Safety and Efficacy of Ibritumomab Tiuxetan (Zevalin®) in Association With a Fludarabine Based Reduced Conditioning Regimen and Allogenic Stem Cell Support in Chemo-sensitive Relapsed CD20 Positive Aggressive Non-Hodgkin's Lymphoma Patients.
18 Years
65 Years
Both
Diffuse Large B-Cell Lymphoma, Mantle Cell Lymphoma
Trial Information
Safety and Efficacy of Ibritumomab Tiuxetan (Zevalin®) in Association With a Fludarabine Based Reduced Conditioning Regimen and Allogenic Stem Cell Support in Chemo-sensitive Relapsed CD20 Positive Aggressive Non-Hodgkin's Lymphoma Patients.
The benefit of Zevalin® in the setting of autologous stem cell transplantation has been
largely reported. The addition of Zevalin® to a fludarabine-based Reduced Intensity
Conditioning regimen has been already evaluated in the setting of allo-SCT and the results
reported so far seem to be promising without an overwhelming toxicity neither a delayed
hematologic recovery. The assumption that the addition of Zevalin® to the conditioning
regimen might improve lymphoma control and the demonstration that nucleoside analogs such as
fludarabine synergize optimally with RIT led us to conduct this trial using the following
preparative regimen: rituximab 250 mg/m² on days -21 and -14, Zevalin® 0,4 mCi/Kg body
weight on day -14, fludarabine 30 mg/m² intravenously from days -6 to -2, Busulfan orally (4
mg/Kg body weight) or intravenously (0,8 mg/Kg body weight) on days -5 and -4 and ATG
(Thymoglobulin®) 2,5 mg/Kg body weight intravenously on day -1. Cyclosporine A is
administered at 2 or 3 mg/Kg body weight from day -1 to day 28 than followed by a dose
reduction.
The purpose of this study is to evaluate the safety and efficacy of Zevalin® in a Reduced
Intensity Conditioning regimen followed by allogenic stem cell support in patients with
aggressive lymphomas who are responsive to a salvage chemotherapy regimen
Patients are followed from the beginning of the RIC regimen until day 365 for primary and
secondary objectives of the study than on a regular basis depending on the practice of each
centre. The evaluation includes physical examination (performance status, hematologic
assessment, acute and chronic GVH disease), biologic tests (blood screening for blood count,
renal and hepatic function, B and T-cell recovery, chimerism analysis, response assessment)
and complementary examinations (marrow biopsies, tomography scan, positron emission
tomography, …).
Inclusion Criteria:
- Age ≥ 18 and ≤ 65
- Patients with this lymphoma:
1. CD20 positive diffuse large B-cell lymphoma in relapse or refractory after two
prior regimens or after one regimen including autologous stem cell
transplantation, or
2. CD20 positive mantle-cell lymphoma in relapse or refractory after two prior
regimens or after one regimen including autologous stem cell transplantation or
3. Other CD20 positive aggressive lymphoma for which an indication of allograft is
selected (Burkitt lymphoma, lymphoblastic lymphoma, intra-vascular lymphoma…..)
or
4. Low grade lymphoma CD20 positive (follicular lymphoma, marginal zone lymphoma)
in histological processing or
5. Low grade lymphoma CD20 positive for which an indication of allograft is
selected
- And sensitive to relapse's treatment
- HLA-matched related or unrelated donor 10/10 or 9/10 with C or DQ mismatch without
contra-indication for stem cell mobilization
- ECOG (Eastern Cooperative Oncology Group) < 2
- Having or not received previously rituximab
- With a chemosensitive relapse NHL (at least partial response > 50% as defined with
cheson criteria (See appendix 5)
- Eligible for an allogenic transplant
- With a signed informed consent (obtained on the screening day at the latest and
before any investigation)
- Patient affiliated to or beneficiary of the National Health Service
Exclusion Criteria:
- Patient allografted previously
- History of cancer
- Patient with HIV or HCV positive serology and requiring treatment
- Childbearing or child breastfeeding women
- Women who are pregnant or nursing, or man, in the absence of effective contraception
during treatment and up to 12 months after stopping treatment
- Any contraindication to allogenic stem cell transplantation:
- Cardiac insufficiency (ejection fraction < 50% by echocardiography)
- Respiratory insufficiency defined as DLCO below 50% of the theoretical value
- Renal failure defined as creatinin clearance < 30 ml/mn
- Hepatic failure defined as a 2-fold increase of bilirubin or transaminases except if
due to the lymphoma
- Known hypersensitivity to murine antibodies and other proteins, the active
ingredients or any of the ingredients of the products under review
- Patient under the protection of justice
Type of Study:
Interventional
Study Design:
Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Outcome Measure:
the treatment-related mortality rate (except if the death is related to the lymphoma exclusively).
Outcome Time Frame:
day 100 post transplant
Safety Issue:
Yes
Principal Investigator
Krimo BOUABDALLAH, MD
Investigator Role:
Principal Investigator
Investigator Affiliation:
University Hospital Bordeaux, France
Authority:
France: Afssaps - Agence française de sécurité sanitaire des produits de santé (Saint-Denis)
Study ID:
CHUBX 2007/11
NCT ID:
NCT00607854
Start Date:
February 2008
Completion Date:
November 2011
Related Keywords:
- Diffuse Large B-Cell Lymphoma
- Mantle Cell Lymphoma
- Zevalin
- Reduced intensity conditioning
- Allogenic stem cell transplantation
- Lymphoma
- Lymphoma, B-Cell
- Lymphoma, Large B-Cell, Diffuse
- Lymphoma, Mantle-Cell
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