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Cladribine, Cytarabine, and Imatinib Mesylate in Treating Patients With Refractory or Relapsed Acute Myeloid Leukemia or Blastic Phase Chronic Myelogenous Leukemia

Primary Purpose

Leukemia

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
filgrastim
cladribine
cytarabine
imatinib mesylate
Sponsored by
University of Rochester
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for Leukemia focused on measuring recurrent adult acute myeloid leukemia, adult acute basophilic leukemia, adult acute eosinophilic leukemia, adult acute megakaryoblastic leukemia (M7), adult acute myeloblastic leukemia with maturation (M2), adult acute myelomonocytic leukemia (M4), adult acute monoblastic leukemia (M5a), adult acute monocytic leukemia (M5b), adult acute myeloblastic leukemia without maturation (M1), adult erythroleukemia (M6a), adult pure erythroid leukemia (M6b), blastic phase chronic myelogenous leukemia, relapsing chronic myelogenous leukemia

Eligibility Criteria

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

DISEASE CHARACTERISTICS: Diagnosis of acute myeloid leukemia (AML) or blastic phase chronic myelogenous leukemia (CML) Refractory AML defined as any of the following: Failure to achieve complete response (CR) after 2 courses of induction chemotherapy Persistent bone marrow blasts > 40% after 1 course of induction chemotherapy Relapse of disease within 3 months since CR Relapsed AML defined as the following: Any evidence of disease recurrence after CR (early relapse occurs within 3-12 months and late relapse occurs > 12 months later) No acute promyelocytic leukemia (AML-M3 FAB subgroup) PATIENT CHARACTERISTICS: Performance status ECOG 0-2 Life expectancy Not specified Hematopoietic Not specified Hepatic Bilirubin ≤ 2.0 mg/dL AST ≤ 2.5 times upper limit of normal No known chronic liver disease (e.g., chronic active hepatitis or cirrhosis) Renal Creatinine < 2.5 mg/dL (if 2.0-2.5 mg/dL, glomerular filtration rate must be measured and dose of cytarabine adjusted if necessary) Cardiovascular No New York Heart Association grade III-IV heart disease No congestive heart failure No myocardial infarction within the past 6 months Ejection fraction ≥ 30% Other Not pregnant or nursing Negative pregnancy test Fertile patients must use effective barrier contraception during and for 3 months after completion of study treatment No uncontrolled systemic active infection No known HIV infection No history of allergic reaction attributed to compounds of similar chemical or biological composition to study drugs No history of other curatively treated malignancy except nonmelanoma skin cancer PRIOR CONCURRENT THERAPY: Biologic therapy No other concurrent biologic agents Chemotherapy See Disease Characteristics No other concurrent chemotherapy Endocrine therapy No concurrent birth control pills Other More than 1 week since any prior investigational agent No other concurrent investigational agents or therapies No other concurrent anticancer agents No concurrent therapeutic anticoagulation with warfarin Low molecular weight heparin or heparin allowed for therapeutic anticoagulation Mini-dose warfarin (e.g., 1 mg per day) allowed for prophylaxis of central venous catheter thrombosis

Sites / Locations

  • James P. Wilmot Cancer Center at University of Rochester Medical Center

Outcomes

Primary Outcome Measures

Secondary Outcome Measures

Full Information

First Posted
November 22, 2005
Last Updated
October 14, 2013
Sponsor
University of Rochester
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1. Study Identification

Unique Protocol Identification Number
NCT00258271
Brief Title
Cladribine, Cytarabine, and Imatinib Mesylate in Treating Patients With Refractory or Relapsed Acute Myeloid Leukemia or Blastic Phase Chronic Myelogenous Leukemia
Official Title
A Phase I Study of CLAG Regimen in Combination With Imatinib Mesylate (Gleevec) in Refractory or Relapsed Leukemias
Study Type
Interventional

2. Study Status

Record Verification Date
October 2013
Overall Recruitment Status
Completed
Study Start Date
March 2005 (undefined)
Primary Completion Date
October 2006 (Actual)
Study Completion Date
October 2006 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Rochester

