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3-AP and Fludarabine in Treating Patients With Myeloproliferative Disorders, Chronic Myelomonocytic Leukemia, or Accelerated Phase or Blastic Phase Chronic Myelogenous Leukemia
This study has been completed.

First Received on September 26, 2006.   Last Updated on August 5, 2011   History of Changes
Sponsor: Sidney Kimmel Comprehensive Cancer Center
Collaborator: National Cancer Institute (NCI)
Information provided by: Sidney Kimmel Comprehensive Cancer Center
ClinicalTrials.gov Identifier: NCT00381550
  Purpose

RATIONALE: Drugs used in chemotherapy, such as 3-AP and fludarabine, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. 3-AP may help fludarabine work better by making cancer cells more sensitive to the drug. 3-AP and fludarabine may also stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Giving 3-AP together with fludarabine may kill more cancer cells.

PURPOSE: This phase II trial is studying how well giving 3-AP together with fludarabine works in treating patients with myeloproliferative disorders (MPD), chronic myelomonocytic leukemia (CMML), or accelerated phase or blastic phase chronic myelogenous leukemia.


Condition Intervention Phase
Chronic Myeloproliferative Disorders
Leukemia
Drug: fludarabine phosphate
Drug: triapine
Genetic: cytogenetic analysis
Genetic: gene expression analysis
Genetic: mutation analysis
Other: laboratory biomarker analysis
Procedure: biopsy
Phase II

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Phase II Trial of Triapine Plus Fludarabine in Adults With Aggressive Myeloproliferative Disorders (MPDs) Including Chronic Myelomonocytic Leukemia (CMML) and Chronic Myelogenous Leukemia in Accelerated Phase (CML-AP) or Blast Crisis (CML-BC)

Resource links provided by NLM:


Further study details as provided by Sidney Kimmel Comprehensive Cancer Center:

Primary Outcome Measures:
  • Efficacy of treatment, in terms of response (complete response, partial response, and hematological improvement) [ Time Frame: 1 year ] [ Designated as safety issue: No ]
  • Toxicity as assessed by NCI CTCAE v3.0 [ Time Frame: 1 year ] [ Designated as safety issue: Yes ]
  • Effect of treatment on circulating leukemic cell genetics [ Time Frame: 1 year ] [ Designated as safety issue: No ]

Enrollment: 37
Study Start Date: August 2006
Study Completion Date: July 2010
Primary Completion Date: July 2010 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Arm A
triapine, fludarabine
Drug: fludarabine phosphate
fludarabine d 1-5
Other Name: fludara
Drug: triapine
triapine d 1-5
Other Name: triapine
Genetic: cytogenetic analysis
bone marrow testing
Genetic: gene expression analysis
bone marrow testing
Genetic: mutation analysis
bone marrow testing
Other: laboratory biomarker analysis
bone marrow testing
Procedure: biopsy
bone marrow testing

Detailed Description:

OBJECTIVES:

  • Determine the efficacy of 3-AP (Triapine®) followed by fludarabine phosphate in patients with myeloproliferative disorders or chronic myelomonocytic leukemia in aggressive phase or transformation or chronic myelogenous leukemia in accelerated phase or blast crisis.
  • Determine the toxicity of this regimen in these patients.
  • Determine, preliminarily, the effect of this regimen on circulating leukemic cell genetics in these patients.

OUTLINE: This is an open-label study.

Patients receive 3-AP (Triapine®) IV over 4 hours followed by fludarabine phosphate IV over 30 minutes on days 1-5. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.

Patients undergo bone marrow and/or peripheral blood collection at baseline and periodically during study treatment for molecular analysis of Janus kinase 2 (JAK2) mutations, GATA-1 mutations, and expression of the death-inducer-obliterator (Dido) genes on chromosome 20q.

After completion of study treatment, patients are followed periodically.

PROJECTED ACCRUAL: A total of 42 patients will be accrued for this study.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Histopathologically confirmed diagnosis of 1 of the following:

    • Myeloproliferative disorders (MPDs) in aggressive phase or transformation, including the following:

      • Polycythemia vera (PV)
      • Essential thrombocythemia (ET)
      • Myelofibrosis with myeloid metaplasia
      • Hypereosinophilic syndrome
      • Atypical (Philadelphia chromosome negative) chronic myelogenous leukemia (Ph- CML)
    • CML in accelerated phase or blast crisis
    • Chronic myelomonocytic leukemia in aggressive phase (5-19% bone marrow blasts) or transformation (> 20% bone marrow blasts)
  • Patients with aggressive phase MPD (PV, ET, or Ph- CML) must meet ≥ 1 of the following criteria:

