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Vorinostat After Stem Cell Transplant in Treating Patients With High-Risk Lymphoma

Histone Deacetylase (HDAC) Inhibition Using Vorinostat (SAHA) After Autologous Hematopoietic Stem Cell Transplantation for High Risk Lymphoma

Status
Completed
Phases
Phase 1
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00561418
Enrollment
23
Registered
2007-11-21
Start date
2007-11-30
Completion date
2013-05-31
Last updated
2015-07-16

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Lymphoma, Small Intestine Cancer

Keywords

recurrent adult diffuse large cell lymphoma, stage III adult diffuse large cell lymphoma, stage IV adult diffuse large cell lymphoma, recurrent grade 3 follicular lymphoma, recurrent adult Hodgkin lymphoma, recurrent mantle cell lymphoma, adult nasal type extranodal NK/T-cell lymphoma, angioimmunoblastic T-cell lymphoma, recurrent adult T-cell leukemia/lymphoma, stage III adult T-cell leukemia/lymphoma, stage IV adult T-cell leukemia/lymphoma, small intestine lymphoma, anaplastic large cell lymphoma

Brief summary

RATIONALE: Vorinostat may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth, and may stimulate the immune system to stop cancer cells from growing. PURPOSE: This phase I trial is studying the side effects and best dose of vorinostat after stem cell transplant in treating patients with high-risk lymphoma.

Detailed description

OBJECTIVES: Primary * To assess dose-limiting and nonhematologic toxicity of prolonged administration of vorinostat (SAHA) when administered after autologous peripheral blood stem cell transplantation in patients with high-risk lymphoma. Secondary * To determine, preliminarily, clinical activity by assessing the overall survival and progression-free survival. * To evaluate the effect of vorinostat on immune reconstruction and acetylation. * To obtain pilot data regarding an association of vorinostat with patient quality of life and inflammatory cytokine production of peripheral blood mononuclear cells. OUTLINE: This is a dose-escalation study of vorinostat (SAHA). Approximately 60 days after autologous hematopoietic stem cell transplantation (HSCT), patients receive oral vorinostat once daily on days 1-21. Treatment repeats every 28 days for up to 11 courses in the absence of unacceptable toxicity or disease progression. Blood and bone marrow samples are collected periodically for laboratory correlative studies comprising immune reconstitution assays, regulatory T-cell expansion analysis, H3 and H4 acetylation by immunohistochemistry, cytokine bead array to quantify interleukin (IL)-2, IL-4, IL-5, IL-6, IL-10, tumor necrosis factor alpha and interferon gamma. Quality of life correlative studies are measured by questionnaires periodically. After completion of study treatment, patients are followed for at least 30 days.

Interventions

DRUGvorinostat

Vorinostat (SAHA) will be administered orally starting approximately day +60 post HSCT for 21 consecutive days of a 28-day cycle for up to a maximum of 11 cycles.

Laboratory as well as quality of life correlative studies will be obtained at days +26 to +38 (at approximately 1 month post HSCT),days +56 to +66 (≈2 mos), and at Cycle 2 Day 1 (≈3 mos.), Cycle 3 Day 1 (≈4 mos.), Cycle 5 Day 1 (≈6 mos.),Cycle 7 Day 1 (≈8 mos.), and off study (ideally at ≈12 mos.)

Sponsors

Merck Sharp & Dohme LLC
CollaboratorINDUSTRY
Ohio State University Comprehensive Cancer Center
Lead SponsorOTHER

