- ICH GCP
- Registre américain des essais cliniques
- Essai clinique NCT00176475
Irradiated Donor Lymphocytes and Rituximab in Treating Patients With Relapsed or Refractory Lymphoproliferative Disease
A Pilot Study of Irradiated HLA-Partially Matched Allogeneic Related Donor Lymphocytes in Conjunction With Rituximab for Selected Patients With CD20 + Malignancies
RATIONALE: When irradiated lymphocytes from a donor are infused into the patient they may help the patient's immune system kill cancer cells. 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 irradiated donor lymphocytes together with rituximab may kill more cancer cells.
PURPOSE: This clinical trial is studying the side effects and how well giving irradiated donor lymphocytes together with rituximab works in treating patients with relapsed or refractory lymphoproliferative disease.
Aperçu de l'étude
Statut
Les conditions
Intervention / Traitement
Description détaillée
OBJECTIVES:
Primary
- Determine the toxicity of irradiated HLA-partially matched related donor lymphocytes when administered with rituximab in patients with relapsed or refractory CD20-positive lymphoproliferative disease.
- Determine the efficacy of this regimen in these patients.
Secondary
- Correlate response with Fc receptor FcγIIIA polymorphisms or predicted HLA-directed natural killer cell reactivity.
OUTLINE: This is a pilot study.
- Rituximab therapy: Patients receive rituximab IV on days -1, 6, 13, and 20. Treatment repeats approximately every 4 months in the absence of disease progression or unacceptable toxicity.
- Donor lymphocyte infusion: Patients receive irradiated donor lymphocytes IV over 1 hour on day 0. Treatment repeats every 8-16 weeks (alternating with courses of rituximab therapy) for up to 6 donor lymphocyte infusions in the absence of disease progression or unacceptable toxicity.
Peripheral blood is collected periodically during study for correlative laboratory studies. Blood samples are analyzed for FcγIIIA polymorphism by fluorescent in situ hybridization or by reverse transcriptase-polymerase chain reaction. Survival of donor lymphocytes is assessed by chimerism studies.
PROJECTED ACCRUAL: A total of 20 patients will be accrued for this study.
Type d'étude
Inscription (Réel)
Phase
- La phase 1
Contacts et emplacements
Lieux d'étude
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New Jersey
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New Brunswick, New Jersey, États-Unis, 08903
- Cancer Institute of New Jersey at UMDNJ - Robert Wood Johnson Medical School
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Critères de participation
Critère d'éligibilité
Âges éligibles pour étudier
Accepte les volontaires sains
Sexes éligibles pour l'étude
La description
DISEASE CHARACTERISTICS:
Histologically confirmed lymphoproliferative disease
- CD20-positive disease
- Bidimensionally measurable disease OR abnormal cells detected in blood
Resistant or refractory to standard therapies and/or unlikely to benefit from additional standard therapies* AND meets 1 of the following criteria:
Disease with anticipated response rate < 20% after treatment with rituximab alone, including any of the following:
- Diffuse large cell lymphoma
- B-cell lymphoblastic lymphoma
- Burkitt's lymphoma
- Acute lymphocytic leukemia
Relapsed or progressive disease after prior treatment with rituximab, including any of the following:
- Hodgkin's lymphoma
- Hairy cell leukemia
Chronic lymphocytic leukemia/small lymphocytic lymphoma meeting any of the following criteria:
- Received prior fludarabine phosphate-containing regimens and relapsed within 1 year of treatment OR ineligible to receive such therapy due to comorbidities or allergies
- Received prior anti-CD52 monoclonal antibody therapy and relapsed within 1 year of treatment OR ineligible to receive such therapy (for patients without symptomatic lymphadenopathy)
- Has documentation of disease-associated symptoms, rapid disease progression, or other indications for treatment
B-cell prolymphocytic leukemia meeting any of the following criteria:
- Received prior fludarabine phosphate- or alkylating agent-containing regimens and relapsed within 1 year of treatment OR ineligible to receive such therapy due to comorbidities or allergies
- Received prior anti-CD52 monoclonal antibody therapy OR ineligible to receive such therapy (for patients without symptomatic lymphadenopathy)
Lymphoplasmacytic lymphoma, marginal zone lymphoma, mucosa-associated lymphoid tissue lymphoma, or follicular lymphoma meeting any of the following criteria:
- Received prior fludarabine phosphate- and/or alkylating agent-containing regimens and relapsed within 1 year of treatment OR ineligible to receive such therapy due to comorbidities or allergies
- Received prior anti-CD20 monoclonal antibody therapy and relapsed within 1 year of treatment OR ineligible to receive such therapy
