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Zevalin Before Stem Cell Transplant in Treating Patients With Non-Hodgkin Lymphoma

Information source: University of California, Davis
ClinicalTrials.gov processed this data on August 23, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Refractory Non Hodgkin Lymphoma; Relapsed Non Hodgkin Lymphoma

Intervention: rituximab (Biological); ibritumomab tiuxetan (Biological); anti-thymocyte globulin (Biological); total nodal irradiation (Radiation); peripheral blood stem cell transplantation (Procedure); allogeneic hematopoietic stem cell transplantation (Procedure); cyclosporine (Drug); mycophenolate mofetil (Drug); laboratory biomarker analysis (Other)

Phase: Phase 2

Status: Recruiting

Sponsored by: University of California, Davis

Official(s) and/or principal investigator(s):
Joseph Tuscano, Principal Investigator, Affiliation: UC Davis Comprehensive Cancer Center

Summary

This phase II trial studies how well ibritumomab tiuxetan before donor peripheral blood stem cell transplant works in treating patients with relapsed or refractory non-Hodgkin lymphoma. Giving rituximab, antithymocyte globulin, and total-lymphoid irradiation (TLI) before a donor peripheral blood stem cell transplant helps stop the growth of cancer cells and helps stop the patient's immune system from rejecting the donor's stem cells. Also, radiolabeled monoclonal antibodies, such as ibritumomab tiuxetan, can find cancer cells and carry cancer-killing substances to them without harming normal cells. When the healthy stem cells from a donor are infused into the patient they may help the patient's bone marrow make stem cells, red blood cells, white blood cells, and platelets. Sometimes the transplanted cells from a donor can make an immune response against the body's normal cells. Giving rituximab, antithymocyte globulin, and TLI before the transplant together with cyclosporine and mycophenolate mofetil after the transplant may stop this from happening. Giving a radiolabeled monoclonal antibody before a donor peripheral blood stem cell transplant may be an effective treatment for non-Hodgkin lymphoma.

Clinical Details

Official title: Use of Zevalin to Enhance the Efficacy of Non-Myeloablative Allogeneic Transplantation in Patients With Relapsed or Refractory CD20+ Non-Hodgkin's Lymphoma

Study design: Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Primary outcome: Response conversion rate (PD/SD to PR and CR)

Secondary outcome:

Time to engraftment/chimerism

Rate of acute GVHD

Rate of chronic GVHD

Overall survival

EFS

Toxicities

Detailed description: PRIMARY OBJECTIVES: I. To measure the response conversion (progressive disease [PD]/stable disease [SD] to partial response [PR] and complete response [CR]). SECONDARY OBJECTIVES: I. To assess the time to engraftment/chimerism. II. To assess the rate of acute and chronic graft-versus-host disease (GVHD). III. To assess toxicity. IV. To determine the overall survival. V. To investigate immune functional and phenotypic analysis. VI. To measure two year event free survival (EFS). OUTLINE:

CONDITIONING REGIMEN: Patients receive rituximab intravenously (IV) on days - 21 and 14,

ibritumomab tiuxetan IV on day - 14, TLI on days -11 to -7 and -4 to -1, and antithymocyte

globulin IV over 4-6 hours on days - 11 to -7. Patients also undergo TLI on days -11 to -7

and - 4 to -1.

TRANSPLANT: Patients undergo allogeneic peripheral blood stem cell transplant (PBSCT) on day 0. GVHD PROPHYLAXIS: Patients receive cyclosporine orally (PO) twice daily (BID) or IV on days

- 3 to 56 with taper to 6 months and mycophenolate mofetil PO BID or IV on days 0-28.

After completion of study treatment, patients are followed up periodically.

Eligibility

Minimum age: 19 Years. Maximum age: 75 Years. Gender(s): Both.

Criteria:

Inclusion Criteria:

- Histologically or cytologically confirmed relapsed cluster of differentiation (CD)20+

non-Hodgkin's lymphoma (NHL) (included in this category are follicular grade I, II, III, marginal zone, mantle cell, diffuse large B cell, small lymphocytic lymphoma) and CD20+ Hodgkin's disease for which standard curative therapy does not exist or is no longer effective

- Patients must have had at least one prior chemotherapeutic regimen; steroids alone

and local radiation do not count as regimens; radiotherapy must have been completed at least 4 weeks prior to entry into the study; Rituxan alone does not count as a regimen; however, Bexxar or Zevalin (ibritumomab tiuxetan) do and patients must have completed radioimmunotherapy (RIT) > 12 months prior to enrollment

- Karnofsky performance status of ≥ 60%

- Life expectancy of greater than 3 months

- Total bilirubin within institutional normal limits

- Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase

[SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 2. 5 times institutional upper limit of normal

- Creatinine within normal institutional limits OR creatinine clearance >= 60

ml/min/1. 73 m^2 for patients with creatinine levels above institutional normal

- Blood counts no restrictions

- Patients who had anything less than a CR (PR, SD or progressive disease) to their

last salvage regimen

- Ability to understand and the willingness to sign a written informed consent document

- Patients fit for non-myeloablative transplantation or best treatment that have an

available matched (9/10 or better) related or unrelated donor

- Patients who are considered rituximab refractory (defined as progression within 6

months of their last rituximab-containing regimen) Exclusion Criteria:

- Patients who have had chemotherapy or radiotherapy within 4 weeks (6 weeks for

nitrosoureas or mitomycin C) prior to entering the study, rituximab within three months (unless there is evidence of progression), or those who have not recovered from adverse events due to agents administered more than 4 weeks earlier are excluded; this does not include the use of steroids which may continue until two days prior to enrollment

- Patients may not be receiving any other investigational agents

- Failure to obtain insurance/payment authorization for Zevalin, unless the subject

agrees to cover the cost

- Patients with known active brain metastases, other neurological disorders/dysfunction

or a history of seizure disorder, or other neurological dysfunction should be excluded from this clinical trial because of their poor prognosis

- Patients who have an uncontrolled infection (presumed or documented) with progression

after appropriate therapy for greater than one month

- Patients with symptomatic coronary artery disease, uncontrolled congestive heart

failure; left ventricular ejection fraction is not required to be measured, however if it is measured, patient is excluded if ejection fraction is < 30%

- Patients requiring supplementary continuous oxygen; diffusion capacity of the lung of

carbon monoxide (DLCO) is not required to be measured, however if it is measured, patient is excluded if DLCO < 35%

- Patients with clinical or laboratory evidence of liver disease will be evaluated for

the cause of liver disease, its clinical severity in terms of liver function and histology, and for the degree of portal hypertension

- Patients with any of the following liver function abnormalities will be excluded:

- Fulminant liver failure

- Cirrhosis with evidence of portal hypertension or bridging fibrosis

- Alcoholic hepatitis

- Esophageal varices

- A history of bleeding esophageal varices

- Hepatic encephalopathy

- Uncorrectable hepatic synthetic dysfunction evidenced by prolongation of the

prothrombin time

- Ascites related to portal hypertension

- Chronic viral hepatitis with total serum bilirubin > 3 mg/dL

- Symptomatic biliary disease

- Pregnant women are excluded from this study

- Human immunodeficiency virus (HIV)-positive patients

Locations and Contacts

UC Davis Comprehensive Cancer Center, Sacramento, California 95817, United States; Recruiting
Joseph M. Tuscano, Phone: 916-734-3089, Email: joseph.tuscano@ucdmc.ucdavis.edu
Joseph M. Tuscano, Principal Investigator
Additional Information

Starting date: March 2013
Last updated: July 11, 2014

Page last updated: August 23, 2015

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