Azacitidine in Treating Patients With Myelofibrosis

• Overall Survival (OS) [ Time Frame: From date of registration until death or 3 years after registration if patient is still alive ] [ Designated as safety issue: No ]
  OS was defined as the time from registration to death due to any cause or time from registration to 3 years after registration if patient is still alive.
• Time to Progression [ Time Frame: up to 3 years ] [ Designated as safety issue: No ]
  Time to progression was defined as the time from registration to progression of disease. Those who die without documentation of disease progression will be considered to have had disease progression at the time of their death unless documented evidence clearly indicates no progression has occured.
• Number of Participants With Treatment Related Adverse Events [ Time Frame: Every 4 weeks during treatment ] [ Designated as safety issue: Yes ]

  Adverse events (AE) that are classified as either possibly, probably, or definitely related to study treatment according to the National Cancer Institute Common Toxicity Criteria for Adverse Events (NCI CTCAE version 3.0). The maximum grade for each type of AE will be recorded for each patient. Grade refers to the severity of the AE.

  Grade 1: Mild AE, Grade 2: Moderate AE, Grade 3: Severe AE, Grade 4: Life-threatening or disabling AE, Grade 5: Death related AE

RATIONALE: Drugs used in chemotherapy, such as azacitidine, work in different ways to stop the growth of abnormal cells, either by killing the cells or by stopping them from dividing.

PURPOSE: This phase II trial is studying how well azacitidine works in treating patients with myelofibrosis.

OBJECTIVES:

Primary

• Determine the efficacy of azacitidine in patients with myelofibrosis (MF) with myeloid metaplasia.
• Evaluate the safety of azacitidine in these patients. Secondary
• Evaluate pertinent biologic characteristics of MF before and during therapy with azacitidine.
• Assess the effects of study treatment on constitutional symptoms in these patients.
• Estimate time to event distributions for overall survival and progression. OUTLINE: Patients receive azacitidine subcutaneously once daily on days 1-5. Treatment repeats every 4 weeks for up to 12 courses in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed periodically for up to 3 years.

PROJECTED ACCRUAL: A total of 35 patients will be accrued for this study.

• Chronic Myeloproliferative Disorders
• Secondary Myelofibrosis

DISEASE CHARACTERISTICS:

• Histologically confirmed myelofibrosis with myeloid metaplasia (MMM), including any of the following subtypes:

  • Agnogenic myeloid metaplasia
  • Post-polycythemic myeloid metaplasia
  • Post-thrombocythemic myeloid metaplasia

• Evaluable and symptomatic disease, defined as 1 of the following:

  • Anemia (hemoglobin < 10 g/dL or erythrocyte transfusion-dependent, requiring 1 transfusion ≤ 8 weeks)
  • Treatment required* for symptomatic palpable splenomegaly (palpable hepatomegaly is acceptable if previously splenectomized) NOTE: *Subjective but painful enough to mandate intervention

• Absence of t(9;22) by fluorescent in situ hybridization (FISH) or standard cytogenetics (by peripheral blood or marrow)

  - Previous demonstration of a lack of this translocation (at any point) is sufficient

• No advanced malignant hepatic tumors

PATIENT CHARACTERISTICS:

• ECOG performance status 0-2
• Absolute neutrophil count ≥ 1,000/mm³
• Platelet count ≥ 50,000/mm³
• Creatinine ≤ 2.0 mg/dL
• Total bilirubin ≤ 2.0 mg/dL OR direct bilirubin ≤ 2.0 mg/dL if total bilirubin elevated (unless attributed to underlying disease)
• AST and ALT ≤ 2 times upper limit of normal (unless clinically attributed to hepatic extramedullary hematopoiesis)
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception
• No baseline peripheral or autonomic neuropathy ≥ grade 2
• No condition, including the presence of laboratory abnormalities, that would preclude study compliance
• No hypersensitivity to mannitol or azacitidine
• Not incarcerated in a municipality (i.e., county, state, or federal prison)

PRIOR CONCURRENT THERAPY:

• At least 14 days since prior chemotherapy, including interferon alfa, anagrelide, or other myelosuppressive agents
• At least 14 days since prior systemic corticosteroids
• At least 14 days since prior investigational agents