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Clofarabine and Cyclophosphamide in Treating Patients With Relapsed or Refractory Acute Leukemia, Chronic Myelogenous Leukemia, or Myeloproliferative Disorders

Primary Purpose

Chronic Myeloproliferative Disorders, Leukemia, Myelodysplastic/Myeloproliferative Diseases

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
clofarabine
cyclophosphamide
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 Chronic Myeloproliferative Disorders focused on measuring adult acute myeloid leukemia with 11q23 (MLL) abnormalities, adult acute myeloid leukemia with inv(16)(p13;q22), adult acute myeloid leukemia with t(15;17)(q22;q12), adult acute myeloid leukemia with t(16;16)(p13;q22), adult acute myeloid leukemia with t(8;21)(q22;q22), recurrent adult acute myeloid leukemia, recurrent childhood acute myeloid leukemia, secondary acute myeloid leukemia, myelodysplastic/myeloproliferative disease, unclassifiable, accelerated phase chronic myelogenous leukemia, chronic idiopathic myelofibrosis, chronic myelomonocytic leukemia, juvenile myelomonocytic leukemia, recurrent adult acute lymphoblastic leukemia, recurrent childhood acute lymphoblastic leukemia, acute undifferentiated leukemia, blastic phase chronic myelogenous leukemia, childhood chronic myelogenous leukemia, adult acute basophilic leukemia, adult acute eosinophilic leukemia, adult acute megakaryoblastic leukemia (M7), adult acute minimally differentiated myeloid leukemia (M0), adult acute monoblastic leukemia (M5a), adult acute monocytic leukemia (M5b), adult acute myeloblastic leukemia with maturation (M2), adult acute myeloblastic leukemia without maturation (M1), adult acute myelomonocytic leukemia (M4), adult acute promyelocytic leukemia (M3), adult erythroleukemia (M6a), adult pure erythroid leukemia (M6b), childhood acute basophilic leukemia, childhood acute monocytic leukemia (M5b), childhood acute eosinophilic leukemia, childhood acute erythroleukemia (M6), childhood acute megakaryocytic leukemia (M7), childhood acute minimally differentiated myeloid leukemia (M0), childhood acute myeloblastic leukemia with maturation (M2), childhood acute myeloblastic leukemia without maturation (M1), childhood acute myelomonocytic leukemia (M4), childhood acute monoblastic leukemia (M5a), childhood acute promyelocytic leukemia (M3)

Eligibility Criteria

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

DISEASE CHARACTERISTICS: Histologically confirmed leukemia or myeloproliferative disorders, including 1 of the following: Acute myeloid leukemia (AML) of any subtype Treatment-related AML OR AML evolving from myeloproliferative disorders (MPD) or transformed from myelodysplastic syndrome Acute lymphocytic leukemia Acute progranulocytic leukemia Must not be eligible for arsenic or retinoic acid therapy Chronic myelogenous leukemia in accelerated phase or blast crisis High-risk MPD, including any of the following: Myelofibrosis Chronic myelomonocytic leukemia with 5%-19% blasts Relapsed or refractory juvenile myelomonocytic leukemia Relapsed and/or refractory disease with progressive disease since last therapy No more than 3 prior induction regimens with cytotoxic agents for adults Must be in second relapse for patients < 21 years of age PATIENT CHARACTERISTICS: ECOG performance status 0-2 (for adults) OR Lansky 50-100% (for pediatric patients) Bilirubin ≤ 1.5 mg/dL (may be elevated due to hemolysis in adult patients) AST and ALT ≤ 5 times upper limit of normal Creatinine ≤ 2.0 mg/dL (for adults) Normal renal function (for pediatric patients) Cardiac function normal as measured by MUGA scan or echocardiogram Not pregnant or nursing Negative pregnancy test Fertile patients must use effective barrier contraception during and for at least 6 months after completion of study treatment HIV negative No active graft-versus-host disease ≥ grade 2 No active, uncontrolled infection No fever No unstable CT scans of the lungs, sinuses, or abdomen within the past 4 weeks No arrhythmias (other than atrial flutter or fibrillation) requiring medication No dyspnea at rest or with minimal exertion No uncontrolled congestive heart failure No myocardial infarction within the past 3 months No history of severe coronary artery disease No other significant concurrent disease, illness, or psychiatric disorder that would compromise patient safety or compliance or interfere with consent, study participation, follow up, or interpretation of study results PRIOR CONCURRENT THERAPY: Must have recovered from all acute toxic effects from prior treatment More than 30 days since prior investigational cytotoxic agents At least 3 days since prior azacitidine, thalidomide, hydroxyurea, imatinib mesylate, or interferon At least 1 week since prior growth factors except epoetin alfa More than 3 weeks since any other prior anticancer therapy No concurrent chemotherapy, radiotherapy, or immunotherapy No other concurrent anticancer investigational or commercial agents No routine prophylactic use of a colony-stimulating factor (filgrastim [G-CSF] or sargramostim [GM-CSF]) Therapeutic use of colony-stimulating factors may be considered at the discretion of the investigator No prolonged use of corticosteroids to prevent or treat emesis or as a chemotherapeutic agent

