Phase I evaluation of prolonged-infusion gemcitabine with mitoxantrone for relapsed or refractory acute leukemia

David A. Rizzieri, Adam J. Bass, Gary Rosner, Jon P. Gockerman, Carlos M. DeCastro, William P. Petros, David J. Adams, Mary J. Laughlin, Patti Davis, Traci Foster, Robert Jacobson, Herbert Hurwitz, Joseph O. Moore

Research output: Contribution to journalArticle

Abstract

Purpose: To ascertain the maximum tolerated duration of infusion of gemcitabine at 10 mg/m2/min in combination with mitoxantrone at 12 mg/m2 daily for 3 days in the treatment of acute leukemia. Patients and Methods: Thirty-four patients were enrolled. Stratum I consisted of 26 patients, median age 50 years (range, 25 to 71 years), with relapsed or refractory leukemia. Stratum II contained eight patients, median age 62.5 years (range, 38 to 83 years), who had received fewer than three cycles of myelotoxic therapy for chronic myeloid leukemia or myelodysplasia that had evolved into leukemia. Patients received mitoxantrone at 12 mg/m2 daily for 3 days. After the first mitoxantrone dose, gemcitabine was provided intravenously at 10 mg/m2/min with the duration adjusted by following a continuous reassessment model. Results: Severe myelosuppression, and stomatitis or esophagitis were the most common hematologic and nonhematologic dose-limiting toxicities. Several patients developed febrile neutropenia, nausea, or vomitting. In both strata, the maximum recommended duration of infusion of gemcitabine was 12 hours (7,200 mg/m2). The mean steady-state concentration of gemcitabine was 24.72 μmol/L and varied over a fivefold range among patients. Overall response rates in this phase I trial for strata I and II were 42% and 63%, respectively. Conclusion: Prolonged-infusion gemcitabine at a fixed dose rate of 10 mg/m2/min for 12 hours with 12 mg/m2/d mitoxantrone for 3 days is a tolerable induction regimen and achieves plasma concentrations sufficient for maximal intracellular activation. Stomatitis or esophagitis should be anticipated; however, this regimen may induce significant responses in patients with difficult-to-treat leukemias.

Original languageEnglish (US)
Pages (from-to)674-679
Number of pages6
JournalJournal of Clinical Oncology
Volume20
Issue number3
DOIs
StatePublished - Feb 1 2002
Externally publishedYes

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gemcitabine
Mitoxantrone
Leukemia
Stomatitis
Esophagitis
Febrile Neutropenia
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Nausea

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Phase I evaluation of prolonged-infusion gemcitabine with mitoxantrone for relapsed or refractory acute leukemia. / Rizzieri, David A.; Bass, Adam J.; Rosner, Gary; Gockerman, Jon P.; DeCastro, Carlos M.; Petros, William P.; Adams, David J.; Laughlin, Mary J.; Davis, Patti; Foster, Traci; Jacobson, Robert; Hurwitz, Herbert; Moore, Joseph O.

In: Journal of Clinical Oncology, Vol. 20, No. 3, 01.02.2002, p. 674-679.

