A Phase II Study in Poor Risk Diffuse Large B-cell Lymphoma (DLBCL) of Total Lymphoid Irradiation (TLI) and Antithymocyte Globulin (ATG) Followed by Matched Allogeneic Hematopoietic Transplantation as a Consolidation to Autologous Hematopoietic Cell Transplantation (AHCT)
- Age 18 to 70 years.
- Histologically proven diffuse large B-cell lymphoma (DLBCL) by the WHO
- Relapse after achieving initial remission or failure to achieve initial remission.
Patients with residual radiographic abnormalities after primary therapy are eligible
if abnormalities are FDG-PET positive.
- Receipt of 2 cycles of second-line therapy and FDG-PET positive per Stanford
(central) review. FDG-PET to be done 2 weeks after cycle 2 of second line
- ECOG performance status < 2
- Matched related or unrelated donor identified and available
- Bone marrow biopsy and cytogenetic analysis within 8 weeks of registration
- Women of child-bearing potential and sexually active males are strongly advised to
use an accepted and effective method of birth control.
- Patients must have a pretreatment serum bilirubin < 2 x the institutional ULN, a
serum creatinine < 2 x the institutional ULN and measured or estimated creatinine
clearance > 60 cc/min by the following formula (all tests must be performed within 28
days prior to registration):
- Estimated Creatinine Clearance = (140 age)X WT(kg) X 0.85 if female 72X serum
- Patients must have an EKG within 42 days prior to registration that shows no
significant abnormalities that are suggestive of active cardiac disease.
- Patients requiring therapy for coronary artery disease, cardiomyopathy, dysrhythmia,
or congestive heart failure are not eligible.
- Patients must have a radionuclide ejection fraction within 42 days of registration.
If the ejection fraction is <40%, the patient will not be eligible. If the ejection
fraction is 40-50%, the patient will have a cardiology consult.
- Patients must have a corrected diffusion capacity >55%.
- Patients with known allergy to etoposide or a history of Grade 3 hemorrhagic cystitis
with cyclophosphamide are not eligible.
- Patients with > grade 2 sensory or motor peripheral neuropathy from prior vinca
alkaloid use are not eligible.
- Patients must be informed of the investigational nature of this study and must sign
and give written informed consent in accordance with institutional and federal
Exclusion Criteria:- Pregnant or breast-feeding women are ineligible due to the known
birth defects association with the treatments used in this study.
- Patients known to be human immunodeficiency virus (HIV)-positive are ineligible
because the concern for opportunistic infection and hematologic reserve are
considered to be significantly greater in this population. The antibody test for HIV
must be performed within 42 days of registration.
- No chemotherapy other than corticosteroids should be administered within 2 weeks of
the initiation of protocol therapy.
- No prior malignancy is allowed except adequately treated basal cell or squamous cell
skin cancer, in situ cervical cancer or other cancer for which the patients has been
disease-free for five years. Patients with a prior diagnosis of non-Hodgkin's
lymphoma are not eligible.
- Patients with active infection requiring oral or intravenous antibiotics are
- No prior autologous or allogeneic hematopoietic cell transplantation.
- No prior radioimmunotherapy
- Related or unrelated HLA identical donors who are in good health and have no
contra-indication to donation.
- No contra-indication for the donor to collection by apheresis of mononuclear cells
mobilized by G-CSF at a dose of 16 µg/kg of body weight.
- Donors will be evaluated with a full history and physical examination.
- Virology testing including CMV, HIV, EBV, HTLV, RPR, Hepatitis A, B and C will be
performed within 30 days of donation.
- Prospective donors will be screened for CMV seroreactivity and seronegative donors
will be utilized if available. If the possibility of more than one HLA-matched
related donor exists, then the donor will be selected on the basis of CD31 allotype.