Lymphoma
Conditions
Keywords
recurrent mantle cell lymphoma, stage III mantle cell lymphoma, stage IV mantle cell lymphoma, recurrent adult diffuse large cell lymphoma, stage III adult diffuse large cell lymphoma, stage IV adult diffuse large cell lymphoma, recurrent grade 1 follicular lymphoma, recurrent grade 2 follicular lymphoma, recurrent grade 3 follicular 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 immunoblastic large cell lymphoma, stage IV adult immunoblastic large cell lymphoma, recurrent adult immunoblastic large cell lymphoma
Brief summary
This phase II clinical trial studies how well yttrium Y 90 ibritumomab tiuxetan, rituximab, and high-dose chemotherapy followed by peripheral blood stem cell transplant in treating patients with relapsed B-cell non-Hodgkin lymphoma. Monoclonal antibodies, such as yttrium Y 90 ibritumomab tiuxetan and rituximab, can block cancer growth in different ways. Some block the ability of cancer cells to grow and spread. Others find cancer cells and help kill them or carry cancer-killing substances to them. Radiolabeled monoclonal antibodies can find tumor cells and carry tumor-killing substances to them without harming normal cells. Giving monoclonal antibody therapy, radioimmunotherapy (RIT), and high-dose combination chemotherapy before a peripheral blood stem cell transplant may be an effective treatment for non-Hodgkin lymphoma.
Detailed description
PRIMARY OBJECTIVE: I. To estimate the 2-year progression free survival. SECONDARY OBJECTIVES: II. To estimate the 2-year overall survival. III. To estimate the 2-year cumulative incidence of progression. IV. To estimate time to hematopoietic recovery, using absolute neutrophil and platelet engraftment. V. To estimate incidence of grade 3-4 toxicities by Bearman Scale, Day 0 to Day 100. VI. To estimate the response rate (CR/PR). VII. To estimate 100-day treatment related mortality. VIII. To estimate incidence of myelodysplasia and therapy related acute myeloid leukemia (AML). IX. To descriptively compare the outcomes of patients treated on this protocol to a comparable patient population treated with chemotherapy alone. OUTLINE: RADIOIMMUNOTHERAPY: Patients receive yttrium Y 90 ibritumomab tiuxetan intravenously (IV) following rituximab IV on day -14. HIGH-DOSE COMBINATION CHEMOTHERAPY: Patients receive carmustine IV on days -7 and -6; etoposide IV over 1 hour twice daily (BID) and cytarabine IV over 2 hours BID on days -5 to -2; and melphalan IV on day -1. STEM CELL TRANSPLANTATION: Patients undergo autologous peripheral blood stem cell transplant on day 0. Patients also receive rituximab on day 8\*. NOTE: \* Some patients may also receive rituximab on day -1. Treatment continues in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up periodically.
Interventions
BIOLOGICALrituximab
Given IV
DRUGcarmustine
Given IV
DRUGcytarabine
Given IV
DRUGetoposide
Given IV
DRUGmelphalan
Given IV
PROCEDUREASCT
Undergo autologous peripheral blood stem cell transplant
RADIATIONyttrium Y 90 ibritumomab tiuxetan
Given IV
Sponsors
National Cancer Institute (NCI)
City of Hope Medical Center
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
* All patients must have biopsy proven diagnosis of low- and intermediate-grade non-Hodgkin lymphoma (NHL) working formulation B, C,D, E, F, and G; including mantle cell lymphoma; patients with transformed lymphoma are also eligible * Demonstrated monoclonal CD20 positive b-cell population in lymph nodes and/or bone marrow * Patients must have relapsed after achieving a complete or partial response to prior therapy, have never responded to prior therapy or have poor risk disease * Patients with prior bone marrow involvement must have bone marrow aspiration and biopsy within 60 days prior to stem cell collection which shows =\< 10% lymphomatous involvement of total cellularity; alternatively, patients with prior bone marrow involvement should have a normal bone marrow study which shows =\< 10% lymphomatous involvement within 28 days before salvage chemotherapy * Normal renal function test with serum creatinine of \< upper limit of normal (ULN), and a creatinine clearance of \>= 60 ml/min (measured or calculated) * Adequate pulmonary function as measured by forced expiratory volume in 1 second (FEV1) \> 60% of predicted measured, or a diffusion capacity of carbon monoxide (DLCO) \>= 50% of predicted measured * Cardiac ejection fraction of \> 50% by echocardiogram or multi gated acquisition (MUGA) scan; the left ventricular ejection fraction (LVEF) from the prestudy echocardiogram (ECHO) or MUGA may be used for eligibility purposes, even if the prestudy stress test indicated a lower LVEF * Adequate liver function tests with a bilirubin of =\< 1.5 x ULN and serum glutamic oxaloacetic transaminase (SGOT) or serum glutamic pyruvic transaminase (SGPT) =\< 2 x ULN * Negative human immunodeficiency virus antibody * Eastern Cooperative Oncology Group (ECOG) performance status = 0 or 1; karnofsky performance status (KPS) \>= 80 * No active central nervous system (CNS) disease or prior history of CNS disease * Patients must have recovered from last therapy and should be at least four weeks from prior radiation or systemic chemotherapy on the day of administration of Y2B8 * After the last systemic therapeutic chemotherapy (Cytoxan, administered only for stem cell mobilization is not considered therapeutic) and prior to initiation of high dose treatment, the patient should have a baseline computed tomography (CT) scan and positron emission tomography (PET) scan done; an fluorodeoxyglucose-computed tomography (FDG/CT) scan is sufficient, however, is clinically indicated, an additional diagnostic CT may be ordered; exception: if scans were done and were negative for disease just prior to priming chemotherapy (therapeutic or nontherapeutic) and subsequent stem cell harvest, they do not need to be repeated prior to initiation of high dose treatment
Exclusion criteria
* Presence of human anti-Zevalin antibody (HAZA) * Prior radioimmunotherapy * Failure to collect adequate number of CD34+ cells \>= 3 x 10\^6/kg * Abnormal cytogenetic study not related to the underlying lymphoma on the bone marrow aspirate sample prior to stem cell collection; if cytogenetics were not performed on the marrow aspirate prior to stem cell collection, cytogenetics on the peripheral blood may be performed * Prior bone marrow transplantation * Prior malignancy except for: * Adequately treated basal cell or squamous cell skin cancer * Adequately treated noninvasive carcinoma * Other cancer from which the patient has been disease-free for at least five years * Active evidence of Hepatitis B or C infection; Hepatitis B surface antigen positive * Patients who have had prior radiation to the lung will be excluded from the study, although mediastinal irradiation will be permitted if minimal lung is in the treatment volume * Patients who have received \> 500cGy radiation to the kidneys will be excluded from the study * Patients who are pregnant or lactating
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 2-Year Progression-Free Survival | From peripheral stem cell infusion (Day0 ASCT) to first observation of progressive disease or death due to any cause, whichever comes first, assessed up to 5 years | Progression-free survival (PFS) was defined as time from peripheral stem cell infusion to recurrence, progression or death. In a clinical trial, measuring the progression-free survival is one way to see how well a new treatment works. Progression-free survival was estimated using the Kaplan-Meier method; the 95% confidence interval was calculated using Greenwood's formula \[Breslow NE, Day NE. Statistical methods in cancer research: volume II, the design and analysis of cohort studies. IARC Sci Publ 1987;82:1-406.\] |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| 2-Year Cumulative Incidence of Progression | From peripheral stem cell infusion (Day0 ASCT) to date of first observation of progressive disease or relapsed disease, assessed up to 5 years | The cumulative incidence was estimated after taking into account the competing risk of early death. |
| Number of Patients With Active Disease at ASCT Achieving CR/PR by Day 100 After ASCT | Up to Day 100 post-ASCT | Responses are assessed using the Revised Criteria for Malignant Lymphoma Response Definitions for Clinical Trials (Cheson et al. 2007). Complete Response (CR) defined as disappearance of all evidence of disease. Partial Response (PR) defined as regression of measurable disease and no new sites. |
| Number of Patients With Grade 3-4 Bearman Toxicities. | From initial of study treatment to Day 100 post-ASCT | Toxicities were recorded using the modified Bearman Scale for non-hematologic adverse events. |
