3-AP and High-Dose Cytarabine in Treating Patients With Advanced Hematologic Malignancies

Drugs used in chemotherapy, such as cytarabine, work in different ways to stop cancer cells from dividing so they stop growing or die. 3-AP may help cytarabine kill more cancer cells by making them more sensitive to the drug. This phase I trial is studying the side effects and best dose of 3-AP when given with high-dose cytarabine in treating patients with advanced hematologic malignancies

PRIMARY OBJECTIVES:

I. Determine the maximum tolerated dose of 3-AP (Triapine) administered with high-dose cytarabine in patients with advanced hematologic malignancies.

SECONDARY OBJECTIVES:

I. Determine the clinical activity of this regimen in these patients. II. Determine the effect of treatment with 3-AP (Triapine) on intracellular levels of cytarabine in these patients.

OUTLINE: This is a dose-escalation study of 3-AP (Triapine).

Patients receive high-dose cytarabine IV over 2 hours on days 1-5 and 3-AP (Triapine) IV over 2 hours on days 2-5. Treatment repeats every 28 days for up to 4 courses in the absence of disease progression or unacceptable toxicity.

Cohorts of 3-6 patients in each stratum receive escalating doses of 3-AP (Triapine) until the maximum tolerated dose (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 for up to 2 years.

PROJECTED ACCRUAL: A total of 6-48 patients (3-24 per stratum) will be accrued for this study within 15-24 months.

Eligibility Criteria:
Inclusion Criteria:

* Histologically confirmed diagnosis of 1 of the following hematologic malignancies:

  * Relapsed or refractory acute myeloid leukemia (AML)
  * Relapsed or refractory acute lymphoblastic leukemia
  * Secondary AML, including AML arising from antecedent hematologic diseases, such as myelodysplastic syndromes or myeloproliferative disorders OR therapy-related AML
  * Chronic myeloid leukemia in accelerated or blast phase
* Refractory to standard therapy or no standard therapy exists
* No known brain metastases
* Performance status - CALGB 0-2
* Performance status - Karnofsky 60-100%
* No G6PD deficiency
* Bilirubin \< 2.0 mg/dL (unless due to Gilbert's syndrome)
* AST and ALT \< 2.5 times upper limit of normal (ULN)
* Creatinine \< 1.5 times ULN
* No symptomatic congestive heart failure
* No unstable angina pectoris
* No cardiac arrhythmia
* No pulmonary disease requiring oxygen
* Not pregnant or nursing
* Negative pregnancy test
* Fertile patients must use effective contraception
* No prior allergic reactions attributed to compounds of similar chemical or biological composition to study drugs
* No neuropathy
* No ongoing or active infection
* No psychiatric illness or social situation that would preclude study compliance
* No other concurrent uncontrolled illness
* No concurrent biologic agents
* At least 72 hours since prior hydroxyurea
* At least 2 weeks since other prior chemotherapy (6 weeks for mitomycin or nitrosoureas)
* No other concurrent chemotherapy
* At least 2 weeks since prior radiotherapy
* No concurrent radiotherapy
* Recovered from all prior therapy
* At least 4 weeks since prior investigational agents
* No other concurrent investigational therapy
* No other concurrent anticancer therapy
* No concurrent combination antiretroviral therapy for HIV-positive patients