Treatment of Acute Promyelocytic Leukemia (APL) With All-Trans Retinoic Acid, and Arsenic +/- Gemtuzumab
All-trans retinoic acid (ATRA) and ATO are designed to cause the APL cells to mature and
function normally. Idarubicin is designed to cause breaks in both strands of DNA (the
genetic material of cells).
If you are found to be eligible to take part in this study, you will begin induction.
During induction, you will receive ATRA, by mouth starting on Day 1. You will also receive
ATO through a needle in your vein over 2 hours starting on Day 1. You will continue
receiving the drugs every day until your bone marrow no longer shows APL cells.
If you had a high white blood cell count at screening, you will receive idarubicin through a
needle in your vein over about 30 minutes one dose only on any day of Day 1 through 5.
During induction, blood (about 1-3 tablespoons) will be drawn every day during Week 1, and
then 2 times a week after that. This blood will be drawn for routine tests.
During induction (about 21-28 days after beginning treatment), you will have a bone marrow
aspirate to check the status of the disease. This may be performed more often if the doctor
thinks it is needed.
If you achieve a complete remission during the induction phase, you will continue to the
maintenance phase. During the maintenance phase, you will receive ATO by vein over 2 hours
Monday-Friday for 4 weeks. After the 4 weeks of receiving the study drug, you will have a
4-week period "off" (when no study drug is given). ATRA is given by mouth every day for 2
weeks. This 2 weeks is followed by 2 additional weeks when no study drug will be given.
You will continue to take ATRA until treatment with ATO is complete.
During maintenance, blood (about 1-3 tablespoons) will be drawn before every 4-week cycle of
ATO, and then every week for routine tests. You will also have an ECG before every 4 week
cycle when you take ATO.
If you do not achieve a complete remission during induction you will be taken off study.
If at any point during the study your white blood cell count rises above 10,000, you will
receive idarubicin by vein over 30 minutes.
You will remain in the hospital for about the first 7 days of induction. After that, you
must remain in Houston for the next 3-4 weeks. Once in the maintenance phase, you may be
treated at home, but must return to M. D. Anderson for study visits.
After maintenance is complete, you will have follow-up visits for an additional 2 years. If
at any time during the active study or follow-up the disease gets worse or intolerable side
effects occur, you will be taken off the study.
If you had a low or high white blood cell count when you joined the study, you will have
follow-up visits every 3 months for 2 years. At these visits, blood (about 1 tablespoon)
will be drawn for routine tests and you will have a bone marrow aspirate.
This is an investigational study. Idarubicin, ATRA and ATO are FDA approved and
commercially available. However, their use in this study and in this combination is
considered investigational. Its use in APL patients is investigational. Up to 80 patients
will take part in this multicenter study. All will be enrolled at M. D. Anderson.
Allocation: Non-Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Complete Response (CR) Rate
Daily during 7 days of induction, then 2 times weekly
Farhad Ravandi-Kashani, MD
M.D. Anderson Cancer Center
United States: Institutional Review Board
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