| 2-Year Overall Survival | From peripheral stem cell infusion (Day0 ASCT) to death due to any cause, assessed up to 5 years | Overall survival (OS) was measured from peripheral stem cell infusion to death from any cause. It was estimated using the Kaplan-Meier method; the 95% confidence interval was calculated using Greenwood's formula. \[Breslow NE, Day NE. Statistical methods in cancer research: volume II, the design and analysis of cohort studies. IARC Sci Publ 1987;82:1-406.\] |
| Time to Neutrophil Recovery | From peripheral stem cell infusion (Day0 ASCT) till the first of 3 consecutive days of an absolute neutrophil count ≥ 500/µL.) | Neutrophil recovery was defined as the first of 3 consecutive days of an absolute neutrophil count ≥ 500/µL. |
| Time to Platelet Recovery | From peripheral stem cell infusion (Day0 ASCT) till the first of 7 consecutive days with a platelet count ≥ 20,000/µL with no transfusions | Platelet recovery was defined as the first of 7 consecutive days with a platelet count ≥ 20,000/µL with no transfusions. |
| Number of Patients With RIT/ZBEAM Developing Therapy Induced MDS and AML | From peripheral stem cell infusion (Day0 ASCT) to onset of therapy induced MDS/AML, assessed up to 5 years | Patient receiving the full treatment of RIT/ZBEAM developed therapy induced MDS or AML. |
| 100-Day Treatment-Related Mortality | From peripheral stem cell infusion (Day0 ASCT) to death due to any couse, assessed up to 5 years | The cumulative incidence was estimated after taking into account the competing risk of relapse post-ASCT. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Treatment (RIT, ZBEAM, ASCT) RADIOIMMUNOTHERAPY: Patients receive yttrium Y 90 ibritumomab tiuxetan IV following rituximab IV on day -14. HIGH-DOSE COMBINATION CHEMOTHERAPY: Patients receive carmustine IV on days -7 and -6; etoposide IV over 1 hour twice daily and cytarabine IV over 2 hours twice daily on days -5 to -2; and melphalan IV on day -1. STEM CELL TRANSPLANTATION: Patients undergo autologous peripheral blood stem cell transplant on day 0. Patients also receive rituximab on day 8\*. NOTE: \* Some patients may also receive rituximab on day -1. Treatment continues in the absence of disease progression or unacceptable toxicity.
rituximab: Given IV
carmustine: Given IV
cytarabine: Given IV
etoposide: Given IV
melphalan: Given IV
ASCT: Undergo autologous peripheral blood stem cell transplant
yttrium Y 90 ibritumomab tiuxetan: Given IV | 122 |
| Total | 122 |
Baseline characteristics
| Characteristic | Treatment (RIT, ZBEAM, ASCT) |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 19 Participants |
| Age, Categorical Between 18 and 65 years | 103 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 30 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 92 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 10 Participants |
| Race (NIH/OMB) Black or African American | 6 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 | 2 Participants |
| Race (NIH/OMB) White | 104 Participants |
| Region of Enrollment United States | 122 Participants |
| Sex: Female, Male Female | 49 Participants |
| Sex: Female, Male Male | 73 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 25 / 122 |
| other Total, other adverse events | 121 / 122 |
| serious Total, serious adverse events | 2 / 122 |
Outcome results
Primary
2-Year Progression-Free Survival
Progression-free survival (PFS) was defined as time from peripheral stem cell infusion to recurrence, progression or death. In a clinical trial, measuring the progression-free survival is one way to see how well a new treatment works. Progression-free survival was estimated using the Kaplan-Meier method; the 95% confidence interval was calculated using Greenwood's formula \[Breslow NE, Day NE. Statistical methods in cancer research: volume II, the design and analysis of cohort studies. IARC Sci Publ 1987;82:1-406.\]
Time frame: From peripheral stem cell infusion (Day0 ASCT) to first observation of progressive disease or death due to any cause, whichever comes first, assessed up to 5 years
Population: 6 patients did not receive full treatment so are excluded from the result analysis.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Treatment (RIT, ZBEAM, ASCT) | 2-Year Progression-Free Survival | 71 Percentage of Participants (%) |
Secondary
100-Day Treatment-Related Mortality
The cumulative incidence was estimated after taking into account the competing risk of relapse post-ASCT.
