Acute Myeloid Leukemia Clinical Trial
Bexarotene and GM-CSF in Treating Patients With Myelodysplastic Syndrome or Acute Myeloid Leukemia
Summary
RATIONALE: Bexarotene may help cancer or abnormal cells become more like normal cells, and to grow and spread more slowly. Colony-stimulating factors, such as GM-CSF, may increase the number of immune cells found in bone marrow or peripheral blood. Giving bexarotene together with GM-CSF may be an effective treatment for myelodysplastic syndrome (MDS) or acute myeloid leukemia.
PURPOSE: This phase II trial is studying how well giving bexarotene together with GM-CSF works in treating patients with MDS or acute myeloid leukemia.
Full Description
OBJECTIVES:
Primary
Assess the clinical response in patients with myelodysplastic syndromes or acute myeloid leukemia treated with bexarotene and sargramostim (GM-CSF).
Secondary
Determine the clinical activity of this regimen, in terms of transfusion requirements, in these patients.
Determine the biological activity of this regimen, in terms of biological markers and cytogenetic abnormalities, in these patients.
Assess the toxicity profile of this regimen in these patients.
OUTLINE: Patients receive oral bexarotene and sargramostim (GM-CSF) subcutaneously on days 1-28. Treatment repeats every 28 days for up to 6 courses in the absence of disease progression or unacceptable toxicity.
Blood and bone marrow samples are collected at baseline and after 1 or 2 courses of study therapy. Samples are examined by flow cytometry for laboratory studies, including biological markers, and by fluorescent in situ hybridization (FISH) for cytogenetic changes.
After completion of study treatment, patients are followed periodically for 6 months.
PROJECTED ACCRUAL: A total of 18 patients will be accrued for this study.
Eligibility Criteria
DISEASE CHARACTERISTICS:
Diagnosis (confirmed by bone marrow aspirate and/or biopsy) of 1 of the following:
Myelodysplastic syndromes of 1 of the following cell types:
Refractory anemia (RA) with ringed sideroblasts
Refractory cytopenia with multilineage dysplasia (RCMD)
RCMD and ringed sideroblasts
RA with excess blasts-1
RA with excess blasts-2
Myelodysplastic syndromes, unclassified
Chronic myelomonocytic leukemia
Relapsed or refractory acute myeloid leukemia (AML), meeting 1 of the following criteria:
Recurrent genetic abnormalities (11q23 [MLL] abnormalities)
Multilineage dysplasia
Therapy-related AML
Not otherwise categorized, including any of the following:
M0 minimally differentiated
M1 without maturation
M2 with maturation
M4 myelomonocytic leukemia
M5 monoblastic/monocytic leukemia
M6 erythroid leukemia
M7 megakaryoblastic leukemia
Newly diagnosed untreated AML allowed provided patient does not qualify for or refused potentially curative intensive chemotherapeutic regimens
No RA with 5q-syndrome
No peripheral leukemia with blast count > 30,000/mm³ (uncontrolled with hydroxyurea)
Relatively stable bone marrow function for > 7 days (i.e., no WBC doubling to > 10,000/mm^3)
No acute promyelocytic leukemia
No clinical symptoms of active CNS disease (if CNS disease is suspected, patient must have lumbar puncture with negative cytology)
PATIENT CHARACTERISTICS:
ECOG performance status 0-2
Creatinine ≤ 2.0 mg/dL
Bilirubin ≤ 1.6 mg/dL (unless secondary to hemolysis)
AST and ALT ≤ 4 times upper limit of normal (unless disease related)
Hemoglobin ≥ 8 g/dL (transfusions allowed)
Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective barrier contraception
No untreated positive blood cultures or progressive infection as assessed by radiographic studies
No history of intolerance to sargramostim (GM-CSF)
PRIOR CONCURRENT THERAPY:
Recovered from prior therapy
At least 2 weeks since prior treatment for myeloid disorder, including any of the following:
Chemotherapy
Hematopoietic growth factors
Biologic therapy (e.g., monoclonal antibodies)
Hydroxyurea for patients with WBC > 10,000/mm^3 allowed
No concurrent vitamin A supplementation
No concurrent gemfibrozil
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There is 1 Location for this study
Baltimore Maryland, 21231, United States
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