Combination Chemotherapy and Interferon Alfa in Treating Patients With Chronic Myelogenous Leukemia
Information source: National Cancer Institute (NCI)
Information obtained from ClinicalTrials.gov on May 11, 2007
Link to the current ClinicalTrials.gov record.
Condition(s) targeted: Leukemia
Intervention: cyclophosphamide (Drug); cytarabine (Drug); etoposide (Drug); methotrexate (Drug); mitoxantrone hydrochloride (Drug); recombinant interferon alfa (Drug); sargramostim (Drug); biological therapy (Procedure); bone marrow ablation with stem cell support (Procedure); chemotherapy (Procedure); colony-stimulating factor therapy (Procedure); cytokine therapy (Procedure); high-dose chemotherapy (Procedure); interferon therapy (Procedure); radiation therapy (Procedure)
Phase: Phase 2
Status: Completed
Sponsored by: Memorial Sloan-Kettering Cancer Center Official(s) and/or principal investigator(s):
Mark Adam Weiss, MD, Study Chair, Affiliation: Memorial Sloan-Kettering Cancer Center
Summary
RATIONALE: Drugs used in chemotherapy use different ways to stop cancer cells from dividing so they stop growing or die. Combining more than one drug may kill more cancer cells. Interferon alfa may interfere with the growth of cancer cells.
PURPOSE: Phase II trial to study the effectiveness of combination chemotherapy and interferon alfa in treating patients with chronic myelogenous leukemia.
Clinical Details
Official title:
A PHASE II STUDY OF MITOXANTRONE AND HIGH-DOSE ARA-C FOLLOWED BY INTENSIVE CONSOLIDATION WITH CYCLOPHOSPHAMIDE AND ETOPOSIDE FOR MYELOID BLAST CRISIS OF CHRONIC MYELOGENOUS LEUKEMIA (CML)
Study design: Interventional, Treatment, Open Label
Detailed description:
OBJECTIVES:
* Determine the effectiveness of induction with high-dose mitoxantrone and cytarabine in patients with chronic myelogenous leukemia (CML) in blast crisis.
* Determine the toxicity and activity of consolidation with high-dose cyclophosphamide and etoposide in these patients.
* Determine the toxicity and activity of maintenance with interferon alfa in these patients.
* Determine the efficacy and tolerability of this regimen in these patients.
* Assess minimal residual disease by cytogenetics, DNA gene rearrangement (Southern blotting), and polymerase chain reaction (PCR) in patients treated with this regimen, and use semiquantitative PCR to evaluate the antileukemic activity of subsequent phases of treatment in patients achieving complete remission.
OUTLINE: Patients are stratified by prior therapy for blast crisis (yes vs no).
* Induction: Patients receive high-dose cytarabine IV over 3 hours on days 1-5 and mitoxantrone IV on day 3. Sargramostim (GM-CSF) is administered subcutaneously (SC) (or IV over 4 hours) daily beginning on day 7 and continuing until blood counts recover. After completion of induction, patients with a suitable HLA-identical bone marrow donor undergo allogeneic bone marrow transplantation according to an appropriate IRB-approved protocol. Patients without a donor proceed to consolidation approximately 4 weeks after hospital discharge following induction.
* Consolidation: Patients receive high-dose cyclophosphamide IV on days 1-4 and etoposide IV continuously on days 5-7. GM-CSF is administered SC (or IV over 4 hours) beginning on day 8 and continuing until blood counts recover. Patients achieving a second chronic phase or complete remission proceed to maintenance approximately 4 weeks after hospital discharge following consolidation.
* Maintenance: Patients receive interferon alfa SC on day 1. Treatment with interferon alfa continues daily in the absence of disease progression or unacceptable toxicity.
Patients with CNS involvement at entry or who develop CNS disease during the study receive CNS therapy as outlined below.
* CNS therapy: Patients undergo whole brain irradiation as soon as possible but not concurrently with mitoxantrone. Patients also receive methotrexate intrathecally 3 times a week until the CSF is clear, weekly for 4 weeks, and then monthly for 6 months.
PROJECTED ACCRUAL: A total of 14-30 patients will be accrued for this study within 4 years.
Eligibility
Minimum age: 16 Years.
Gender(s): Both.
Criteria:
DISEASE CHARACTERISTICS:
* Diagnosis of chronic myelogenous leukemia in blast crisis
- Bone marrow blasts at least 20% OR
- Bone marrow blasts plus promyelocytes at least 50%
* Ineligible for higher priority protocols
PATIENT CHARACTERISTICS:
Age:
* 16 and over
Performance status:
* Not specified
Hematopoietic:
* Not specified
Hepatic:
* Bilirubin less than 2. 0 mg/dL
Renal:
* Creatinine less than 2. 0 mg/dL
Cardiovascular:
* LVEF greater than 50% by MUGA scan or echocardiogram
Other:
* HIV negative
* Not pregnant
* Fertile patients must use effective contraception
PRIOR CONCURRENT THERAPY:
Biologic therapy
* Not specified
Chemotherapy
* Not specified
Endocrine therapy
* Not specified
Radiotherapy
* Not specified
Surgery
* Not specified
Other
* Prior therapy for blast crisis allowed
Locations and Contacts
Memorial Sloan-Kettering Cancer Center, New York, New York 10021, United States
Additional Information
Clinical trial summary from the National Cancer Institute's PDQ® database
Last updated: March 5, 2007
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