Phase I trial to study the effectiveness of combining oblimersen with cytarabine and
daunorubicin in treating older patients who have previously untreated acute myeloid
leukemia. Drugs used in chemotherapy use different ways to stop cancer cells from dividing
so they stop growing or die. Oblimersen may help cytarabine and daunorubicin kill more
cancer cells by making them more sensitive to chemotherapy.
I. Determine the maximum tolerated dose of daunorubicin in combination with cytarabine and
oblimersen in older patients with previously untreated acute myeloid leukemia.
II. Determine the qualitative and quantitative toxic effects of this regimen in these
III. Determine the pharmacokinetics of oblimersen in this regimen in these patients.
IV. Determine the disease-free survival and overall survival of patients treated with this
V. Assess the spontaneous rate of apoptosis in leukemic blasts in patients before and after
initiation of treatment with oblimersen.
VI. Determine therapeutic response (complete remission) in patients treated with this
OUTLINE: This is a dose-escalation study of daunorubicin. Patients are stratified according
to disease status (primary vs secondary).
INDUCTION THERAPY: Patients receive oblimersen (G3139) IV continuously on days 1-10 and
cytarabine IV continuously on days 4-10. Patients also receive daunorubicin IV daily on days
Patients with bone marrow cellularity of at least 20% and at least 5% leukemic blasts at day
17 or evidence of refractory disease receive a second induction comprising G3139 IV
continuously on days 1-8, cytarabine IV continuously on days 4-8, and daunorubicin IV on
CONSOLIDATION THERAPY: Beginning no sooner than 14 days after hematologic recovery from
induction therapy, patients receive G3139 IV continuously on days 1-8 and cytarabine IV over
4 hours on days 4-8. Patients receive a second course of consolidation therapy no sooner
than 14 days after hematologic recovery from the first course.
Cohorts of 3-6 patients receive escalating doses of daunorubicin 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 every 2 months for 2 years.
- Histologically confirmed primary or secondary acute myeloid leukemia (AML)
- More than 20% bone marrow blasts
- Myelodysplastic syndromes (MDS) or a chronic myeloproliferative disorder
antecedent to AML allowed
- Therapy-related AML allowed
- No acute promyelocytic leukemia
- At least 4 weeks
- Bilirubin no greater than 2 mg/dL
- ALT and AST no greater than 2 times upper limit of normal (unless directly
attributable to AML)
- Creatinine no greater than 2.5 mg/dL
- Ejection fraction at least 50% by MUGA or echocardiogram
- No symptomatic congestive heart failure
- No unstable angina pectoris
- No cardiac arrhythmia
- No allergy to any of the study medications
- No other uncontrolled concurrent illness
- No serious medical or psychiatric illness that would preclude giving informed consent
- Not pregnant or nursing
- Fertile patients must use effective contraception
- No prior therapy for primary AML except emergency leukapheresis
- No prior anthracyclines
- No prior chemotherapy for primary AML except hydroxyurea for hyperleukocytosis
- At least 3 months since prior chemotherapy for MDS or chronic myeloproliferative
disorders antecedent to AML
- No other concurrent chemotherapy
- No concurrent corticosteroids as anti-emetics
- No concurrent steroids except for adrenal failure or septic shock
- No concurrent hormonal therapy except hormones for non-disease-related conditions
(e.g., insulin for diabetes, tamoxifen or equivalent for breast cancer prevention or
adjuvant treatment, or estrogens or progestins for gynecologic indications)
- No prior radiotherapy for primary AML except cranial radiotherapy for CNS leukostasis
- No concurrent palliative radiotherapy
- No concurrent whole brain radiotherapy
- No other concurrent investigational or commercial agents or therapies
- No concurrent cyclooxygenase-2 inhibitors