Agatolimod Sodium, Rituximab, and Yttrium Y 90 Ibritumomab Tiuxetan in Treating Patients With Recurrent or Refractory Non-Hodgkin Lymphoma

Sponsor
Mayo Clinic (Other)
Overall Status
Completed
CT.gov ID
NCT00438880
Collaborator
National Cancer Institute (NCI) (NIH)
38
2
1
121
19
0.2

Study Details

Study Description

Brief Summary

RATIONALE: Biological therapies, such as agatolimod sodium, 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. Radiolabeled monoclonal antibodies, such as yttrium Y 90 ibritumomab tiuxetan, can find cancer cells and carry cancer-killing substances to them without harming normal cells. Giving agatolimod sodium together with rituximab and yttrium Y 90 ibritumomab tiuxetan may kill more cancer cells.

PURPOSE: This phase I/II trial is studying the side effects and best dose of agatolimod sodium when given together with rituximab and yttrium Y 90 ibritumomab tiuxetan and to see how well it works in treating patients with recurrent or refractory non-Hodgkin lymphoma.

Condition or Disease Intervention/Treatment Phase
  • Drug: Agatolimod Sodium
  • Radiation: Indium In-111 Ibritumomab Tiuxetan
  • Other: Laboratory Biomarker Analysis
  • Procedure: Radionuclide Imaging
  • Biological: Rituximab
  • Procedure: Single Photon Emission Computed Tomography
  • Radiation: Yttrium Y-90 Ibritumomab Tiuxetan
Phase 1/Phase 2

Detailed Description

PRIMARY OBJECTIVES:
  1. To determine the maximum tolerated dose of CpG 7909 that can be delivered in four doses (days 6, 13, 20, 27) for patients with relapsed CD20+ non-Hodgkin's lymphoma. (Phase I) II. To assess the toxicity of CpG 7909 when combined with rituximab and Y-90 Zevalin in patients with lymphoma. (Phase I) III. To assess the overall response rate (CR + PR) of this regimen in relapsed diffuse large B cell lymphoma. (Phase II) IV. To assess the toxicity of the treatment regimen in patients with relapsed diffuse large B cell lymphoma. (Phase II) V. To assess the time to progression and duration of response in patients with relapsed diffuse large B cell lymphoma. (Phase II)
SECONDARY OBJECTIVES:
  1. To report the response rate (complete remission + complete remission unconfirmed + partial remission) in this patient population after CpG 7909, rituximab, and Y-90 Zevalin. (Phase I)
  2. To compare the biodistribution of In-111 Zevalin radioimmunoconjugate scans before and after CpG 7909. (Phase I) III. To determine the HAMA/HACA rate in patients treated with this regimen. (Phase I) IV. To determine if CpG 7909 when given in the context of rituximab and Y-90 Zevalin can stimulate immune effector cells in the blood and tumor tissue. (Phase I)
OUTLINE:

This is a dose escalation study of agatolimod sodium followed by a phase II study.

PHASE I (patients with relapsed, refractory, or residual CD20+ non-Hodgkin lymphoma [closed to accrual as of 10/29/07]): Patients receive rituximab IV on days 1, 8 and 15, agatolimod sodium IV over 2 hours on days 6, 13, 20, and 27, and yttrium Y 90 ibritumomab tiuxetan* IV over 10 minutes on day 15 in the absence of disease progression and unacceptable toxicity.

*NOTE: Patients receive indium In 111 ibritumomab tiuxetan IV over 10 minutes on days 1 and 8. Patients undergo whole-body gamma camera imaging, single-photon emission computed tomography/CT scans, and blood sampling after each dose of indium In 111 ibritumomab tiuxetan to determine biodistribution. If biodistribution is acceptable, patients receive yttrium Y 90 ibritumomab tiuxetan.

PHASE II (patients with relapsed, refractory, or residual diffuse large B-cell lymphoma):

Patients receive agatolimod sodium at the MTD as determined in phase I. Patients receive rituximab and yttrium Y 90 ibritumomab tiuxetan as in phase I.

