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Yttrium Y 90 Ibritumomab Tiuxetan With or Without Rituximab, Combination Chemotherapy, and an Autologous Stem Cell Transplant in Treating Patients With Non-Hodgkin Lymphoma
This study is currently recruiting participants.
Verified by National Cancer Institute (NCI), December 2008
Sponsors and Collaborators: Beckman Research Institute
National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00695409
  Purpose

RATIONALE: Monoclonal antibodies such as rituximab and yttrium Y 90 ibritumomab tiuxetan can locate cancer cells and either kill them or deliver radioactive cancer-killing substances to them without harming normal cells. Drugs used in chemotherapy work in different ways to kill cancer cells or stop them from growing. Giving rituximab, yttrium Y 90 ibritumomab tiuxetan, and combination chemotherapy before an autologous peripheral blood stem cell transplant may be an effective treatment for non-Hodgkin lymphoma.

PURPOSE: This phase II trial is studying how well giving yttrium Y 90 ibritumomab tiuxetan and high-dose combination chemotherapy with or without rituximab followed by an autologous stem cell transplant works in treating patients with relapsed B-cell non-Hodgkin lymphoma.


Condition Intervention Phase
Lymphoma
Drug: carmustine
Drug: cytarabine
Drug: etoposide
Drug: melphalan
Drug: rituximab
Drug: yttrium Y 90 ibritumomab tiuxetan
Procedure: autologous hematopoietic stem cell transplantation
Procedure: peripheral blood stem cell transplantation
Phase II

MedlinePlus related topics: Cancer Lymphoma
Drug Information available for: Cytarabine Cytarabine hydrochloride Etoposide Carmustine Melphalan Rituximab Etoposide phosphate Immunoglobulins Globulin, Immune Ibritumomab tiuxetan Melphalan hydrochloride Sarcolysin
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Open Label
Official Title: A Phase II Study of Yttrium-90-Labeled Anti-CD20 Monoclonal Antibody in Combination With High-Dose Beam (BCNU, Etoposide, Cytarabine and Melphalan) Followed by Autologous Stem Cell Transplantation for Patients With Poor Risk/Relapsed B-Cell Lymphoma

Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:
  • Progression-free survival (PFS)/relapse-free survival [ Designated as safety issue: No ]
  • Overall survival [ Designated as safety issue: No ]
  • Hematopoietic recovery [ Designated as safety issue: No ]
  • Early and late pulmonary, cardiac, and hepatic toxicities during the first 100 days post autologous stem cell transplantation (ASCT) and again at 1 year post ASCT as assessed by NCI CTCAE v3.0 [ Designated as safety issue: Yes ]
  • Response rate [ Designated as safety issue: No ]
  • Disease progression or relapse [ Designated as safety issue: No ]
  • Incidence of therapy-induced myelodysplasia and acute myeloid leukemia [ Designated as safety issue: Yes ]

Estimated Enrollment: 108
Study Start Date: March 2008
Estimated Primary Completion Date: March 2018 (Final data collection date for primary outcome measure)
Detailed Description:

OBJECTIVES:

  • To estimate the progression-free or relapse-free survival and overall survival of patients with poor-risk or relapsed follicular lymphoma (grades1-3), diffuse large B-cell lymphoma, immunoblastic lymphoma, mantle cell lymphoma, and transformed low-grade lymphoma undergoing rituximab-based autologous stem cell transplantation (ASCT).
  • To evaluate hematopoietic recovery using neutrophil (ANC ≥ 500 x 10^³/μL, ANC ≥ 1,000 x 10^³/μL) and unmaintained platelet (≥ 20 x10^³/μL, ≥ 100 x 10^³/μL) engraftment as the primary criterion in patients treated with this regimen.
  • To characterize early and late pulmonary, cardiac, and hepatic toxicities during the first 100 days post ASCT and again 1 year post ASCT.
  • To evaluate the response rate and the disease progression or relapse rate in patients treated with this regimen.
  • To evaluate long-term incidence of myelodysplasia and therapy-related AML in patients treated with this new preparative regimen.
  • To descriptively compare the outcomes of patients treated with this regimen with a comparable patient population treated with chemotherapy alone.