Sites / Locations

  • Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

Outcomes

Primary Outcome Measures

Secondary Outcome Measures

Full Information

First Posted
February 16, 2006
Last Updated
May 5, 2010
Sponsor
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00293410
Brief Title
Clofarabine and Cyclophosphamide in Treating Patients With Relapsed or Refractory Acute Leukemia, Chronic Myelogenous Leukemia, or Myeloproliferative Disorders
Official Title
Phase I Dose-Escalation Trial of Clofarabine Followed by Escalating Doses of Fractionated Cyclophosphamide in Adults and Children With Relapsed or Refractory Acute Leukemias
Study Type
Interventional

2. Study Status

Record Verification Date
May 2010
Overall Recruitment Status
Completed
Study Start Date
November 2005 (undefined)
Primary Completion Date
April 2010 (Actual)
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 clofarabine and cyclophosphamide, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Giving more than one drug (combination chemotherapy) may kill more cancer cells. PURPOSE: This phase I trial is studying the side effects and best dose of clofarabine and cyclophosphamide in treating patients with relapsed or refractory acute leukemia, chronic myelogenous leukemia, or myeloproliferative disorders.
Detailed Description
OBJECTIVES: Primary Determine the feasibility and tolerability of administering clofarabine and fractionated cyclophosphamide in patients with relapsed or refractory acute leukemia, chronic myelogenous leukemia, or high-risk myeloproliferative disorders Determine the maximum tolerated dose of clofarabine and fractionated cyclophosphamide in these patients. Determine the toxic effects of these drugs in these patients. Secondary Obtain preliminary data of biologic and pharmacodynamic effects of this regimen on marrow and circulating leukemic blasts in these patients. OUTLINE: This is a dose-escalation study. Patients are stratified according to age (adult vs child). Patients receive cyclophosphamide IV over 2 hours on day 0. Patients then receive clofarabine IV over 2 hours and cyclophosphamide IV over 2 hours on days 1-3 and 8-10. Treatment with clofarabine and cyclophosphamide repeats every 28 days for at least 2 courses in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of clofarabine and cyclophosphamide until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. At least 10 patients are treated at the MTD. After completion of study treatment, patients are followed periodically for 1 year. PROJECTED ACCRUAL: A total of 70 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
Chronic Myeloproliferative Disorders, Leukemia, Myelodysplastic/Myeloproliferative Diseases
Keywords
adult acute myeloid leukemia with 11q23 (MLL) abnormalities, adult acute myeloid leukemia with inv(16)(p13;q22), adult acute myeloid leukemia with t(15;17)(q22;q12), adult acute myeloid leukemia with t(16;16)(p13;q22), adult acute myeloid leukemia with t(8;21)(q22;q22), recurrent adult acute myeloid leukemia, recurrent childhood acute myeloid leukemia, secondary acute myeloid leukemia, myelodysplastic/myeloproliferative disease, unclassifiable, accelerated phase chronic myelogenous leukemia, chronic idiopathic myelofibrosis, chronic myelomonocytic leukemia, juvenile myelomonocytic leukemia, recurrent adult acute lymphoblastic leukemia, recurrent childhood acute lymphoblastic leukemia, acute undifferentiated leukemia, blastic phase chronic myelogenous leukemia, childhood chronic myelogenous leukemia, adult acute basophilic leukemia, adult acute eosinophilic leukemia, adult acute megakaryoblastic leukemia (M7), adult acute minimally differentiated myeloid leukemia (M0), adult acute monoblastic leukemia (M5a), adult acute monocytic leukemia (M5b), adult acute myeloblastic leukemia with maturation (M2), adult acute myeloblastic leukemia without maturation (M1), adult acute myelomonocytic leukemia (M4), adult acute promyelocytic leukemia (M3), adult erythroleukemia (M6a), adult pure erythroid leukemia (M6b), childhood acute basophilic leukemia, childhood acute monocytic leukemia (M5b), childhood acute eosinophilic leukemia, childhood acute erythroleukemia (M6), childhood acute megakaryocytic leukemia (M7), childhood acute minimally differentiated myeloid leukemia (M0), childhood acute myeloblastic leukemia with maturation (M2), childhood acute myeloblastic leukemia without maturation (M1), childhood acute myelomonocytic leukemia (M4), childhood acute monoblastic leukemia (M5a), childhood acute promyelocytic leukemia (M3)

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Enrollment
70 (Anticipated)

8. Arms, Groups, and Interventions

Intervention Type
Drug
Intervention Name(s)
clofarabine
Intervention Type
Drug
Intervention Name(s)
cyclophosphamide

10. Eligibility

Sex
All
Minimum Age & Unit of Time
2 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically confirmed leukemia or myeloproliferative disorders, including 1 of the following: Acute myeloid leukemia (AML) of any subtype Treatment-related AML OR AML evolving from myeloproliferative disorders (MPD) or transformed from myelodysplastic syndrome Acute lymphocytic leukemia Acute progranulocytic leukemia Must not be eligible for arsenic or retinoic acid therapy Chronic myelogenous leukemia in accelerated phase or blast crisis High-risk MPD, including any of the following: Myelofibrosis Chronic myelomonocytic leukemia with 5%-19% blasts Relapsed or refractory juvenile myelomonocytic leukemia Relapsed and/or refractory disease with progressive disease since last therapy No more than 3 prior induction regimens with cytotoxic agents for adults Must be in second relapse for patients < 21 years of age PATIENT CHARACTERISTICS: ECOG performance status 0-2 (for adults) OR Lansky 50-100% (for pediatric patients) Bilirubin ≤ 1.5 mg/dL (may be elevated due to hemolysis in adult patients) AST and ALT ≤ 5 times upper limit of normal Creatinine ≤ 2.0 mg/dL (for adults) Normal renal function (for pediatric patients) Cardiac function normal as measured by MUGA scan or echocardiogram Not pregnant or nursing Negative pregnancy test Fertile patients must use effective barrier contraception during and for at least 6 months after completion of study treatment HIV negative No active graft-versus-host disease ≥ grade 2 No active, uncontrolled infection No fever No unstable CT scans of the lungs, sinuses, or abdomen within the past 4 weeks No arrhythmias (other than atrial flutter or fibrillation) requiring medication No dyspnea at rest or with minimal exertion No uncontrolled congestive heart failure No myocardial infarction within the past 3 months No history of severe coronary artery disease No other significant concurrent disease, illness, or psychiatric disorder that would compromise patient safety or compliance or interfere with consent, study participation, follow up, or interpretation of study results PRIOR CONCURRENT THERAPY: Must have recovered from all acute toxic effects from prior treatment More than 30 days since prior investigational cytotoxic agents At least 3 days since prior azacitidine, thalidomide, hydroxyurea, imatinib mesylate, or interferon At least 1 week since prior growth factors except epoetin alfa More than 3 weeks since any other prior anticancer therapy No concurrent chemotherapy, radiotherapy, or immunotherapy No other concurrent anticancer investigational or commercial agents No routine prophylactic use of a colony-stimulating factor (filgrastim [G-CSF] or sargramostim [GM-CSF]) Therapeutic use of colony-stimulating factors may be considered at the discretion of the investigator No prolonged use of corticosteroids to prevent or treat emesis or as a chemotherapeutic agent
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
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21231-2410
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
17562873
Citation
Karp JE, Ricklis RM, Balakrishnan K, Briel J, Greer J, Gore SD, Smith BD, McDevitt MA, Carraway H, Levis MJ, Gandhi V. A phase 1 clinical-laboratory study of clofarabine followed by cyclophosphamide for adults with refractory acute leukemias. Blood. 2007 Sep 15;110(6):1762-9. doi: 10.1182/blood-2007-03-081364. Epub 2007 Jun 11.
Results Reference
derived

Learn more about this trial

Clofarabine and Cyclophosphamide in Treating Patients With Relapsed or Refractory Acute Leukemia, Chronic Myelogenous Leukemia, or Myeloproliferative Disorders

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