*NOTE: Patients receive indium In 111 ibritumomab tiuxetan IV over 10 minutes on day 8. Patients undergo whole-body gamma camera imaging and blood sampling after each dose of indium In 111 ibritumomab tiuxetan to determine biodistribution.

After completion of study treatment, patients are followed periodically for up to 5 years.

Study Design

Study Type:
Interventional
Actual Enrollment :
38 participants
Allocation:
N/A
Intervention Model:
Single Group Assignment
Masking:
None (Open Label)
Primary Purpose:
Treatment
Official Title:
A Phase I/II Trial of CpG 7909, Rituximab Immunotherapy, and Y-90 Zevalin Radioimmunotherapy for Patients With Previously Treated CD20+ Non-Hodgkin Lymphoma
Study Start Date :
Oct 1, 2004
Actual Primary Completion Date :
Oct 1, 2010
Actual Study Completion Date :
Nov 1, 2014

Arms and Interventions

Arm Intervention/Treatment
Experimental: Arm I

See Detailed Description

Drug: Agatolimod Sodium
Given IV
Other Names:
  • (3'-5')d(P-thio)(T-C-G-T-C-G-T-T-T-T-G-T-C-G-T-T-T-T-G-T-C-G-T-T) Tricosasodium Salt
  • CpG 7909
  • PF-3512676
  • ProMune
  • Radiation: Indium In-111 Ibritumomab Tiuxetan
    Given IV
    Other Names:
  • IDEC In2B8
  • IDEC-In2B8
  • In 111 Ibritumomab Tiuxetan
  • In 111 Zevalin
  • indium In 111 ibritumomab tiuxetan
  • Other: Laboratory Biomarker Analysis
    Correlative study

    Procedure: Radionuclide Imaging
    Undergo imaging scans
    Other Names:
  • nuclear medicine scan
  • radioimaging
  • Radionuclide Scanning
  • Scan
  • SCINTIGRAPHY
  • Biological: Rituximab
    Given IV
    Other Names:
  • BI 695500
  • C2B8 Monoclonal Antibody
  • Chimeric Anti-CD20 Antibody
  • IDEC-102
  • IDEC-C2B8
  • IDEC-C2B8 Monoclonal Antibody
  • MabThera
  • Monoclonal Antibody IDEC-C2B8
  • PF-05280586
  • Rituxan
  • Rituximab Biosimilar BI 695500
  • Rituximab Biosimilar PF-05280586
  • Rituximab Biosimilar RTXM83
  • RTXM83
  • Procedure: Single Photon Emission Computed Tomography
    Undergo imaging scans
    Other Names:
  • Medical Imaging, Single Photon Emission Computed Tomography
  • Single Photon Emission Tomography
  • single-photon emission computed tomography
  • SPECT
  • SPECT imaging
  • SPECT SCAN
  • SPET
  • tomography, emission computed, single photon
  • Tomography, Emission-Computed, Single-Photon
  • Radiation: Yttrium Y-90 Ibritumomab Tiuxetan
    Given IV
    Other Names:
  • IDEC-Y2B8
  • IDEC-Y2B8 monoclonal antibody
  • Y 90 Ibritumomab Tiuxetan
  • Y 90 Zevalin
  • Yttrium Y 90 Ibritumomab Tiuxetan
  • yttrium Y90 ibritumomab tiuxetan
  • Outcome Measures

    Primary Outcome Measures

    1. Maximum Tolerated Dose of CpG 7909 as Determined Using the Number of Participants With a DLT at Each Dose Level [at least 10 weeks post treatment up to 3 months.]

