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A Phase I/II Trial of Escalating Dose of Yttrium-90-labeled Anti-CD20 Monoclonal Antibody in Combination With High-Dose Etoposide and Cyclophosphamide Followed by Autologous Stem Cell Transplantation for Patients With Relapsed B-Cell Non-Hodgkin's Lymphoma


Phase 1/Phase 2
18 Years
60 Years
Open (Enrolling)
Both
Lymphoma

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Trial Information

A Phase I/II Trial of Escalating Dose of Yttrium-90-labeled Anti-CD20 Monoclonal Antibody in Combination With High-Dose Etoposide and Cyclophosphamide Followed by Autologous Stem Cell Transplantation for Patients With Relapsed B-Cell Non-Hodgkin's Lymphoma


OBJECTIVES:

- To evaluate the safety and efficacy of a new preparative regimen of yttrium Y 90
ibritumomab tiuxetan in combination with high-dose etoposide and cyclophosphamide
followed by autologous stem cell transplantation (ASCT) for treatment of patients with
poor-risk, relapsed, or refractory non-Hodgkin lymphoma (NHL).

- To determine the maximum tolerated dose of yttrium Y 90 ibritumomab tiuxetan which can
be given with high-dose etoposide and high-dose cyclophosphamide followed by ASCT in
patients with NHL.

- To perform dosimetry study to estimate the radiation dose delivered to the tumor and
normal organs.

- To evaluate the short-term and long-term complications of this new preparative regimen.

OUTLINE: This is a phase I does-escalation study of yttrium Y 90 ibritumomab tiuxetan
followed by an open-label phase II study.

- Preparation for transplantation: Peripheral blood stem cells (PBSCs) are collected via
leukapheresis. Samples are analyzed by cytogenetic studies, immunophenotyping, and gene
rearrangement. Patients with an adequate number of collected CD34-positive cells (≥ 3
times 10^6 /kg) proceed to radioimmunotherapy.

- Radioimmunotherapy: Patients receive yttrium Y 90 ibritumomab tiuxetan IV on days -21
and -14. Patients undergo bone marrow biopsy and dose estimation on day -7.

- Chemotherapy: Patients receive etoposide IV on day -4 and cyclophosphamide IV over 2
hours on day -2.

- Transplantation: Patients undergo reinfusion of PBSCs on day 1.

- Growth factor therapy: Patients receive filgrastim (G-CSF) IV beginning on day 1 and
continuing until blood counts recover.

Treatment continues in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed periodically.

Inclusion Criteria


DISEASE CHARACTERISTICS:

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

- Follicular small cleaved

- Follicular mixed

- Follicular large cell

- Diffuse small cleaved

- Diffuse mixed

- Diffuse large cell

- Immunoblastic (working formulation B, C, D, E, F, G and H) 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.

- Mantle cell and transformed low-grade lymphomas allowed

- Demonstrated monoclonal CD20-positive B-cell population in lymph nodes and/or bone
marrow

- Favorable biodistribution on imaging dose

- Patient either relapsed after achieving a complete (CR) or partial response (PR) to
prior therapy, never responded to prior therapy, or has poor-risk disease

- Sensitivity of disease based on 1 of the following:

- Induction failure: patients who did not achieve a CR or PR from induction
chemotherapy

- Resistant relapse: patients who did not achieve a CR or PR from the most
recent standard salvage chemotherapy

- Sensitive relapse: patients who 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 (IPI) 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 aggressive NHL including mantle cell lymphoma and who
required 2 different induction chemotherapy regimens to achieve a CR/PR

- Patients with B-cell NHL and who failed to achieve a CR after adequate
induction chemotherapy regimen(s)

- Patients must have bone marrow aspiration and biopsy within 42 days before salvage
chemotherapy or stem cell collection which show ≤ 10% lymphomatous involvement of
total cellularity

- Normal cytogenetic study on bone marrow (prior to salvage chemotherapy or stem cell
collection)

- Cytogenetic study on peripheral blood is acceptable if bone marrow biopsy has
already been done and shows no sign of myelodysplastic syndrome (MDS) or
lymphoma and a repeat bone marrow is deemed unnecessary by attending physician

- No active or prior history of CNS diseases

- No human anti-mouse antibody (HAMA) or human anti-chimeric antibody

PATIENT CHARACTERISTICS:

- ECOG performance status (PS) 0-1 or Karnofsky PS 80-100%

- Platelet count normal

- Serum creatinine ≤ 1.5 mg/dL or creatinine clearance ≥ 60 mL/min

- FEV_1 > 65% of predicted or DLCO ≥ 50% of predicted

- LVEF > 50% by ECHO or MUGA scan

- Bilirubin ≤ 1.5 times normal

- SGOT or SGPT ≤ 2 times normal

- HIV antibody-negative

- No prior malignancy except for 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 five years

- No active evidence of hepatitis B or C infection

- No hepatitis B surface antigen positivity

- No history of alcohol abuse

- Body weight ≤ 250 pounds

PRIOR CONCURRENT THERAPY:

- See Disease Characteristics

- Patients who have received involved field external beam therapy to area excluding
lung, heart, liver and kidney are allowed, but will be evaluated on a case-by-case
basis

- Patients must have recovered from last therapy and should be at least four weeks from
prior radiation or chemotherapy

- No prior radioimmunotherapy

- No prior bone marrow transplantation

Type of Study:

Interventional

Study Design:

Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Response

Safety Issue:

No

Principal Investigator

Auayporn P. Nademanee, MD

Investigator Role:

Study Chair

Investigator Affiliation:

Beckman Research Institute

Authority:

United States: Food and Drug Administration

Study ID:

98153

NCT ID:

NCT00562978

Start Date:

September 1999

Completion Date:

Related Keywords:

  • Lymphoma
  • recurrent grade 1 follicular lymphoma
  • recurrent grade 2 follicular lymphoma
  • recurrent grade 3 follicular lymphoma
  • recurrent adult diffuse large cell lymphoma
  • recurrent adult diffuse mixed cell lymphoma
  • recurrent adult diffuse small cleaved cell lymphoma
  • recurrent adult immunoblastic large cell lymphoma
  • recurrent mantle cell 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 diffuse large cell lymphoma
  • stage III adult diffuse mixed cell lymphoma
  • stage III adult diffuse small cleaved cell lymphoma
  • stage IV adult diffuse large cell lymphoma
  • stage IV adult diffuse mixed cell lymphoma
  • stage IV adult diffuse small cleaved cell lymphoma
  • stage III mantle cell lymphoma
  • stage IV mantle cell lymphoma
  • stage III adult immunoblastic large cell lymphoma
  • stage IV adult immunoblastic large cell lymphoma
  • Lymphoma
  • Lymphoma, Non-Hodgkin
  • Lymphoma, B-Cell
  • Lymphoma, Large-Cell, Immunoblastic

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