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Carmustine, Etoposide, Cyclophosphamide, and Stem Cell Transplant in Treating Patients With HIV-Associated 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: NCT00641381
  Purpose

RATIONALE: Giving high-dose chemotherapy drugs, such as carmustine, etoposide, and cyclophosphamide, before a peripheral blood stem cell transplant stops the growth of cancer cells by stopping them from dividing or killing them. After treatment, stem cells that were collected from the patient's blood are returned to the patient to replace the blood-forming cells that were destroyed by the chemotherapy.

PURPOSE: This clinical trial is studying the side effects of giving high-dose carmustine, etoposide, and cyclophosphamide together with a stem cell transplant and to see how well it works in treating patients with HIV-associated lymphoma.


Condition Intervention
Lymphoma
Drug: carmustine
Drug: cyclophosphamide
Drug: etoposide
Procedure: autologous hematopoietic stem cell transplantation
Procedure: peripheral blood stem cell transplantation
Procedure: pharmacological study

MedlinePlus related topics: AIDS Cancer Hodgkin's Disease Lymphoma
Drug Information available for: Cyclophosphamide Etoposide Carmustine Etoposide phosphate
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment
Official Title: High Dose Chemotherapy and Combination Anti-HIV Therapy for HIV-Associated Hodgkin's and Non-Hodgkin's Lymphoma

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

Primary Outcome Measures:
  • Number of days to engraftment as defined by the standard operating procedures of the department of biostatistics at the City of Hope [ Designated as safety issue: No ]
  • Feasibility and treatment-associated toxicity of this regimen [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Ability to mobilize adequate numbers of peripheral blood stem cells (2.5 x 10e6 CD34+cells) [ Designated as safety issue: No ]
  • Disease-free and overall survival [ Designated as safety issue: No ]
  • HIV viral load, CD4+/CD8+ counts, and immune recovery [ Designated as safety issue: No ]

Estimated Enrollment: 25
Study Start Date: March 2000
Estimated Primary Completion Date: March 2013 (Final data collection date for primary outcome measure)
Detailed Description:

OBJECTIVES:

Primary

  • To evaluate the feasibility and toxicity of high-dose chemotherapy comprising carmustine, etoposide, and cyclophosphamide followed by autologous stem cell infusion in patients with HIV-associated lymphoma receiving combination anti-HIV therapy and to determine the efficiency of stem cell collection from these patients.
  • To estimate the disease-free and overall survival of patients treated with this regimen.
  • To evaluate HIV viral load, CD+4/CD+8 counts, and immune recovery after high-dose anti- lymphoma chemotherapy.
  • To determine the pharmacokinetics of high-dose etoposide in patients receiving highly active anti-retroviral therapy (HAART).

OUTLINE: Patients undergo leukapheresis to obtain peripheral blood stem cells (PBSCs) for transplantation. At least 5 days later, patients with an adequate number of collected cells proceed to high-dose chemotherapy.

  • High-dose chemotherapy: Patients receive carmustine IV over 4 hours on days -7 to -5, etoposide IV over 4 hours on day -4, and cyclophosphamide IV on day -2.
  • Autologous PBSC transplantation: Patients receive PBSC infusion on day 0. Patients undergo blood sample collection periodically for pharmacokinetic studies of etoposide.

After completion of study treatment, patients are followed at approximately 30 days and 100 days, every 3 months for 1 year, every 6 months for 1 year, and then annually thereafter.

  Eligibility

Ages Eligible for Study:   10 Years to 60 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Biopsy-confirmed lymphoma, meeting 1 of the following criteria:

    • Hodgkin lymphoma of any subtype except nodular L&H lymphocyte predominant

      • Partial response after standard chemotherapy
      • First relapse after initial complete remission with standard chemotherapy
    • Intermediate-grade or high-grade non-Hodgkin lymphoma* (working formulation groups D-H and J)

      • First complete remission after standard chemotherapy with high-risk features as specified by the International Prognostic Index
      • Partial response after standard chemotherapy
      • Relapse after initial complete remission with standard chemotherapy 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.
  • HIV seropositive at or before the time of lymphoma diagnosis
  • Must be on a multi-drug regimen (excluding azidothymidine [AZT])* to maintain HIV viral load < 50,000 genome copies (gc)/mL

    • If the CD4 count at enrollment is < 100/mm^3, then the viral load should be < 10,000 gc/mL by RT-PCR
    • If the CD4 count is > 100/mm^3 prior to the start of any lymphoma chemotherapy and is > 100/mm^3 for at least 3 months, then the viral load must be < 150,000 gc/mL and clinically stable
    • If no pre-chemotherapy CD4 counts are available, then the viral load alone will be used from enrollment NOTE: *No AZT pre-transplant during stem cell collection and during the immediate period of engraftment post-transplant. Resumption of AZT should not begin until there is evidence of stable engraftment. Therefore, AZT should not be resumed until at least 2 months after last blood product support is used.
  • Must be on a prophylactic regimen for pneumocystis pneumonia if the CD4 counts are < 200/mm^3
  • Patients with prior marrow involvement must demonstrate < 10% involvement by morphology pre-stem cell collection
  • Patients who are not in complete remission must have measurable disease defined as the following:

    • Bidimensionally measurable lesion by medical photograph, CAT scan or MRI scan, or palpation of lesions with both diameters > 2 cm
  • Patients with a history of positive CSF cytology that has become negative with intrathecal chemotherapy are eligible