      Participants will be treated in cohorts of 6 patients at each dose level of CpG 7909 (0.08 mg/kg, 0.16 mg/kg, 0.32 mg/kg, 0.48 mg/kg) and observed for at least 10 weeks post treatment. If at most one of the 6 patients experiences a dose limiting toxicity (DLT), a new cohort of 6 patients will be treated at the next higher dose level. A DLT for this study is defined as patients with one of the following: Absolute neutrophil counts or platelet counts below 10*10^9/L for 14 days Absolute neutrophil counts greater than 0.5 or less than 1*10^9/L Platelet counts greater than 10 or less than 50*10^9/L for 28 days. Any grade 3 non-hematologic toxicity not explainable by another obvious cause as assessed using the Common Terminology Criteria for Adverse Events (CTCAE) v3.0. We are reporting the number of DLTs at each of the dose levels. The maximum tolerated dose will be 0.48 mg/kg or the largest dose level where 1 or fewer participants reports a dose limiting toxicity.

    2. Tumor Response [Evaluations occur every three months up to a year]

      Complete Response (CR): No measurable or nonmeasurable disease. No symptoms of Lymphoma. Non-palpable spleen, if palpable at baseline. Histologically negative bone marrow, if positive at baseline. All nodes <1.5 cm in transverse diameter. Partial Response (PR): greater than 50% decrease from baseline in the sum of the products of the longest perpendicular diameters of the six largest dominant lesions. No new lesions We are reporting the number of participants that attained a status of CR or PR.

    Secondary Outcome Measures

    1. Progression-free Survival [Up to 1 year from treatment start date]

      The Progression-free survival (PFS) is defined as the time from registration to progression or death due to any cause. The distribution of PFS will be estimated using the method of Kaplan-Meier.

    2. Duration of Response [Up to 1 year from treatment start date]

      Duration of response (DoR) will be calculated from the documentation of response until the date of progression in the subset of patients who respond.

    Eligibility Criteria

    Criteria

    Ages Eligible for Study:
    18 Years and Older
    Sexes Eligible for Study:
    All
    Accepts Healthy Volunteers:
    No
    Inclusion Criteria:
    • The following histologic types by REAL classification and International Working Formulation (IWF) when applicable (NOTE: Closed to accrual as of 10/29/07): Small lymphocytic lymphoma; Lymphoplasmacytoid lymphoma; Follicular center lymphoma, follicular grades 1, 2, and 3; Extranodal marginal zone B cell lymphoma of MALT type; Nodal marginal zone B cell lymphoma

    • The following histologic types by REAL classification and International Working Formulation (IWF) when applicable: Diffuse large cell; Transformed lymphoma

    • Less than 25% bone marrow involvement of cellular marrow with lymphoma as determined by bilateral bone marrow aspirate and biopsy (the percent involvement should be estimated by the hematopathologist using all of the biopsy material)

    • There is no limit on the number of prior therapies (patients who have previously received rituximab are eligible)

    • Bi-dimensionally measurable disease: The patients must have >= 1 lesion that has a single diameter of >= 2 cm

    • Absolute neutrophil count >= 1500/mm^3

    • Platelet count >= 150,000

    • Total lymphocyte count < 5000/mm^3 only for patients with small lymphocytic lymphoma

    • HGB >= 8

    • Biopsy-proven relapsed, refractory, or residual CD20+ non-Hodgkin's lymphomas; previous biopsies =<6 months prior to treatment on this protocol will be acceptable as long as there has not been intervening therapy; if the patient has received therapy for NHL between the time of the last biopsy and this protocol, then a re-biopsy is necessary

    • ECOG performance status (PS) 0, 1, or 2

    • Expected survival >= 3 months

    • Willingness to provide all biologic specimens as required by the protocol

    • Total bilirubin =< 2 x ULN mg/dL (if abnormal, direct bilirubin =< 1.5 x ULN)

    Exclusion Criteria:
    • Prior myeloablative therapies with autologous or allogeneic bone marrow transplantation or peripheral blood stem cell support

    • Prior radioimmunotherapy including Y-90 Zevalin or 131-Iodine anti-B1 antibody or Lym-1

    • Presence of CNS lymphoma

    • Serious non-malignant disease such as active infection or other condition which in the opinion of the investigator would compromise other protocol objectives

    • Major surgery other than diagnostic surgery =< 4 weeks prior to registration

    • Another active primary malignancy

    • Known HAMA/HACA (Human anti-mouse or anti-chimeric antibodies)

    • Myelodysplastic syndrome or marrow chromosomal changes suggesting myelodysplasia

    • Pregnant women

    • Nursing women

    • Men or women of childbearing potential who are unwilling to employ adequate contraception (condoms, diaphragm, birth control pills, injections, intrauterine device [IUD], surgical sterilization, abstinence, etc.)

