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Blood, 8 January 2009, Vol. 113, No. 2, pp. 299-305. Prepublished online as a Blood First Edition Paper on October 17, 2008; DOI 10.1182/blood-2008-02-137943.
Submitted February 15, 2008
M. D. Anderson Cancer Center, Houston, TX, United States * Corresponding author; email: sobrien{at}mdanderson.org.
Obatoclax mesylate is a small molecule pan-Bcl-2 antagonist with in vitro activity against chronic lymphocytic leukemia (CLL) cells. Obatoclax was administered to patients with advanced CLL at doses ranging from 3.5 to 14 mg/m2 as a 1-hr infusion and from 20 to 40 mg/m2 as a 3-hr infusion every 3 weeks. Twenty six patients received a total of 74 cycles. Dose limiting reactions were neurological (somnolence, euphoria, ataxia) and associated with the infusion. The MTD was 28 mg/m2 over 3 hours every 3 weeks. One (4%) of 26 patients achieved a partial response. Patients with anemia (3/11) or thrombocytopenia (4/14) experienced improvements in hemoglobin and platelet counts. Circulating lymphocyte counts were reduced in 18/26 patients with a median reduction of 24%. Overall, the plasma Cmax and AUC values of obatoclax were dose proportional. Activation of Bax and Bak was demonstrated in peripheral blood mononuclear cells and induction of apoptosis was related to overall obatoclax exposure, as monitored by the plasma concentration of oligonucleosomal DNA/histone complexes. Obatoclax mesylate has biological activity and modest single agent activity in heavily pretreated patients with advanced CLL. Further evaluation in less heavily pretreated patients and in combination with other therapeutic agents is warranted. This trial has been registered with clinicaltrials.gov under identifier NCT00600964.
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