    • Patients should have a negative spinal fluid cytology within 30 days prior to enrollment
  • No abnormal cytogenetics on screening bone marrow biopsy

PATIENT CHARACTERISTICS:

Inclusion criteria:

  • Karnofsky performance status 70-100%
  • SGOT and SGPT < 1.5 x upper limit of normal (ULN)
  • Bilirubin < 1.5 x ULN
  • Serum creatinine < 2 x ULN and 24-hour urine creatinine clearance > 60 mL/min
  • PT/PTT < 2 x normal
  • Not pregnant or nursing
  • Negative pregnancy test
  • FEV_1 OR DLCO > 50% predicted
  • LVEF > 50% by 2-D echocardiogram or MUGA scan

    • No cardiomyopathy, congestive heart failure, or dysrhythmia
  • Patients who are hepatitis C antibody positive or hepatitis B surface antigen positive without clinical evidence of cirrhosis will be eligible after further evaluation of viral loads

    • Patients with hepatitis B and ongoing evidence of viral replication may require therapy prior to receiving high-dose chemotherapy at the discretion of the treating physician

Exclusion criteria:

  • Active bacterial or fungal infection
  • AIDS-related opportunistic infection within the past year, excluding treatment-responsive Mycobacterium Avium Intracellular infection, treatment-responsive oral thrush, herpes simplex, or herpes zoster
  • Active CMV retinitis or other CMV-related organ dysfunction

    • Patients with a history of treated CMV infection are allowed
  • Relapse of pneumocystis carinii pneumonia within the past year
  • AIDS-related syndromes or symptoms that pose a perceived excessive risk for transplantation-related morbidity as determined by the principle investigator
  • Intractable and severe diarrhea defined as > 1,500 cc of diarrheal fluid/day or diarrhea causing persistent severe electrolyte abnormalities or hypoalbuminemia
  • History of grade III hemorrhagic cystitis due to prior chemotherapy
  • Any prior malignancy except treated basal cell carcinoma of the skin

    • Patients with cervical dysplasia may be included at the discretion of the treating physician and the principal investigator
  • Psychosocial conditions that hinder compliance

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00641381

Locations
United States, California
City of Hope Comprehensive Cancer Center Recruiting
Duarte, California, United States, 91010-3000
Contact: Clinical Trials Office - City of Hope Comprehensive Cancer Cen     800-826-4673     becomingapatient@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

Study ID Numbers: CDR0000589621, CHNMC-99067
Study First Received: March 21, 2008
Last Updated: December 9, 2008
ClinicalTrials.gov Identifier: NCT00641381  
Health Authority: Unspecified

Keywords provided by National Cancer Institute (NCI):
stage III adult Hodgkin lymphoma
stage III childhood Hodgkin lymphoma
stage IV adult Hodgkin lymphoma
stage IV childhood Hodgkin lymphoma
recurrent childhood lymphoblastic lymphoma
recurrent mantle cell lymphoma
recurrent adult Hodgkin lymphoma
recurrent/refractory childhood Hodgkin lymphoma
recurrent adult T-cell leukemia/lymphoma
recurrent cutaneous T-cell non-Hodgkin lymphoma
AIDS-related diffuse large cell lymphoma
AIDS-related diffuse mixed cell lymphoma
AIDS-related immunoblastic large cell lymphoma
AIDS-related lymphoblastic lymphoma
AIDS-related small noncleaved cell lymphoma
Burkitt lymphoma
stage III adult diffuse large cell lymphoma
stage III adult diffuse mixed cell lymphoma
stage IV adult diffuse large cell lymphoma
stage IV adult diffuse mixed cell lymphoma
stage III grade 3 follicular lymphoma
stage IV grade 3 follicular lymphoma
stage III adult immunoblastic large cell lymphoma
stage IV adult immunoblastic large cell lymphoma
stage III adult lymphoblastic lymphoma
stage III childhood lymphoblastic lymphoma
stage IV adult lymphoblastic lymphoma
stage IV childhood lymphoblastic lymphoma
stage III adult Burkitt lymphoma
stage IV adult Burkitt lymphoma

Study placed in the following topic categories:
Hodgkin's disease
Hodgkin lymphoma, adult
Cutaneous T-cell lymphoma
Lymphoma, Mantle-Cell
Lymphoma, Follicular
Lymphoma, small cleaved-cell, diffuse
Cyclophosphamide
Etoposide phosphate
Small non-cleaved cell lymphoma
Lymphoma, large-cell, immunoblastic
Lymphoma, large-cell
Burkitt's lymphoma
Leukemia
Lymphoma, AIDS-Related
Lymphoma, T-Cell
Lymphoma, Large-Cell, Immunoblastic
Etoposide
Hodgkin Disease
Lymphoma
Lymphoma, AIDS-related
Lymphoma, Large B-Cell, Diffuse
Immunoproliferative Disorders
Leukemia-Lymphoma, Adult T-Cell
Carmustine
Acquired Immunodeficiency Syndrome
Lymphoblastic lymphoma
Mantle cell lymphoma
Recurrence
Lymphatic Diseases
HIV Infections

Additional relevant MeSH terms:
Neoplasms by Histologic Type
Immune System Diseases
Molecular Mechanisms of Pharmacological Action
Immunologic Factors
Antineoplastic Agents
Physiological Effects of Drugs
Immunosuppressive 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 14, 2009