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Phase II/III Randomized Study of Immunotherapy Comprising Cyclosporine, Interferon Gamma, and Interleukin-2 After High-Dose Myeloablative Chemotherapy With Autologous Stem Cell Transplantation in Patients With Refractory or Relapsed Hodgkin's Lymphoma
Alternate Title Basic Trial Information Objectives Entry Criteria Expected Enrollment Outcomes Outline Published Results Trial Contact Information Related Information Registry Information
Alternate Title
Immunotherapy Using Cyclosporine, Interferon gamma, and Interleukin-2 After High-Dose Myeloablative Chemotherapy With Autologous Stem Cell Transplantation in Treating Patients With Refractory or Relapsed Hodgkin's Lymphoma
Basic Trial Information
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Protocol IDs
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Phase III, Phase II
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Treatment
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Closed
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Under 30
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NCI
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COG-AHOD0121 NCT00070187, AHOD0121
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Objectives Primary - Phase II
- Determine the feasibility and toxicity of immunotherapy comprising cyclosporine, interferon gamma, and interleukin-2 after high-dose myeloablative chemotherapy with autologous stem cell transplantation (ASCT) in patients with refractory or relapsed Hodgkin's lymphoma.
- Phase III
- Compare the event-free and overall survival of patients treated with vs without this immunotherapy regimen.
Secondary - Determine the event-free and overall survival rates, toxic effects, and response rates to reinduction chemotherapy followed by hyperfractionated involved-field radiotherapy, high-dose chemotherapy comprising carmustine, etoposide, cytarabine, and melphalan, and ASCT in these patients.
- Correlate tumor biologic characteristics with response in patients treated with these regimens.
- Determine the effectiveness of this immunotherapy regimen in producing autologous graft-vs-host disease (GVHD) and auto-reactive cytotoxic T-lymphocyte activity in these patients.
- Correlate greater levels of autologous GVHD and in vitro cytolytic activity with improved event-free and overall survival in patients treated with these regimens.
- Determine whether treatment with immunotherapy can overcome the negative prognostic significance of p53 mutation and high serum levels of interleukin-10 and interleukin-2 receptor in these patients.
- Determine the genotoxicity of retrieval therapy and the incidence of hypermutability by longitudinal genotoxic biomonitoring in these patients.
- Correlate HLA class II invariant peptide (CLIP) expression in tumor cells with improved event-free and overall survival in patients treated with immunotherapy regimen.
Entry Criteria Disease Characteristics:
- Diagnosis of Hodgkin's lymphoma
- Histologically confirmed at original diagnosis AND at relapse or disease progression
- Relapsed or refractory to conventional therapy
- No recurrence without B symptoms or bulky disease at least 1 year after completion of minimal systemic therapy defined by either of the following:
- Stage IA/IIA with nodal disease previously treated with radiotherapy only
- Stage IA/IIA with nodal disease previously treated with less than 3 courses of standard dose chemotherapy
- Concurrently enrolled on the COG-AHOD00P1 salvage chemotherapy study OR received other appropriate salvage therapy (e.g., ifosfamide and vinorelbine)
Prior/Concurrent Therapy:
Biologic therapy - Recovered from prior immunotherapy
- At least 1 week since prior antineoplastic biologic agents
- More than 1 week since prior growth factors
- No prior stem cell transplantation
- No other concurrent immunomodulating agents
Chemotherapy - See Disease Characteristics
- More than 2 weeks since prior myelosuppressive chemotherapy (4 weeks for nitrosoureas) and recovered
- No other concurrent anticancer chemotherapy
Endocrine therapy - No concurrent steroids, including dexamethasone as an antiemetic
Radiotherapy - See Disease Characteristics
- Recovered from prior radiotherapy
Surgery Other - No concurrent participation in another COG therapeutic study
Patient Characteristics:
Age Performance status - ECOG 0-2 (for adults)
- Lansky 50-100% (for children)
Life expectancy Hematopoietic - Absolute neutrophil count at least 500/mm3
Hepatic - Bilirubin no greater than 1.5 times normal
- SGPT less than 2.5 times normal
Renal - Creatinine no greater than 1.5 times normal