OUTLINE:

  • Autologous stem cell collection: Patients undergo leukapheresis to obtain peripheral blood stem cells (PBSCs). Patients with an adequate number of collected CD34-positive cells (≥ 3 times 10^6/kg) proceed to radioimmunotherapy.
  • Radioimmunotherapy: Patients undergo blood sample collection on day -23 to determine rituximab levels (from previous therapies). If rituximab levels are < 10 μg/mL, patients receive rituximab IV prior to the biodistribution imaging on day -21.

Patients undergo pre-therapy biodistribution imaging with infusion of indium In 111 ibritumomab tiuxetan over 10 minutes on day -21 and undergo whole-body gamma camera images at approximately 2-24 hours, 48-72 hours, and an optional third scan at approximately 90-120 hours after the infusion. Patients with unfavorable biodistribution are removed from study. Patients with favorable biodistribution undergo repeat evaluation of rituximab levels in the blood on day -16. If rituximab levels are ≥ 10 μg/mL, patients receive yttrium Y 90 ibritumomab tiuxetan IV over 10 minutes on day -14. Patients with unacceptably low antibody levels receive rituximab prior to administration of yttrium Y 90 ibritumomab tiuxetan on day -14.

  • High-dose BEAM chemotherapy: Patients receive carmustine IV on days -7 to -6; etoposide IV and cytarabine IV twice daily on days -5 to -2; and rituximab IV (if not received previously on day -21 and/or day -14) and melphalan IV on day -1.
  • PBSCs transplantation: Patients undergo reinfusion of PBSCs on day 0.
  • Growth factor therapy: Patients receive filgrastim (G-CSF) IV beginning on day 5 and continuing daily until blood counts recover.

After completion of study treatment, patients are followed periodically.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Biopsy-proven diagnosis of low- or intermediate-grade* non-Hodgkin lymphoma (NHL) including any of the following:

    • Working formulation B, C, D, E, F, G and H
    • Follicular lymphoma (grade1-3)
    • Diffuse large B-cell lymphoma
    • Immunoblastic lymphoma
    • Mantle cell lymphoma NOTE: *A new classification scheme for adult non-Hodgkin lymphoma has been adopted by PDQ. The terminology of "indolent" or "aggressive" lymphoma will replace the former terminology of "low-", "intermediate-", or "high-" grade lymphoma. However, this protocol uses the former terminology.
  • Transformed low-grade lymphomas allowed
  • Demonstrated monoclonal CD20-positive B-cell population in lymph nodes and/or bone marrow
  • Patient either relapsed after achieving a complete response (CR) or partial response (PR) to prior therapy, has never responded to prior therapy, or has poor-risk disease

    • Sensitivity of disease based on 1 of the following:

      • Induction failure: patients did not achieve a CR or PR from induction chemotherapy
      • Resistant relapse: patients did not achieve a CR or PR from the most recent standard salvage chemotherapy
      • Sensitive relapse: patients did achieve a CR or PR from the most recent standard salvage chemotherapy
    • Poor-risk disease defined as any of the following:

      • Age-adjusted International Prognostic Index High (3 risk factors) or High-Intermediate (2 risk factors) based on the following risk factors:

        • Stage III-IV disease
        • Elevated serum lactate dehydrogenase level
        • ECOG performance status 2-4
      • Patients with follicular lymphoma (grade 1-3) or diffuse large B-cell lymphoma who fail to achieve a CR after adequate induction chemotherapy
      • Patients with mantle cell lymphoma histology, including patients in first CR
      • Patients with transformed low-grade lymphoma, including those in first remission
  • Patients with prior bone marrow involvement must have bone marrow aspiration and biopsy that show ≤ 10% lymphomatous involvement of total cellularity within 42 days prior to stem cell collection or salvage chemotherapy
  • Candidate for high-dose therapy and autologous stem cell transplantation
  • No abnormal cytogenetic study not related to the underlying lymphoma on the bone marrow aspirate sample prior to stem cell collection

    • If cytogenetics was not performed on the marrow aspirate prior to stem cell collection, cytogenetics on the peripheral blood may be performed
  • No prior or active CNS disease
  • No human anti-Zevalin antibody (HAHA) antibody
  • Must be enrolled concurrently on protocol 98117, "Molecular Pathogenesis of Therapy-Related Leukemia"