    • Failed stem cell collection

    • Marrow cellularity =< 15% (as determined on all bone marrow samples)

    • Known to have lymphoma related to HIV or AIDS (these patients are excluded because it is unknown what effects prolonged B-cell depletion will have on these patient's immune system)

    • G-CSF or GM-CSF therapy =< 1 week prior to study registration (pegylated filgrastim =< 3 weeks)

    • Myelosuppressive chemotherapy =< 3 weeks prior to study registration (=< 6 weeks if rituximab, nitrosourea, or Mitomycin C)

    • Skin rash (such as Stevens-Johnson's syndrome or toxic epidermal necrolysis) with prior rituximab therapy should not be entered on this study because of the risk of reoccurrence of that skin toxicity

    • Abnormal renal function (serum creatinine > 2 mg/dL)

    • Pre-existent clinical autoimmune or antibody mediated diseases, including systemic lupus erythematosus, rheumatoid arthritis, multiple sclerosis, Sjogren's syndrome, and autoimmune thrombocytopenia (patients that have no clinical symptoms of these diseases, but merely have previously detected antibodies are eligible)

    • Received prior external beam radiation therapy to > 25% of active bone marrow

    • Corticosteroid therapy at the time the patient enters the protocol; patients using prednisone or its equivalent for adrenal failure or using < 20mg of prednisone/day for other benign causes are accepted

    Contacts and Locations

    Locations

    Site City State Country Postal Code
    1 University of Iowa/Holden Comprehensive Cancer Center Iowa City Iowa United States 52242
    2 Mayo Clinic Rochester Minnesota United States 55905

    Sponsors and Collaborators

    • Mayo Clinic
    • National Cancer Institute (NCI)

    Investigators

    • Principal Investigator: Thomas Witzig, Mayo Clinic

    Study Documents (Full-Text)

    None provided.

    More Information

    Publications

    None provided.
    Responsible Party:
    Mayo Clinic
    ClinicalTrials.gov Identifier:
    NCT00438880
    Other Study ID Numbers:
    • LS0382
    • NCI-2009-01275
    • LS0382
    • P30CA015083
    First Posted:
    Feb 22, 2007
    Last Update Posted:
    Feb 4, 2016
    Last Verified:
    Sep 1, 2015

    Study Results

    Participant Flow

    Recruitment Details Phase I of this study opened 10/20/2004 and accrued 30 patients before closing 10/29/2007. Eight patients were accrued to the Phase II portion at the maximum tolerated dose established in Phase I.
    Pre-assignment Detail
    Arm/Group Title Phase I Phase II
    Arm/Group Description Phase I patients will receive the following treatment: 250 mg/m^2 Rituximab IV on days 1, 8, and 15 of a 27 day cycle 5 mCi (Indium-111), 1.6 mg Ibritumomab IV on day 1 10 mCi (Indium-111), 1.6 mg Ibritumomab IV on day 8 CpG 7909 (Agatolimod Sodium) doses will be assigned in groups of 6 patients. Dose levels will escalate in each group until maximum tolerability is attained (starting at 0.08 mg/kg and sequentially escalating to 0.16 mg/kg, 0.32 mg/kg, 0.48 mg/kg). Doses will be taken day 6, 13, 20, and 27 of a 27 day cycle. 0.4 mCi/kg Yttrium-90 Zevalin IV on day 15 Phase II patients will receive the following treatment: 250 mg/m^2 Rituximab IV on days 1, 8, and 15 of a 27 day cycle 5 mCi (Indium-111), 1.6 mg Ibritumomab IV on day 8 0.48 mg/kg CpG 7909 (Agatolimod Sodium) doses will be taken day 6, 13, 20, and 27 of a 27 day cycle. 0.4 mCi/kg Yttrium-90 Zevalin IV on day 15
    Period Title: Overall Study
    STARTED 30 8
    COMPLETED 30 8
    NOT COMPLETED 0 0

