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Fludarabine Plus Cyclophosphamide Followed by Zevalin in Non-Follicular Indolent Lymphomas Refractory or Relapsed
This study is currently recruiting participants.
Verified by Ospedali Riuniti di Bergamo, July 2006
Sponsored by: Ospedali Riuniti di Bergamo
Information provided by: Ospedali Riuniti di Bergamo
ClinicalTrials.gov Identifier: NCT00354822
  Purpose

Pilot multicentric, open label study with the aim to evaluate antitumor activity in term of sum of complete and partial response (O.R.R.) of chemotherapy (cyclophosphamide and fludarabine) followed by Zevalin radioimmunotherapy and response duration (Time to relapse or progression)and to evaluate the safety of the treatment as acute and late toxicity.

Secondary objective is to evaluate the overall survival (OS) and the event-free survival (EFS).


Condition Intervention Phase
Lymphoma, Non-Hodgkin
Drug: Zevalin
Phase II

MedlinePlus related topics: Lymphoma
Drug Information available for: Cyclophosphamide Fludarabine Fludarabine monophosphate Ibritumomab tiuxetan
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Non-Randomized, Open Label, Uncontrolled, Single Group Assignment, Safety/Efficacy Study
Official Title: Phase II Study for Use of Oral Fludarabine Plus Cyclophosphamide Followed by Zevalin in the Treatment of Non-Follicular Indolent Lymphomas Refractory or Relapsed After Conventional Front-Line Chemotherapy Not Containing Fludarabine.

Further study details as provided by Ospedali Riuniti di Bergamo:

Primary Outcome Measures:
  • achievement and duration of complete or partial reduction of lymphnodes six weeks after the end of treatment with zevalin

Secondary Outcome Measures:
  • overall and event free survival

Estimated Enrollment: 80
Study Start Date: August 2005
Estimated Study Completion Date: August 2009
Detailed Description:

Test medication:

  • Yttrium-90 (90Y) ibritumomab tiuxetan 0.4 mCi/kg is delivered to patient achieving at least a partial remission (PR) after chemotherapy as a single dose for patients with baseline platelet counts>150x10^9/L or 0.3 mCi/kg for patients with baseline platelet counts of 100 to 149x10^9/L. Rituximab 250mg/sqm is given prior to therapeutic radiolabeled antibodies.
  • Standard dose chemotherapy consisting of cyclophosphamide (CTX) and fludarabine given every 28 days up to the best response (maximum 6 courses).
  • A prophylaxis for pneumocystis carinii as well as for herpes zoster are needed during treatment.

Main parameters of activity: Activity of Yttrium-90 (90Y) ibritumomab tiuxetan after Cytoxan and Fludarabine combination

  Eligibility

Ages Eligible for Study:   18 Years to 70 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients with a lymphoma refractory to front-line chemotherapy, not including fludarabine, or in first relapse after chemotherapy not including fludarabine, not suitable for high-dose chemotherapy supported by auto or allogeneic bone marrow transplantation.
  • Histologically-confirmed small lymphocytic (SLL), lymphoplasmacytic (LPL) and marginal zone (MZL) lymphomas.
  • All prior chemotherapy, including corticosteroids, had to have been completed > 4 weeks before study treatment; < 25% of active bone marrow irradiated previously; no prior bone marrow transplantation.
  • Age: 18-70 years
  • ECOG- performance status: 0-2.
  • No allergy to mouse proteins.
  • CD20 positive B cell lymphoma.
  • Ann Arbor stage III or IV disease with bidimensionally measurable disease in at least one site which has not irradiated, including any adenopathy or mass that could be measured during a physical examination or that was > 5 cm on a computed tomographic scan (CT). In the event of splenomegaly or hepatomegaly, extension 5 cm below the costal margin was considered evidence of measurable disease. Osteoblastic bone lesions, ascites and pleural effusion are not considered measurable disease.
  • Tumor involvement in the marrow<25% before treatment with Zevalin.
  • Acceptable hematologic status within one week prior study start: Hb>9g/dL, white blood count >3x10^9/L, absolute neutrophil count >1.5x10^9/L, platelets >100x10^9/L.
  • Written informed consent prior to any study specific screening procedures, with the understanding that the patient has the right to withdraw from that study at any time, without prejudice.
  • Patients willing and able to comply with the protocol for the duration of the study.
  • Patients, if sexually active, must agree to be using effective contraception for the entire treatment period and for 1 year following treatment. Women, of child-bearing potential, must have a negative pregnancy test.

Exclusion Criteria:

  • Histologies other than those included
  • History of malignancy other than squamous cell carcinoma, basal cell carcinoma of the skin or carcinoma in situ of cervix within the last 5 years.
  • Major surgery, other than diagnostic surgery, within the last 4 weeks.
  • Presence of malignant ascites or pleural effusions.
  • Evidence of CNS involvement. Patients with a history of uncontrolled seizures, central nervous system disorders or psychiatric disability judged by the investigator to be clinically significant and adversely affecting compliance to study drugs.
  • Clinically significant cardiac disease (e.g. congestive heart failure, symptomatic coronary artery disease, cardiac arrhythmias not well controlled with medication, or myocardial infarction within the last 6 months, NYHA class III or IV heart disease), abnormal liver function tests, not disease related, within 1 week prior to study start (serum bilirubin >2 mg/dL; ALAT >2.5 x upper normal limit; alkaline phosphatase >2.5xupper normal limit), abnormal renal function, not disease related (serum creatinine >2.0 mg/dL), active opportunistic infections.
  • Serum positivity for HIV, HBsAg and HCV except for those with no sign of active viral replication, assessed by HCV-RNA and HBV-DNA. This latter group of patients can be enrolled in the study, but they will receive lamivudine prophylaxis and bimonthly evaluation of HbSAg, HbCAb and HBV-DNA will be provided.
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00354822

Contacts
Contact: Delaini Federica, Dr 0039035 266148 oro@ospedaliriuniti.bergamo.it

Locations
Italy, BG
USC Ematologia Ospedali Riuniti di Bergamo Recruiting
Bergamo, BG, Italy, 24128
Contact: Delaini Federica, Dr     00390350266148     oro@ospedaliriuniti.bergamo.it    
Principal Investigator: Rambaldi Alessandro, MD            
Italy, ME
Sergio Baldari Recruiting
Messina, ME, Italy, 98125
Principal Investigator: Baldari Sergio, MD            
Italy, to
Massimo Aglietta Not yet recruiting
Candiolo, to, Italy, 10060
Principal Investigator: Aglietta Massimo, MD            
Italy, TV
Filippo Gherlinzoni Not yet recruiting
Treviso, TV, Italy, 31100
Principal Investigator: Gherlinzoni Filippo, MD            
Sponsors and Collaborators
Ospedali Riuniti di Bergamo
Investigators
Principal Investigator: Cortelazzo Sergio, MD Ospedale Centrale di Bolzano (Italy)
  More Information

Publications of Results:
Brandt L, Kimby E, Nygren P, Glimelius B; SBU-group. Swedish Council of Technology Assessment in Health Care. A systematic overview of chemotherapy effects in indolent non-Hodgkin's lymphoma. Acta Oncol. 2001;40(2-3):213-23. Review.
Solal-Celigny P, Brice P, Brousse N, Caspard H, Bastion Y, Haioun C, Bosly A, Tilly H, Bordessoule D, Sebban C, Harousseau JL, Morel P, Dupas B, Plassart F, Vasile N, Fort N, Leporrier M. Phase II trial of fludarabine monophosphate as first-line treatment in patients with advanced follicular lymphoma: a multicenter study by the Groupe d'Etude des Lymphomes de l'Adulte. J Clin Oncol. 1996 Feb;14(2):514-9.
Santini G, Nati S, Spriano M, Gallamini A, Pierluigi D, Congiu AM, Truini M, Rubagotti A, Chisesi T, Vimercati R, Rossi E, Sertoli MR, Mattei D, Marino G, Gobbi M. Fludarabine in combination with cyclophosphamide or with cyclophosphamide plus mitoxantrone for relapsed or refractory low-grade non-Hodgkin's lymphoma. Haematologica. 2001 Mar;86(3):282-6.
Hiddemann W, Dreyling M, Unterhalt M. Rituximab plus chemotherapy in follicular and mantle cell lymphomas. Semin Oncol. 2003 Feb;30(1 Suppl 2):16-20. Review.
Witzig TE, Flinn IW, Gordon LI, Emmanouilides C, Czuczman MS, Saleh MN, Cripe L, Wiseman G, Olejnik T, Multani PS, White CA. Treatment with ibritumomab tiuxetan radioimmunotherapy in patients with rituximab-refractory follicular non-Hodgkin's lymphoma. J Clin Oncol. 2002 Aug 1;20(15):3262-9.
Witzig TE, Gordon LI, Cabanillas F, Czuczman MS, Emmanouilides C, Joyce R, Pohlman BL, Bartlett NL, Wiseman GA, Padre N, Grillo-Lopez AJ, Multani P, White CA. Randomized controlled trial of yttrium-90-labeled ibritumomab tiuxetan radioimmunotherapy versus rituximab immunotherapy for patients with relapsed or refractory low-grade, follicular, or transformed B-cell non-Hodgkin's lymphoma. J Clin Oncol. 2002 May 15;20(10):2453-63.

Study ID Numbers: EUDRACT 2005-000699-41
Study First Received: July 19, 2006
Last Updated: July 19, 2006
ClinicalTrials.gov Identifier: NCT00354822  
Health Authority: Italy: Ministry of Health

Keywords provided by Ospedali Riuniti di Bergamo:
Zevalin
Lymphoma, Non-Hodgkin

Study placed in the following topic categories:
Lymphatic Diseases
Immunoproliferative Disorders
Fludarabine
Fludarabine monophosphate
Cyclophosphamide
Lymphoproliferative Disorders
Lymphoma, Non-Hodgkin
Lymphoma

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

ClinicalTrials.gov processed this record on January 14, 2009