L-Ascorbic Acid Depletion to Treat Acute Myeloid Leukemia and Myelodysplastic Syndromes

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00329498
Recruitment Status : Suspended
First Posted : May 24, 2006
Last Update Posted : October 26, 2006
Jin Yang Pharmaceutical
Information provided by:
Samsung Medical Center

Brief Summary:
To document therapeutic gain achieved by cyclic application of L-ascorbic acid (LAA) supplementation and depletion, while confirming safety and avoidance of clinically significant scurvy, in chemorefractory patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS).

Condition or disease Intervention/treatment Phase
Acute Myeloid Leukemia Myelodysplastic Syndrome Drug: L-Ascorbic Acid Phase 2

Detailed Description:

The seminal discovery that the in vitro growth of malignant cells could be absolutely dependent on L-ascorbic acid (LAA) was originally published in Sciene. The cell culture assay used with a mouse plasmacytoma model in this discovery was based on colony formation, and was essentially the same as the one used to grow normal hemopoietic colonies, such as CFU-GM and CFU-G, from normal bone marrow specimens. Subsequent analysis of the growth factors for these CFUs using this same culture system eventually led to the discovery of colony stimulating factors, such as GM-CSF and G-CSF, now widely used clinically. Human leukemia, specifically acute myeloid leukemia (AML), cell colonies also grow well in this culture system, as shown by extensive cell biology studies. In addition, cells from patients with myelodysplastic syndrome (MDS), a significant proportion of them progressing to AML behave similarly to AML cells in this culture system . In particular both AML and MDS are identical in that the growth of colonies is enhanced by addition of LAA to the cell culture media in a high proportion of these patients.

The large volume of in vitro data thus generated, including correlations with direct clinical relevance is increasingly convincing that lowering of LAA levels could potentially be developed and utilized as a treatment for specific hemopoeitic malignancies. This was particularly attractive in view of the fact that the growth of normal hemopoietic colonies, such as CFU-GM and CFU-G, is never enhanced by LAA. Such an absolute selectivity would predict a lack of clinical adverse hemopoetic events from an intervention which lowered LAA levels. We also had seemingly-contradictory data that the growth of colonies from AML and MDS patients could be suppressed by addition of LAA, infrequently but sometimes profoundly. However, detailed dose response analysis later clarified this: low physiologic doses enhance and high pharmacologic doses suppress formation of leukemic colonies. From a therapeutic perspective, we would have greater expectations for a depletion strategy than for supplementation, because 1) leukemic suppression by addition of LAA is often accompanied by some mild suppression of the normal CFU and therefore is not absolutely selective; and 2) LAA supplementation has been clinically tested in a variety of solid tumors, with controversial outcomes.

Therefore, our original protocol was developed primarily to accomplish lowering of LAA levels, with a subsequent oral LAA supplementation used primarily to prevent scurvy and only secondarily for possible benefit. However, with the first patient there was a strong indication of antileukemic effects during both the LAA depletion and supplementation phases. Based on this encouragement, the protocol was amended to formally alternate depletion with supplementation, and to utilize intravenous (IV) administration of LAA to achieve high dose supplementation. With 17 subsequent subjects having been treated, this study of the safety and efficacy of cyclic manipulation of LAA levels has demonstrated beneficial outcome in a high proportion of refractory and terminal patients with AML or MDS. Moreover, growing laboratory evidence being produced provides a molecular basis for these clinical outcomes.

Study Type : Interventional  (Clinical Trial)
Enrollment : 25 participants
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Manipulation of L-Ascorbic Acid Level For The Treatment of Selected Cases Of Acute Myeloid Leukemia and Myelodysplastic Syndromes
Study Start Date : May 1998
Study Completion Date : August 2005

Primary Outcome Measures :
  1. Efficacy
  2. Safety, clinically

Secondary Outcome Measures :
  1. Correlative studies between the modulation of the growth of leukemic colony-forming-cells(CFC) by L-ascorbic acid (LAA) in cell-culture and clinical response.

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Ages Eligible for Study:   Child, Adult, Senior
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Patients should have AML or MDS according to new WHO classification, with minimum of 5% blasts in peripheral blood.
  • There must be a clear and acceptable reason for not receiving standard treatments (chemotherapy and/or stem cell transplantation); or standard treatments have already been given and this option exhausted with evidence of refractory disease.
  • Prior treatments of any forms are allowed provided there is no potential residual beneficial effect and the patients are off treatment for at least 4 weeks, with estimated life expectancy of at least 2 months.
  • Adequate amount (4 ml) of bone marrow sent to the laboratory for cell culture studies.
  • There are no restrictions based on age, sex, or ethnicity except that adequate contraception must be practiced in women of childbearing ages. Although AML is rare in children, pediatric patients will be accepted.
  • There is no deficiency of G6PD (RBC).
  • Asymptomatic patients with disease progression and symptomatic patients.

Exclusion Criteria:

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00329498

Korea, Republic of
Samsung Medical Center
Seoul, Korea, Republic of
Sponsors and Collaborators
Samsung Medical Center
Jin Yang Pharmaceutical
Principal Investigator: Won Seog Kim, MD Samsung Medical Center

Publications automatically indexed to this study by Identifier (NCT Number): Identifier: NCT00329498     History of Changes
Other Study ID Numbers: SMCIRB-98-04-02
First Posted: May 24, 2006    Key Record Dates
Last Update Posted: October 26, 2006
Last Verified: October 2006

Keywords provided by Samsung Medical Center:
ascorbic acid

Additional relevant MeSH terms:
Leukemia, Myeloid
Leukemia, Myeloid, Acute
Myelodysplastic Syndromes
Pathologic Processes
Neoplasms by Histologic Type
Bone Marrow Diseases
Hematologic Diseases
Precancerous Conditions
Ascorbic Acid
Molecular Mechanisms of Pharmacological Action
Protective Agents
Physiological Effects of Drugs
Growth Substances