Chemotherapy, Total-Body Irradiation, Rituximab, and Donor Stem Cell Transplant in Treating Patients With B-Cell Non-Hodgkin's Lymphoma or Chronic Lymphocytic Leukemia
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.
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
- Medicin: cyclophosphamid
- Biologisk: anti-thymocyt globulin
- Medicin: fludarabin fosfat
- Stråling: bestråling af hele kroppen
- Biologisk: filgrastim
- Biologisk: rituximab
- Medicin: cyclosporin
- Biologisk: graft-versus-tumor-induktionsterapi
- Medicin: mycophenolatmofetil
- Procedure: ikke-myeloablativ allogen hæmatopoietisk stamcelletransplantation
Undersøgelsestype
Undersøgelsestype
Tilmelding (Faktiske)
Tilmelding
Fase
Fase
- Fase 2
Kontakter og lokationer
Studiesteder
-
-
New York
-
New York, New York, Forenede Stater, 10065
- Memorial Sloan Kettering Cancer Center
-
-
Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
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
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: N/A
- Interventionel model: Enkelt gruppeopgave
- Maskning: Ingen (Åben etiket)
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
|
Andet: 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).
|
Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Tidsramme |
|---|---|
|
Overall Survival at 1 Year
Tidsramme: 1 year
|
1 year
|
Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Tidsramme |
|---|---|
|
Time to Neutrophil Engraftment
Tidsramme: 2 years
|
2 years
|
|
Time to Platelet Engraftment
Tidsramme: 1 year
|
1 year
|
|
Incidence of Moderate to Severe Grades II to IV Graft Versus Host Disease (GVHD) at 100 Days
Tidsramme: 100 days
|
100 days
|
|
Incidence of Chronic GVHD at 1 Year
Tidsramme: 1 year
|
1 year
|
|
Immune Reconstruction/CD4+ Count at 3 Months
Tidsramme: 3 months
|
3 months
|
|
Response to Treatment
Tidsramme: 2 years
|
2 years
|
|
Immune Reconstruction/CD4+ Count at 6 Months
Tidsramme: 6 months
|
6 months
|
|
Immune Reconstruction/CD4+ Count at 1 Year
Tidsramme: 1 year
|
1 year
|
Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Samarbejdspartnere
Samarbejdspartnere
Efterforskere
Efterforskere
- Ledende efterforsker: Juliet Barker, MBBS, Memorial Sloan Kettering Cancer Center
- Ledende efterforsker: Craig Moskowitz, MD, Memorial Sloan Kettering Cancer Center
- Ledende efterforsker: Hugo R. Castro-Malaspina, MD, Memorial Sloan Kettering Cancer Center
Publikationer og nyttige links
Hjælpsomme links
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Studiestart
Primær færdiggørelse (Faktiske)
Primær færdiggørelse
Studieafslutning (Faktiske)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Skøn)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Nøgleord
- B-celle kronisk lymfatisk leukæmi
- stadium III voksent diffust storcellet lymfom
- stadium III voksen immunoblastisk storcellet lymfom
- stadium IV voksent diffust storcellet lymfom
- stadium IV voksen immunoblastisk storcellet lymfom
- tilbagevendende voksent diffust storcellet lymfom
- tilbagevendende voksen immunoblastisk storcellet lymfom
- stadium III grad 1 follikulært lymfom
- stadium III grad 2 follikulært lymfom
- stadium IV grad 1 follikulært lymfom
- stadium IV grad 2 follikulært lymfom
- stadium III mantelcellelymfom
- stadium IV mantelcellelymfom
- tilbagevendende grad 1 follikulært lymfom
- tilbagevendende grad 2 follikulært lymfom
- ikke-sammenhængende stadium II grad 1 follikulært lymfom
- ikke-sammenhængende stadium II grad 2 follikulært lymfom
- ikke-sammenhængende trin II lille lymfocytisk lymfom
- noncontiguous stadium II marginal zone lymfom
- tilbagevendende marginal zone lymfom
- tilbagevendende lille lymfocytisk lymfom
- stadium III lille lymfatisk lymfom
- stadium III marginal zone lymfom
- stadium IV lille lymfocytisk lymfom
- stadium IV marginal zone lymfom
- ekstranodal marginal zone B-celle lymfom af slimhinde-associeret lymfoid væv
- nodal marginal zone B-celle lymfom
- milt marginal zone lymfom
- tilbagevendende kappecellelymfom
- refraktær kronisk lymfatisk leukæmi
- stadium III kronisk lymfatisk leukæmi
- stadium IV kronisk lymfatisk leukæmi
- ikke-sammenhængende stadium II mantelcellelymfom
- ikke-sammenhængende stadium II voksent diffust storcellet lymfom
- ikke-sammenhængende stadium II voksent immunoblastisk storcellet lymfom
Yderligere relevante MeSH-vilkår
- Sygdomme i immunsystemet
- Neoplasmer efter histologisk type
- Neoplasmer
- Lymfoproliferative lidelser
- Lymfesygdomme
- Immunproliferative lidelser
- Leukæmi, lymfoid
- Leukæmi, B-celle
- Lymfom
- Leukæmi
- Leukæmi, lymfatisk, kronisk, B-celle
- Lægemidlers fysiologiske virkninger
- Molekylære mekanismer for farmakologisk virkning
- Anti-infektionsmidler
- Enzymhæmmere
- Antirheumatiske midler
- Antimetabolitter, Antineoplastisk
- Antimetabolitter
- Antineoplastiske midler
- Immunsuppressive midler
- Immunologiske faktorer
- Antineoplastiske midler, Alkylering
- Alkyleringsmidler
- Myeloablative agonister
- Antineoplastiske midler, immunologiske
- Dermatologiske midler
- Antibakterielle midler
- Antibiotika, antineoplastisk
- Antifungale midler
- Antituberkulære midler
- Antibiotika, Antituberkulær
- Calcineurin-hæmmere
- Cyclofosfamid
- Rituximab
- Fludarabin
- Fludarabin phosphat
- Mycophenolsyre
- Antimfocyt serum
- Cyclosporin
- Cyclosporiner
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- 06-150
- MSKCC-06150
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