Single Agent Decitabine in TP53 Mutated Relapsed/Refractory Acute Myeloid Leukemia

In this study, the investigators seek to determine whether decitabine therapy can improve outcomes, specifically overall survival this selected subset of acute myeloid leukemia (AML) patients with the poorest prognosis based on refractoriness to induction treatment and high risk genetic mutations.


Eligibility Criteria:
Inclusion Criteria:

* TP53 mutant AML. The presence of a TP53 mutation should be determined by Genoptix (or institutional preferred equivalent assay). Detection of a TP53 mutation at the time of initial diagnosis is sufficient for enrollment at the time of relapsed/refractory disease. Detection of a TP53 mutation in either the peripheral blood or bone marrow is adequate for enrollment. Alternatively, patients who have not had TP53 mutation analysis performed, but who have \> 20% TP53 positive cells by immunohistochemistry detected on a bone marrow aspirate may also be enrolled,29 provided that mutation analysis is requested at the time of enrollment.
* Relapsed/refractory AML following 7+3 (or similar cytarabine containing induction chemotherapy for AML) disease detected by one of the following methods:

  * bone marrow blasts \> 5%, or
  * Hematologics flow cytometry assay (threshold \> 0.5%) (alternative equivalent assay may be substituted), or
  * Persistent cytogenetic abnormality (e.g. del5, del17p, etc), by FISH or conventional karotyping, or
  * Persistent TP53 mutation (at least 5 variant reads with at least 50x coverage) determined by Genoptix (or institutional preferred equivalent assay).
* Patients with \> 10% blasts on a day +14 bone marrow biopsy following 7+3 may either be enrolled or may be treated with a course of standard re-induction (e.g. 5+2 or similar) and then re-evaluated for response. Eligible patients will meet any of the above criteria on a subsequent biopsy.
* Bone marrow and organ function as defined below:

  * Peripheral white blood cell count \< 50,000/mcl (patients may receive hydroxyurea as necessary for cytoreduction),
  * Total bilirubin \< 1.5 x upper limit of normal,
  * AST and ALT \< 2.5 x upper limit of normal,
  * Serum creatinine \< 2.0 x upper limit of normal, and,
* At least 18 years of age.
* Women of childbearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control, abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study, she must inform her treating physician immediately
* Ability to understand and willingness to sign an IRB approved written informed consent document (or that of legally authorized representative, if applicable
* Performance status ≤ 3

Exclusion Criteria:

* Prior treatment with either decitabine or azacitidine or an investigational agent
* Acute promyelocytic leukemia with PML-RARA or t(15;17).
* History of HIV, Hepatitis B, or Hepatitis C infection.
* Concurrent illness including, but not limited to, ongoing uncontrolled infection, symptomatic NYHA class 3 or 4 congestive heart failure, unstable angina pectoris, or cardiac arrhythmia.
* Radiation therapy within 14 days of enrollment.
* Chemotherapy administration in the 7 days preceding enrollment with the exception of hydroxyurea, which can be continued until Cycle 2. A washout period for oral tyrosine kinase inhibitors (e.g. Jakafi, etc) is not required, although tyrosine kinase inhibitors therapy must be discontinued prior to enrollment.
* Malignancies (other than AML) requiring active therapy or diagnosed within the last year, with the exception of non-melanoma skin cancer which can be treated or in situ malignancies (such as cervical, breast, prostate, etc.)
* Currently receiving any other investigational agents.
* Known central nervous system (CNS) leukemia or testicular involvement of leukemia
* A history of allergic reactions attributed to compounds of similar chemical or biologic composition to decitabine or other agents used in the study.
* Pregnant and/or breastfeeding. Women of childbearing potential must have a negative urine pregnancy test within 7 days of study entry.