This phase I trial studies the side effects and best dose of pomalidomide after combination chemotherapy in treating patients with newly diagnosed acute myeloid leukemia or high-risk myelodysplastic syndrome. Drugs used in chemotherapy, such as cytarabine, daunorubicin hydrochloride, and etoposide, 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. Pomalidomide may kill cancer cells by stopping blood flow to the cancer and by stimulating white blood cells to kill cancer cells. Giving more than one drug (combination chemotherapy) and pomalidomide may kill more cancer cells.
PRIMARY OBJECTIVES: I. To define the maximum tolerated dose (MTD) of pomalidomide when given at the time of early lymphocyte recovery following intensive induction timed sequential therapy (TST) with cytarabine (cytosine arabinoside), daunorubicin hydrochloride (daunorubicin) and etoposide (AcDVP-16) in patients with newly diagnosed intermediate- and poor-risk acute myeloid leukemia and high-risk myelodysplastic syndrome (MDS). II. To evaluate the safety, tolerability and toxicity of pomalidomide given at the time of early lymphocyte recovery following induction AcDVP-16 chemotherapy in adults with newly diagnosed intermediate- and poor-risk acute myeloid leukemia and high-risk MDS. SECONDARY OBJECTIVES: I. To evaluate the safety, tolerability and toxicity of pomalidomide given as a continuation therapy following induction and/or consolidation chemotherapy in adults with newly diagnosed intermediate- and poor-risk acute myeloid leukemia and high-risk MDS. II. To document responses (complete remission \[CR\], CR with incomplete count recovery \[CRi\], partial remission \[PR\]) to AcDVP-16 followed by pomalidomide at the time of lymphocyte recovery in newly diagnosed adults with intermediate- and poor-risk acute myeloid leukemia (AML) and high-risk MDS, including duration of response, disease-free and overall survival. III. Correlative pharmacodynamics studies: a) to characterize the effects of pomalidomide on the functional dynamics of different lymphocyte subpopulations (effector T \[Teff\], regulatory T \[Treg\], natural killer \[NK\] cells) and its impact on tumor-associated antigen (TAA)-specific T cell immunity when given following induction and as a maintenance; b) to examine for the presence of minimal residual disease (MRD) before and after pomalidomide administration during induction and continuation therapy; c) to examine cereblon expression in primary leukemia cells at diagnosis and in sorted T cells prior to and after pomalidomide treatment. OUTLINE: This is a dose-escalation study of pomalidomide. INDUCTION: Patients receive cytarabine intravenously (IV) continuously and daunorubicin hydrochloride IV on days 1-3 (patients may otherwise receive idarubicin hydrochloride IV over 10-15 minutes on days 1-3 if daunorubicin hydrochloride is unavailable), and etoposide IV over 3 hours on days 8-10. At the time of early lymphocyte recovery (after day +14), patients also receive pomalidomide orally (PO) for 10-21 days. CONSOLIDATION: Patients achieving CR or CRi receive cytarabine based treatment at the discretion of the treating investigator, with possible regimens comprising cytarabine IV continuously on days 1-3, and 10-12 and daunorubicin hydrochloride IV on days 1-3, or high- or medium-dose cytarabine IV every 12 hours on days 1, 3, and 5 for 1-4 courses. CONTINUATION: Patients achieving CR or CRi who did not undergo allogeneic stem cell transplant receive pomalidomide PO daily on days 1-21 beginning 6 weeks following blood count recovery. Treatment repeats every 4-6 weeks for up to 4 courses in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up for 2 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
50
Given IV
Given IV
Given IV
Given IV
Correlative studies
Correlative studies
Given PO
Yale University
New Haven, Connecticut, United States
Johns Hopkins University/Sidney Kimmel Cancer Center
Baltimore, Maryland, United States
UNC Lineberger Comprehensive Cancer Center
Chapel Hill, North Carolina, United States
Maximum tolerated dose of pomalidomide, defined as the highest dose at which 0 or 1 dose-limiting toxicities are observed in 6 patients by National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0 (5.0 beginning April 1, 2018)
The proportion of dose-limiting toxicities at each dose level will be reported with exact binomial 95% confidence intervals. Adverse events will be summarized by dose level for all doses. All toxicities by type and grade will be reported.
Time frame: Up to 21 days
Proportion of toxicities in the expansion cohort graded according to National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0 (5.0 beginning April 1, 2018)
The proportion of toxicities by type and grade in the expansion cohort will be reported with exact binomial 95% confidence intervals.
Time frame: Up to 2 years
Proportion of patients achieving complete remission, complete remission with incomplete count recovery, or partial remission
The proportion of patients achieving each category of response will be reported with 95% exact binomial confidence intervals.
Time frame: Up to 2 years
Progression-free survival
Standard life table methods will be used to analyze progression-free survival. One-year and median progression-free survival with 95% confidence intervals will be reported.
Time frame: Time from start of treatment to time of progression or relapse or death, assessed up to 2 years
Overall survival
Standard life table methods will be used to analyze overall survival.
Time frame: Time of enrollment onto this study to the time of death, assessed up to 2 years
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