17-N-Allylamino-17-Demethoxygeldanamycin and Cytarabine in Treating Patients With Relapsed or Refractory Acute Myeloid Leukemia, Acute Lymphoblastic Leukemia, Chronic Myelogenous Leukemia, Chronic Myelomonocytic Leukemia, or Myelodysplastic Syndromes
- user warning: Table './intheclinic/cache_filter' is marked as crashed and should be repaired query: SELECT data, created, headers, expire, serialized FROM cache_filter WHERE cid = '1:e68e768f1cf78504f89efcc3de2dbd27' in /persistent/html/includes/cache.inc on line 26.
- user warning: Table './intheclinic/cache_filter' is marked as crashed and should be repaired query: UPDATE cache_filter SET data = '<p>RATIONALE: Drugs used in chemotherapy, such as 17-N-allylamino-17-demethoxygeldanamycin and cytarabine, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. 17-N-allylamino-17-demethoxygeldanamycin may also help cytarabine kill more cancer cells by making cancer cells more sensitive to the drug. Giving 17-N-allylamino-17-demethoxygeldanamycin together with cytarabine may kill more cancer cells. PURPOSE: This phase I trial is studying the side effects and best dose of 17-N-allylamino-17-demethoxygeldanamycin when given with cytarabine in treating patients with relapsed or refractory acute myeloid leukemia, acute lymphoblastic leukemia, chronic myelogenous leukemia, chronic myelomonocytic leukemia, or myelodysplastic syndromes.</p>\n', created = 1283572104, expire = 1283658504, headers = '', serialized = 0 WHERE cid = '1:e68e768f1cf78504f89efcc3de2dbd27' in /persistent/html/includes/cache.inc on line 109.
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- user warning: Table './intheclinic/cache_filter' is marked as crashed and should be repaired query: UPDATE cache_filter SET data = '<p>A Phase I And Pharmacological Trial Of 17-Allylamino -17-Demethoxygeldanamycin (17-AAG) And Cytarabine In Refractory Leukemia And Myelodysplastic Syndrome</p>\n', created = 1283572104, expire = 1283658504, headers = '', serialized = 0 WHERE cid = '1:4ff6c517382353afc2f6da8806b85a68' in /persistent/html/includes/cache.inc on line 109.
- user warning: Table './intheclinic/cache_filter' is marked as crashed and should be repaired query: SELECT data, created, headers, expire, serialized FROM cache_filter WHERE cid = '1:ae9943969a1916ae0c27d6dec4b2e349' in /persistent/html/includes/cache.inc on line 26.
- user warning: Table './intheclinic/cache_filter' is marked as crashed and should be repaired query: UPDATE cache_filter SET data = '<p>OBJECTIVES:\n<ul>\n<li>Determine the maximum tolerated dose of 17-N-allylamino-17-demethoxygeldanamycin (17-AAG) when administered with cytarabine in patients with relapsed or refractory acute myeloid leukemia, acute lymphoblastic leukemia, chronic myelogenous leukemia, chronic myelomonocytic leukemia, or high-grade myelodysplastic syndromes.</li>\n<li>Determine the toxic effects of this regimen in these patients.</li>\n<li>Determine, preliminarily, the activity of this regimen in these patients.</li>\n<li>Correlate the pharmacokinetics of this regimen with cytochrome p450 3A5 genotype in these patients.</li>\n<li>Determine the effect of this regimen on client proteins in vivo and ex vivo using leukemic blasts from patients treated with this regimen.</li>\n</ul>\n</p><p> OUTLINE: This is a multicenter, dose-escalation study of 17-N-allylamino-17-demethoxygeldanamycin (17-AAG). Patients receive induction therapy comprising cytarabine IV continuously on days 1-5 and 17-AAG IV over 1 hour on days 3 and 6. Patients achieving a morphologic complete response with incomplete blood count recovery (CRi) or partial response may be eligible to receive a second induction course of therapy after day 21 at the discretion of the principal investigator. Patients achieving a complete response (CR) receive up to 4 courses of consolidation therapy with cytarabine and 17-AAG. Consolidation therapy repeats approximately every 60 days in the absence of disease progression or unacceptable toxicity. Patients who achieve CR and remain in remission for ≥ 6 months may be retreated with cytarabine and 17-AAG (at the current dose level or the maximum tolerated dose [MTD]) at the time of relapse. Cohorts of 3-6 patients receive escalating doses of 17-AAG until the MTD is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. Patients are followed at 3 months. PROJECTED ACCRUAL: A total of 3-42 patients will be accrued for this study within 2.1 years.</p>\n', created = 1283572104, expire = 1283658504, headers = '', serialized = 0 WHERE cid = '1:ae9943969a1916ae0c27d6dec4b2e349' in /persistent/html/includes/cache.inc on line 109.
