Recurrent B-Cell Non-Hodgkin Lymphoma, Recurrent Hodgkin Lymphoma, Recurrent T-Cell Non-Hodgkin Lymphoma, Refractory B-Cell Non-Hodgkin Lymphoma, Refractory Hodgkin Lymphoma, Refractory T-Cell Non-Hodgkin Lymphoma
Conditions
Brief summary
This phase I trial studies the side effects and best dose of iodine I 131 monoclonal antibody BC8 when given before autologous stem cell transplant in treating patients with Hodgkin lymphoma or non-Hodgkin lymphoma that has returned after a period of improvement or does not respond to treatment. Radiolabeled monoclonal antibodies, such as iodine I 131 monoclonal antibody BC8, can find cancer cells and carry cancer-killing substances to them without harming normal cells. Giving iodine I 131 monoclonal antibody BC8 before an autologous stem cell transplant may kill more cancer cells.
Detailed description
PRIMARY OBJECTIVES: I. To estimate the maximally tolerated dose of 131I-BC8 (anti-cluster of differentiation \[CD\]45) (iodine I 131 monoclonal antibody BC8) that can be delivered prior to autologous stem cell transplantation for patients with relapsed/refractory B-non-Hodgkin lymphoma (NHL), T-NHL, or Hodgkin lymphoma (HL). SECONDARY OBJECTIVES: I. To optimize the protein dose (antibody \[Ab\]) to deliver a favorable biodistribution in the majority of patients. II. To assess the radiation dose delivered to tumor sites and normal organs by the above therapy. III. To evaluate the dose-response relationship of radiation-dose to tumor and clinical response. IV. To estimate the overall and progression-free survival of the above regimen in such patients. V. To evaluate the toxicity and tolerability of the above therapy. VI. To evaluate the feasibility of delivering high-dose 131I-BC8 and autologous stem cell transplantation (ASCT) to B-Cell NHL, T-NHL, and HL patients. VII. To evaluate the ability to reduce infusion reactions via unlabeled BC8 preinfusion. OUTLINE: This is a dose-escalation study. Patients receive a dosimetric dose of iodine I 131 monoclonal antibody BC8 intravenously (IV) on day -20 and a therapeutic dose on day -11. Before day -20, patients may also receive up to 2 additional dosimetric doses of iodine I 131 monoclonal antibody BC8 IV approximately 1-2 weeks apart. Patients then undergo autologous stem cell transplantation on day 0. After completion of study treatment, patients are followed up at 1, 3, 6, and 12 months and then annually thereafter.
Interventions
PROCEDUREAutologous Hematopoietic Stem Cell Transplantation
Autologous stem cells given via central catheter
RADIATIONIodine I 131 Monoclonal Antibody BC8
Given IV
OTHERLaboratory Biomarker Analysis
Correlative studies
Sponsors
National Cancer Institute (NCI)
Fred Hutchinson Cancer Center
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
A single site, open label clinical trial.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients must have a histologically confirmed diagnosis of B-NHL, T-NHL, or HL; CD45 antigen expression must be documented on tumor specimens in all cases except HL, in whom histologic demonstration of CD45+ cells adjacent to the Reed Sternberg cells is required * Patients must have received at least one prior standard systemic therapy with documented recurrent or refractory disease * Mantle cell lymphoma (MCL), T-NHL, or other high-risk malignancies may be enrolled/transplanted in complete remission (CR)/first partial remission (PR1) * Patients are preferred to have either a tumor mass amenable to core needle biopsy during the dosimetry phase, or a measurable tumor mass with at least one site of involvement measuring 2.0 cm in largest dimension on computed tomography (CT) imaging for purposes of planar and/or single-photon emission CT (SPECT)/CT tumor dosimetry (patients with disease that does not allow tumor dosimetry will be allowed on study since they still can contribute toward achieving the primary endpoint, but these patients will be given a lower priority over those with evaluable disease) * Creatinine \[Cr\] \< 2.0 * Bilirubin \< 1.5 mg/dL, with the exception of patients thought to have Gilbert's syndrome, who may have a total bilirubin above 1.5 mg/dL * All patients eligible for therapeutic study must have a minimum of \>= 4 x10\^6 CD34/kg autologous hematopoietic stem cells harvested and cryopreserved and divided into 2 aliquots of at least \>= 2 x10\^6 CD34/kg each; patients with a history of prior autologous hematopoietic cell transplant (HCT) are only required to have \>= 2x10\^6 CD34/kg stored * Patients must have an expected survival of \> 60 days and must be free of major infection
Exclusion criteria