    Baseline Characteristics

    Arm/Group Title Phase I Phase II Total
    Arm/Group Description Phase I patients will receive the following treatment: 250 mg/m^2 Rituximab IV on days 1, 8, and 15 of a 27 day cycle 5 mCi (Indium-111), 1.6 mg Ibritumomab IV on day 1 10 mCi (Indium-111), 1.6 mg Ibritumomab IV on day 8 CpG 7909 (Agatolimod Sodium) doses will be assigned in groups of 6 patients. Dose levels will escalate in each group until maximum tolerability is attained (starting at 0.08 mg/kg and sequentially escalating to 0.16 mg/kg, 0.32 mg/kg, 0.48 mg/kg). Doses will be taken day 6, 13, 20, and 27 of a 27 day cycle. 0.4 mCi/kg Yttrium-90 Zevalin IV on day 15 Phase II patients will receive the following treatment: 250 mg/m^2 Rituximab IV on days 1, 8, and 15 of a 27 day cycle 5 mCi (Indium-111), 1.6 mg Ibritumomab IV on day 8 0.48 mg/kg CpG 7909 (Agatolimod Sodium) doses will be taken day 6, 13, 20, and 27 of a 27 day cycle. 0.4 mCi/kg Yttrium-90 Zevalin IV on day 15 Total of all reporting groups
    Overall Participants 30 8 38
    Age (years) [Median (Full Range) ]
    Median (Full Range) [years]
    60.5
    68.5
    62.5
    Sex: Female, Male (Count of Participants)
    Female
    13
    43.3%
    4
    50%
    17
    44.7%
    Male
    17
    56.7%
    4
    50%
    21
    55.3%
    Region of Enrollment (participants) [Number]
    United States
    30
    100%
    8
    100%
    38
    100%

    Outcome Measures

    1. Primary Outcome
    Title Maximum Tolerated Dose of CpG 7909 as Determined Using the Number of Participants With a DLT at Each Dose Level
    Description Participants will be treated in cohorts of 6 patients at each dose level of CpG 7909 (0.08 mg/kg, 0.16 mg/kg, 0.32 mg/kg, 0.48 mg/kg) and observed for at least 10 weeks post treatment. If at most one of the 6 patients experiences a dose limiting toxicity (DLT), a new cohort of 6 patients will be treated at the next higher dose level. A DLT for this study is defined as patients with one of the following: Absolute neutrophil counts or platelet counts below 10*10^9/L for 14 days Absolute neutrophil counts greater than 0.5 or less than 1*10^9/L Platelet counts greater than 10 or less than 50*10^9/L for 28 days. Any grade 3 non-hematologic toxicity not explainable by another obvious cause as assessed using the Common Terminology Criteria for Adverse Events (CTCAE) v3.0. We are reporting the number of DLTs at each of the dose levels. The maximum tolerated dose will be 0.48 mg/kg or the largest dose level where 1 or fewer participants reports a dose limiting toxicity.
    Time Frame at least 10 weeks post treatment up to 3 months.