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- user warning: Table './intheclinic/cache_filter' is marked as crashed and should be repaired query: UPDATE cache_filter SET data = '<p>DISEASE CHARACTERISTICS:\n<ul>\n<li>Diagnosis of 1 of the following:\n<ul>\n<li>Acute myeloid leukemia, except acute promyelocytic leukemia (M3 disease), meeting 1 of the following criteria:\n<ul>\n<li>Failed to achieve complete remission (CR) after initial induction therapy regimen* NOTE: *Patients receiving 7+3 as induction chemotherapy may be eligible provided the day 14 bone marrow shows a blast index > 0.25 times the initial baseline value. Patients not meeting this criteria may be re-treated with 5+2 re-induction therapy at the discretion of the treating physician</li>\n<li>First relapse within 1 year of initial CR</li>\n<li>Failed re-induction therapy at first or second relapse</li>\n<li>Second or third relapse after completing ≤ 3 different induction therapy regimens</li>\n<li>Antecedent hematologic disorder (myelodysplastic syndromes [MDS], chronic myeloproliferative disease, or chronic myelomonocytic leukemia [CMML])</li>\n<li>Received prior chemotherapy for a non-hematologic malignancy</li>\n<li>High-risk cytogenetic abnormalities (abnormalities of chromosome 5, 7, 8, or 11 OR ≥ 3 karyotypic abnormalities)</li>\n</ul>\n</li>\n<li>Acute lymphoblastic leukemia, meeting 1 of the following criteria:\n<ul>\n<li>Failed to achieve CR after initial induction therapy regimen</li>\n<li>First relapse within 1 year of initial CR</li>\n<li>Failed re-induction therapy at first or second relapse</li>\n<li>Second or third relapse after completing ≤ 3 different induction therapy regimens</li>\n</ul>\n</li>\n<li>Chronic myelogenous leukemia, meeting the following criteria:\n<ul>\n<li>Accelerated OR blast phase (> 10% increase in the blast percentage in bone marrow)</li>\n<li>Failed prior imatinib mesylate\n<ul>\n<li>No more than 1 prior chemotherapy regimen in addition to imatinib mesylate</li>\n</ul>\n</li>\n</ul>\n</li>\n<li>CMML, meeting the following criteria:\n<ul>\n<li>More than 10% increase in blast percentage AND organ infiltration OR impending marrow failure as evidenced by cytopenia</li>\n<li>No t(5;12) by cytogenetics (unless failed prior trial of imatinib mesylate)</li>\n</ul>\n</li>\n<li>High-grade MDS, defined as > 10% blasts on marrow cellularity (refractory anemia with excess blasts in transformation) OR International Prognostic Scoring System MDS prognostic score > 1.5</li>\n</ul>\n</li>\n<li>Not a candidate for allogenic bone marrow transplantation* from a related sibling donor (i.e., HLA-identical sibling) NOTE: *Patients with prior pulmonary aspergillus and inadequate pulmonary, cardiac, renal, and hepatic functions are not considered candidates for transplantation</li>\n<li>No known standard or potentially curative therapy exists or is capable of extending life expectancy</li>\n<li>No clinical symptoms suggesting CNS leukemia</li>\n</ul>\n</p><p> PATIENT CHARACTERISTICS: Age\n<ul>\n<li>18 and over</li>\n</ul>\n</p><p> Performance status\n<ul>\n<li>ECOG 0-2</li>\n</ul>\n</p><p> Life expectancy\n<ul>\n<li>At least 60 days</li>\n</ul>\n</p><p> Hematopoietic\n<ul>\n<li>See Disease Characteristics</li>\n</ul>\n</p><p> Hepatic\n<ul>\n<li>Bilirubin ≤ 1.5 times upper limit of normal (unless attributed to underlying disease)</li>\n</ul>\n</p><p> Renal\n<ul>\n<li>Creatinine clearance ≥ 60 mL/min</li>\n</ul>\n</p><p> Cardiovascular\n<ul>\n<li>No New York Heart Association class III-IV heart failure</li>\n<li>No myocardial infarction within the past year</li>\n<li>LVEF ≥ 40% by MUGA</li>\n<li>No cardiac symptoms ≥ grade 2</li>\n<li>No uncontrolled dysrhythmia requiring medication</li>\n<li>No poorly controlled angina</li>\n<li>QTc ≤ 450 msec for men and ≤ 470 msec for women</li>\n<li>No congenital long QT syndrome</li>\n<li>No left bundle branch block</li>\n<li>No ischemic heart disease within the past 