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Phase I Study of a Pharmacologically Derived Hybrid Bolus-Infusion Schedule of Flavopiridol (NSC 649890, IND 46,211) Given in Timed Sequential Combination With Cytosine Arabinoside (Ara-C) and Mitoxantrone for Adults With Relapsed and Refractory Acute Leukemias


Phase 1
18 Years
N/A
Not Enrolling
Both
Adult Acute Megakaryoblastic Leukemia (M7), Adult Acute Minimally Differentiated Myeloid Leukemia (M0), Adult Acute Monoblastic Leukemia (M5a), Adult Acute Monocytic Leukemia (M5b), Adult Acute Myeloblastic Leukemia With Maturation (M2), Adult Acute Myeloblastic Leukemia Without Maturation (M1), Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities, Adult Acute Myeloid Leukemia With Inv(16)(p13;q22), Adult Acute Myeloid Leukemia With t(16;16)(p13;q22), Adult Acute Myeloid Leukemia With t(8;21)(q22;q22), Adult Acute Myelomonocytic Leukemia (M4), Adult Erythroleukemia (M6a), Adult Pure Erythroid Leukemia (M6b), Malignant Neoplasm, Recurrent Adult Acute Lymphoblastic Leukemia, Recurrent Adult Acute Myeloid Leukemia

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Trial Information

Phase I Study of a Pharmacologically Derived Hybrid Bolus-Infusion Schedule of Flavopiridol (NSC 649890, IND 46,211) Given in Timed Sequential Combination With Cytosine Arabinoside (Ara-C) and Mitoxantrone for Adults With Relapsed and Refractory Acute Leukemias


OBJECTIVES:

I. Determine the toxicities of escalating doses of flavopiridol administered by "hybrid"
bolus-infusion schedule and given in timed sequence with cytarabine and mitoxantrone
hydrochloride in patients with refractory or relapsed acute leukemia.

II. Determine the incidence of clinical response in patients treated with this regimen.

OUTLINE: This is a dose-escalation study of flavopiridol. Patients receive flavopiridol IV
over 30 minutes on days 1, 2, and 3.

Patients receive cytarabine IV continuously over 72 hours beginning on day 6 and
mitoxantrone hydrochloride IV over 60-120 minutes on day 9. Treatment repeats every 35-63
days for up to 2 courses in the absence of disease progression or unacceptable toxicity.

Cohorts of 3-6 patients receive escalating doses of flavopiridol until the maximum tolerated
dose (MTD) is determined. The MTD is defined as the dose preceding that at which 1 of 3 or 2
of 6 patients experience dose-limiting toxicity.

Serum and bone marrow samples are collected at baseline, during, and after completion of
treatment for future studies. Flavopiridol levels are measured at baseline and on days 1-3
for pharmacokinetics.


Inclusion Criteria:



- Pathologically confirmed acute myeloid leukemia or acute lymphoblastic leukemia:

- Relapsed >= 1 time OR refractory disease:

- Patients who fail primary induction therapy or who relapse after achieving
complete remission are eligible if they have received =< 3 prior courses of
induction/reinduction therapy

- Relapsed >= 1 time OR refractory disease

- Patients who fail primary induction therapy or who relapse after achieving complete
remission are eligible if they have received =< 3 prior courses of
induction/reinduction therapy

- No active CNS leukemia

- ECOG performance status 0-2

- AST and ALT =< 5 times upper limit normal (ULN)

- Alkaline phosphatase =< 5 times ULN

- Bilirubin =< 2.0 mg/dL

- Creatinine =< 2.0 mg/dL

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception

- LVEF >= 45% by MUGA or ECHO

- No active, uncontrolled infection

- No other life-threatening illness

- No mental deficits and/or psychiatric history that would preclude study compliance

- No active graft-vs-host disease

- Recovered from all prior therapies

- At least 24 hours since prior hydroxyurea, steroids, imatinib mesylate, arsenic
trioxide, interferon, or leukapheresis for blast count control

- At least 4 weeks since prior stem cell transplantation (autologous or allogeneic)

- At least 4 days since prior growth factors

- At least 3 weeks since prior chemotherapy, except for non-aplasia producing
treatments (e.g., low-dose cyclophosphamide, hydroxyurea, interferon, imatinib
mesylate, mercaptopurine, thalidomide, azacitidine, or decitabine)

- No prior flavopiridol

- No other concurrent chemotherapy, radiotherapy, or immunotherapy

- No acute promyelocytic leukemia (M3)

- No hyperleukocytosis with > 50,000 blasts/mm^3

Type of Study:

Interventional

Study Design:

Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Maximum tolerated dose determined by dose-limiting toxicities graded according to NCI-CTC version 3.0

Outcome Time Frame:

Up to 63 days

Safety Issue:

Yes

Principal Investigator

Judith Karp

Investigator Role:

Principal Investigator

Investigator Affiliation:

Johns Hopkins University

Authority:

United States: Food and Drug Administration

Study ID:

NCI-2009-00243

NCT ID:

NCT00470197

Start Date:

April 2007

Completion Date:

Related Keywords:

  • Adult Acute Megakaryoblastic Leukemia (M7)
  • Adult Acute Minimally Differentiated Myeloid Leukemia (M0)
  • Adult Acute Monoblastic Leukemia (M5a)
  • Adult Acute Monocytic Leukemia (M5b)
  • Adult Acute Myeloblastic Leukemia With Maturation (M2)
  • Adult Acute Myeloblastic Leukemia Without Maturation (M1)
  • Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities
  • Adult Acute Myeloid Leukemia With Inv(16)(p13;q22)
  • Adult Acute Myeloid Leukemia With t(16;16)(p13;q22)
  • Adult Acute Myeloid Leukemia With t(8;21)(q22;q22)
  • Adult Acute Myelomonocytic Leukemia (M4)
  • Adult Erythroleukemia (M6a)
  • Adult Pure Erythroid Leukemia (M6b)
  • Malignant Neoplasm
  • Recurrent Adult Acute Lymphoblastic Leukemia
  • Recurrent Adult Acute Myeloid Leukemia
  • Congenital Abnormalities
  • Neoplasms
  • Leukemia
  • Leukemia, Erythroblastic, Acute
  • Leukemia, Lymphoid
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma
  • Leukemia, Megakaryoblastic, Acute
  • Leukemia, Monocytic, Acute
  • Leukemia, Myeloid, Acute
  • Leukemia, Myeloid
  • Leukemia, Myelomonocytic, Acute
  • Leukemia, Myelomonocytic, Chronic

Name

Location

Johns Hopkins University Baltimore, Maryland  21205
University of Wisconsin Hospital and Clinics Madison, Wisconsin  53792-0001