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

DISEASE CHARACTERISTICS: * Must have received a BEAM (cytarabine, etoposide, melphalan, carmustine)-conditioned autologous stem cell transplantation for any of the following high-risk lymphomas: * Diffuse large B-cell lymphoma as defined by: * Induction failure but with response to salvage therapy * Relapse less than one year after completion of induction therapy * Elevated lactate dehydrogenase (LDH) at relapse * Stage III/IV disease at relapse * Positive PET scan after induction or salvage therapy * Age ≤ 75 and ≥ 60 years * Follicular lymphoma as defined by: * Progressive disease after two or more prior regimens * Transformed to aggressive lymphoma but still chemotherapy sensitive * Not felt to be a good candidate for an allogeneic transplantation * Hodgkin lymphoma as defined by: * Primary refractory disease * Relapse less than one year after completion of induction therapy * Relapse with PET-positive disease after salvage therapy * Relapsed refractory and not felt to be a good candidate for an allogeneic transplantation * Mantle cell lymphoma * Chemotherapy-sensitive disease after induction therapy * Chemotherapy-sensitive relapsed disease and not felt to be a good candidate for an allogeneic transplantation * T-cell non-Hodgkin lymphoma (NHL) * Peripheral T-cell lymphoma not otherwise specified and one or more of the following at diagnosis: * High LDH * Marrow involvement * Age \> 60 years * Low platelet count * Relapsed chemotherapy-sensitive disease * Angioimmunoblastic lymphadenopathy with dysproteinemia * Anaplastic lymphoma kinase-negative anaplastic NHL * Enteropathy-associated T-cell NHL * Natural killer (NK)/T-cell NHL and stage III/IV disease at diagnosis * NK blastic NHL PATIENT CHARACTERISTICS: * ECOG (Eastern Cooperative Oncology Group) /WHO performance status 0-2 * ANC (absolute neutrophil count) ≥ 1,000/μL * Platelet count ≥ 75,000/μL * Total bilirubin ≤ 1.5 mg/dL * AST (aspartate aminotransferase)/ALT (Alanine transaminase) ≤ 2 x upper limit of normal (ULN) * Serum creatinine ≤ 1.5 x ULN OR creatinine clearance ≥ 50 mL/min * No severe or uncontrolled systemic illness * Patients must be able to swallow capsules * Negative pregnancy test * Not pregnant or nursing * Fertile patients must use at least two adequate barrier methods of contraception during study and for 90 days after completion of study therapy * No other malignancy within the past 5 years other than nonmelanoma skin cancer, carcinoma in situ of the cervix, or a malignancy considered by their physician to be at less than 30% risk of relapse * No congenital long QT syndrome * No significant history of uncontrolled cardiac disease (i.e., uncontrolled hypertension, unstable angina, myocardial infarction within the past 6 months, or uncontrolled congestive heart failure) * No active bacterial, fungal, or viral infection * No known HIV infection * No active hepatitis B and/or hepatitis C infection * No other medical condition, including mental illness or substance abuse, deemed by the Investigator(s) to interfere with a patient's ability to sign informed consent, cooperate and participate in the study, or interfere with the interpretation of the results PRIOR CONCURRENT THERAPY: * Recovered from the majority of the toxicities from the autologous transplantation (must have returned to their pretransplant baseline or have no greater than grade I extramedullary toxicity Common Toxicity Criteria for Adverse Effects\[CTCAE 3.0\]) * No prior treatment with a histone deacetylase (HDAC) inhibitor (e.g., depsipeptide, MS-275, LAQ-824, belinostat, valproic acid) * More than 4 weeks since prior and no concurrent class Ia, Ib, or Ic antiarrhythmic drugs * No other concurrent antineoplastic chemotherapy or biologic therapy * No concurrent radiotherapy, unless for local control of bone pain * Irradiated area for pain management should be as small as possible and lesions within the irradiated field cannot be used for response * No concurrent use of complementary or alternative medicines that would confound the interpretation of toxicities and antitumor activity of vorinostat (SAHA)

Design outcomes

Primary

MeasureTime frameDescription
Safety and Tolerability of Vorinostat (SAHA) After Autologous Stem Cell TransplantationUp to 3 yearsNCI CTCAE version 3.0 was used to assess Adverse Events (AE) Grade 1=Mild AE Grade 2=Moderate AE Grade 3=Severe AE Grade 4=Life-threatening or disabling AE

