand Rapids Michigan, 49503, United States
Michigan State University - Breslin Cancer Center
Lansing Michigan, 48910, United States
Children's Hospitals and Clinics of Minnesota - Minneapolis
Minneapolis Minnesota, 55404, United States
University of Mississippi Medical Center
Jackson Mississippi, 39216, United States
Saint John's Mercy Medical Center
Saint Louis Missouri, 63141, United States
Children's Hospital and Medical Center of Omaha
Omaha Nebraska, 68114, United States
University of Nebraska Medical Center
Omaha Nebraska, 68198, United States
Nevada Cancer Research Foundation CCOP
Las Vegas Nevada, 89106, United States
Hackensack University Medical Center
Hackensack New Jersey, 07601, United States
Saint Peter's University Hospital
New Brunswick New Jersey, 08901, United States
UMDNJ - Robert Wood Johnson University Hospital
New Brunswick New Jersey, 08903, United States
University of New Mexico Cancer Center
Albuquerque New Mexico, 87106, United States
Montefiore Medical Center
Bronx New York, 10467, United States
Roswell Park Cancer Institute
Buffalo New York, 14263, United States
New York University Langone Medical Center
New York New York, 10016, United States
Columbia University Medical Center
New York New York, 10032, United States
University of Rochester
Rochester New York, 14642, United States
Ny Cancer%
Valhalla New York, 10595, United States
Mission Hospital-Memorial Campus
Asheville North Carolina, 28801, United States
Wake Forest University Health Sciences
Winston-Salem North Carolina, 27157, United States
Children's Hospital Medical Center of Akron
Akron Ohio, 44308, United States
Cleveland Clinic Foundation
Cleveland Ohio, 44195, United States
Nationwide Children's Hospital
Columbus Ohio, 43205, United States
The Children's Medical Center of Dayton
Dayton Ohio, 45404, United States
The Toledo Hospital/Toledo Children's Hospital
Toledo Ohio, 43606, United States
University of Oklahoma Health Sciences Center
Oklahoma City Oklahoma, 73104, United States
Lehigh Valley Hospital - Muhlenberg
Bethlehem Pennsylvania, 18017, United States
Geisinger Medical Center
Danville Pennsylvania, 17822, United States
Children's Hospital of Philadelphia
Philadelphia Pennsylvania, 19104, United States
Children's Hospital of Pittsburgh of UPMC
Pittsburgh Pennsylvania, 15224, United States
Palmetto Health Richland
Columbia South Carolina, 29203, United States
Sanford USD Medical Center - Sioux Falls
Sioux Falls South Dakota, 57117, United States
Driscoll Children's Hospital
Corpus Christi Texas, 78411, United States
University of Texas Southwestern Medical Center
Dallas Texas, 75390, United States
Brooke Army Medical Center
Fort Sam Houston Texas, 78234, United States
Cook Children's Medical Center
Fort Worth Texas, 76104, United States
Baylor College of Medicine
Houston Texas, 77030, United States
University of Texas Health Science Center at San Antonio
San Antonio Texas, 78229, United States
Methodist Children's Hospital of South Texas
San Antonio Texas, 78229, United States
Childrens Hospital-King's Daughters
Norfolk Virginia, 23507, United States
Providence Sacred Heart Medical Center and Children's Hospital
Spokane Washington, 99204, United States
Madigan Army Medical Center
Tacoma Washington, 98431, United States
Marshfield Clinic
Marshfield Wisconsin, 54449, United States
CancerCare Manitoba
Winnipeg Manitoba, R3E 0, Canada
Janeway Child Health Centre
Saint John's Newfoundland and Labrador, A1B 3, Canada
McMaster Children's Hospital at Hamilton Health Sciences
Hamilton Ontario, L8N 3, Canada
Cancer Centre of Southeastern Ontario at Kingston General Hospital
Kingston Ontario, K7L 5, Canada
Hospital for Sick Children
Toronto Ontario, M5G 1, Canada
The Montreal Children's Hospital of the MUHC
Montreal Quebec, H3H 1, Canada

How clear is this clinincal trial information?

Study is for people with:

Acute Myeloid Leukemia

Phase:

Phase 3

Estimated Enrollment:

624

Study ID:

NCT01371656

Recruitment Status:

Completed

Sponsor:


Children's Oncology Group

How clear is this clinincal trial information?

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