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

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