Thalidomide, Prednisone, and Cyclophosphamide in Treating Patients With Myelofibrosis and Myeloid Metaplasia

Mayo Clinic

Status and phase: Completed; Phase 2

Conditions: Secondary Myelofibrosis; Chronic Myeloproliferative Disorders

Treatments: Other: laboratory biomarker analysis; Drug: thalidomide; Drug: cyclophosphamide; Drug: prednisone; Other: immunohistochemistry staining method; Procedure: biopsy

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT00445900

MC028A (Other Identifier)

P30CA015083 (U.S. NIH Grant/Contract)

1360-03 (Other Identifier)

CDR0000530973

Details and patient eligibility

About

RATIONALE: Giving thalidomide together with prednisone and cyclophosphamide may lessen symptoms caused by myelofibrosis and myeloid metaplasia.

PURPOSE: This phase II trial is studying the side effects and how well giving thalidomide together with prednisone and cyclophosphamide works in treating patients with myelofibrosis and myeloid metaplasia.

Full description

OBJECTIVES:

Primary

• Determine the benefit of thalidomide, prednisone, and cyclophosphamide in alleviating disease-associated anemia, thrombocytopenia, and/or splenomegaly in patients with myelofibrosis with myeloid metaplasia (MMM).
• Determine the benefit of this regimen in palliating four hypercatabolic constitutional symptoms (i.e., weight loss, fatigue, drenching night sweats, and unexplained fevers) in these patients.
• Determine the toxicity profile of this regimen in these patients.

Secondary

• Determine the effect of this regimen on leukocyte count.
• Determine the effect of this regimen on bone marrow histology, including microvessel density and reticulin fibrosis.
• Determine the effect of this regimen on intramedullary and urinary markers of angiogenesis.
• Determine the effect of this regimen on circulating myeloid progenitor cells by quantifying CD34+ cells.

OUTLINE: Patients receive oral thalidomide, oral prednisone, and oral cyclophosphamide (TPC) once daily on days 1-28. Treatment repeats every 28 days for 3 courses. After 3 courses (3 months) of treatment, patients who respond to TPC therapy may receive oral thalidomide alone once daily for up to 3 months in the absence of disease progression or unacceptable toxicity.

Patients undergo bone marrow aspirate and biopsy prior to study entry, 6 months after starting therapy, and then every 6 months for up to 3 years. Samples are analyzed by microvessel density/angiogenesis studies (i.e., CD34 immunohistochemical and vascular endothelium-specific staining) to determine the effect of therapy on markers of bone marrow angiogenesis.

After completion of study therapy, patients are followed every 6 months for up to 3 years.

PROJECTED ACCRUAL: A total of 22 patients will be accrued for this study.

Enrollment: 22 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

DISEASE CHARACTERISTICS:

• Histologically confirmed myelofibrosis with myeloid metaplasia (MMM) of any of the following subtypes:

  • Agnogenic myeloid metaplasia
  • Post-polycythemic myeloid metaplasia
  • Post-thrombocythemic myeloid metaplasia

• Must have 1 of the following MMM-related conditions:

  • Anemia, defined as hemoglobin < 10 g/dL

    • Iron deficiency must be excluded as cause

  • Thrombocytopenia, defined as platelet count < 100,000/mm³

  • Palpable hepatomegaly or splenomegaly

• No evidence of myelofibrosis-associated conditions in the bone marrow, including any of the following:

  • Metastatic carcinoma
  • Lymphoma
  • Myelodysplasia
  • Hairy cell leukemia
  • Mast cell disease
  • Acute leukemia (including M7 type)
  • Acute myelofibrosis

• No chromosomal translocation t(9:22) or bcr-abl as determined by bone marrow chromosome analysis or peripheral blood fluorescent in situ hybridization (FISH) analysis

PATIENT CHARACTERISTICS:

• ECOG performance status 0-3

• Absolute neutrophil count ≥ 750/mm³

• Bilirubin ≤ 2 times upper limit of normal (ULN), unless elevation due to MMM

• AST ≤ 5 times ULN, unless elevation due to MMM

• Creatinine ≤ 2.5 mg/dL

• No uncontrolled infection, including tuberculosis

  • No known history of positive purified protein derivative (PPD) untreated by isoniazid therapy

    • Positive PPD with normal chest X-ray and completion of full-course isoniazid therapy allowed

• No federal medical center inmates or other incarcerated patients

• No peripheral neuropathy ≥ grade 2

• No comorbid condition in which the use of study therapy is felt to be potentially harmful

• Not pregnant or nursing

• Negative pregnancy test

• Fertile patients must use 2 forms of effective contraception

PRIOR CONCURRENT THERAPY:

• No chemotherapy (e.g., hydroxyurea, myelosuppressive therapy) within the past 14 days
• Prior splenectomy for MMM allowed
• No concurrent hematopoietic growth factors