Leukemia
Conditions
Keywords
recurrent childhood acute lymphoblastic leukemia, recurrent childhood acute myeloid leukemia, relapsing chronic myelogenous leukemia, chronic myelogenous leukemia, BCR-ABL1 positive, childhood chronic myelogenous leukemia
Brief summary
RATIONALE: Imatinib mesylate may interfere with the growth of cancer cells and may be an effective treatment for leukemia. PURPOSE: Phase I trial to study the effectiveness of imatinib mesylate in treating patients who have recurrent leukemia.
Detailed description
OBJECTIVES: * Determine the maximum tolerated dose and dose-limiting toxicity of imatinib mesylate in patients with recurrent Philadelphia chromosome-positive leukemia. * Characterize the pharmacokinetic behavior of this drug in this patient population. * Determine preliminarily the antileukemic activity of this drug in these patients. OUTLINE: This is a dose-escalation, multicenter study. Patients receive oral imatinib mesylate (STI571) once daily for 28 days. Treatment continues in the absence of unacceptable toxicity or disease progression. Cohorts of 3-6 patients receive escalating doses of STI571 until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which at least 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. Patients are followed every 6 months for 4 years and then annually thereafter. PROJECTED ACCRUAL: A maximum of 32 patients will be accrued for this study within 3.5 years.
Interventions
Sponsors
Study design
Eligibility
Inclusion criteria
DISEASE CHARACTERISTICS: * Recurrent Philadelphia (Ph) chromosome-positive leukemia * Recurrent or refractory acute lymphoblastic or myeloblastic leukemia OR * Chronic myelogenous leukemia with resistance to interferon alfa with any of the following: * WBC at least 20,000/mm\^3 after at least 3 months of interferon therapy * At least 100% increase in WBC to at least 20,000/mm\^3 confirmed over 2 weeks while receiving interferon alfa * At least 66% Ph chromosome-positive cells after 1 year of interferon therapy * At least 30% increase in number of Ph chromosome-positive cells after an interferon-induced response while continuing interferon therapy PATIENT CHARACTERISTICS: Age: * Under 22 Performance status: * Karnofsky 50-100% if over 10 years of age OR * Lansky 50-100% if 10 years of age and under Life expectancy: * At least 8 weeks Hematopoietic: * See Disease Characteristics Hepatic: * Bilirubin no greater than 1.5 times normal * SGPT less than 3 times normal * Albumin greater than 2 g/dL Renal: * Creatinine no greater than 1.5 times normal OR * Creatinine clearance or radioisotope glomerular filtration rate at least 70 mL/min Other: * Not pregnant or nursing * Negative pregnancy test * Fertile patients must use effective contraception * If prior allogeneic stem cell transplantation, no uncontrolled graft-versus -host disease * No seizure disorder if on anticonvulsants * No uncontrolled infection * No CNS toxicity greater than grade 2 PRIOR CONCURRENT THERAPY: Biologic therapy: * See Disease Characteristics * At least 1 week since prior biologic therapy and recovered * At least 3 months since prior stem cell transplantation (SCT) * At least 1 week since prior growth factors * At least 1 week since prior interferon alfa Chemotherapy: * Recovered from prior chemotherapy * At least 6 weeks since prior busulfan and nitrosoureas * At least 2 weeks since prior homoharringtonine * At least 1 week since low-dose cytarabine * At least 2 weeks since prior moderate-dose cytarabine * At least 4 weeks since prior high-dose cytarabine * At least 3 weeks since all other prior cytotoxic chemotherapies * No prior hydroxyurea Endocrine therapy: * Must be on a stable dose of steroids if received prior allogeneic SCT Radiotherapy: * Recovered from prior radiotherapy * At least 2 weeks since prior local palliative radiotherapy (small port) * At least 6 months since prior craniospinal radiotherapy * At least 6 months since prior radiotherapy to 50% or more of the pelvis * At least 6 weeks since other prior substantial bone marrow radiotherapy Surgery: * Not specified Other: * No other concurrent investigational agents * No concurrent anticonvulsants
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Survival | Length of study | To estimate the maximum tolerated dose (MTD) of STI571 administered orally once daily without interruption to children with recurrent Ph+ leukemia. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Dose-limiting toxicities | Length of study | To determine the dose-limiting toxicities (DLT) of STI571 given on this schedule. |
| Characterize the pharmacokinetic behavior | Length of study | To characterize the pharmacokinetic behavior of STI571 in children with recurrent Ph+ leukemia. |
| Define the anti-leukemic activity of STI571 | Length of study | To preliminarily define the anti-leukemic activity of STI571 within the confines of a Phase I study. |
Countries
Australia, Canada, Netherlands, New Zealand, Puerto Rico, Switzerland, United States