- Received prior radioconjugated anti-CD20 monoclonal antibody therapy OR ineligible to receive such therapy
- Has documentation of disease-associated symptoms, rapid disease progression, or other indications for treatment
Multiple myeloma meeting any of the following criteria:
- Received prior alkylating agent-, thalidomide-, corticosteroid-, or bortezomib-containing regimens and relapsed after 1 year of treatment OR ineligible to receive such therapies due to comorbidities or allergies
- Received prior high-dose chemotherapy followed by autologous hematopoietic stem cell rescue and relapsed after treatment OR ineligible to receive such therapy
Mantle cell lymphoma meeting the following criteria:
- Received prior combination chemotherapy and anti-CD20 monoclonal antibody therapy and relapsed after treatment OR ineligible to receive such therapy
Diffuse large B-cell lymphoma meeting any of the following criteria:
- Received prior combination chemotherapy and relapsed after treatment OR ineligible to receive such therapy
- Received prior salvage combination chemotherapy with or without high-dose chemotherapy followed by autologous hematopoietic stem cell rescue and relapsed after treatment OR not a candidate to receive such therapy
- Received prior radiolabeled anti-CD20 monoclonal antibody therapy for transformed large cell lymphoma OR ineligible to receive such therapy
Burkitt's lymphoma meeting any of the following criteria:
- Received prior combination chemotherapy and relapsed after treatment OR ineligible to receive such therapy
- Received prior salvage combination chemotherapy with or without high-dose chemotherapy followed by autologous hematopoietic stem cell rescue and relapsed after treatment OR ineligible to receive such therapy
Lymphomatoid granulomatosis meeting any of the following criteria:
- Received prior single-agent or combination chemotherapy and relapsed after treatment OR ineligible to receive such therapy
- Has documentation of disease-associated symptoms, rapid disease progression, or other indications for treatment
Acute lymphocytic leukemia meeting any of the following criteria:
- Received prior multi-agent combination chemotherapy administered in sequential induction, consolidation, and maintenance courses and relapsed during or after treatment OR ineligible to receive such therapy
- Received prior chemotherapy with or without radiotherapy followed by allogeneic hematopoietic stem cell transplantation (HSCT) and relapsed after treatment OR not a candidate for such therapy
- Received prior treatment with chemotherapy with or without radiotherapy followed by allogeneic HSCT and relapsed after treatment (or not a candidate for such therapy) AND demonstrates persistent cytogenetic, fluorescent in situ hybridization, or molecular (reverse transcriptase-polymerase chain reaction) evidence of the bcr-abl fusion gene despite 6 weeks of treatment with imatinib mesylate NOTE: *Not eligible to receive standard available salvage regimens anticipated to result in durable remission
- No active CNS malignancy
- Not considered a candidate for allogeneic HSCT
- HLA-partially matched (≥ 2/6) related donor available
PATIENT CHARACTERISTICS:
- ECOG performance status 0-1
- Life expectancy > 3 months
- Not pregnant
- Negative pregnancy test
- Fertile women must use effective contraception
- Bilirubin < 1.5 times upper limit of normal (ULN)
- AST < 3.0 times ULN
- Cardiac ejection fraction > 35%
- Absolute neutrophil count > 1,000/mm³ (without cytokines)
- Platelet count > 50,000/mm³ (untransfused)
- No significant organ dysfunction
- No active uncontrolled infections
- No hypersensitivity reaction to rituximab that has precluded completion of a 4-week course of rituximab therapy
- No uncontrolled psychiatric illness or medical condition that would preclude tolerance of study treatment
PRIOR CONCURRENT THERAPY:
- See Disease Characteristics
- Recovered from prior therapy for at least 7 days
- More than 30 days since prior cytotoxic chemotherapy
- At least 14 days since prior steroids
- At least 14 days since prior radiotherapy to non-target lesions
Plan d'étude
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Traitement
- Répartition: N / A
- Modèle interventionnel: Affectation à un seul groupe
- Masquage: Aucun (étiquette ouverte)
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
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Expérimental: Therapeutic allogeneic lymphocytes with rituximab
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Patients will receive a single day infusion of standard dose rituximab (375 mg/m2) on days -1, 6, 13, 20 approximately every 4 months (in conjunction with alternating doses of the lymphocyte infusion).
The product will then be assigned to the specific patient and the released product will be transported to and administered to the patient at CINJ, after premedication of the patient with acetaminophen 650 mg PO and diphenhydramine- HCl 25 mg PO.
