This phase I/II trial is studying the side effects and best dose of bendamustine hydrochloride when given together with idarubicin in treating older patients with previously untreated acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS). Drugs used in chemotherapy, such as bendamustine hydrochloride or idarubicin, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Giving more than one drug (combination chemotherapy) may kill more cancer cells
PRIMARY OBJECTIVES: I. The maximum tolerated dose (MTD) that is associated with a complete remission (CR) rate of at least 40%, and a rate of grade 3-4 extramedullary toxicity \< 30% in patients aged 50 or older with previously untreated AML or high-risk MDS. SECONDARY OBJECTIVES: I. The disease-free survival (DFS), and overall survival (OS) after therapy at each level of the dosing strategy. OUTLINE: This is a phase I, dose-escalation study of bendamustine hydrochloride followed by a phase II study. Patients receive bendamustine hydrochloride intravenously (IV) on days 1-5 and idarubicin IV on days 1 and 2. Treatment repeats every 28 days for up to 3 courses in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 3 months for 2 years and then annually thereafter for 3 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
39
Given IV
Given IV
Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium
Seattle, Washington, United States
Response
Assessed by cytogenetics/fluorescence in situ hybridization (FISH) and flow cytometry of blood and bone marrow samples. The response criteria defined by Cheson et al. will be used in this study. These criteria are: morphologic leukemia-free state; morphologic complete remission (CR); cytogenetic CR (CRc); molecular CR (CRm); morphologic CR with incomplete blood count recovery (CRi); partial remission (PR); treatment failure; recurrence (progressive disease).
Time frame: 6 months
Incidence of Greater Than or Equal to Grade 3 Toxicity
Toxicities will be graded using the National Cancer Institute (NCI) Common Toxicity Criteria version 3.0.
Time frame: Up to day +100 after end of therapy or until the patient received an alternative treatment for leukemia, whatever happens earlier
Maximum Tolerated Dose
A bayesian approach to estimate the MTD of bendamustine associated with a CR rate of at least 40% and with \<30% grade 3-4 non-haematological toxicity was used (Wathen et al, 2008).The MTD of bendamustine in combination with idarubicin was determined after two cases of grade 3 toxicity were noted in the three patients entered at the 75 mg/m2 dose. The DLTs were congestive heart failure and mucositis in one patient each. Patients subsequent to this were treated at the 60 mg/m2 bendamustine dose.
Time frame: 6 months
Median Survival
In a five year following, the median survival was obtained.
Time frame: 5 years
Disease-free Survival (DFS)
In a five year following, the disease free survival was obtained.
Time frame: 5 years
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