Time frame: From peripheral stem cell infusion (Day0 ASCT) to death due to any couse, assessed up to 5 years
Population: 6 patients did not receive full treatment so are excluded from the result analysis.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Treatment (RIT, ZBEAM, ASCT) | 100-Day Treatment-Related Mortality | 0.9 Percentage of Participants (%) |
Secondary
2-Year Cumulative Incidence of Progression
The cumulative incidence was estimated after taking into account the competing risk of early death.
Time frame: From peripheral stem cell infusion (Day0 ASCT) to date of first observation of progressive disease or relapsed disease, assessed up to 5 years
Population: 6 patients did not receive full treatment so are excluded from the result analysis
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Treatment (RIT, ZBEAM, ASCT) | 2-Year Cumulative Incidence of Progression | 28 Percentage of Participants (%) |
Secondary
2-Year Overall Survival
Overall survival (OS) was measured from peripheral stem cell infusion to death from any cause. It was estimated using the Kaplan-Meier method; the 95% confidence interval was calculated using Greenwood's formula. \[Breslow NE, Day NE. Statistical methods in cancer research: volume II, the design and analysis of cohort studies. IARC Sci Publ 1987;82:1-406.\]
Time frame: From peripheral stem cell infusion (Day0 ASCT) to death due to any cause, assessed up to 5 years
Population: 6 patients did not receive full treatment so are excluded from the result analysis.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Treatment (RIT, ZBEAM, ASCT) | 2-Year Overall Survival | 89 Percentage of Participants (%) |
Secondary
Number of Patients With Active Disease at ASCT Achieving CR/PR by Day 100 After ASCT
Responses are assessed using the Revised Criteria for Malignant Lymphoma Response Definitions for Clinical Trials (Cheson et al. 2007). Complete Response (CR) defined as disappearance of all evidence of disease. Partial Response (PR) defined as regression of measurable disease and no new sites.
Time frame: Up to Day 100 post-ASCT
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Treatment (RIT, ZBEAM, ASCT) | Number of Patients With Active Disease at ASCT Achieving CR/PR by Day 100 After ASCT | 53 Participants |
Secondary
Number of Patients With Grade 3-4 Bearman Toxicities.
Toxicities were recorded using the modified Bearman Scale for non-hematologic adverse events.
Time frame: From initial of study treatment to Day 100 post-ASCT
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Treatment (RIT, ZBEAM, ASCT) | Number of Patients With Grade 3-4 Bearman Toxicities. | Gastrointestinal Toxicity | 1 Participants |
| Treatment (RIT, ZBEAM, ASCT) | Number of Patients With Grade 3-4 Bearman Toxicities. | Pulmonary Toxicity | 1 Participants |
| Treatment (RIT, ZBEAM, ASCT) | Number of Patients With Grade 3-4 Bearman Toxicities. | No Grade 3-4 Toxicity | 120 Participants |
Secondary
Number of Patients With RIT/ZBEAM Developing Therapy Induced MDS and AML
Patient receiving the full treatment of RIT/ZBEAM developed therapy induced MDS or AML.
Time frame: From peripheral stem cell infusion (Day0 ASCT) to onset of therapy induced MDS/AML, assessed up to 5 years
Population: 6 patients did not receive full treatment so are excluded from the result analysis.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Treatment (RIT, ZBEAM, ASCT) | Number of Patients With RIT/ZBEAM Developing Therapy Induced MDS and AML | 0 Participants |
Secondary
Time to Neutrophil Recovery
Neutrophil recovery was defined as the first of 3 consecutive days of an absolute neutrophil count ≥ 500/µL.
Time frame: From peripheral stem cell infusion (Day0 ASCT) till the first of 3 consecutive days of an absolute neutrophil count ≥ 500/µL.)
Population: 6 patients did not receive full treatment so are excluded from the result analysis.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Treatment (RIT, ZBEAM, ASCT) | Time to Neutrophil Recovery | 10 Days |
Secondary
Time to Platelet Recovery
Platelet recovery was defined as the first of 7 consecutive days with a platelet count ≥ 20,000/µL with no transfusions.
Time frame: From peripheral stem cell infusion (Day0 ASCT) till the first of 7 consecutive days with a platelet count ≥ 20,000/µL with no transfusions
Population: 6 patients did not receive full treatment so are excluded from the result analysis.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Treatment (RIT, ZBEAM, ASCT) | Time to Platelet Recovery | 12 Days |