Blood product administration will be every 8 weeks and undertaken according to CINJ standard procedures
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Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Délai |
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Toxicity as assessed by NCI CTCAE v3.0
Délai: 4 years
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4 years
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Mesures de résultats secondaires
Mesure des résultats |
Délai |
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Efficacy
Délai: 4 years
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4 years
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Collaborateurs et enquêteurs
Collaborateurs
Dates d'enregistrement des études
Dates principales de l'étude
Début de l'étude
Achèvement primaire (Réel)
Achèvement de l'étude (Réel)
Dates d'inscription aux études
Première soumission
Première soumission répondant aux critères de contrôle qualité
Première publication (Estimation)
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Estimation)
Dernière mise à jour soumise répondant aux critères de contrôle qualité
Dernière vérification
Plus d'information
Termes liés à cette étude
Mots clés
- Lymphome diffus à grandes cellules de stade III chez l'adulte
- Lymphome de Burkitt de stade III chez l'adulte
- Lymphome folliculaire de stade IV de grade 3
- Lymphome diffus à grandes cellules de stade IV chez l'adulte
- Lymphome de Burkitt de stade IV chez l'adulte
- lymphome folliculaire de grade 3 récurrent
- lymphome diffus à grandes cellules récurrent de l'adulte
- lymphome de Burkitt adulte récurrent
- lymphome hodgkinien adulte récurrent
- Macroglobulinémie de Waldenström
- Lymphome folliculaire stade III grade 1
- Lymphome folliculaire stade III grade 2
- Lymphome folliculaire stade III grade 3
- Lymphome folliculaire de stade IV de grade 1
- lymphome folliculaire de stade IV grade 2
- lymphome à cellules du manteau de stade III
- lymphome à cellules du manteau de stade IV
- myélome multiple stade II
- myélome multiple stade III
- lymphome folliculaire de grade 1 récurrent
- lymphome folliculaire de grade 2 récurrent
- lymphome récurrent de la zone marginale
- petit lymphome lymphocytaire récurrent
- Lymphome lymphocytaire de stade III
- lymphome de la zone marginale de stade III
- Lymphome lymphocytaire de stade IV
- lymphome de la zone marginale de stade IV
- lymphome à cellules B de la zone marginale extranodale du tissu lymphoïde associé aux muqueuses
- lymphome ganglionnaire de la zone marginale à cellules B
- lymphome de la zone marginale splénique
- lymphome lymphoblastique récurrent de l'adulte
- lymphome à cellules du manteau récurrent
- leucémie lymphoïde chronique réfractaire
- leucémie lymphoïde chronique stade III
- leucémie lymphoïde chronique de stade IV
- Lymphome hodgkinien de stade III chez l'adulte
- Lymphome hodgkinien de stade IV chez l'adulte
- lymphome lymphoblastique adulte de stade III
- Lymphome lymphoblastique adulte stade IV
- granulomatose lymphomatoïde récurrente de grade III chez l'adulte
- myélome multiple réfractaire
- leucémie aiguë lymphoblastique récurrente de l'adulte
- leucémie à tricholeucocytes réfractaire
- leucémie prolymphocytaire
- leucémie à tricholeucocytes progressive, traitement initial
Termes MeSH pertinents supplémentaires
- Maladies cardiovasculaires
- Maladies vasculaires
- Maladies du système immunitaire
- Tumeurs par type histologique
- Tumeurs
- Troubles lymphoprolifératifs
- Maladies lymphatiques
- Troubles immunoprolifératifs
- Maladies hématologiques
- Troubles hémorragiques
- Troubles hémostatiques
- Paraprotéinémies
- Troubles des protéines sanguines
- Lymphome
- Myélome multiple
- Tumeurs, plasmocyte
- Leucémie
- Plasmocytome
- Effets physiologiques des médicaments
- Agents antirhumatismaux
- Agents antinéoplasiques
- Facteurs immunologiques
- Agents antinéoplasiques immunologiques
- Rituximab
Autres numéros d'identification d'étude
- CDR0000540171
- P30CA072720 (Subvention/contrat des NIH des États-Unis)
- CINJ-010406 (Autre identifiant: Cancer Institute of New Jersey)
Ces informations ont été extraites directement du site Web clinicaltrials.gov sans aucune modification. Si vous avez des demandes de modification, de suppression ou de mise à jour des détails de votre étude, veuillez contacter register@clinicaltrials.gov. Dès qu'un changement est mis en œuvre sur clinicaltrials.gov, il sera également mis à jour automatiquement sur notre site Web .
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Children's Oncology GroupNational Cancer Institute (NCI)Actif, ne recrute pasTrouble lymphoprolifératif post-transplantation lié à l'EBV | Trouble lymphoprolifératif post-transplantation monomorphe | Trouble lymphoprolifératif post-transplantation polymorphe | Trouble lymphoprolifératif post-transplantation monomorphe récurrent | Trouble lymphoprolifératif polymorphe... et d'autres conditionsÉtats-Unis
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National Cancer Institute (NCI)Celgene CorporationActif, ne recrute pasLymphome folliculaire Ann Arbor Stade III Grade 1 | Ann Arbor Stade III Grade 2 Lymphome folliculaire | Ann Arbor Stade IV Grade 1 Lymphome Folliculaire | Ann Arbor Stade IV Grade 2 Lymphome folliculaire | Ann Arbor Stade II Grade 3 Lymphome folliculaire contigu | Ann Arbor Stade II Grade... et d'autres conditionsÉtats-Unis
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