* Circulating human anti-mouse antibody (HAMA), to be determined before each infusion * Systemic anti-lymphoma therapy given in the previous 30 days before the scheduled therapy dose with the exception of rituximab * Inability to understand or give an informed consent * Lymphoma involving the central nervous system * Other serious medical conditions considered to represent contraindications to bone marrow transplant (BMT) (e.g. abnormally decreased cardiac ejection fraction, diffusion capacity of the lung for carbon monoxide (DLCO) \< 50% predicted, forced expiratory volume in one second (FEV1) \< 70% predicted, acquired immune deficiency syndrome \[AIDS\], etc.) * Known human immunodeficiency virus (HIV) seropositivity * Pregnancy or breast feeding * Prior allogeneic bone marrow or stem cell transplant * Prior autologous bone marrow or stem cell transplant or prior radiation therapy (RT) \> 20 Gy to a critical organ within 1 year of enrollment * Presence of circulating lymphoma cells by morphology or flow cytometry (\> 0.1%) at or near the time of peripheral blood stem cell (PBSC) collection if unpurged/unselected PBSC are to be used (patients with cryopreserved stem cells which are negative \[=\< 0.1% involved\] by flow cytometry will also be considered eligible) * Southwest Oncology Group (SWOG) performance status \>= 2.0 * Unable to perform self-care during radiation isolation * Expected survival if untreated less than 60 days
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Maximum Tolerated Dose (MTD) of I-131-BC8 That Can be Delivered Prior to Transplant | Within 30 days post-transplant | Dose escalation/de-escalation will be conducted by the two-stage approach introduced by Storer. Escalation will continue until a dose-limiting toxicity (DLT) occurs. A DLT will be defined as a therapy-related grade III or IV Bearman (transplant) toxicity. The MTD is estimated to be the dose that is associated with a toxicity rate of 25% (Bearman grade 3-4). |
| I-131 Activity Administered | At time of I-131 therapy | — |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Adverse Events | Up to 6 years | Descriptive statistics will be calculated. DLT will be defined by the Bearman Scale that is designed to address the specific toxicities associated with transplantation. |
| Overall Survival | Up to 6 years | — |
| Progression-free Survival | Up to 6 years | number of people with progression free survival |
| Relapse Rate | Up to 6 years | Number of relapse |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Treatment (Iodine I 131 Monoclonal Antibody B, Autologous HCT) Patients receive a dosimetric dose of iodine I 131 monoclonal antibody BC8 IV on day -20 and a therapeutic dose on day -11. Before day -20, patients may also receive up to 2 additional dosimetric doses of iodine I 131 monoclonal antibody BC8 IV approximately 1-2 weeks apart. Patients then undergo autologous stem cell transplantation on day 0.
Autologous Hematopoietic Stem Cell Transplantation: Autologous stem cells given via central catheter
Iodine I 131 Monoclonal Antibody BC8: Given IV
Laboratory Biomarker Analysis: Correlative studies | 16 |
| Total | 16 |
Baseline characteristics
| Characteristic | Treatment (Iodine I 131 Monoclonal Antibody B, Autologous HCT) |
|---|---|
| Age, Continuous | 56.81 years STANDARD_DEVIATION 15.63 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants |
| Race (NIH/OMB) Black or African American | 0 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 | 16 Participants |
| Region of Enrollment United States | 16 participants |
| Sex: Female, Male Female | 6 Participants |
| Sex: Female, Male Male | 10 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 0 / 16 |
| serious Total, serious adverse events | 3 / 16 |
Outcome results
Primary
I-131 Activity Administered
Time frame: At time of I-131 therapy
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Treatment (Iodine I 131 Monoclonal Antibody B, Autologous HCT) | I-131 Activity Administered | 668.15 mCi I-131 |
Primary
Maximum Tolerated Dose (MTD) of I-131-BC8 That Can be Delivered Prior to Transplant
Dose escalation/de-escalation will be conducted by the two-stage approach introduced by Storer. Escalation will continue until a dose-limiting toxicity (DLT) occurs. A DLT will be defined as a therapy-related grade III or IV Bearman (transplant) toxicity. The MTD is estimated to be the dose that is associated with a toxicity rate of 25% (Bearman grade 3-4).
Time frame: Within 30 days post-transplant
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Treatment (Iodine I 131 Monoclonal Antibody B, Autologous HCT) | Maximum Tolerated Dose (MTD) of I-131-BC8 That Can be Delivered Prior to Transplant | NA Gray of I-131 (absorbed dose that the I |
Secondary
Adverse Events
Descriptive statistics will be calculated. DLT will be defined by the Bearman Scale that is designed to address the specific toxicities associated with transplantation.
Time frame: Up to 6 years
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Treatment (Iodine I 131 Monoclonal Antibody B, Autologous HCT) | Adverse Events | 0 number of adverse events |
Secondary
Overall Survival
Time frame: Up to 6 years
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Treatment (Iodine I 131 Monoclonal Antibody B, Autologous HCT) | Overall Survival | 1057 days | Standard Deviation 633.59 |
Secondary
Progression-free Survival
number of people with progression free survival
Time frame: Up to 6 years
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Treatment (Iodine I 131 Monoclonal Antibody B, Autologous HCT) | Progression-free Survival | 5 Participants |
Secondary
Relapse Rate
Number of relapse
Time frame: Up to 6 years
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Treatment (Iodine I 131 Monoclonal Antibody B, Autologous HCT) | Relapse Rate | 5 Participants |