    • Marrow blasts > 5%
    • Peripheral blood blasts plus progranulocytes > 10%
    • New onset or increasing myelofibrosis
    • New onset or > 25% increase in hepatomegaly or splenomegaly
    • New onset constitutional symptoms (fever, weight loss, splenic pain, bone pain)
  • Multilineage bone marrow failure
  • Ineligible for established curative regimens, including stem cell transplantation

PATIENT CHARACTERISTICS:

  • ECOG performance status 0-2
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception
  • Creatinine normal OR creatinine clearance ≥ 60 mL/min
  • AST and ALT ≤ 2.5 times normal
  • Bilirubin ≤ 2.0 mg/dL unless due to leukemia, Gilbert's syndrome, or hemolysis
  • No chronic toxicity from prior chemotherapy > grade 1
  • No active heart disease
  • No myocardial infarction within the past 3 months
  • No history of severe coronary artery disease
  • No arrhythmias (other than atrial flutter or fibrillation) requiring medication
  • No uncontrolled congestive heart failure
  • No dyspnea at rest or with minimal exertion
  • No severe pulmonary disease requiring supplemental oxygen
  • No known glucose-6-phosphate dehydrogenase (G6PD) deficiency

    • G6PD screening required for high-risk groups (i.e., patients of African, Asian, or Mediterranean origin/ancestry)
  • No active uncontrolled infection

    • Infections under active treatment and controlled with antibiotics are allowed
  • No chronic hepatitis
  • No history of allergic reactions attributed to compounds of similar chemical or biological composition to 3-AP (Triapine®) and/or fludarabine phosphate
  • No other life-threatening illness
  • No history of mental deficits and/or psychiatric illness that would preclude study compliance

PRIOR CONCURRENT THERAPY:

  • No more than 4 prior induction regimens (3 cytotoxic chemotherapy regimens)
  • At least 3 weeks since prior myelosuppressive cytotoxic agents (6 weeks for mitomycin C or nitrosoureas) and recovered
  • At least 1 week since prior nonmyelosuppressive treatment
  • At least 48 hours since prior noncytotoxic agents for peripheral blood leukemic cell count control, including but not limited to the following:

    • Hydroxyurea
    • Imatinib mesylate
    • Interferon
    • Mercaptopurine
    • Cyclophosphamide
  • At least 2 weeks since prior and no concurrent radiotherapy to treat cancer
  • At least 1 week since prior biologic therapy, including hematopoietic growth factors (e.g., epoetin alfa, darbepoetin alfa, filgrastim [G-CSF], sargramostim [GM-CSF], interleukin-3, or interleukin-11)
  • No concurrent myeloid growth factors
  • No other concurrent chemotherapy to treat cancer
  • No concurrent immunotherapy to treat cancer
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00381550

Locations
United States, Maryland
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Baltimore, Maryland, United States, 21231-2410
Sponsors and Collaborators
Sidney Kimmel Comprehensive Cancer Center
Investigators
Study Chair: Judith E. Karp, MD Sidney Kimmel Comprehensive Cancer Center
  More Information

Additional Information:
No publications provided

Responsible Party: Judith E. Karp, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
ClinicalTrials.gov Identifier: NCT00381550     History of Changes
Other Study ID Numbers: J0638 CDR0000499828, U01CA070095, P30CA006973, JHOC-J0638, NCI-7704
Study First Received: September 26, 2006
Last Updated: August 5, 2011
Health Authority: United States: Food and Drug Administration

Keywords provided by Sidney Kimmel Comprehensive Cancer Center:
polycythemia vera
essential thrombocythemia
accelerated phase chronic myelogenous leukemia
blastic phase chronic myelogenous leukemia
Philadelphia chromosome negative chronic myelogenous leukemia
chronic myelomonocytic leukemia
relapsing chronic myelogenous leukemia
chronic idiopathic myelofibrosis
atypical chronic myeloid leukemia
chronic eosinophilic leukemia

Additional relevant MeSH terms:
Blast Crisis
Leukemia
Leukemia, Myeloid
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Leukemia, Myelomonocytic, Chronic
Leukemia, Myelomonocytic, Acute
Myeloproliferative Disorders
Neoplasms by Histologic Type
Neoplasms
Cell Transformation, Neoplastic
Neoplastic Processes
Bone Marrow Diseases
Hematologic Diseases
Pathologic Processes
Myelodysplastic-Myeloproliferative Diseases
Fludarabine monophosphate
Vidarabine
Fludarabine
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Pharmacologic Actions
Antimetabolites, Antineoplastic
Antimetabolites
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Therapeutic Uses
Antiviral Agents
Anti-Infective Agents

ClinicalTrials.gov processed this record on February 09, 2012