Augmerosen Plus Fludarabine and Cytarabine in Treating Patients With Refractory or Relapsed Acute Myeloid Leukemia or Acute Lymphoblastic Leukemia
A Phase I Study of G3139 (NSC 683428) in Combination With Salvage Chemotherapy for Treatment of Refractory and Relapsed Acute Myeloid Leukemia (AML) and Acute Lymphoblastic Leukemia (ALL)
Visão geral do estudo
Status
Condições
Intervenção / Tratamento
Descrição detalhada
OBJECTIVES:
I. Determine the maximum tolerated dose of fludarabine and cytarabine when combined with augmerosen (G3139) in patients with refractory or relapsed acute myeloid leukemia or acute lymphoblastic leukemia and recommend a starting dose for phase II studies.
II. Determine the qualitative and quantitative toxic effects of this regimen in these patients with regard to organ specificity, time course, predictability, and reversibility.
III. Document the therapeutic response in patients treated with this regimen. IV. Measure bcl-2 and related antiapoptotic and proapoptotic proteins in circulating and/or marrow leukemia cells before, during, and after treatment with G3139.
V. Measure WT1 expression in leukemic blasts as a surrogate marker for minimal residual disease and correlate it with bcl-2 and related antiapoptotic and proapoptotic gene expression.
VI. Determine the time required for bcl-2 levels to recover after treatment with this regimen.
VII. Determine if TP53 mutations are present in leukemic blasts and how these mutations may affect expression of BAX, level of treatment induced apoptosis, and clinical endpoints.
VIII. Assess apoptosis in leukemic cells before, during, and after treatment with this regimen.
IX. Determine the pharmacokinetics of fludarabine and cytarabine in patients treated with this regimen.
X. Perform pharmacodynamic studies of fludarabine and cytarabine on the leukemic cells of patients prior to treatment.
OUTLINE: This is a dose-escalation study of fludarabine and cytarabine.
Patients receive augmerosen IV continuously on days 1-10 and filgrastim (G-CSF) subcutaneously beginning on day 5 and continuing until blood counts recover. Patients receive fludarabine IV over 30 minutes followed 3.5 hours later by cytarabine IV over 4 hours on days 6-10. Patients who achieve complete response (CR) receive a second course beginning 4 weeks after completion of the first course. Patients who achieve CR and have a matched sibling or unrelated bone marrow donor may undergo allogeneic bone marrow transplantation. Cohorts of 3-6 patients receive escalating doses of fludarabine and cytarabine 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.
Tipo de estudo
Inscrição (Real)
Estágio
- Fase 1
Contactos e Locais
Locais de estudo
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Ohio
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Columbus, Ohio, Estados Unidos, 43210-1240
- Arthur G. James Cancer Hospital - Ohio State University
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Critérios de participação
Critérios de elegibilidade
Idades elegíveis para estudo
Aceita Voluntários Saudáveis
Gêneros Elegíveis para o Estudo
Descrição
DISEASE CHARACTERISTICS:
- Histologically proven refractory or relapsed acute myeloid leukemia or acute lymphoblastic leukemia
- Marrow cellularity must be at least 20%
- Must have diagnostic lumbar puncture and treatment with prophylactic intrathecal methotrexate within 1 week prior to entering study
- No active CNS involvement
- CNS involvement allowed if no residual leukemic cells are detected in CSF following intrathecal chemotherapy
PATIENT CHARACTERISTICS:
- Age: 16 and over
- Performance status: ECOG 0-2
- Life expectancy: At least 4 weeks
Bilirubin no greater than 2 times upper limit of normal(ULN)
- ALT and AST no greater than 2 times ULN
- Alkaline phosphatase no greater than 2 times ULN*
- Unless attributable to malignancy
- Creatinine no greater than 1.5 mg/dL unless attributable to malignancy
- No symptomatic congestive heart failure
- No unstable angina pectoris No or cardiac arrhythmia
- Resting cardiac ejection fraction no less than 45% unless attributable to malignancy
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception before and during study
- No history of allergy to study medications
- No uncontrolled concurrent illness
- No active infection
- No serious medical or psychiatric illness that would preclude informed consent or limit survival to less than 4 weeks
PRIOR CONCURRENT THERAPY:
- At least 2 weeks since prior chemotherapy except hydroxyurea
- No concurrent corticosteroids except for grade 4 toxicity unresponsive to all other agents
- At least 4 weeks since prior radiotherapy
- No other concurrent investigational or standard agents or therapies for leukemia
Plano de estudo
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Tratamento
- Alocação: N / D
- Modelo Intervencional: Atribuição de grupo único
- Mascaramento: Nenhum (rótulo aberto)
Armas e Intervenções
Grupo de Participantes / Braço |
Intervenção / Tratamento |
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Experimental: Arm I
Patients receive augmerosen IV continuously on days 1-10 and filgrastim (G-CSF) subcutaneously beginning on day 5 and continuing until blood counts recover.
Patients receive fludarabine IV over 30 minutes followed 3.5 hours later by cytarabine IV over 4 hours on days 6-10.
Patients who achieve complete response (CR) receive a second course beginning 4 weeks after completion of the first course.
Patients who achieve CR and have a matched sibling or unrelated bone marrow donor may undergo allogeneic bone marrow transplantation.
Cohorts of 3-6 patients receive escalating doses of fludarabine and cytarabine 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.
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Colaboradores e Investigadores
Patrocinador
Investigadores
- Cadeira de estudo: Guido Marcucci, MD, Ohio State University Comprehensive Cancer Center
Datas de registro do estudo
Datas Principais do Estudo
Início do estudo
Conclusão Primária (Real)
Datas de inscrição no estudo
Enviado pela primeira vez
Enviado pela primeira vez que atendeu aos critérios de CQ
Primeira postagem (Estimativa)
Atualizações de registro de estudo
Última Atualização Postada (Estimativa)
Última atualização enviada que atendeu aos critérios de controle de qualidade
Última verificação
Mais Informações
Termos relacionados a este estudo
Palavras-chave
Termos MeSH relevantes adicionais
- Doenças do sistema imunológico
- Neoplasias por Tipo Histológico
- Neoplasias
- Distúrbios Linfoproliferativos
- Doenças Linfáticas
- Distúrbios imunoproliferativos
- Leucemia
- Leucemia Mieloide
- Leucemia Mieloide Aguda
- Leucemia-Linfoma Linfoblástico de Células Precursoras
- Leucemia Linfóide
- Efeitos Fisiológicos das Drogas
- Mecanismos Moleculares de Ação Farmacológica
- Agentes Anti-Infecciosos
- Antivirais
- Antimetabólitos, Antineoplásicos
- Antimetabólitos
- Agentes Antineoplásicos
- Agentes imunossupressores
- Fatores imunológicos
- Fludarabina
- Fosfato de fludarabina
- Citarabina
- Oblimersen
Outros números de identificação do estudo
- NCI-2012-01399
- OSU-99H0257
- OSU-9977
- NCI-T99-0057
- CDR0000067515 (Identificador de registro: PDQ (Physician Data Query))
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