Secondary

MeasureTime frameDescription
Clinical BenefitUp to 3 yearsPer Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR.
Duration of ResponseUp to 5 yearsMedian follow up of living patients
Time to ProgressionUp to 3 yearsProgression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions

Countries

United States

Participant flow

Participants by arm

ArmCount
Vorinostat (SAHA)
Vorinostat (SAHA) will be administered orally starting approximately day +60 post HSCT for 21 consecutive days of a 28-day cycle for up to a maximum of 11 cycles with the dose escalations. vorinostat: Vorinostat (SAHA) will be administered orally starting approximately day +60 post HSCT for 21 consecutive days of a 28-day cycle for up to a maximum of 11 cycles. Correlative studies: Laboratory as well as quality of life correlative studies will be obtained at days +26 to +38 (at approximately 1 month post HSCT),days +56 to +66 (≈2 mos), and at C2D1 (≈3 mos.), C3D1 (≈4 mos.), C5D1 (≈6 mos.),C7D1 (≈8 mos.), and off study (ideally at ≈12 mos.)
23
Total23

Baseline characteristics

CharacteristicVorinostat (SAHA)
Age, Continuous55 years
Ethnicity (NIH/OMB)
Hispanic or Latino
0 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
23 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
Race (NIH/OMB)
Asian
0 Participants
Race (NIH/OMB)
Black or African American
1 Participants
Race (NIH/OMB)
More than one race
0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants
Race (NIH/OMB)
White
22 Participants
Region of Enrollment
United States
23 patients
Sex: Female, Male
Female
4 Participants
Sex: Female, Male
Male
19 Participants

Adverse events

Event typeEG000
affected / at risk
deaths
Total, all-cause mortality
— / —
other
Total, other adverse events
12 / 23
serious
Total, serious adverse events
0 / 23

Outcome results

Primary

Safety and Tolerability of Vorinostat (SAHA) After Autologous Stem Cell Transplantation

NCI CTCAE version 3.0 was used to assess Adverse Events (AE) Grade 1=Mild AE Grade 2=Moderate AE Grade 3=Severe AE Grade 4=Life-threatening or disabling AE

Time frame: Up to 3 years

ArmMeasureGroupValue (NUMBER)
Vorinostat (SAHA)Safety and Tolerability of Vorinostat (SAHA) After Autologous Stem Cell TransplantationFatigue (Grade 1, 2)12 patients
Vorinostat (SAHA)Safety and Tolerability of Vorinostat (SAHA) After Autologous Stem Cell TransplantationLymphopenia (Grade 1-4)11 patients
Vorinostat (SAHA)Safety and Tolerability of Vorinostat (SAHA) After Autologous Stem Cell TransplantationThrombocytopenia (Grade 1-3)11 patients
Vorinostat (SAHA)Safety and Tolerability of Vorinostat (SAHA) After Autologous Stem Cell TransplantationLeukopenia (Grade 1-3)10 patients
Vorinostat (SAHA)Safety and Tolerability of Vorinostat (SAHA) After Autologous Stem Cell TransplantationAnemia (Grade 1-3)10 patients
Secondary

Clinical Benefit

Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR.

Time frame: Up to 3 years

Population: Response following AHSCT

ArmMeasureGroupValue (NUMBER)
Vorinostat (SAHA)Clinical BenefitStable Disease(SD)2 patients
Vorinostat (SAHA)Clinical BenefitNot evaluable5 patients
Vorinostat (SAHA)Clinical BenefitComplete Response (CR)13 patients
Vorinostat (SAHA)Clinical BenefitPartial Response (PR)3 patients
Secondary

Duration of Response

Median follow up of living patients

Time frame: Up to 5 years

ArmMeasureValue (MEDIAN)
Vorinostat (SAHA)Duration of Response23.2 months
Secondary

Time to Progression

Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions

Time frame: Up to 3 years

Population: Unable to calculate time to progression for patients due to not enough follow up time

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026