Continuous Infusion Chemotherapy (CI-CLAM) for the Treatment of Relapsed or Refractory Acute Myeloid Leukemia or Other High-Grade Myeloid Neoplasms
Continuous Infusion Chemotherapy (CI-CLAM) for the Treatment of Relapsed or Refractory Acute Myeloid Leukemia or Other High-Grade Myeloid Neoplasms
This phase I trial studies the side effects and best dose of a chemotherapy regimen given by
 continuous intravenous infusion (CI-CLAM), and to see how well it works in treating patients
 with acute myeloid leukemia that has come back (relapsed) or does not respond to treatment
 (refractory) or other high-grade myeloid neoplasms. Drugs used in CI-CLAM include cladribine,
 cytarabine and mitoxantrone, and work in different ways to stop the growth of cancer cells,
 either by killing the cells, by stopping them from dividing, or by stopping them from
 spreading. Continuous intravenous infusion involves giving drugs over a time duration of
 equal to or more than 24 hours. Giving CLAM via continuous infusion may result in fewer side
 effects and have similar effectiveness when compared to giving CLAM over the shorter standard
 amount of time.
OUTLINE: This is a dose-escalation study.

 Patients receive CI-CLAM consisting of cladribine and cytarabine via continuous intravenous
 infusion (CIV) on days 1-2, 1-3, 1-4, 1-5, or 1-6 depending on dose level assignment, and
 mitoxantrone via CIV on days 1-2 or 1-3 depending on dose level assignment. G-CSF may be
 added at the discretion of the treating physician, as per standard of care. Patients that do
 not achieve a response of minimal residual disease (MRD)-negative complete remission (CR)
 after the first cycle are eligible to receive a second cycle of CI-CLAM. Treatment continues
 for 2 cycles in the absence of disease progression or unacceptable toxicity.

 After completion of study treatment, patients are followed up periodically for up to 5 years.
Inclusion Criteria:

 -  Initial presentation with > 10% myeloid blasts in peripheral blood or marrow and,
 after at least one course of induction treatment, now with > 5% blasts in peripheral
 blood or marrow, as assessed by morphology or multiparameter flow cytometry (MFC).
 Outside diagnostic material is acceptable if reviewed here. Patients may never have
 achieved an initial complete remission (< 5% blasts in marrow, absolute neutrophil
 count > 1,000 per microliter, platelet count > 100,000 per microliter) or may have
 relapsed from such a remission. Note that although "AML" is formally denoted by > 20%
 blasts and other high-grade myeloid neoplasm by 10-20% blasts, these two entities
 often have similar prognoses and respond similarly to therapy, with trials at
 University of Washington (UW)/Seattle Cancer Care Alliance (SCCA) as well as MD
 Anderson and various European cooperative groups not distinguishing between AML and
 other high grade myeloid neoplasms

 -  Treatment related mortality (TRM) score < 13.1

 -  Bilirubin < 2.0 mg/dl unless abnormalities thought due to organ infiltration by AML as
 suggested for example by white blood cell (WBC) > 25,000 and rising rapidly

 -  Creatinine < 2.0 mg/dl unless abnormalities thought due to organ infiltration by AML
 as suggested for example by WBC > 25,000 and rising rapidly

 -  Left ventricular ejection fraction > 45% by multigated acquisition scan (MUGA) scan or
 echocardiography, performed within 6 months prior to consent

 -  Off any active therapy for AML other than hydroxyurea for at least 1 week prior to
 study registration unless patient has rapidly progressive disease with resolution of
 all grade 2-4 non-hematologic toxicities. Patients with symptoms/signs of
 hyperleukocytosis or WBC > 100,000 and in whom there is a delay in scheduling a MUGA
 scan or other logistical delays can receive two doses of cytarabine (500 mg/m^2 each,
 but dosing is ultimately based on physician discretion)

 -  Men and women of childbearing potential must agree to use adequate contraception

 -  Not pregnant or lactating

 -  Not receiving other investigational agents

 -  Provision of informed written consent on study-specific consent form