NCT00381550 · REGISTRY CONDITION SEARCH

3-AP and Fludarabine in Treating Patients With Myeloproliferative Disorders, Chronic Myelomonocytic Leukemia, or Accelerated Phase or Blastic Phase Chronic Myelogenous Leukemia

Found through the registry condition index, not selected as a treatment recommendation. This discovery collection was restricted to studies with posted results.

Phase: PHASE2
Status at capture: COMPLETED
Registry last update: 2015-01-06

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. 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.

Open the original ClinicalTrials.gov record → · Download preserved record

What did the study report?

Outcomes, safety and baseline populations are separate source sections. Quality-of-life measures appear under their original outcome titles.

flow

Participant flow

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baseline

Baseline characteristics

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outcome · POSTED

Response Rate Including Complete Response, Partial Response, and Hematological Improvement Assessed by Blood Cell Counts, Number of Blasts in Bone Marrow, and Clinical Evaluation

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outcome · POSTED

Incidence of Grade 3 or 4 Drug-related Non-hematologic Toxicity as Assessed by NCI CTCAE v3.0

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adverse events

Adverse events

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more info

Limitations, agreements, and source contact

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Who could take part

eligibility Criteria: Criteria: * Not pregnant or nursing * Histopathologically confirmed diagnosis of 1 of the following: * Myeloproliferative disorders (MPDs) in aggressive phase or transformation * CML in accelerated phase or blast crisis * Chronic myelomonocytic leukemia in aggressive phase (5-19% bone marrow blasts) or transformation (\> 20% bone marrow blasts) * 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) * 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 * ECOG performance status 0-2 * Negative pregnancy test * Fertile patients must use effective contraception * No chronic toxicity from prior chemotherapy \> grade 1 * No history of severe coronary artery disease * 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 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 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 * 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 other concurrent chemotherapy to treat cancer * No concurrent immunotherapy to treat cancer * 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 heart disease * No concurrent myeloid growth factors * No active uncontrolled infection (Infections under active treatment and controlled with antibiotics are allowed) * No chronic hepatitis
healthy Volunteers: false
minimum Age: 18 Years
sex: ALL
std Ages: ADULT
OLDER_ADULT

Treatment arms and interventions

arm Groups

description
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.
intervention Names
Drug: fludarabine phosphate
Drug: triapine
Procedure: laboratory biomarker analysis
label
Arm I
type
EXPERIMENTAL

interventions

arm Group Labels
Arm I
description
Given IV
name
fludarabine phosphate
other Names
2-F-ara-AMP
Beneflur
Fludara
type
DRUG
arm Group Labels
Arm I
description
Given IV
name
triapine
other Names
3-AP
OCX-191
type
DRUG
arm Group Labels
Arm I
description
Correlative study
name
laboratory biomarker analysis
type
PROCEDURE

Study design

allocation

intervention Model

SINGLE_GROUP

masking Info

masking: NONE

primary Purpose

TREATMENT

Enrollment

count: 35
type: ACTUAL

Registered outcome plans (not posted results)

primary Outcomes

description
Bone marrow aspiration and biopsies were performed prior to treatment, during week 3 of the first cycle, at the time of hematologic recovery from all cycles of therapy (defined as neutrophil count \>500/mm3 and platelets \>20,000/mm3 independently of transfusion), or at any time that leukemia regrowth was suspected. The overall response rate was defined as complete remission, partial remission, or hematologic improvement, lasting for ≥30 days. Given the different subsets of diseases, standardized response criteria were used for CMML (the Myelodysplastic Syndrome International Working Group criteria),33 CMML transforming to acute myeloid leukemia (standard AML response criteria) , accelerated MPN (Giles et al.), and transformation of MPN to secondary AML (Mascarenhas et al.).
measure
Response Rate Including Complete Response, Partial Response, and Hematological Improvement Assessed by Blood Cell Counts, Number of Blasts in Bone Marrow, and Clinical Evaluation
time Frame
Up to 4 years
measure
Incidence of Grade 3 or 4 Drug-related Non-hematologic Toxicity as Assessed by NCI CTCAE v3.0
time Frame
Up to 4 years

Full study description

brief Summary: 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. 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.
detailed Description: OBJECTIVES: I. 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. II. Determine the toxicity of this regimen in these patients. III. 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.

Source references

references

citation
Zeidner JF, Karp JE, Blackford AL, Smith BD, Gojo I, Gore SD, Levis MJ, Carraway HE, Greer JM, Ivy SP, Pratz KW, McDevitt MA. A phase II trial of sequential ribonucleotide reductase inhibition in aggressive myeloproliferative neoplasms. Haematologica. 2014 Apr;99(4):672-8. doi: 10.3324/haematol.2013.097246. Epub 2013 Dec 20.
pmid
24362550
type
RESULT

Source notices and limitations

Discovery and provenance

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Preserved source evidence · Not medical advice