Acute Myeloid Leukemia Clinical Trial
MS-275 and GM-CSF in Treating Patients With Myelodysplastic Syndrome and/or Relapsed or Refractory Acute Myeloid Leukemia or Acute Lymphocytic Leukemia
Summary
This phase II trial is studying how well giving MS-275 together with GM-CSF works in treating patients with myelodysplastic syndrome and/or relapsed or refractory acute myeloid leukemia. MS-275 may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth and by blocking blood flow to the cancer. Colony-stimulating factors, such as GM-CSF, may increase the number of immune cells found in bone marrow or peripheral blood. Giving MS-275 together with GM-CSF may be an effective treatment for myelodysplastic syndrome and acute myeloid leukemia
Full Description
PRIMARY OBJECTIVE:
I. Determine clinical response in patients with myelodysplastic syndromes and/or relapsed or refractory acute myeloid leukemia or acute lymphocytic leukemia treated with MS-275 in combination with sargramostim (GM-CSF).
SECONDARY OBJECTIVES:
I. Determine the clinical activity of this regimen, in terms of changes in peripheral blood counts and changes in individual patient transfusion requirements, in these patients.
II. Determine the biologic activity of this regimen, in terms of changes in the peripheral blood and bone marrow phenotype (i.e., induction of markers of myeloid differentiation or lymphoid differentiation) and changes in detectable cytogenetic abnormalities in the blood and marrow compartments, in these patients.
III. Determine the toxicity profile of this regimen in these patients.
OUTLINE:
Patients receive oral MS-275 on days 1, 8, 15, and 22. Patients also receive sargramostim (GM-CSF) subcutaneously once daily on days 1-42 in courses 3 and 5 and on days 1-35 in courses 1, 2, 4, and 6. Treatment repeats every 6 weeks for 2-6 courses in the absence of disease progression or unacceptable toxicity.
After completion of 2 courses of study therapy, patients who achieve a complete or partial response may receive an additional 4 courses. Patients who maintain stable disease for more than 2 months after completion of 6 courses of study therapy may receive an additional 6 courses at the time of disease progression, provided they meet original eligibility criteria.
Patients undergo blood and bone marrow (BM) collection at baseline and periodically during study for biologic correlative studies. Peripheral blood and bone marrow samples are assessed for changes in progenitor phenotype and clonogenic growth by flow cytometry and for changes in cytogenetics (i.e., malignant:nonmalignant cell ratio in BM CD34-positive cells, peripheral blood monocytes, peripheral blood neutrophils, and bone marrow and peripheral blood lymphoblasts) by FISH. Terminal differentiation of CD34-positive progenitor cells is studied in vitro in long-term cultures.
After completion of study therapy, patients are followed periodically for up to 2 years.
Eligibility Criteria
Inclusion Criteria:
Diagnosis of 1 of the following diseases by bone marrow aspiration and/or biopsy:
Myelodysplastic syndromes (MDS) meeting the following criteria:
Must have 1 of the following subtypes:
Refractory anemia (RA) (no RA with 5q-syndrome),
RA with ringed sideroblasts or
Refractory cytopenia with multilineage dysplasia
Myelodysplastic syndromes (MDS) meeting the following criteria:
Must have 1 of the following subtypes:
Refractory cytopenia with multilineage dysplasia and ringed sideroblasts,
RA with excess blasts (RAEB)-1, RAEB-2,
Myelodysplastic syndromes, unclassified or
Chronic myelomonocytic leukemia
International Prognostic Scoring System score of intermediate-2 or high-risk
Acute myeloid leukemia (AML) meeting 1 of the following criteria:
Relapsed or refractory AML, including any of the following subtypes:
* AML with recurrent cytogenetic abnormalities (i.e., AML with 11q23 [MLL] abnormalities)
AML with multilineage dysplasia
AML that is therapy-related
AML, not otherwise categorized (M0 [minimally differentiated], M1 [without maturation], M2 [with maturation], M4 [myelomonocytic leukemia], M5 [monoblastic/monocytic leukemia], M6 [erythroid leukemia], and M7 [megakaryoblastic leukemia])
Untreated AML
Newly diagnosed patients are eligible provided they do not qualify for potentially curative intensive chemotherapeutic regimens
Acute lymphocytic leukemia (ALL) meeting 1 of the following criteria:
Relapsed or refractory ALL
Patients with any measurable residual disease are eligible, including cytogenetic abnormalities
Untreated ALL
Newly diagnosed patients are eligible provided they do not qualify for potentially curative intensive chemotherapeutic regimens, including any of the following:
Patients who have refused chemotherapy for untreated ALL
Patients who are deemed to be poor candidates medically for ALL induction chemotherapy
Relatively stable bone marrow function for > 7 days prior to study entry
WBC count that has not doubled within the past 7 days
WBC =<10,000/mm³
No uncontrolled peripheral leukemia (i.e., blast count > 30,000/mm³)
No active CNS disease
Lumbar puncture with negative cytology required for patients with clinical symptoms of active CNS disease
Not a candidate for a potentially curative allogeneic stem cell transplantation OR considered a poor candidate for such a procedure due to age, medical comorbidities, or lack of a suitable donor
Hemoglobin >= 8 g/dL (transfusions allowed)
Creatinine =< 2.0 mg/dL
Bilirubin =< 1.6 mg/dL (unless secondary to hemolysis)
AST or ALT =< 3 times upper limit of normal (unless disease-related)
Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective contraception
No untreated or progressive infections
No history of intolerance to sargramostim (GM-CSF)
Recovered from all treatment-related toxicities
More than 2 weeks since prior therapy for AML, ALL, or MDS, including chemotherapy, hematopoietic growth factors, or biologic therapy such as monoclonal antibodies
Concurrent hydroxyurea allowed during course 1 for control of leukocytosis if WBC > 30,000/mm³
ECOG performance status 0-2
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There is 1 Location for this study
Baltimore Maryland, 21287, United States
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