Research output: Contribution to journalArticle

Rizzieri, DA, Bass, AJ, Rosner, G, Gockerman, JP, DeCastro, CM, Petros, WP, Adams, DJ, Laughlin, MJ, Davis, P, Foster, T, Jacobson, R, Hurwitz, H & Moore, JO 2002, 'Phase I evaluation of prolonged-infusion gemcitabine with mitoxantrone for relapsed or refractory acute leukemia', Journal of Clinical Oncology, vol. 20, no. 3, pp. 674-679. https://doi.org/10.1200/JCO.20.3.674
Rizzieri, David A. ; Bass, Adam J. ; Rosner, Gary ; Gockerman, Jon P. ; DeCastro, Carlos M. ; Petros, William P. ; Adams, David J. ; Laughlin, Mary J. ; Davis, Patti ; Foster, Traci ; Jacobson, Robert ; Hurwitz, Herbert ; Moore, Joseph O. / Phase I evaluation of prolonged-infusion gemcitabine with mitoxantrone for relapsed or refractory acute leukemia. In: Journal of Clinical Oncology. 2002 ; Vol. 20, No. 3. pp. 674-679.
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abstract = "Purpose: To ascertain the maximum tolerated duration of infusion of gemcitabine at 10 mg/m2/min in combination with mitoxantrone at 12 mg/m2 daily for 3 days in the treatment of acute leukemia. Patients and Methods: Thirty-four patients were enrolled. Stratum I consisted of 26 patients, median age 50 years (range, 25 to 71 years), with relapsed or refractory leukemia. Stratum II contained eight patients, median age 62.5 years (range, 38 to 83 years), who had received fewer than three cycles of myelotoxic therapy for chronic myeloid leukemia or myelodysplasia that had evolved into leukemia. Patients received mitoxantrone at 12 mg/m2 daily for 3 days. After the first mitoxantrone dose, gemcitabine was provided intravenously at 10 mg/m2/min with the duration adjusted by following a continuous reassessment model. Results: Severe myelosuppression, and stomatitis or esophagitis were the most common hematologic and nonhematologic dose-limiting toxicities. Several patients developed febrile neutropenia, nausea, or vomitting. In both strata, the maximum recommended duration of infusion of gemcitabine was 12 hours (7,200 mg/m2). The mean steady-state concentration of gemcitabine was 24.72 μmol/L and varied over a fivefold range among patients. Overall response rates in this phase I trial for strata I and II were 42{\%} and 63{\%}, respectively. Conclusion: Prolonged-infusion gemcitabine at a fixed dose rate of 10 mg/m2/min for 12 hours with 12 mg/m2/d mitoxantrone for 3 days is a tolerable induction regimen and achieves plasma concentrations sufficient for maximal intracellular activation. Stomatitis or esophagitis should be anticipated; however, this regimen may induce significant responses in patients with difficult-to-treat leukemias.",
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T1 - Phase I evaluation of prolonged-infusion gemcitabine with mitoxantrone for relapsed or refractory acute leukemia

AU - Rizzieri, David A.

AU - Bass, Adam J.

AU - Rosner, Gary

AU - Gockerman, Jon P.

AU - DeCastro, Carlos M.

AU - Petros, William P.

AU - Adams, David J.

AU - Laughlin, Mary J.

AU - Davis, Patti

AU - Foster, Traci

AU - Jacobson, Robert

AU - Hurwitz, Herbert

AU - Moore, Joseph O.

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N2 - Purpose: To ascertain the maximum tolerated duration of infusion of gemcitabine at 10 mg/m2/min in combination with mitoxantrone at 12 mg/m2 daily for 3 days in the treatment of acute leukemia. Patients and Methods: Thirty-four patients were enrolled. Stratum I consisted of 26 patients, median age 50 years (range, 25 to 71 years), with relapsed or refractory leukemia. Stratum II contained eight patients, median age 62.5 years (range, 38 to 83 years), who had received fewer than three cycles of myelotoxic therapy for chronic myeloid leukemia or myelodysplasia that had evolved into leukemia. Patients received mitoxantrone at 12 mg/m2 daily for 3 days. After the first mitoxantrone dose, gemcitabine was provided intravenously at 10 mg/m2/min with the duration adjusted by following a continuous reassessment model. Results: Severe myelosuppression, and stomatitis or esophagitis were the most common hematologic and nonhematologic dose-limiting toxicities. Several patients developed febrile neutropenia, nausea, or vomitting. In both strata, the maximum recommended duration of infusion of gemcitabine was 12 hours (7,200 mg/m2). The mean steady-state concentration of gemcitabine was 24.72 μmol/L and varied over a fivefold range among patients. Overall response rates in this phase I trial for strata I and II were 42% and 63%, respectively. Conclusion: Prolonged-infusion gemcitabine at a fixed dose rate of 10 mg/m2/min for 12 hours with 12 mg/m2/d mitoxantrone for 3 days is a tolerable induction regimen and achieves plasma concentrations sufficient for maximal intracellular activation. Stomatitis or esophagitis should be anticipated; however, this regimen may induce significant responses in patients with difficult-to-treat leukemias.

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