Azacitidine and Lintuzumab in Treating Patients With Previously Untreated Myelodysplastic Syndromes

This is an interventional treatment trial for Leukemia focused on measuring de novo myelodysplastic syndromes, secondary myelodysplastic syndromes, chronic myelomonocytic leukemia, refractory anemia with excess blasts in transformation, refractory anemia with excess blasts, refractory anemia with ringed sideroblasts, refractory anemia, refractory cytopenia with multilineage dysplasia Read More

Eligibility Criteria:

• Age >18 with untreated MDS by FAB or WHO criteria (note: FAB criteria for MDS includes <29% blasts; FAB criteria includes CMML).
• Patients with therapy related disease (t-MDS).
• If the patient has co-morbid medical illness, life expectancy attributed to this must be greater than 6 months.
• Eastern Cooperative Oncology Group (ECOG) performance status <2.

• Must have adequate organ function as defined below:

  • total bilirubin <2.0mg/dL
  • AST(SGOT)/ALT(SGPT) <2.5 X institutional upper limit of normal
  • creatinine <2.0mg/dL
  • NYHA CHF(congestive heart failure)Class II or better
• Women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence).
• Ability to understand and willingness to sign the written informed consent document.
• CD33 expression is required on at least 25% of left shifted dysplastic myeloid cells, including blasts. This testing will be done on bone marrow aspirate, but for patients whose CD33 expression in this cellular compartment cannot be ascertained, peripheral blood will be allowed to determine this.

Exclusion Criteria:

• Patients who have had chemotherapy or radiotherapy within 6 months (for other cancers) prior to entering the study.
• Patients receiving any other investigational agents or patients that have received other investigational agents within 1 month of enrollment.
• Patients with active central nervous system disease or with granulocytic sarcoma as sole site of disease.
• Patients with history of allergic reactions attributed to compounds of similar chemical or biologic composition to AZA or lintuzumab that are not easily managed are excluded. Patients with hypersensitivity to mannitol are excluded.
• Uncontrolled intercurrent illness including, but not limited to, symptomatic congestive heart failure, unstable angina pectoris, serious cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements. As infection is a common feature of MDS, patients with active infection are permitted to enroll provided that the infection is under control. Myocardial infarction within 6 months prior to enrollment or has New York Heart Association (NYHA) Class III or IV heart failure, uncontrolled angina, severe uncontrolled ventricular arrhythmias, or electrocardiographic evidence of acute ischemia or active conduction system abnormalities.
• Psychiatric conditions that prevent compliance with protocol or consent.
• Pregnant women or women who are breastfeeding are excluded from this study.
• HIV-positive patients on combination antiretroviral therapy are ineligible.
• Patients with serious medical or psychiatric illness likely to interfere with participation in this clinical study.
• Patients with serious medical or psychiatric illness likely to interfere with participation in this clinical study.
• Patients with baseline fibrinogen <100mg/dL, or those with clinically significant disseminated intravascular coagulation, are excluded.
• Patients who require ongoing therapeutic anticoagulation with warfarin, lovenox, or similar agent are excluded. This does not apply to patients on low dose prophylaxis therapy.
• Patients who require ongoing clopidogrel therapy are excluded. In cases where clopidogrel use at screening is subsequently discontinued due to ongoing or future risk of drug and treatment related cytopenias, such patients will be eligible.
• Patients with platelet <10,000/uL who are refractory to platelet transfusion are not eligible (must bump to at least >10,000/uL after transfusion)
• Patients who have previously received lenalidomide or thalidomide are excluded.