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
RATIONALE: Drugs used in chemotherapy, such as cladribine and cytarabine, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Imatinib mesylate may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Giving cladribine and cytarabine together with imatinib mesylate may kill more cancer cells. PURPOSE: This phase I trial is studying the side effects and best dose of imatinib mesylate when given together with cladribine and cytarabine in treating patients with refractory or relapsed acute myeloid leukemia or blastic phase chronic myelogenous leukemia.
Detailed Description
OBJECTIVES: Determine the safety and feasibility of cladribine, cytarabine, and imatinib mesylate in patients with refractory or relapsed acute myeloid leukemia or blastic phase chronic myelogenous leukemia. Determine the maximum tolerated dose of imatinib mesylate in patients treated with this regimen. Correlate the expression of c-kit and the presence of c-kit mutations with clinical response in patients treated with this regimen. Correlate the in vitro inhibitory effects of imatinib mesylate and cytarabine on the proliferation and survival of leukemic cells with clinical response in patients treated with this regimen. OUTLINE: This is a dose-escalation study of imatinib mesylate. Patients receive oral imatinib mesylate once daily on days 1-15 and cladribine IV over 2 hours and cytarabine IV over 4 hours on days 3-7. Patients also receive filgrastim (G-CSF) subcutaneously on days 2-7. Treatment repeats every 15 days for 2 courses in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of imatinib mesylate 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. After completion of study treatment, patients are followed periodically for up to 1 year. PROJECTED ACCRUAL: A total of 12-18 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
Keywords
recurrent adult acute myeloid leukemia, adult acute basophilic leukemia, adult acute eosinophilic leukemia, adult acute megakaryoblastic leukemia (M7), adult acute myeloblastic leukemia with maturation (M2), adult acute myelomonocytic leukemia (M4), adult acute monoblastic leukemia (M5a), adult acute monocytic leukemia (M5b), adult acute myeloblastic leukemia without maturation (M1), adult erythroleukemia (M6a), adult pure erythroid leukemia (M6b), blastic phase chronic myelogenous leukemia, relapsing chronic myelogenous leukemia

7. Study Design

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

8. Arms, Groups, and Interventions

Intervention Type
Biological
Intervention Name(s)
filgrastim
Intervention Type
Drug
Intervention Name(s)
cladribine
Intervention Type
Drug
Intervention Name(s)
cytarabine
Intervention Type
Drug
Intervention Name(s)
imatinib mesylate

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Diagnosis of acute myeloid leukemia (AML) or blastic phase chronic myelogenous leukemia (CML) Refractory AML defined as any of the following: Failure to achieve complete response (CR) after 2 courses of induction chemotherapy Persistent bone marrow blasts > 40% after 1 course of induction chemotherapy Relapse of disease within 3 months since CR Relapsed AML defined as the following: Any evidence of disease recurrence after CR (early relapse occurs within 3-12 months and late relapse occurs > 12 months later) No acute promyelocytic leukemia (AML-M3 FAB subgroup) PATIENT CHARACTERISTICS: Performance status ECOG 0-2 Life expectancy Not specified Hematopoietic Not specified Hepatic Bilirubin ≤ 2.0 mg/dL AST ≤ 2.5 times upper limit of normal No known chronic liver disease (e.g., chronic active hepatitis or cirrhosis) Renal Creatinine < 2.5 mg/dL (if 2.0-2.5 mg/dL, glomerular filtration rate must be measured and dose of cytarabine adjusted if necessary) Cardiovascular No New York Heart Association grade III-IV heart disease No congestive heart failure No myocardial infarction within the past 6 months Ejection fraction ≥ 30% Other Not pregnant or nursing Negative pregnancy test Fertile patients must use effective barrier contraception during and for 3 months after completion of study treatment No uncontrolled systemic active infection No known HIV infection No history of allergic reaction attributed to compounds of similar chemical or biological composition to study drugs No history of other curatively treated malignancy except nonmelanoma skin cancer PRIOR CONCURRENT THERAPY: Biologic therapy No other concurrent biologic agents Chemotherapy See Disease Characteristics No other concurrent chemotherapy Endocrine therapy No concurrent birth control pills Other More than 1 week since any prior investigational agent No other concurrent investigational agents or therapies No other concurrent anticancer agents No concurrent therapeutic anticoagulation with warfarin Low molecular weight heparin or heparin allowed for therapeutic anticoagulation Mini-dose warfarin (e.g., 1 mg per day) allowed for prophylaxis of central venous catheter thrombosis
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Camille Abboud, MD
Organizational Affiliation
James P. Wilmot Cancer Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
James P. Wilmot Cancer Center at University of Rochester Medical Center
City
Rochester
State/Province
New York
ZIP/Postal Code
14642
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
18571721
Citation
Walker AR, Komrokji RS, Ifthikharuddin J, Messina P, Mulford D, Becker M, Friedberg J, Oliva J, Phillips G, Liesveld JL, Abboud C. Phase I study of cladribine, cytarabine (Ara-C), granulocyte colony stimulating factor (G-CSF) (CLAG Regimen) and simultaneous escalating doses of imatinib mesylate (Gleevec) in relapsed/refractory AML. Leuk Res. 2008 Dec;32(12):1830-6. doi: 10.1016/j.leukres.2008.04.026. Epub 2008 Jun 20.
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Cladribine, Cytarabine, and Imatinib Mesylate in Treating Patients With Refractory or Relapsed Acute Myeloid Leukemia or Blastic Phase Chronic Myelogenous Leukemia

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