Chemotherapy, Total-Body Irradiation, Rituximab, and Donor Stem Cell Transplant in Treating Patients With B-Cell Non-Hodgkin's Lymphoma or Chronic Lymphocytic Leukemia

October 24, 2017 updated by: Memorial Sloan Kettering Cancer Center

A Non-Myeloablative Conditioning Regimen With Peri-Transplant Rituximab and the Transplantation of Hematopoietic Stem Cells From HLA-Compatible Related or Unrelated Donors in Patients With B Cell Lymphoid Malignancies

RATIONALE: Giving low doses of chemotherapy and total-body irradiation before a donor stem cell transplant helps stop the growth of cancer cells. It also helps stop the patient's immune system from rejecting the donor's stem cells. Also, monoclonal antibodies, such as rituximab, can find cancer cells and either kill them or deliver cancer-killing substances to them without harming normal cells. The donated stem cells may replace the patient's immune cells and help destroy any remaining cancer cells (graft-versus-tumor effect). Sometimes the transplanted cells from a donor can also make an immune response against the body's normal cells. Giving rituximab before transplant and cyclosporine and mycophenolate mofetil after transplant may stop this from happening.

PURPOSE: This phase II trial is studying the side effects and how well giving chemotherapy and radiation therapy together with rituximab and donor stem cell transplant works in treating patients with B-cell non-Hodgkin's lymphoma or chronic lymphocytic leukemia.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Actual)

61

Phase

  • Phase 2

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • New York
      • New York, New York, United States, 10065
        • Memorial Sloan Kettering Cancer Center

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 70 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

DISEASE CHARACTERISTICS:

  • Diagnosis of 1 of the following:

    • CD20-positive aggressive B-cell non-Hodgkin's lymphoma (NHL), including any of the following subtypes:

      • Diffuse large cell lymphoma*, meeting 1 of the following criteria:

        • Relapsed disease after initial therapy, but failed to mobilize or had bone marrow involvement and therefore is not suitable for an autologous stem cell transplantation
        • High-intermediate- or high-risk second-line, age-adjusted International Prognostic Index score and in second complete remission (CR) or partial remission (PR) after autologous stem cell transplantation
        • Failed prior autologous stem cell transplantation and in PR or better after salvage chemotherapy

      • Large cell transformation of indolent NHL or chronic lymphocytic leukemia (CLL), meeting the following criteria:

        • In CR or PR of the large cell component of disease after salvage chemotherapy or autologous stem cell transplantation

      • Mantle cell lymphoma*, meeting 1 of the following criteria:

        • High-risk disease (e.g., p53 positivity) and in first CR or PR after initial therapy
        • Relapsed disease after initial therapy and in second or third CR or PR after salvage chemotherapy NOTE: *No progressive disease at allograft work-up

    • CD20-positive indolent NHL (e.g., follicular lymphoma, small cell lymphoma, or marginal zone NHL) OR CLL

      • Second or subsequent progression (pre-allograft cytoreduction necessary, but CR or PR not required)
  • Relapsed disease must be biopsy-proven

  • Must have received pre-allograft salvage chemotherapy, including 1 of the following:

    • Single autologous stem cell transplantation using high-dose chemotherapy conditioning within the past 120 days
    • At least 2 courses of intensive combination chemotherapy (e.g., RICE [rituximab, ifosfamide, carboplatin, etoposide]), according to diagnosis, within the past 80 days
    • CLL patients who have received CAMPATH do not have to receive pre-allograft salvage chemotherapy

  • HLA-compatible related or unrelated donor available

    • HLA-matched ≥ 9/10 of the A, B, C, DRB1, and DQB1 loci, as tested by high resolution typing

      • One allele mismatch allowed

PATIENT CHARACTERISTICS:

  • Karnofsky performance status 70-100%
  • Creatinine < 1.2 mg/mL OR creatinine clearance ≥ 50 mL/min
  • Bilirubin < 2.5 mg/dL
  • AST and ALT ≤ 3 times upper limit of normal (unless benign congenital hyperbilirubinemia is present)
  • Spirometry and corrected DLCO ≥ 50% of normal
  • LVEF ≥ 40%
  • Albumin ≥ 2.5 g/dL
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception
  • No active uncontrolled infection, including active infection with Aspergillus or other mold
  • No HIV infection
  • No hepatitis B antibody or antigen positivity

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • No prior allogeneic transplantation

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Other: treatment
This is a phase 2 study of a treatment regimen consisting of a non-myeloablative (NMA) conditioning regimen incorporating low dose chemotherapy and low dose radiation as well as peri-transplant Rituximab and the transplantation of peripheral blood stem cells (PBSC) or bone marrow if PBSC collection not possible from an HLA compatible related or unrelated donor in patients with B cell lymphoid malignancies including diffuse large cell (DLC) and mantle cell non-Hodgkin's lymphoma (NHL), indolent B cell NHL, or chronic lymphocytic leukemia (CLL).
Drug: cyclophosphamide
Biological: anti-thymocyte globulin
Drug: fludarabine phosphate
Radiation: total-body irradiation
Biological: filgrastim
Biological: rituximab
Drug: cyclosporine
Biological: graft-versus-tumor induction therapy
Drug: mycophenolate mofetil
Procedure: nonmyeloablative allogeneic hematopoietic stem cell transplantation

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Overall Survival at 1 Year
Time Frame: 1 year
1 year

Secondary Outcome Measures

Outcome Measure
Time Frame
Time to Neutrophil Engraftment
Time Frame: 2 years
2 years
Time to Platelet Engraftment
Time Frame: 1 year
1 year
Incidence of Moderate to Severe Grades II to IV Graft Versus Host Disease (GVHD) at 100 Days
Time Frame: 100 days
100 days
Incidence of Chronic GVHD at 1 Year
Time Frame: 1 year
1 year
Immune Reconstruction/CD4+ Count at 3 Months
Time Frame: 3 months
3 months
Response to Treatment
Time Frame: 2 years
2 years
Immune Reconstruction/CD4+ Count at 6 Months
Time Frame: 6 months
6 months
Immune Reconstruction/CD4+ Count at 1 Year
Time Frame: 1 year
1 year

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Memorial Sloan Kettering Cancer Center

Collaborators

National Cancer Institute (NCI)

Investigators

  • Principal Investigator: Juliet Barker, MBBS, Memorial Sloan Kettering Cancer Center
  • Principal Investigator: Craig Moskowitz, MD, Memorial Sloan Kettering Cancer Center
  • Principal Investigator: Hugo R. Castro-Malaspina, MD, Memorial Sloan Kettering Cancer Center

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

November 28, 2006

Primary Completion (Actual)

October 28, 2016

Study Completion (Actual)

October 28, 2016

Study Registration Dates

First Submitted

January 19, 2007

First Submitted That Met QC Criteria

January 19, 2007

First Posted (Estimate)

January 23, 2007

Study Record Updates

Last Update Posted (Actual)

October 31, 2017

Last Update Submitted That Met QC Criteria

October 24, 2017

Last Verified

February 1, 2017

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 06-150
  • MSKCC-06150

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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