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3-AP Followed By Fludarabine In Treating Patients With Relapsed or Refractory Acute or Chronic Leukemia or High-Risk Myelodysplastic Syndrome

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Johns Hopkins Medicine

Status and phase

Completed
Phase 1

Conditions

Leukemia
Myelodysplastic/Myeloproliferative Diseases
Myelodysplastic Syndromes

Treatments

Drug: fludarabine phosphate
Drug: triapine

Study type

Interventional

Funder types

Other
NIH

Identifiers

NCT00077558
U01CA070095 (U.S. NIH Grant/Contract)
NCI-6255
P30CA006973 (U.S. NIH Grant/Contract)
JHOC-J0357
CDR0000352322, J0357

Details and patient eligibility

About

RATIONALE: Drugs used in chemotherapy, such as fludarabine, work in different ways to stop cancer cells from dividing so they stop growing or die. 3-AP may help fludarabine kill more cancer cells by making them more sensitive to the drug.

PURPOSE: This phase I trial is studying the side effects and best dose of fludarabine when given together with 3-AP in treating patients with relapsed or refractory acute leukemia, chronic leukemia, or high-risk myelodysplastic syndrome.

Full description

OBJECTIVES:

  • Determine the feasibility and tolerability of 3-AP (Triapine^® ) followed by fludarabine in patients with relapsed or refractory acute or chronic leukemia or high-risk myelodysplastic syndromes.
  • Determine the toxic effects of this regimen in these patients.
  • Determine the maximum tolerated dose of this regimen in these patients.

OUTLINE: This is a multicenter, dose-escalation study of fludarabine. Patients are stratified according to disease (acute leukemias and myelodysplastic syndromes [MDS] vs chronic lymphocytic leukemia and prolymphocytic leukemia). Patients are assigned to 1 of 2 treatment groups.

  • Group 1 (chronic lymphocytic leukemia or prolymphocytic leukemia): Patients receive 3-AP (Triapine^®) IV over 4 hours and fludarabine IV over 30 minutes on days 1-5.

Cohorts of 3-6 patients receive escalating doses of fludarabine until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 6 patients experience dose-limiting toxicity. Once the MTD is determined, 10 additional patients are treated at that dose level.

  • Group 2 (acute leukemias or MDS): Patients receive 3-AP IV continuously over 24 hours on day 1. Beginning within 4 hours after completion of 3-AP, patients receive fludarabine IV over 30 minutes on days 2-6.

In both groups, treatment repeats every 3 weeks in the absence of disease progression or unacceptable toxicity.

PROJECTED ACCRUAL: A total of 3-34 patients will be accrued for this study.

Sex

All

Ages

18+ years old

Volunteers

No Healthy Volunteers

Inclusion and exclusion criteria

DISEASE CHARACTERISTICS:

  • Histologically confirmed diagnosis of 1 of the following:

    • High-risk myelodysplastic syndromes (MDS), including refractory anemia with excess blasts and chronic myelomonocytic leukemia

      • International Prognostic Scoring System (IPSS) score at least 1.5 based on the following:

        • More than 10% marrow blasts
        • Cytopenias in at least 2 lineages
        • Adverse cytogenetics
    • Acute myeloid leukemia (AML)

      • All subtypes, including MDS/AML and treatment-related (secondary) AML
    • Acute lymphoblastic leukemia

    • Acute progranulocytic leukemia

      • Ineligible for arsenic therapy
    • Chronic myelogenous leukemia

      • Accelerated phase or blastic crisis
    • Chronic lymphocytic leukemia

    • Prolymphocytic leukemia

  • Received or ineligible for established curative regimens, including stem cell transplantation

  • Acute and chronic leukemias must be relapsed and/or refractory with progressive disease since last therapy

PATIENT CHARACTERISTICS:

Age

  • 18 and over

Performance status

  • ECOG 0-2

Life expectancy

  • Not specified

Hematopoietic

  • No history of hemolytic anemia grade 2 or greater

  • No known glucose-6-phosphate dehydrogenase (G6PD) deficiency

    • G6PD screening required for high-risk groups (i.e., patients of African, Asian, or Mediterranean origin/ancestry)

Hepatic

  • SGOT and SGPT no greater than 2.5 times normal
  • Bilirubin no greater than 2 mg/dL
  • No chronic hepatitis

Renal

  • Creatinine normal OR
  • Creatinine clearance at least 60 mL/min

Cardiovascular

  • No active heart disease
  • No myocardial infarction within the past 3 months
  • No severe coronary artery disease
  • No arrhythmias (other than atrial flutter or fibrillation) requiring medication
  • No uncontrolled congestive heart failure

Pulmonary

  • No dyspnea at rest or with minimal exertion
  • No severe pulmonary disease requiring supplemental oxygen

Other

  • Not pregnant or nursing

  • Negative pregnancy test

  • Fertile patients must use effective contraception

  • No neuropathy grade 2 or greater

  • No active uncontrolled infection

    • Infections under active treatment and controlled by antibiotics are allowed
  • No other life-threatening illness

  • No psychiatric illness that would preclude study compliance

PRIOR CONCURRENT THERAPY:

Biologic therapy

  • See Disease Characteristics
  • At least 1 week since prior hematopoietic growth factor (e.g., epoetin alfa, filgrastim [G-CSF], sargramostim [GM-CSF], interleukin-3, and interleukin-11)
  • No concurrent immunotherapy

Chemotherapy

  • Recovered from prior chemotherapy (no greater than grade 1 chronic toxic effects)
  • At least 72 hours since prior hydroxyurea
  • At least 3 weeks since prior myelosuppressive cytotoxic agents (6 weeks for mitomycin or nitrosoureas)
  • No more than 12 prior courses of fludarabine
  • No more than 3 prior cytotoxic chemotherapy regimens
  • No other concurrent chemotherapy

Endocrine therapy

  • Not specified

Radiotherapy

  • At least 2 weeks since prior radiotherapy
  • No concurrent radiotherapy

Surgery

  • Not specified

Other

  • At least 1 week since prior non-myelosuppressive treatment
  • No more than 4 prior induction regimens
  • No other concurrent therapy

Trial contacts and locations

4

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Data sourced from clinicaltrials.gov

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