High-Dose Gemcitabine, Busulfan and Melphalan With Hematopoietic Cell Support for Patients With Relapsed/Refractory Hodgkin's Disease
Study Drugs:
Busulfan and melphalan are designed to kill cancer cells by binding to DNA (the genetic
material of cells), which may cause cancer cells to die. They are commonly used in stem cell
transplantation.
Gemcitabine is designed to disrupt the growth of cancer cells, which may cause cancer cells
to die. It may help to increase the effect of busulfan and melphalan on cancer cells by not
allowing these cells to repair the DNA damage caused by busulfan or melphalan.
Apheresis:
Your cells have previously been collected by a procedure called apheresis. Apheresis is the
process of filtering part of the blood from the body in order to remove the stem cells. The
rest of the blood is then returned back to your body. You signed a separate consent for this
procedure.
Busulfan Test Dose:
You will receive a test dose of busulfan by vein over about 1 hour. This low-level test
dose of busulfan is to check how the level of busulfan in your blood levels changes over
time. This information will be used to decide the next dose needed to reach the target blood
level that matches your body size. You will most likely receive this as an outpatient
during the week before you are admitted to the hospital. If it cannot be given as an
outpatient, you will be admitted to the hospital on Day -11 (11 days before your stem cells
are returned to your body) and the test dose will be given on Day -10.
About 11 samples of blood (about 1 teaspoon each time) will be drawn for pharmacokinetic
(PK) testing of busulfan. PK testing measures the amount of study drug in the body at
different time points and will help the study doctor determine what your dose of busulfan
should be on study. These blood samples will be drawn at various timepoints before you
receive busulfan and over about the next 11 hours. The blood samples will be repeated again
on the first day of high-dose busulfan treatment (Day -8). A temporary heparin lock line
will be placed in your vein to lower the number of needle sticks needed for these draws. If
it is not possible for the PK tests to be performed for technical or scheduling reasons, you
will receive the standard fixed dose of busulfan.
If you receive the busulfan test dose as an outpatient:
On Days -12 through Day -10, you will receive palifermin by vein over about 30 seconds each
day to help decrease the risk of side effects in the mouth and throat.
You will be admitted on Day -9 and will receive fluids by vein. You will begin to swish the
liquids caphosol and glutamine in your mouth 4 times a day, for about 2 minutes each time.
You will swish these liquids every day until you leave the hospital. These drugs are also
used to help decrease the risk of side effects in the mouth and throat.
If you receive the busulfan test dose as an inpatient:
On Days -13 through Day -11, you will receive palifermin by vein over about 30 seconds each
day to help decrease the risk of side effects in the mouth and throat.
You will be admitted on Day -11 and will receive fluids by vein. You will begin to swish the
liquids caphosol and glutamine in your mouth 4 times a day, for about 2 minutes each time.
You will swish these liquids every day until you leave the hospital. These drugs are also
used to help decrease the risk of side effects in the mouth and throat.
On Day -10 you will receive the Busulfan test dose by vein over 1 hour.
Study Drug Administration (for all patients):
On Days -9 through -2, you will receive dexamethasone by vein over about 15 minutes to help
decrease the risk of the possible side effects of the study drugs.
On Days -8 through -5, you will receive busulfan by vein over about 3 hours each day.
On Days -8 and -3, you will receive gemcitabine by vein over about 4 hours on both days.
On Days -3 and -2, you will receive melphalan by vein over about 30 minutes on both days.
On Day -1, you will not receive any study drugs.
On Day 0, your stem cells will be returned to your body by vein over 30-60 minutes.
On Days 0 through 2, you will receive palifermin by vein over about 30 seconds each day.
Beginning on Day +5, you will receive filgrastim (a drug that helps with the growth of white
blood cells) through a needle under your skin 1 time each day until your blood cell levels
return to normal.
If your tumor cells are found to have the CD20 protein, you will receive rituximab by vein
over 4-8 hours on Days 1 and 8, which is standard treatment for this type of tumor when
combined with high-dose chemotherapy.
Study Tests:
While you are in the hospital, you will be checked for any side effects as part of your
standard of care. Blood (about 2 teaspoons) will be drawn every day to check for side
effects.
As part of standard care, you will remain in the hospital for about 3-4 weeks after
transplantation. After you are released from the hospital, you must remain in the Houston
area to be monitored for infections and other transplant side effects until about Day 30.
During this time, you will return to the clinic 1 time each week and the following tests and
procedures will be performed:
- You will be asked about how you are feeling and about any side effects you may be
having.
- Blood (about 2 teaspoons) will be drawn for routine tests.
Around Day 30, if your doctor thinks it is needed, you will have a positron-emission
tomography/CT (PET/CT) and/or a CT scan of the chest, abdomen, and pelvis to check the
status of the disease.
You will have a lung function test about 30-100 days after the transplant.
Length of Study:
You will be taken off study about 100 days after the transplant. You may be taken off study
early if the disease gets worse or you experience any intolerable side effects.
You must talk to the study doctor if you want to leave the study early. It may be
life-threatening to leave the study after you have begun to receive the study drugs but
before you receive the stem cells.
End-of-Study Visit:
At Day 100, the following tests and procedures will be performed:
- Your medical history will be recorded.
- You will have a physical exam.
- Blood (about 2 teaspoons) and urine will be collected for routine tests.
- If your doctor thinks it is needed, you will have a (PET/CT) and/or a CT scan of the
chest, abdomen, and pelvis to check the status of the disease.
- If your doctor thinks it is needed, you will have a bone marrow biopsy to check the
status of the disease.
This is an investigational study. Busulfan, gemcitabine, and melphalan are all FDA approved
and commercially available for the treatment of lymphoma and several other tumors. The use
of these study drugs together and the use of gemcitabine at the dose level used in this
study is investigational.
Interventional
Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Event-Free Survival (EFS)
100 days
Yes
Yago Nieto, MD, PHD
Principal Investigator
UT MD Anderson Cancer Center
United States: Institutional Review Board
2010-0142
NCT01200329
June 2011
Name | Location |
---|---|
UT MD Anderson Cancer Center | Houston, Texas 77030 |