    Outcome Measure Data

    Analysis Population Description
    Only participants accrued to the Phase I portion of this study were used to determine the maximum tolerated dose.
    Arm/Group Title Phase I Phase II
    Arm/Group Description Phase I patients will receive the following treatment: 250 mg/m^2 Rituximab IV on days 1, 8, and 15 of a 27 day cycle 5 mCi (Indium-111), 1.6 mg Ibritumomab IV on day 1 10 mCi (Indium-111), 1.6 mg Ibritumomab IV on day 8 CpG 7909 (Agatolimod Sodium) doses will be assigned in groups of 6 patients. Dose levels will escalate in each group until maximum tolerability is attained (starting at 0.08 mg/kg and sequentially escalating to 0.16 mg/kg, 0.32 mg/kg, 0.48 mg/kg). Doses will be taken day 6, 13, 20, and 27 of a 27 day cycle. 0.4 mCi/kg Yttrium-90 Zevalin IV on day 15 Phase II patients will receive the following treatment: 250 mg/m^2 Rituximab IV on days 1, 8, and 15 of a 27 day cycle 5 mCi (Indium-111), 1.6 mg Ibritumomab IV on day 8 0.48 mg/kg CpG 7909 (Agatolimod Sodium) doses will be taken day 6, 13, 20, and 27 of a 27 day cycle. 0.4 mCi/kg Yttrium-90 Zevalin IV on day 15
    Measure Participants 30 0
    Dose Level 1: (.08 mg/kg), n=6
    0
    0%
    Dose Level 2: (.16 mg/kg), n=6
    1
    3.3%
    Dose Level 3: (.32 mg/kg), n=6
    0
    0%
    Dose Level 4: (.48 mg/kg), n=12
    1
    3.3%
    2. Primary Outcome
    Title Tumor Response
    Description Complete Response (CR): No measurable or nonmeasurable disease. No symptoms of Lymphoma. Non-palpable spleen, if palpable at baseline. Histologically negative bone marrow, if positive at baseline. All nodes <1.5 cm in transverse diameter. Partial Response (PR): greater than 50% decrease from baseline in the sum of the products of the longest perpendicular diameters of the six largest dominant lesions. No new lesions We are reporting the number of participants that attained a status of CR or PR.
    Time Frame Evaluations occur every three months up to a year

    Outcome Measure Data

    Analysis Population Description
    Participants accrued to the Phase I portion of this study were not used to analyze the Phase II primary endpoint.
    Arm/Group Title Phase I Phase II
    Arm/Group Description Phase I patients will receive the following treatment: 250 mg/m^2 Rituximab IV on days 1, 8, and 15 of a 27 day cycle 5 mCi (Indium-111), 1.6 mg Ibritumomab IV on day 1 10 mCi (Indium-111), 1.6 mg Ibritumomab IV on day 8 CpG 7909 (Agatolimod Sodium) doses will be assigned in groups of 6 patients. Dose levels will escalate in each group until maximum tolerability is attained (starting at 0.08 mg/kg and sequentially escalating to 0.16 mg/kg, 0.32 mg/kg, 0.48 mg/kg). Doses will be taken day 6, 13, 20, and 27 of a 27 day cycle. 0.4 mCi/kg Yttrium-90 Zevalin IV on day 15 Phase II patients will receive the following treatment: 250 mg/m^2 Rituximab IV on days 1, 8, and 15 of a 27 day cycle 5 mCi (Indium-111), 1.6 mg Ibritumomab IV on day 8 0.48 mg/kg CpG 7909 (Agatolimod Sodium) doses will be taken day 6, 13, 20, and 27 of a 27 day cycle. 0.4 mCi/kg Yttrium-90 Zevalin IV on day 15
    Measure Participants 0 8
    Complete Response (CR)
    1
    3.3%
    Partial Response (PR)
    0
    0%
    3. Secondary Outcome
    Title Progression-free Survival
    Description The Progression-free survival (PFS) is defined as the time from registration to progression or death due to any cause. The distribution of PFS will be estimated using the method of Kaplan-Meier.
    Time Frame Up to 1 year from treatment start date

