Arsenic Trioxide in Treating Young Patients With Refractory Leukemia or Lymphoma

OBJECTIVES:

• Determine the toxic effects of arsenic trioxide in pediatric patients with refractory leukemia or lymphoma.
• Determine the maximum tolerated dose of this drug in this patient population.
• Determine the plasma pharmacokinetics of this drug in these patients.

OUTLINE: This is a dose-escalation, multicenter study. Patients are stratified according to disease (acute promyelocytic leukemia [APL] vs non-APL).

• Stratum I (APL patients): Patients receive standard-dose arsenic trioxide IV over 2 hours daily 5 days a week for 4 weeks. Treatment continues every 6 weeks for up to 3 courses in the absence of disease progression or unacceptable toxicity.
• Stratum II (Non-APL patients): Cohorts of 3-6 patients receive escalating doses of arsenic trioxide (according to the stratum 1 schedule above) until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which at least 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. Once the MTD is determined, additional patients are accrued to receive treatment with arsenic trioxide at the recommended phase II dose.

Leukemia patients in both strata without progressive disease who have not achieved complete remission after the first 20 doses may continue to receive arsenic trioxide for 2 additional weeks.

Patients are followed every 3 months for 1 year.

PROJECTED ACCRUAL: A maximum of 18 patients will be accrued for stratum I of this study within 2-3 years. A total of 3-30 patients will be accrued for stratum II of this study within 1-2 years.

DISEASE CHARACTERISTICS:

• Histologically confirmed leukemia or lymphoma refractory to standard curative treatment regimens
• Measurable or evaluable disease
• No meningeal leukemia or lymphoma
• No HIV-related lymphoma
• No lymphoproliferative diseases

PATIENT CHARACTERISTICS:

Age:

• 2 to 21

• Acute promyelocytic leukemia (APL) patients (stratum I) must be age 2 to 12

Performance status:

• ECOG 0-2

Life expectancy:

• Not specified

Hematopoietic:

• Not specified

Hepatic:

• Bilirubin normal
• SGPT less than 2 times upper limit of normal
• No significant hepatic dysfunction that would preclude study therapy

Renal:

• Creatinine normal (age adjusted) OR
• Creatinine clearance at least 60 mL/min
• Potassium, magnesium, and calcium at least lower limit of normal (oral or IV supplementation allowed)
• No significant renal dysfunction that would preclude study therapy

Cardiovascular:

• Rate corrected QTc interval no greater than 0.48 on EKG
• No significant cardiac dysfunction that would preclude study therapy
• No cardiac disease, including dysrhythmias

Pulmonary:

• No significant pulmonary dysfunction that would preclude study therapy

Other:

• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception
• No persistent grade 3 or greater sensory or motor neuropathy
• No prior grand mal seizures (grade 3 or greater) within the past 2 years other than febrile seizures (except for patients with APL at discretion of investigator)
• No clinically significant unrelated systemic illness that would preclude study therapy (e.g., serious infection)
• HIV negative

PRIOR CONCURRENT THERAPY:

Biologic therapy:

• At least 1 week since prior colony-stimulating factors (e.g., filgrastim [G-CSF], sargramostim [GM-CSF], and epoetin alfa)
• No concurrent immunotherapy

Chemotherapy:

• No prior arsenic trioxide
• At least 2 weeks since prior chemotherapy (4 weeks for nitrosoureas) and recovered
• No concurrent intrathecal chemotherapy except for acute promyelocytic leukemia (APL) patients experiencing progressive meningeal leukemia and demonstrating benefit from arsenic trioxide for systemic disease
• No other concurrent anticancer chemotherapy

Endocrine therapy:

• No concurrent steroids (except corticosteroids for retinoic acid syndrome)

Radiotherapy:

• At least 4 weeks since prior radiotherapy and recovered
• No concurrent radiotherapy

Surgery:

• Not specified

Other:

• At least 6 months since prior anticonvulsants
• At least 1 week since prior retinoid therapy
• No concurrent retinoids
• No other concurrent investigational agents