6 months</li>\n<li>No history of cardiac toxicity after treatment with anthracyclines (e.g., doxorubicin hydrochloride, daunorubicin hydrochloride, mitoxantrone hydrochloride, bleomycin, or carmustine</li>\n<li>No other significant cardiac disease</li>\n</ul>\n</p><p> Immunologic\n<ul>\n<li>No active uncontrolled infection</li>\n<li>No history of serious allergic reaction to eggs</li>\n<li>No known HIV infection or AIDS (with or without highly active antiretroviral treatment)</li>\n</ul>\n</p><p> Pulmonary\n<ul>\n<li>DLCO > 80%</li>\n<li>No pulmonary symptoms ≥ grade 2</li>\n<li>No symptomatic pulmonary disease requiring medication including any of the following:\n<ul>\n<li>Dyspnea on or off exertion</li>\n<li>Paroxysmal nocturnal dyspnea</li>\n<li>Significant pulmonary disease (e.g., chronic obstruction/restrictive pulmonary disease)</li>\n</ul>\n</li>\n<li>No oxygen requirement\n<ul>\n<li>No home oxygen that meets the medicare requirement</li>\n</ul>\n</li>\n<li>No history of pulmonary toxicity after treatment with anthracyclines (e.g., doxorubicin hydrochloride, daunorubicin hydrochloride, mitoxantrone hydrochloride, bleomycin, or carmustine</li>\n</ul>\n</p><p> Other\n<ul>\n<li>Not pregnant or nursing</li>\n<li>Negative pregnancy test</li>\n<li>Fertile patients must use effective contraception</li>\n<li>No psychosis</li>\n<li>No other serious underlying medical condition that would preclude study participation</li>\n</ul>\n</p><p> PRIOR CONCURRENT THERAPY: Biologic therapy\n<ul>\n<li>No prior allogeneic or autologous bone marrow transplantation</li>\n<li>No concurrent immunotherapy</li>\n<li>No concurrent biologic agents</li>\n<li>No concurrent gene therapy</li>\n</ul>\n</p><p> Chemotherapy\n<ul>\n<li>See Disease Characteristics</li>\n<li>Recovered from prior chemotherapy</li>\n<li>At least 48 hours since prior hydroxyurea for prevention of leukostasis</li>\n<li>No other concurrent chemotherapy</li>\n</ul>\n</p><p> Endocrine therapy\n<ul>\n<li>At least 48 hours since prior glucocorticoids for prevention of leukostasis</li>\n</ul>\n</p><p> Radiotherapy\n<ul>\n<li>No prior radiotherapy that included the heart in the field (e.g., mantle) or chest</li>\n<li>No concurrent radiotherapy</li>\n</ul>\n</p><p> Surgery\n<ul>\n<li>Not specified</li>\n</ul>\n</p><p> Other\n<ul>\n<li>No concurrent drugs that may cause QTc prolongation</li>\n<li>No concurrent participation in another clinical trial involving a pharmacologic agent for symptom control or therapeutic intent</li>\n<li>No other concurrent investigational drugs or therapy</li>\n</ul>\n</p>', created = 1283572104, expire = 1283658504, headers = '', 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- user warning: Table './intheclinic/cache_filter' is marked as crashed and should be repaired query: UPDATE cache_filter SET data = '<p>Remission rate as measured by standard published criteria based on bone marrow and peripheral blood examination at day 63 [ Designated as safety issue: No ]</p>\n', created = 1283572104, expire = 1283658504, headers = '', serialized = 0 WHERE cid = '1:751f9b05c61a925893aa964ff4619501' in /persistent/html/includes/cache.inc on line 109.
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RATIONALE: Drugs used in chemotherapy, such as 17-N-allylamino-17-demethoxygeldanamycin and cytarabine, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. 17-N-allylamino-17-demethoxygeldanamycin may also help cytarabine kill more cancer cells by making cancer cells more sensitive to the drug. Giving 17-N-allylamino-17-demethoxygeldanamycin together with cytarabine may kill more cancer cells. PURPOSE: This phase I trial is studying the side effects and best dose of 17-N-allylamino-17-demethoxygeldanamycin when given with cytarabine in treating patients with relapsed or refractory acute myeloid leukemia, acute lymphoblastic leukemia, chronic myelogenous leukemia, chronic myelomonocytic leukemia, or myelodysplastic syndromes.