    Outcome Measure Data

    Analysis Population Description
    Only participants accrued to the Phase II portion of the study were evaluated for this endpoint.
    Arm/Group Title Phase I Phase II
    Arm/Group Description Phase I patients will receive the following treatment: 250 mg/m^2 Rituximab IV on days 1, 8, and 15 of a 27 day cycle 5 mCi (Indium-111), 1.6 mg Ibritumomab IV on day 1 10 mCi (Indium-111), 1.6 mg Ibritumomab IV on day 8 CpG 7909 (Agatolimod Sodium) doses will be assigned in groups of 6 patients. Dose levels will escalate in each group until maximum tolerability is attained (starting at 0.08 mg/kg and sequentially escalating to 0.16 mg/kg, 0.32 mg/kg, 0.48 mg/kg). Doses will be taken day 6, 13, 20, and 27 of a 27 day cycle. 0.4 mCi/kg Yttrium-90 Zevalin IV on day 15 Phase II patients will receive the following treatment: 250 mg/m^2 Rituximab IV on days 1, 8, and 15 of a 27 day cycle 5 mCi (Indium-111), 1.6 mg Ibritumomab IV on day 8 0.48 mg/kg CpG 7909 (Agatolimod Sodium) doses will be taken day 6, 13, 20, and 27 of a 27 day cycle. 0.4 mCi/kg Yttrium-90 Zevalin IV on day 15
    Measure Participants 0 8
    Median (95% Confidence Interval) [months]
    1.57
    4. Secondary Outcome
    Title Duration of Response
    Description Duration of response (DoR) will be calculated from the documentation of response until the date of progression in the subset of patients who respond.
    Time Frame Up to 1 year from treatment start date

    Outcome Measure Data

    Analysis Population Description
    The duration of response was not analyzed due to a lack of more than one response.
    Arm/Group Title Phase I Phase II
    Arm/Group Description Phase I patients will receive the following treatment: 250 mg/m^2 Rituximab IV on days 1, 8, and 15 of a 27 day cycle 5 mCi (Indium-111), 1.6 mg Ibritumomab IV on day 1 10 mCi (Indium-111), 1.6 mg Ibritumomab IV on day 8 CpG 7909 (Agatolimod Sodium) doses will be assigned in groups of 6 patients. Dose levels will escalate in each group until maximum tolerability is attained (starting at 0.08 mg/kg and sequentially escalating to 0.16 mg/kg, 0.32 mg/kg, 0.48 mg/kg). Doses will be taken day 6, 13, 20, and 27 of a 27 day cycle. 0.4 mCi/kg Yttrium-90 Zevalin IV on day 15 Phase II patients will receive the following treatment: 250 mg/m^2 Rituximab IV on days 1, 8, and 15 of a 27 day cycle 5 mCi (Indium-111), 1.6 mg Ibritumomab IV on day 8 0.48 mg/kg CpG 7909 (Agatolimod Sodium) doses will be taken day 6, 13, 20, and 27 of a 27 day cycle. 0.4 mCi/kg Yttrium-90 Zevalin IV on day 15
    Measure Participants 0 0

