A Study of Aezea® (Cenersen) in Transfusion Dependent Anemia Associated With Myelodysplastic Syndrome (MDS)

The purpose of the study is to test the safety of six cycles of cenersen treatment and to begin to test the hypothesis that intermittent administration of cenersen may lead to a reduced dependence on transfusion.

The study is a nonrandomized open-label treatment with varying doses of cenersen by intravenous administration to:

Primary

\*To assess the safety profile and dose limiting toxicities (DLT) of cenersen for each of three increasing dose levels as stipulated by the protocol in patients with lower risk MDS defined as low or intermediate-1 risk by IPSS.

Secondary

* To determine the lowest pharmacologically active exposure from among three increasing dose levels as stipulated by the protocol that exhibits the desired activity on erythropoiesis after evaluation of all dose levels, and
* To determine if intermittent treatment with cenersen will reduce transfusion requirements for patients with lower risk MDS.

Eligibility Criteria:
Inclusion Criteria:

* Must have histologically or cytologically confirmed diagnosis of MDS according to WHO classification that meets IPSS low to intermediate-1 risk criteria.
* For patients with del(5q) MDS, documented del(5q) MDS by metaphase cytogenetics or FISH analysis with up to 1 additional cytogenetic abnormality other than 1 involving chromosome 7 or chromosome 17.
* Demonstrated refractoriness or intolerance to standard approved therapy (lenalidomide in del(5q) MDS patients \& azanucleosides in non-del(5q)patients).
* Recovered from acute toxicities of other treatments (≤ Grade 2). All other MDS treatments discontinued at least 4 weeks prior to treatment except epoetin alpha (Procrit) 2 weeks.
* Ability to understand \& willingness to sign a written informed consent document.
* Age ≥ 18 years at time of signing informed consent form.
* ECOG performance status ≤2.
* Life expectancy \>4 weeks following initiation.
* Must meet following requirements:

  * total bilirubin: ≤2 x upper normal limit (UNL) (patients with Gilbert's disease are eligible, hyperbilirubinemia is intermittent \& indirect)
  * AST(SGOT)/ALT(SGPT): ≤3 x UNL
  * creatinine: ≤2 x UNL
* \<1% peripheral blood blasts.
* \<10% bone marrow blasts.
* Medical history of RBC transfusion dependent anemia ≥4 units of RBCs during the 16 weeks prior to admin of study drug \& ≥2 units of RBCs over prior 8 weeks (day -56 to day 1 prior to treatment; baseline period) for documented Hgb of ≤ 9g/dL (during baseline). Didn't have a 56 day RBC transfusion-free period during 16 weeks prior to administration of study drug.
* Teratogenic effects of cenersen are unknown, women of child-bearing potential \& men must agree to use adequate contraception prior to study entry \& for the duration of study participation.

Exclusion Criteria:

* Receiving MDS treatment except blood transfusion and/or iron chelation within 4 weeks prior to entering study or no recovery from adverse events due to agents administered more than 4 weeks earlier.
* no current or prior use of investigational agents within 4 weeks of study entry.
* Known history of malignancy diagnosed within 2 years other than non-melanoma skin cancer.
* History of allergic reactions attributed to compounds of similar chemical or biologic composition to cenersen.
* exclude use of acetaminophen or acetaminophen-containing medications from 1 day before to 1 day after completion of treatment. The active metabolite of acetaminophen, N-acetyl-p-benzoquinone imine (NAPQI), is known to block effects of cenersen \& use of acetaminophen during treatment with study regimen has been associated with a failure to achieve a response in a past clinical trial of cenersen.
* Uncontrolled intercurrent illness that would limit compliance with study requirements.
* Pregnant women are excluded from this study. Breastfeeding should be discontinued if the mother is treated with cenersen
* HIV-positive patients on combination antiretroviral therapy are ineligible because of unknown potential for interactions with cenersen.
* Any condition, including presence of laboratory abnormalities, which places subject at unacceptable risk if s/he were to participate in study or confounds ability to interpret data from study according to investigator assessment.
* Therapy related MDS.
* Clinically significant anemia according to investigator's assessment due to factors such as iron, B12 or folate deficiencies, autoimmune or hereditary hemolysis or gastrointestinal bleeding.
* Received hematopoietic growth factors within specified limits prior to treatment (2 weeks for epoetin alpha (Procrit) \& 4 weeks for darbepoetin alpha (Aranesp)).
* Active hepatitis B or C or other active liver disease.
* Chronic use (\>2 weeks) of greater than physiologic doses of corticosteroid agent (dose equivalent to ≥10mg of prednisone) within 28 days of 1st day of study drug treatment \& during treatment