Lymphoma
Conditions
Keywords
stage II grade 1 follicular lymphoma, stage II grade 2 follicular lymphoma, stage II 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
Brief summary
RATIONALE: Biological therapies, such as GM-CSF, may stimulate the immune system in different ways and stop cancer cells from growing. Monoclonal antibodies, such as 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. Giving GM-CSF together with rituximab may kill more cancer cells. PURPOSE: This phase II trial is studying how well giving GM-CSF together with rituximab works in treating patients with previously untreated follicular non-Hodgkin lymphoma.
Detailed description
OBJECTIVES: Primary * Evaluate the clinical efficacy of sargramostim (GM-CSF) and rituximab, in terms of overall objective complete and partial response rates, in patients with previously untreated follicular non-Hodgkin lymphoma. Secondary * Evaluate the time to progression in patients treated with this regimen. * Evaluate the overall survival of patients treated with this regimen. * Evaluate the duration of response in patients treated with this regimen. * Evaluate the safety profile of this regimen in these patients. * Evaluate the influence of FcγR polymorphisms on clinical response. * Monitor FcγR-expressing cells in peripheral blood during treatment. * Monitor the molecular biological marker bcl2 \[t(14;18)\] in peripheral blood and bone marrow. OUTLINE: This is a multicenter study. * Induction therapy: Patients receive sargramostim (GM-CSF) subcutaneously (SC) on days 1-5 and rituximab IV on day 1. Treatment repeats every 21 days for up to 8 courses in the absence of disease progression or unacceptable toxicity. * Maintenance therapy: Patients receive GM-CSF SC on days 1-5 and rituximab IV on day 1. Treatment repeats every 8 weeks for up to 12 courses in the absence of disease progression or unacceptable toxicity. Blood and bone marrow samples are collected at baseline and periodically during study for analysis of bcl2 rearrangement by PCR assay; FcγR expression by immunophenotyping; and FcγR polymorphisms. After completion of study therapy, patients are followed every 3 months for 1 year and then every 6 months for up to 4 years.
Interventions
BIOLOGICALrituximab
BIOLOGICALsargramostim
GENETICgene expression analysis
GENETICgene rearrangement analysis
GENETICpolymerase chain reaction
GENETICpolymorphism analysis
OTHERlaboratory biomarker analysis
Sponsors
French Innovative Leukemia Organisation
Study design
Allocation
NON_RANDOMIZED
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
DISEASE CHARACTERISTICS: * Histologically and immunophenotypically confirmed CD20+ follicular lymphoma according to WHO classification * Grade 1-3a disease * Stage II-IV disease * Non-bulky disease * Must have undergone initial nodal biopsy within the past 4 months * At least 1 measurable lesion * Low tumor-burden, as defined by the following GELF criteria: * Nodal or extranodal tumor mass (diameter \< 7 cm) * No systemic B symptoms * No increased LDH and β2 microglobulinemia * No substantial splenic enlargement * No serous effusion * No compression syndrome PATIENT CHARACTERISTICS: * ECOG performance status 0-1 * Negative pregnancy test * Fertile patients must use effective contraception * No active hepatitis PRIOR CONCURRENT THERAPY: * No prior treatment, including steroids and radiotherapy
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Overall objective tumor response rate at the end of induction therapy | — |
Secondary
| Measure | Time frame |
|---|---|
| Overall survival | — |
| Duration of response | — |
| Time to next treatment | — |
| Time to progression | — |
| Influence of FcγR polymorphisms on clinical response and survival | — |
| FcγR expression during study treatment | — |
| Molecular biological marker bcl2 [t(14;18)] in peripheral blood and bone marrow as measured by PCR assay | — |
| Safety profile | — |
Outcome results
None listed