Chronic Myeloproliferative Disorders
Conditions
Keywords
chronic idiopathic myelofibrosis, polycythemia vera, essential thrombocythemia
Brief summary
RATIONALE: Imatinib mesylate may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. PURPOSE: This phase II trial is studying the side effects of imatinib mesylate and how well it works in treating patients with myelofibrosis.
Detailed description
OBJECTIVES: Primary * Determine the safety, efficacy, and tolerability of imatinib mesylate in patients with myelofibrosis with myeloid metaplasia. * Determine the 3-, 6-, and 12-month major and minor erythroid response rates in patients treated with this drug. Secondary * Determine reduction in marrow fibrosis in patients treated with this drug. * Determine decrease in spleen size in patients treated with this drug. OUTLINE: This is a multicenter, open-label, nonrandomized, pilot study. Patients receive oral imatinib mesylate once daily for 1 year in the absence of disease progression or unacceptable toxicity. Patients who do not experience a minor erythroid response or a 50% reduction in spleen size after 6 months of treatment are removed from the study. Patients experiencing clinical benefit (e.g., ongoing erythroid response) after 1 year of treatment may continue treatment with imatinib mesylate as above at the discretion of the principal investigator. PROJECTED ACCRUAL: A total of 20 patients will be accrued for this study.
Interventions
Once daily oral administration of Imatinib Mesylate at a dose of 600mg for 12 months.
Sponsors
Study design
Eligibility
Inclusion criteria
DISEASE CHARACTERISTICS: * Diagnosis of myelofibrosis with myeloid metaplasia (MMM), defined by all of the following: * Leukoerythroblastic blood picture * Fibrosis involving \> 1/3 sectional area of bone marrow biopsy * Splenomegaly (unless patient has undergone prior splenectomy) * Philadelphia chromosome negative * No myelodysplastic syndrome * No systemic disorders associated with marrow fibrosis * Red blood cell transfusion dependent, defined by 1 of the following: * Patient has required ≥ 2 units of red blood cells every 4 weeks within the past 8 weeks * Hemoglobin ≤ 8 g/dL on ≥ 3 occasions (≥ 2 weeks apart ) over the past 8 weeks * No evidence of disease transformation to acute myelogenous leukemia, defined as \> 20% blasts in bone marrow and/or peripheral blood PATIENT CHARACTERISTICS: Performance status * ECOG 0-3 Life expectancy * Not specified Hematopoietic * Absolute neutrophil count \> 1,000/mm\^3 * Platelet count \> 50,000/mm\^3 Hepatic * Bilirubin ≤ 1.5 times upper limit of normal (ULN) * AST or ALT ≤ 2 times ULN (unless due to extramedullary hematopoiesis in the liver) Renal * Creatinine ≤ 1.5 times ULN Cardiovascular * No New York Heart Association grade III-IV heart disease Other * Not pregnant or nursing * Negative pregnancy test * Fertile patients must use effective barrier method contraception during and for 3 months after completion of study treatment * No serious, uncontrolled medical condition * No patients who are considered potentially unreliable or with a history of noncompliance to medical regimens PRIOR CONCURRENT THERAPY: Biologic therapy * More than 2 weeks since prior interferon alfa Chemotherapy * No concurrent chemotherapy except hydroxyurea to control elevated blood counts Endocrine therapy * More than 4 weeks since prior corticosteroids, danazol, or other androgens for MMM Other * More than 4 weeks since other prior treatment for MMM * No other concurrent experimental drug therapy for MMM
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Major and/or Minor Erythroid Responses at 3, 6, and 12 Months of Therapy | At 3,6, and 12 months of therapy | A major response = transfusion independent or a\>2.0g/dl rise in hemoglobin without transfusion maintained for at least 8 weeks. Minor response= \> 1 to 2.0g/dl incremental rise in hemoglobin maintained for at lease 8 weeks with a decrease in transfusion requirements of at least 50% compared to the mean transfusion requirement during the 8 week pre-study period. |
Secondary
| Measure | Time frame |
|---|---|
| Reduction in Marrow Fibrosis and Decrease in Spleen Size | After 6 and 12 months of therapy |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Imatinib Mesylate (Gleevec) Once daily oral administration of Imatinib Mesylate at a dose of 600mg for 12 months. | 10 |
| Total | 10 |
Baseline characteristics
| Characteristic | Imatinib Mesylate (Gleevec) |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 7 Participants |
| Age, Categorical Between 18 and 65 years | 3 Participants |
| Age Continuous | 68.2 years STANDARD_DEVIATION 11.00303 |
| Region of Enrollment United States | 10 participants |
| Sex: Female, Male Female | 1 Participants |
| Sex: Female, Male Male | 9 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 2 / 10 |
| serious Total, serious adverse events | 10 / 10 |
Outcome results
Percentage of Participants With Major and/or Minor Erythroid Responses at 3, 6, and 12 Months of Therapy
A major response = transfusion independent or a\>2.0g/dl rise in hemoglobin without transfusion maintained for at least 8 weeks. Minor response= \> 1 to 2.0g/dl incremental rise in hemoglobin maintained for at lease 8 weeks with a decrease in transfusion requirements of at least 50% compared to the mean transfusion requirement during the 8 week pre-study period.
Time frame: At 3,6, and 12 months of therapy
Reduction in Marrow Fibrosis and Decrease in Spleen Size
Time frame: After 6 and 12 months of therapy