OR - Creatinine clearance or radioisotope glomerular filtration rate at least 70 mL/min/1.73 m2
Cardiovascular - Shortening fraction at least 27% by echocardiogram
OR - Ejection fraction at least 50% by MUGA
Pulmonary - No evidence of dyspnea at rest
- No exercise intolerance
- DLCO at least 50% (patients 8 years of age and over)
Other - Not pregnant or nursing
- Negative pregnancy test
- No concurrent serious illness
Expected Enrollment A total of 156 patients (25 for phase II and 131 for phase III) will be accrued for this study within 5.4 years. Outcomes Primary Outcome(s)Event-free survival at 3 years after stem cell rescue Overall survival at 3 years after stem cell rescue
Secondary Outcome(s)Non-relapse mortality at 100 days after stem cell rescue Graft-vs-host disease at 100 days after stem cell rescue T-lymphocyte activity at 100 days after stem cell rescue Invariant peptide expression at 100 days after stem cell rescue
Outline This is a nonrandomized, multicenter phase II study followed by a randomized, multicenter phase III study. Patients are stratified according to study phase (II vs III). Patients receive 2 courses of salvage induction therapy on COG-AHOD00P1 or equivalent. Within 2-5 weeks after completion of salvage induction therapy, patients receive protocol therapy. - Phase II: All patients receive the following treatment:
- Hyperfractionated involved-field radiotherapy: Patients who have completed prior salvage induction therapy and have not received full tissue tolerance from prior radiotherapy may receive hyperfractionated involved-field radiotherapy twice daily for 7 days.
- High-dose preparative regimen: Beginning within 7 days after radiotherapy, patients receive carmustine IV over 3 hours on day -6; etoposide IV over 1 hour and cytarabine IV over 1 hour on days -5 to -2; and melphalan IV over 30 minutes on day -1.
- Autologous stem cell transplantation: Patients undergo autologous bone marrow or peripheral blood stem cell transplantation on day 0. Patients then receive filgrastim (G-CSF) subcutaneously (SC) or IV beginning on day 1 and continuing until blood counts recover.
- Immunotherapy: Patients receive cyclosporine IV twice daily beginning on day 0 and continuing until the completion of the course of interferon gamma and interleukin-2. When sufficiently recovered, patients also receive interferon gamma SC every other day for 10 doses. Beginning 2 days after the start of interferon gamma, patients also receive interleukin-2 SC once daily for 18 days.
- Phase III: Patients who respond to prior salvage induction therapy are randomized to 1 of 2 treatment arms. Patients who have progressive disease after 2 courses of prior salvage induction therapy are assigned to arm I.
- Arm I: Patients receive treatment as in phase II.
- Arm II: Patients receive treatment as in phase II without immunotherapy.
In both phases, treatment continues in the absence of disease progression or unacceptable toxicity. Patients are followed at 1 year. Published ResultsChen AR, Hutchison R, Hess A, et al.: Clinical outcomes of patients with recurrent/refractory Hodgkin disease receiving cyclosporine, interferon-, and interleukin-2 immunotherapy to induce auto-reactivity after autologous stem cell transplantation with BEAM: a COG study. [Abstract] Blood 110 (11): A-1896, 2007.
Trial Contact Information
Trial Lead Organizations Children's Oncology Group | | | Allen Chen, MD, PhD, MHS, Protocol chair | | | | Sharon Gardner, MD, Protocol co-chair | | | |
Related Information PDQ® clinical trial COG-AHOD00P1
Registry Information | | Official Title | | A Phase II/III Study of Immunomodulation After High Dose Myeloablative Therapy with Autologous Stem Cell Rescue for Refractory/Relapsed Hodgkin Disease | | Trial Start Date | | 2003-11-03 | | Registered in ClinicalTrials.gov | | NCT00070187 | | Date Submitted to PDQ | | 2003-08-15 | | Information Last Verified | | 2007-06-04 | | NCI Grant/Contract Number | | CA13539, CA98543 |
Note: The purpose of most clinical trials listed in this database is to test new cancer treatments, or new methods of diagnosing, screening, or preventing cancer. Because all potentially harmful side effects are not known before a trial is conducted, dose and schedule modifications may be required for participants if they develop side effects from the treatment or test. The therapy or test described in this clinical trial is intended for use by clinical oncologists in carefully structured settings, and may not prove to be more effective than standard treatment. A responsible investigator associated with this clinical trial should be consulted before using this protocol. Back to Top |
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