PATIENT CHARACTERISTICS:

  • ECOG performance status 0-1 OR Karnofsky PS 80-100%
  • Serum creatinine less than upper limit of normal (ULN) OR creatinine clearance ≥ 60 mL/min
  • FEV_1 > 60% of predicted OR DLCO ≥ 50% of predicted
  • LVEF > 50% by ECHO or MUGA scan
  • Bilirubin ≤ 1.5 times ULN
  • SGOT or SGPT ≤ 2 times ULN
  • HIV antibody negative
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception
  • No prior malignancy except adequately treated basal cell or squamous cell skin cancer, adequately treated noninvasive carcinoma, or other cancer from which the patient has been disease-free for at least 5 years
  • No active evidence of hepatitis B or C infection
  • No hepatitis B surface antigen positivity

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • Recovered from last therapy
  • At least 4 weeks since prior radiotherapy or chemotherapy
  • No prior radioimmunotherapy
  • No prior bone marrow transplantation
  • No prior radiotherapy to the lung except mediastinal irradiation provided minimal lung is in the treatment volume
  • No prior radiotherapy dose to the kidneys > 500 cGy
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00695409

Locations
United States, California
City of Hope Comprehensive Cancer Center Recruiting
Duarte, California, United States, 91010-3000
Contact: Phyllis Broene     800-826-4673     PBroene@coh.org    
Sponsors and Collaborators
Beckman Research Institute
Investigators
Principal Investigator: Amrita Y. Krishnan, MD Beckman Research Institute
  More Information

Clinical trial summary from the National Cancer Institute's PDQ® database  This link exits the ClinicalTrials.gov site

Responsible Party: City of Hope Comprehensive Cancer Center ( Amrita Y. Krishnan )
Study ID Numbers: CDR0000597569, CHNMC-07076
Study First Received: June 10, 2008
Last Updated: December 9, 2008
ClinicalTrials.gov Identifier: NCT00695409  
Health Authority: Unspecified

Keywords provided by National Cancer Institute (NCI):
recurrent mantle cell lymphoma
stage III mantle cell lymphoma
stage IV mantle cell lymphoma
recurrent adult diffuse large cell lymphoma
stage III adult diffuse large cell lymphoma
stage IV adult diffuse large cell lymphoma
recurrent grade 1 follicular lymphoma
recurrent grade 2 follicular lymphoma
recurrent grade 3 follicular lymphoma
stage III grade 1 follicular lymphoma
stage III grade 2 follicular lymphoma
stage III grade 3 follicular lymphoma
stage IV grade 1 follicular lymphoma
stage IV grade 2 follicular lymphoma
stage IV grade 3 follicular lymphoma
stage III adult immunoblastic large cell lymphoma
stage IV adult immunoblastic large cell lymphoma
recurrent adult immunoblastic large cell lymphoma

Study placed in the following topic categories:
Melphalan
Lymphoma, Mantle-Cell
Lymphoma, small cleaved-cell, diffuse
Lymphoma, Follicular
Etoposide phosphate
Lymphoma, large-cell, immunoblastic
Lymphoma, B-Cell
Lymphoma, large-cell
Antibodies, Monoclonal
Lymphoma, Large-Cell, Immunoblastic
Lymphoma
Etoposide
Cytarabine
Immunoglobulins
Lymphoma, Large B-Cell, Diffuse
Immunoproliferative Disorders
Rituximab
Carmustine
Mantle cell lymphoma
Recurrence
Lymphatic Diseases
Antibodies
B-cell lymphomas
Lymphoproliferative Disorders
Lymphoma, Non-Hodgkin
Follicular lymphoma

Additional relevant MeSH terms:
Antimetabolites
Anti-Infective Agents
Neoplasms by Histologic Type
Antimetabolites, Antineoplastic
Immunologic Factors
Immune System Diseases
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Physiological Effects of Drugs
Immunosuppressive Agents
Antiviral Agents
Pharmacologic Actions
Neoplasms
Therapeutic Uses
Myeloablative Agonists
Antineoplastic Agents, Alkylating
Antirheumatic Agents
Antineoplastic Agents, Phytogenic
Alkylating Agents

ClinicalTrials.gov processed this record on January 16, 2009