3-AP Followed By Fludarabine In Treating Patients With Relapsed or Refractory Acute or Chronic Leukemia or High-Risk Myelodysplastic Syndrome
A Phase I Trial Of Sequential Administration Of Triapine (3-Aminopyridine-2-Carboxaldehyde Thiosemicarbazone) Followed By Fludarabine In Adults With Relapsed And Refractory Leukemias And Myelodysplasias
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.
研究概览
详细说明
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.
研究类型
阶段
- 阶段1
联系人和位置
学习地点
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Georgia
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Atlanta、Georgia、美国、30342-4777
- Blood and Marrow Transplant Group of Georgia
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Maryland
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Baltimore、Maryland、美国、21231
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
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Baltimore、Maryland、美国、21201
- Greenebaum Cancer Center at University of Maryland Medical Center
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Texas
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Houston、Texas、美国、77030-4095
- M.D. Anderson Cancer Center at University of Texas
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
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
学习计划
研究是如何设计的?
设计细节
- 主要用途:治疗
合作者和调查者
出版物和有用的链接
研究记录日期
研究主要日期
学习开始
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (估计)
研究记录更新
最后更新发布 (估计)
上次提交的符合 QC 标准的更新
最后验证
更多信息
与本研究相关的术语
关键字
- 顽固性贫血伴原始细胞过多
- 慢性粒单核细胞白血病
- 既往治疗过的骨髓增生异常综合征
- 继发性骨髓增生异常综合征
- 具有 11q23 (MLL) 异常的成人急性髓性白血病
- 伴有 inv(16)(p13;q22) 的成人急性髓性白血病
- 成人急性髓性白血病伴 t(15;17)(q22;q12)
- 成人急性髓性白血病伴 t(16;16)(p13;q22)
- 成人急性髓性白血病伴 t(8;21)(q22;q22)
- 继发性急性髓性白血病
- 复发性成人急性髓性白血病
- 非典型慢性粒细胞白血病
- 骨髓增生异常/骨髓增生性疾病,无法分类
- 成人急性红细胞白血病 (M6)
- 成人急性巨核细胞白血病 (M7)
- 成人急性低分化髓性白血病 (M0)
- 成人急性单核细胞白血病 (M5a)
- 成人急性单核细胞白血病 (M5b)
- 成熟型成人急性成髓细胞白血病 (M2)
- 未成熟的成人急性成髓细胞白血病 (M1)
- 成人急性粒单核细胞白血病 (M4)
- 成人急性嗜碱性白血病
- 成人急性嗜酸性粒细胞白血病
- 母细胞期慢性粒细胞白血病
- 复发性慢性粒细胞白血病
- 难治性慢性淋巴细胞白血病
- 复发性成人急性淋巴细胞白血病
- 幼淋巴细胞白血病
- 加速期慢性粒细胞白血病
- 成人急性早幼粒细胞白血病 (M3)
其他相关的 MeSH 术语
其他研究编号
- CDR0000352322, J0357
- P30CA006973 (美国 NIH 拨款/合同)
- U01CA070095 (美国 NIH 拨款/合同)
- JHOC-J0357
- NCI-6255
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