Combination Chemotherapy With or Without PSC 833, Peripheral Stem Cell Transplantation, and/or Interleukin-2 in Treating Patients With Acute Myeloid Leukemia
Condition: Adult Acute Basophilic Leukemia; Adult Acute Eosinophilic Leukemia; Adult Acute Erythroid Leukemia (M6); Adult Acute Megakaryoblastic Leukemia (M7); Adult Acute Minimally Differentiated Myeloid Leukemia (M0); Adult Acute Monoblastic Leukemia (M5a); Adult Acute Monoblastic Leukemia and Acute Monocytic Leukemia (M5); Adult Acute Monocytic Leukemia (M5b); Adult Acute Myeloblastic Leukemia With Maturation (M2); Adult Acute Myeloblastic Leukemia Without Maturation (M1); Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Del(5q); Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); Adult Acute Myeloid Leukemia With t(16;16)(p13;q22); Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); Adult Acute Myelomonocytic Leukemia (M4); Adult Erythroleukemia (M6a); Adult Pure Erythroid Leukemia (M6b); Childhood Acute Basophilic Leukemia; Childhood Acute Eosinophilic Leukemia; Childhood Acute Erythroleukemia (M6); Childhood Acute Megakaryocytic Leukemia (M7); Childhood Acute Minimally Differentiated Myeloid Leukemia (M0); Childhood Acute Monoblastic Leukemia (M5a); Childhood Acute Monoblastic Leukemia and Acute Monocytic Leukemia (M5); Childhood Acute Monocytic Leukemia (M5b); Childhood Acute Myeloblastic Leukemia With Maturation (M2); Childhood Acute Myeloblastic Leukemia Without Maturation (M1); Childhood Acute Myelomonocytic Leukemia (M4); Childhood Myelodysplastic Syndromes; de Novo Myelodysplastic Syndromes; Untreated Adult Acute Myeloid Leukemia; Untreated Childhood Acute Myeloid Leukemia and Other Myeloid Malignancies
MeSH terms: Leukemia; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Preleukemia; Leukemia, Myelomonocytic, Acute; Leukemia, Myelomonocytic, Chronic; Leukemia, Monocytic, Acute; Leukemia, Megakaryoblastic, Acute; Leukemia, Erythroblastic, Acute; Leukemia, Basophilic, Acute; Leukemia, Eosinophilic, Acute; Myelodysplastic Syndromes; Hypereosinophilic Syndrome; Syndrome
Study type: Interventional
Phase: Phase 3

Summary: 
      Drugs used in chemotherapy use different ways to stop cancer cells from dividing so they stop
      growing or die. PSC 833 may increase the effectiveness of chemotherapy by making cancer cells
      more sensitive to the drugs. Combining chemotherapy with peripheral stem cell transplantation
      may allow the doctor to give higher doses of chemotherapy drugs and kill more cancer cells.
      Interleukin-2 may stimulate a person's white blood cells to kill cancer cells. This
      randomized phase III trial is studying giving combination chemotherapy together with PSC 833
      followed by a peripheral stem cell transplant with or without interleukin-2 to see how well
      it works compared to combination chemotherapy alone followed by a peripheral stem cell
      transplant with or without interleukin-2 in treating patients with acute myeloid leukemia.
    

Detailed description: 
      PRIMARY OBJECTIVES:

      I. To determine whether the addition of PSC-833 (valspodar) to induction chemotherapy
      improves disease-free survival and overall survival for patients with acute myeloid leukemia
      (AML) < 60 years.

      II. To determine whether post-consolidation immunotherapy with low-dose
      continuous/intermittent high-dose bolus subcutaneous recombinant interleukin-2 (rIL-2)
      (aldesleukin) improves disease-free survival and overall survival in patients with AML < 60
      years in first complete remission (CR).

      SECONDARY OBJECTIVES:

      I. To continue to evaluate the effectiveness of three courses of high-dose ARA-C (HiDAC)
      (cytarabine) as curative consolidation chemotherapy in patients with core binding factor
      (CBF) leukemias.

      II. To continue to establish the use of intensive post-remission chemotherapy with PSCT or a
      novel intensification sequence consisting of HiDAC/high-dose etoposide/G-CSF (filgrastim)
      followed by two cycles of HiDAC in patients in CR with unfavorable cytogenetics.

      III. To correlate the rate of relapse and toxicity with busulfan pharmacokinetics when
      busulfan and etoposide are used prior to autologous stem cell transplantation for AML
      patients in first CR.

      OUTLINE: This is a randomized, multicenter study.

      INDUCTION THERAPY: Patients are randomized to 1 of 2 treatment arms.

