Vorinostat, Cytarabine, and Etoposide in Treating Patients With Relapsed and/or Refractory Acute Leukemia or Myelodysplastic Syndromes or Myeloproliferative Disorders
Accelerated Phase Chronic Myelogenous Leukemia, Adult Acute Basophilic Leukemia, Adult Acute Eosinophilic Leukemia
About this trial
This is an interventional treatment trial for Accelerated Phase Chronic Myelogenous Leukemia
Eligibility Criteria
Inclusion Criteria: Histologically or cytologically confirmed diagnosis of 1 of the following: Relapsed or refractory acute myeloid leukemia (AML) Patients with acute promyelocytic leukemia t(15;17) must have failed prior tretinoin and arsenic trioxide-containing regimen Must be refractory to both agents with absence of durable hematologic response OR relapsed after a complete response duration of < 6 months Relapsed or refractory acute lymphoblastic leukemia Chronic myelogenous leukemia in accelerated or blastic phase Must be refractory to treatment with imatinib mesylate or dasatinib Disease progression despite continued treatment with imatinib mesylate or dasatinib Patients in accelerated or blastic phase are eligible if unable to tolerate imatinib mesylate provided their disease has progressed on dasatinib or if unable to tolerate dasatinib AML arising in the setting of underlying myelodysplastic syndromes (MDS) and/or myeloproliferative disorders (MPD) Secondary or therapy-related AML No active CNS leukemia Leukostasis OR leukemic blast count > 50,000/mm³ allowed provided patient is treated with emergency leukapheresis or hydroxyurea to reduce leukemic blast count to < 30,000/mm³ ECOG performance status (PS) 0-2 OR Karnofsky PS 60-100% Bilirubin ≤ 1.5 times upper limit of normal (ULN) AST and ALT ≤ 2.5 times ULN Creatinine ≤ 2.0 mg/dL Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception No history of cytarabine-related neurotoxicity No history of allergic reactions attributed to compounds of similar chemical or biologic composition to vorinostat (SAHA) or other agents used in the study No other uncontrolled illness, including, but not limited to, any of the following: Symptomatic congestive heart failure Unstable angina pectoris Cardiac arrhythmia Psychiatric illness or social situation that would preclude compliance with study requirements Infection allowed provided patient is receiving active treatment No HIV positivity See Disease Characteristics Recovered from prior therapy Persistent alopecia, fingernail discoloration, or hematologic abnormalities (primarily related to underlying disease) > 4 weeks after last course of chemotherapy or radiotherapy does not exclude patient At least 2 weeks since prior valproic acid or any other histone deacetylase inhibitor No more than 3 prior courses of induction/reinduction chemotherapy, including induction and consolidation therapy or induction therapy after any bone marrow transplantation or similar procedure Prior low-dose azacitidine, growth factors, cytokines, thalidomide, interferon, or imatinib mesylate for treatment of preceding MDS/MPD do not count as prior induction/reinduction therapy At least 4 weeks since prior chemotherapy (6 weeks for nitrosoureas [e.g., carmustine] or mitomycin C) or radiotherapy At least 24 hours since prior hydroxyurea At least 2 weeks since prior imatinib mesylate, hematopoietic growth factors, and biological agents At least 4 weeks since prior autologous stem cell transplantation Prior allogeneic stem cell transplantation allowed if all of the following criteria are met: At least 90 days since prior transplant No evidence of graft-vs-host disease At least 2 weeks since prior immunosuppressive therapy No other concurrent anticancer agents or therapies No other concurrent investigational agents Concurrent hydroxyurea or leukapheresis allowed on days 1-10 of study treatment to control rising leukemic blasts (blasts > 30,000/mm³) or leukostasis
Sites / Locations
- University of Maryland Greenebaum Cancer Center
- University of Pittsburgh
Arms of the Study
Arm 1
Experimental
Treatment (enzyme inhibitor, chemotherapy)
Patients receive oral SAHA two or three times daily on days 1-7 and cytarabine IV over 3 hours twice daily and etoposide IV over 1 hour once daily on days 11-14. Treatment repeats approximately every 6-7 weeks for up to 3 courses in the absence of disease progression or unacceptable toxicity.