A Phase I Trial Of Sirolimus In Relapsed/Refractory Leukemia And Non-Hodgkin's Lymphoma
Inclusion Criteria
DISEASE CHARACTERISTICS:
- Histologically confirmed diagnosis of 1 of the following:
- Acute lymphoblastic leukemia (ALL) OR acute myeloid leukemia (AML)
- At least 25% blasts in the bone marrow
- Recurrent or refractory disease
- Non-Hodgkin's lymphoma (NHL)
- Second or greater relapse as determined by physical or radiological
evidence
- Disease for which there is no known curative therapy
PATIENT CHARACTERISTICS:
Age
- 21 and under
Performance status
- Karnofsky 50-100% (patients over 10 years of age)
- Lansky 50-100% (patients 10 years of age and under)
Life expectancy
- At least 4 weeks
Hematopoietic
- Absolute neutrophil count at least 1,000/mm^3*
- Platelet count at least 75,000/mm^3 (transfusion independent)*
- Hemoglobin at least 8.0 g/dL (may receive RBC transfusions)* NOTE: *Patients with
ALL, AML, and NHL with tumor metastatic to bone marrow, with granulocytopenia,
anemia, and/or thrombocytopenia are eligible, but will not be evaluable for
hematological toxicity
Hepatic
- Bilirubin no greater than 1.5 times normal
- ALT no greater than 5 times normal
- Albumin at least 2 g/dL
Renal
- Creatinine based on age, as follows:
- No greater than 0.8 mg/dL (5 years of age and under)
- No greater than 1.0 mg/dL (6 to 10 years of age)
- No greater than 1.2 mg/dL (11 to 15 years of age)
- No greater than 1.5 mg/dL (over 15 years of age) OR
- Creatinine clearance or radioisotope glomerular filtration rate at least 70 mL/min
Cardiovascular
- Shortening fraction at least 28% by echocardiogram OR
- Ejection fraction at least 50% by gated radionuclide
Other
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
- Able to ingest oral medication
- No known allergy to sirolimus, tacrolimus, or other mammalian target of rapamycin
(mTOR) inhibitors
- No uncontrolled active infection
- Fungal disease must be stable for at least 2 weeks prior to study entry
- Documented negative blood cultures prior to study entry for patients with
bacteremia
- No active graft-versus-host disease
PRIOR CONCURRENT THERAPY:
Biologic therapy
- Recovered from prior immunotherapy
- More than 1 week since prior hematopoietic growth factors except for epoetin alfa
- At least 7 days since prior biologic antineoplastic agents
- At least 3 months since prior bone marrow or stem cell transplantation
Chemotherapy
- Recovered from all prior chemotherapy
- More than 2 weeks since prior myelosuppressive chemotherapy (4 weeks for
nitrosoureas)
- Prior hydroxyurea within the past 2 weeks is allowed provided peripheral blast count
has been stable or rising for at least 3 days
Endocrine therapy
- Prior corticosteroids within the past 2 weeks are allowed provided peripheral blast
count has been stable or rising for at least 3 days
Radiotherapy
- Recovered from prior radiotherapy
- At least 2 weeks since prior local palliative radiotherapy
- At least 4 weeks since prior craniospinal radiotherapy or radiation to the pelvis of
50% or more
- At least 4 weeks since prior substantial bone marrow radiotherapy
- No concurrent radiotherapy, except for emergent situations or persistent
extramedullary disease with resolution of bone marrow disease
Surgery
- Not specified
Other
- No other concurrent investigational antineoplastic drugs
- No concurrent administration of any of the following:
- Ketoconazole
- Tacrolimus
- Cyclosporine
- Rifampin
- Diltiazem