      ARM I: Patients receive cytarabine IV continuously on days 1-7 and daunorubicin IV over 5-10
      minutes followed by etoposide IV over 2 hours on days 1-3. Patients with 20% or greater bone
      marrow cellularity and greater than 5% leukemia blasts at the end of the first course receive
      a second course of cytarabine IV continuously on days 1-5 and daunorubicin IV over 5-10
      minutes followed by etoposide IV over 2 hours on days 1 and 2.

      ARM II: Patients receive PSC 833 IV continuously on days 1-3 and cytarabine, daunorubicin,
      and etoposide as in arm I. Patients with 20% or greater bone marrow cellularity and greater
      than 5% leukemia blasts at the end of the first course receive a second course of PSC 833 IV
      continuously on days 1 and 2 and cytarabine, daunorubicin, and etoposide as in arm I.

      INTENSIFICATION THERAPY: Patients in complete remission receive intensification therapy.
      Therapy begins no earlier than 2 weeks and no later than 4 weeks after complete remission is
      attained. Patients are stratified according to cytogenetics (favorable [t(8;21)(q22;q22) or
      inv(16)(p13;q22) or t(16;16)(p13;q22)] vs unfavorable [all other karyotypes]).

      FAVORABLE: Patients receive high-dose cytarabine (HiDAC) IV over 3 hours every 12 hours on
      days 1, 3, and 5. Treatment repeats no earlier than 28 days after the prior course and no
      later than 14 days after hematopoietic recovery for two more courses.

      UNFAVORABLE: Patients are further divided into two groups based on ability to receive
      peripheral blood stem cell transplantation (PBSCT) (yes vs no).

      PBSCT GROUP: Patients receive etoposide IV continuously and HiDAC IV over 2 hours every 12
      hours on days 1-4. Patients also receive filgrastim (G-CSF) subcutaneously (SC) daily
      beginning on day 14 and continuing until peripheral blood stem cell (PBSC) collection is
      completed. Patients who are not able to undergo PBSCT after HiDAC/etoposide continue
      treatment in the non-PBSCT group. At least 4 weeks after HiDAC/etoposide recovery, patients
      receive oral busulfan every 6 hours on days -7 to -4 and etoposide IV over 4 hours on day -3
      prior to PBSCT. Patients receive autologous PBSC infusion on day 0. Patients also receive
      G-CSF SC beginning on day 0 and continuing until hematopoietic recovery.

      NON-PBSCT GROUP: Patients receive etoposide, HiDAC, and G-CSF as in the PBSCT group. After
      hematopoietic recovery, patients then receive HiDAC IV over 3 hours every 12 hours on days 1,
      3, and 5. Treatment repeats no earlier than 28 days after prior course and no later than 14
      days after hematopoietic recovery for one more course.

      IMMUNOTHERAPY: Patients are again randomized to 1 of 2 treatment arms.

      ARM I: Patients begin therapy no later than 120 days after the first day of the last course
      of HiDAC treatment OR day 0 of PBSCT. Patients receive low-dose interleukin-2 (IL-2) SC on
      days 1-14, 19-28, 33-42, 47-56, 61-70, and 75-90. In addition, patients receive high-dose
      IL-2 SC on days 15-17, 29-31, 43-45, 57-59, and 71-73.

      ARM II: Patients are observed and receive no further therapy.

      Patients are followed at 1 month, every 2 months for 2 years, every 6 months for 2 years, and
      then annually for 6 years.

      PROJECTED ACCRUAL: A total of 720 patients will be accrued for this study within 4 years.
    

Intervention name(s): cytarabine; daunorubicin hydrochloride; etoposide; valspodar; filgrastim; busulfan; autologous hematopoietic stem cell transplantation; peripheral blood stem cell transplantation; aldesleukin; clinical observation; pharmacological study
Intervention type(s): Drug; Drug; Drug; Drug; Biological; Drug; Procedure; Procedure; Biological; Other; Other
Intervention description(s): Given IV; Given IV; Given IV; Given IV; Given SC; Given orally; Undergo autologous PBSCT; Undergo autologous PBSCT; Given SC; Undergo clinical observation; Correlative studies
Other intervention name(s): ARA-C; arabinofuranosylcytosine; arabinosylcytosine; Cytosar-U; cytosine arabinoside; Cerubidin; Cerubidine; daunomycin hydrochloride; daunorubicin; RP-13057; EPEG; VP-16; VP-16-213; Amdray; PSC 833; G-CSF; Neupogen; BSF; BU; Misulfan; Mitosan; Myeloleukon; PBPC transplantation; PBSC transplantation; peripheral blood progenitor cell transplantation; transplantation, peripheral blood stem cell; IL-2; Proleukin; recombinant human interleukin-2; recombinant interleukin-2; observation; pharmacological studies
Intervention MeSH terms: Cytarabine; Aldesleukin; Etoposide; Daunorubicin; Etoposide phosphate; Busulfan; Interleukin-2
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment