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Sponsors and Collaborators: |
M.D. Anderson Cancer Center Biogen Idec |
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Information provided by: | M.D. Anderson Cancer Center |
ClinicalTrials.gov Identifier: | NCT00048737 |
This is a phase I/II study to determine the safety and efficacy of nonmyeloablative allogeneic stem cell transplantation using 90Y Zevalin/Cyclophosphamide/Fludarabine as a preparative regimen for patients with B-cell lymphoid malignancies.
Condition | Intervention | Phase |
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Lymphoma Leukemia |
Drug: Zevalin Radioimmunotherapy Drug: Rituximab Drug: Fludarabine Drug: Cyclophosphamide Procedure: Allogeneic Stem Cell Transplantation |
Phase I Phase II |
Study Type: | Interventional |
Study Design: | Treatment, Non-Randomized, Open Label, Uncontrolled, Single Group Assignment, Safety/Efficacy Study |
Official Title: | Safety and Efficacy of 90Y Zevalin in Nonmyeloablative Transplantation for Lymphoid Malignancies |
Estimated Enrollment: | 70 |
Study Start Date: | October 2002 |
Estimated Primary Completion Date: | October 2010 (Final data collection date for primary outcome measure) |
Arms | Assigned Interventions |
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1: Experimental
Allogeneic Stem Cell Transplantation with 90Y Zevalin/Cyclophosphamide/Fludarabine as a preparative regimen.
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Drug: Zevalin Radioimmunotherapy
Escalating single dose of 90Y Zevalin 0.2-0.3-0.4 mCi/kg
Drug: Rituximab
250 mg/m^2 on day 1 and day 8
Drug: Fludarabine
30 mg/m^2/day x 3
Drug: Cyclophosphamide
750 mg/m^2/day x 3, given on the same days as fludarabine, at 4-hour intervals
Procedure: Allogeneic Stem Cell Transplantation
Allogeneic stem cell transplantation 2 days after chemotherapy
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Rituxan is an antibody made from human and mouse protein. It reacts with a certain antigen on lymphoma cells and causes the body's immune system to destroy the lymphoma cells. 90Y Zevalin and 111In Zevalin are murine-based antibodies combined with a radioactive agent that can also destroy lymphoma cells. Unlike Rituxan, 90Y Zevalin cannot be traced by regular scanning and requires indium to determine its distribution through the body.
Before treatment starts, patients will have a physical exam, including blood tests and urine tests. Women who are able to have children must have a negative blood pregnancy test. Bone marrow samples will be taken. For bone marrow sampling, a large needle is placed in the hipbone after it has been numbed. The bone marrow is then withdrawn through the needle. Patients will have a chest x-ray, CT scans, an EKG, and tests of lung function.
Blood tests, urine tests, bone marrow sampling, and x-rays will be done as needed to track the effects of the transplant. Patients will have transfusions of blood and platelets as needed. Blood tests will be done daily while patients are in the hospital.
Patients in this study will receive an unlabeled antibody form of Y2B8 called rituxan by vein followed by a dose of 111In Zevalin by vein. 111In Zevalin includes the radioactive agent indium, which shows up when patients have x-rays or scans. The scans can show where and how fast the drug travels in the body and how long the drug stays in the body. Doctors need to be able to see how much of the drug goes to the tumor and how much goes to normal organs to see if it is safe to give 90Y Zevalin on an outpatient basis. A scan will be taken 48 to 72 hours after 111In Zevalin is given.
If the radiation in the 111In Zevalin is not a threat to normal organs and bone marrow, patients may receive 90Y Zevalin. Seven days after the 111In Zevalin injection, patients will receive a second dose of rituxan followed by a dose of 90Y Zevalin.
Patients will also receive fludarabine and cyclophosphamide daily for 3 days. All of the chemotherapy drugs will be given through a catheter (plastic tube) that extends into the large chest vein. The catheter will be left in place throughout treatment. When chemotherapy is finished, blood stem cells from a donor will be given through the catheter. G-CSF, a hormone that helps the production of blood cells, will be injected under the skin once a day until the neutrophil counts recover in the blood. Patients will receive methotrexate for 3 days post transplant and tacrolimus for 6 months or more to prevent graft versus host disease.
All patients will have complete checkups, including blood and urine tests 2 or 3 times during the first 12 weeks of the study. Tumors will be measured by CT or MRI and gallium scans. Patients will be asked to fill out a survey about quality of life issues (maintaining normal routine, family life, social life, pain). It takes about half an hour to fill out the survey. A bone marrow sample may be taken. A test of heart function will be done.
Checkups and tests will be done every 3 months for 1 year and then every 6 months for 4 more years.
Treatment will be given in the hospital at M. D. Anderson. Patients will need to stay in the hospital for about 3 to 4 weeks. Patients must stay in the Houston area for about 100 days after the transplant. After that, patients will need to return to Houston from time to time for blood tests, urine tests, and other exams.
This is an investigational study. 90Y-Zevalin is approved by the FDA for relapsed and refractory lymphoma. Its use in this trial, however, is investigational. About 70 patients will take part in this study. All will be enrolled at M. D. Anderson.
Ages Eligible for Study: | 18 Years to 70 Years |
Genders Eligible for Study: | Both |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
Patients in relapse or considered at high risk for relapse or refractory CD-20-positive B-cell NHL or CLL.
Patients considered for high risk of relapse are patients who do not achieve CR with frontline chemotherapy, CLL is Richter's and CLL with high risk chromosomal abnormalities.
Exclusion Criteria:
Contact: Issa F. Khouri, MD | 713-745-2803 |
United States, Texas | |
MD Anderson Cancer Center | Recruiting |
Houston, Texas, United States, 77030 | |
Principal Investigator: Issa Khouri, MD |
Principal Investigator: | Issa F. Khouri, MD | U.T.M.D. Anderson Cancer Center |
Responsible Party: | U.T. M.D. Anderson Cancer Center ( Issa F. Khouri, MD/Professor ) |
Study ID Numbers: | ID01-233 |
Study First Received: | November 6, 2002 |
Last Updated: | April 9, 2009 |
ClinicalTrials.gov Identifier: | NCT00048737 History of Changes |
Health Authority: | United States: Food and Drug Administration |
Leukemia Lymphoma Lymphoid Malignancy Cyclophosphamide Cytoxan Neosar Fludarabine Fludarabine Phosphate Fludara Rituximab Rituxan |
Zevalin Indium Zevalin 90Y Zevalin CD-20-positive B-cell Lymphoma CD-20-positive B-cell Lymphoma NHL CLL Chronic Lymphocytic Leukemia Allogeneic Stem Cell Transplantation ASCT |
Antimetabolites Leukemia, Lymphoid Immunoproliferative Disorders Immunologic Factors Rituximab Cyclophosphamide Fludarabine monophosphate Immunosuppressive Agents Lymphoma, B-Cell Leukemia Lymphatic Diseases |
Chronic Lymphocytic Leukemia B-cell Lymphomas Leukemia, Lymphocytic, Chronic, B-Cell Antineoplastic Agents, Alkylating Fludarabine Antirheumatic Agents Lymphoproliferative Disorders Leukemia, B-cell, Chronic Alkylating Agents Lymphoma |
Antimetabolites Antimetabolites, Antineoplastic Immunologic Factors Molecular Mechanisms of Pharmacological Action Antineoplastic Agents Physiological Effects of Drugs Cyclophosphamide Leukemia Therapeutic Uses Lymphoma Alkylating Agents Immunoproliferative Disorders Neoplasms by Histologic Type |
Immune System Diseases Rituximab Fludarabine monophosphate Immunosuppressive Agents Pharmacologic Actions Lymphatic Diseases Neoplasms Myeloablative Agonists Fludarabine Antineoplastic Agents, Alkylating Lymphoproliferative Disorders Antirheumatic Agents |