    Adverse Events

    Time Frame
    Adverse Event Reporting Description
    Arm/Group Title Phase I Phase II
    Arm/Group Description Phase I patients will receive the following treatment: 250 mg/m^2 Rituximab IV on days 1, 8, and 15 of a 27 day cycle 5 mCi (Indium-111), 1.6 mg Ibritumomab IV on day 1 10 mCi (Indium-111), 1.6 mg Ibritumomab IV on day 8 CpG 7909 (Agatolimod Sodium) doses will be assigned in groups of 6 patients. Dose levels will escalate in each group until maximum tolerability is attained (starting at 0.08 mg/kg and sequentially escalating to 0.16 mg/kg, 0.32 mg/kg, 0.48 mg/kg). Doses will be taken day 6, 13, 20, and 27 of a 27 day cycle. 0.4 mCi/kg Yttrium-90 Zevalin IV on day 15 Phase II patients will receive the following treatment: 250 mg/m^2 Rituximab IV on days 1, 8, and 15 of a 27 day cycle 5 mCi (Indium-111), 1.6 mg Ibritumomab IV on day 8 0.48 mg/kg CpG 7909 (Agatolimod Sodium) doses will be taken day 6, 13, 20, and 27 of a 27 day cycle. 0.4 mCi/kg Yttrium-90 Zevalin IV on day 15
    All Cause Mortality
    Phase I Phase II
    Affected / at Risk (%) # Events Affected / at Risk (%) # Events
    Total / (NaN) / (NaN)
    Serious Adverse Events
    Phase I Phase II
    Affected / at Risk (%) # Events Affected / at Risk (%) # Events
    Total 14/30 (46.7%) 5/8 (62.5%)
    Blood and lymphatic system disorders
    Febrile neutropenia 1/30 (3.3%) 1 0/8 (0%) 0
    Gastrointestinal disorders
    Constipation 0/30 (0%) 0 1/8 (12.5%) 1
    Investigations
    Leukocyte count decreased 7/30 (23.3%) 7 0/8 (0%) 0
    Neutrophil count decreased 10/30 (33.3%) 11 1/8 (12.5%) 1
    Platelet count decreased 12/30 (40%) 20 4/8 (50%) 7
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Tumor pain 0/30 (0%) 0 1/8 (12.5%) 1
    Other (Not Including Serious) Adverse Events
    Phase I Phase II
    Affected / at Risk (%) # Events Affected / at Risk (%) # Events
    Total 30/30 (100%) 8/8 (100%)
    Blood and lymphatic system disorders
    Hemoglobin decreased 19/30 (63.3%) 40 8/8 (100%) 15
    Cardiac disorders
    Arrhythmia 0/30 (0%) 0 1/8 (12.5%) 1
    Gastrointestinal disorders
    Abdominal pain 1/30 (3.3%) 1 0/8 (0%) 0
    Diarrhea 0/30 (0%) 0 1/8 (12.5%) 1
    Nausea 1/30 (3.3%) 1 0/8 (0%) 0
    General disorders
    Chills 1/30 (3.3%) 1 0/8 (0%) 0
    Fatigue 2/30 (6.7%) 5 1/8 (12.5%) 1
    Localized edema 1/30 (3.3%) 1 0/8 (0%) 0
    Pain 1/30 (3.3%) 1 0/8 (0%) 0
    Infections and infestations
    Abdominal infection 0/30 (0%) 0 1/8 (12.5%) 1
    Sinusitis 3/30 (10%) 3 0/8 (0%) 0
    Investigations
    Alanine aminotransferase increased 0/30 (0%) 0 1/8 (12.5%) 1
    Blood bilirubin increased 0/30 (0%) 0 1/8 (12.5%) 1
    Leukocyte count decreased 26/30 (86.7%) 63 4/8 (50%) 7
    Neutrophil count decreased 23/30 (76.7%) 37 4/8 (50%) 5
    Platelet count decreased 26/30 (86.7%) 34 5/8 (62.5%) 7
    Metabolism and nutrition disorders
    Anorexia 0/30 (0%) 0 1/8 (12.5%) 1
    Blood glucose increased 1/30 (3.3%) 1 0/8 (0%) 0
    Musculoskeletal and connective tissue disorders
    Neck pain 1/30 (3.3%) 1 0/8 (0%) 0
    Nervous system disorders
    Neurological disorder NOS 1/30 (3.3%) 1 0/8 (0%) 0
    Syncope vasovagal 0/30 (0%) 0 1/8 (12.5%) 1
    Skin and subcutaneous tissue disorders
    Petechiae 1/30 (3.3%) 1 0/8 (0%) 0
    Rash desquamating 4/30 (13.3%) 4 0/8 (0%) 0
    Sweating 1/30 (3.3%) 1 0/8 (0%) 0
    Vascular disorders
    Hypotension 1/30 (3.3%) 1 1/8 (12.5%) 1

    Limitations/Caveats

    [Not Specified]

    More Information

    Certain Agreements

    All Principal Investigators ARE employed by the organization sponsoring the study.

    There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.

    Results Point of Contact

    Name/Title Thomas E. Witzig, M.D.
    Organization Mayo Clinic Cancer Center
    Phone
    Email witzig.thomas@mayo.edu
    Responsible Party:
    Mayo Clinic
    ClinicalTrials.gov Identifier:
    NCT00438880
    Other Study ID Numbers:
    • LS0382
    • NCI-2009-01275
    • LS0382
    • P30CA015083
    First Posted:
    Feb 22, 2007
    Last Update Posted:
    Feb 4, 2016
    Last Verified:
    Sep 1, 2015