search
Back to results

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

Primary Purpose

Leukemia, Myelodysplastic Syndromes, Myelodysplastic/Myeloproliferative Diseases

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
fludarabine phosphate
triapine
Sponsored by
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for Leukemia focused on measuring accelerated phase chronic myelogenous leukemia, blastic phase chronic myelogenous leukemia, relapsing chronic myelogenous leukemia, previously treated myelodysplastic syndromes, secondary myelodysplastic syndromes, refractory chronic lymphocytic leukemia, recurrent adult acute lymphoblastic leukemia, prolymphocytic leukemia, refractory anemia with excess blasts, chronic myelomonocytic leukemia, recurrent adult acute myeloid leukemia, secondary acute myeloid leukemia, adult acute minimally differentiated myeloid leukemia (M0), adult acute monocytic leukemia (M5b), adult acute erythroid leukemia (M6), adult acute megakaryoblastic leukemia (M7), adult acute myeloblastic leukemia with maturation (M2), adult acute myeloblastic leukemia without maturation (M1), adult acute myelomonocytic leukemia (M4), adult acute monoblastic leukemia (M5a), adult acute promyelocytic leukemia (M3), adult acute eosinophilic leukemia, adult acute basophilic leukemia, atypical chronic myeloid leukemia, myelodysplastic/myeloproliferative disease, unclassifiable, adult acute myeloid leukemia with t(8;21)(q22;q22), adult acute myeloid leukemia with t(16;16)(p13;q22), adult acute myeloid leukemia with inv(16)(p13;q22), adult acute myeloid leukemia with 11q23 (MLL) abnormalities, adult acute myeloid leukemia with t(15;17)(q22;q12)

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

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

Sites / Locations

  • Blood and Marrow Transplant Group of Georgia
  • Greenebaum Cancer Center at University of Maryland Medical Center
  • Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
  • M.D. Anderson Cancer Center at University of Texas

Outcomes

Primary Outcome Measures

Secondary Outcome Measures

Full Information

First Posted
February 10, 2004
Last Updated
March 9, 2010
Sponsor
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Collaborators
National Cancer Institute (NCI)
search

1. Study Identification

Unique Protocol Identification Number
NCT00077558
Brief Title
3-AP Followed By Fludarabine In Treating Patients With Relapsed or Refractory Acute or Chronic Leukemia or High-Risk Myelodysplastic Syndrome
Official Title
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
Study Type
Interventional

2. Study Status

Record Verification Date
March 2010
Overall Recruitment Status
Completed
Study Start Date
January 2004 (undefined)
Primary Completion Date
undefined (undefined)
Study Completion Date
undefined (undefined)

3. Sponsor/Collaborators

Name of the Sponsor
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Collaborators
National Cancer Institute (NCI)

4. Oversight

5. Study Description

Brief Summary
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.
Detailed 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.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Leukemia, Myelodysplastic Syndromes, Myelodysplastic/Myeloproliferative Diseases
Keywords
accelerated phase chronic myelogenous leukemia, blastic phase chronic myelogenous leukemia, relapsing chronic myelogenous leukemia, previously treated myelodysplastic syndromes, secondary myelodysplastic syndromes, refractory chronic lymphocytic leukemia, recurrent adult acute lymphoblastic leukemia, prolymphocytic leukemia, refractory anemia with excess blasts, chronic myelomonocytic leukemia, recurrent adult acute myeloid leukemia, secondary acute myeloid leukemia, adult acute minimally differentiated myeloid leukemia (M0), adult acute monocytic leukemia (M5b), adult acute erythroid leukemia (M6), adult acute megakaryoblastic leukemia (M7), adult acute myeloblastic leukemia with maturation (M2), adult acute myeloblastic leukemia without maturation (M1), adult acute myelomonocytic leukemia (M4), adult acute monoblastic leukemia (M5a), adult acute promyelocytic leukemia (M3), adult acute eosinophilic leukemia, adult acute basophilic leukemia, atypical chronic myeloid leukemia, myelodysplastic/myeloproliferative disease, unclassifiable, adult acute myeloid leukemia with t(8;21)(q22;q22), adult acute myeloid leukemia with t(16;16)(p13;q22), adult acute myeloid leukemia with inv(16)(p13;q22), adult acute myeloid leukemia with 11q23 (MLL) abnormalities, adult acute myeloid leukemia with t(15;17)(q22;q12)

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1

8. Arms, Groups, and Interventions

Intervention Type
Drug
Intervention Name(s)
fludarabine phosphate
Intervention Type
Drug
Intervention Name(s)
triapine

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility 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
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Judith E. Karp, MD
Organizational Affiliation
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Official's Role
Study Chair
Facility Information:
Facility Name
Blood and Marrow Transplant Group of Georgia
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30342-4777
Country
United States
Facility Name
Greenebaum Cancer Center at University of Maryland Medical Center
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21201
Country
United States
Facility Name
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21231
Country
United States
Facility Name
M.D. Anderson Cancer Center at University of Texas
City
Houston
State/Province
Texas
ZIP/Postal Code
77030-4095
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
17640728
Citation
Karp JE, Giles FJ, Gojo I, Morris L, Greer J, Johnson B, Thein M, Sznol M, Low J. A phase I study of the novel ribonucleotide reductase inhibitor 3-aminopyridine-2-carboxaldehyde thiosemicarbazone (3-AP, Triapine) in combination with the nucleoside analog fludarabine for patients with refractory acute leukemias and aggressive myeloproliferative disorders. Leuk Res. 2008 Jan;32(1):71-7. doi: 10.1016/j.leukres.2007.05.003. Epub 2007 Jul 20.
Results Reference
result

Learn more about this trial

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

We'll reach out to this number within 24 hrs