Rituximab, Fludarabine, Cyclophosphamide, and Yttrium Y 90 Ibritumomab Tiuxetan in Treating Patients With Relapsed B-Cell Non-Hodgkin's Lymphoma

Sponsor

Technische Universität München (Other)

Overall Status

Unknown status

CT.gov ID

NCT00397800

Collaborator

(none)

Enrollment

Locations

Duration (Months)

Patient Per Site

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

RATIONALE: 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. Drugs used in chemotherapy, such as fludarabine and cyclophosphamide, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. 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 rituximab and chemotherapy together with 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 yttrium Y 90 ibritumomab tiuxetan when given together with rituximab, fludarabine, and cyclophosphamide and to see how well they work in treating patients with relapsed B-cell non-Hodgkin's lymphoma.

Condition or Disease	Intervention/Treatment	Phase
Lymphoma	Biological: rituximab Drug: cyclophosphamide Drug: fludarabine phosphate Radiation: yttrium Y 90 ibritumomab tiuxetan	Phase 1/Phase 2

Detailed Description

OBJECTIVES:

Primary

Determine the dose-limiting toxicity and maximum tolerated dose of rituximab and yttrium Y 90 (^90Y) ibritumomab tiuxetan when administered with rituximab as radioimmunotherapy after rituximab, fludarabine, and cyclophosphamide in patients with relapsed indolent, mantle cell, or transformed CD20-positive B-cell non-Hodgkin's lymphoma.

Secondary

Determine the overall survival in patients treated with this regimen.
Determine time to progression and event-free survival in patients treated with this regimen.
Determine partial and complete response rates in patients treated with this regimen.
Determine time to maximal response in patients treated with this regimen.
Determine response duration in patients treated with this regimen.
Determine the feasibility of additional antineoplastic treatment following disease relapse after treatment with rituximab and ^90Y ibritumomab tiuxetan in these patients.

OUTLINE: This is a prospective, nonrandomized, multicenter, phase I dose-escalation study of yttrium Y 90 (^90Y) ibritumomab tiuxetan followed by a phase II open-label study.

Phase I:
Chemoimmunotherapy: Patients receive rituximab IV on day 1 and fludarabine IV over 30 minutes and cyclophosphamide IV over 60 minutes on days 1-3. Treatment repeats every 4 weeks for up to 3 courses in the absence of disease progression. Four weeks after the first day of the last chemoimmunotherapy course, patients receive 1 dose of rituximab IV alone. Patients with disease progression are removed from the study. Patients with stable disease proceed to radioimmunotherapy 8-12 weeks after the first day of the last chemoimmunotherapy course.
Radioimmunotherapy: Patients receive rituximab IV and an imaging dose of indium In III ibritumomab tiuxetan IV over 10 minutes on day 1. Patients then undergo imaging. If dosimetry is acceptable, patients receive rituximab IV and ^90Y ibritumomab tiuxetan IV over 10 minutes on day 8.

Cohorts of 3-6 patients receive escalating doses of ^90Y ibritumomab tiuxetan until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity.

Phase II: Patients receive chemoimmunotherapy and radioimmunotherapy as in phase I, at the MTD determined in phase I.

Treatment continues in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed periodically for up to 2 years.

PROJECTED ACCRUAL: A total of 12 patients will be accrued for this study.

Study Design

Study Type:

Interventional

Anticipated Enrollment :

12 participants

Allocation:

Non-Randomized

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

Safety and Efficacy of Sequential Treatment With a Combination of Rituximab, Fludarabine and Cyclophosphamide Followed by Zevalin (Rituximab and Y-Ibritumomab Tiuxetan) - A Phase I/II Study for Treatment of Patients With Relapsed Indolent and Transformed CD20-Positive B-Cell Non-Hodgkin's-Lymphoma Ineligible for High-Dose Chemo(Radio)Therapy Supported by Autologous Peripheral Blood Stem-Cells

Study Start Date :

Jun 1, 2005

Actual Primary Completion Date :

May 1, 2008

Anticipated Study Completion Date :

May 1, 2013

Outcome Measures

Primary Outcome Measures

Dose-limiting toxicity []

Secondary Outcome Measures

Response []
Survival []

Eligibility Criteria

Criteria

Ages Eligible for Study:

50 Years to 75 Years

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

DISEASE CHARACTERISTICS:

Histologically confirmed CD20-positive B-cell non-Hodgkin's lymphoma (NHL), including any of the following subtypes:
Indolent NHL, including any of the following:
Follicular
Lymphoplasmacytoid
Marginal zone
Mantle cell NHL
Transformed B-cell NHL
In at least first relapse with an indication for systemic antineoplastic treatment, as defined by the following:
Local or constitutional (B-) symptoms
Hypersplenism due to splenic involvement
Bulky disease (> 7.5 cm in diameter)
Impending medical problems derived from rapid disease progression within the past 6 months, as defined by an observed or anticipated > 50% increase in the sum of the areas calculated from multiplying the greatest perpendicular diameters of each lesion
Measurable lesions of lymphoma infiltration
Medically ineligible for high-dose treatment followed by autologous stem cell support
Adequate bone marrow cellularity (> 15% of marrow area covered by hematopoiesis)
No CNS, leptomeningeal, spinal cord, or testes lymphoma involvement
No lymphoma lesion mandating emergency radiotherapy
No clinical, cytological, cytogenetic, or histopathologic indication of myelodysplastic syndrome
If there is bone marrow infiltration detected prior to chemoimmunotherapy, patient must undergo a repeat bone marrow biopsy prior to planned treatment with radioimmunotherapy to verify the level of bone marrow infiltration is < 25%

PATIENT CHARACTERISTICS:

ECOG performance status 0-2
Life expectancy ≥ 3 months
Absolute neutrophil count > 1,500/mm³
Platelet count > 150,000/mm³
Hemoglobin > 9 g/dL
Creatinine < 1.5 times upper limit of normal (ULN)
Bilirubin < 2 times ULN
ALT and AST < 2 times ULN
Albumin > 2.5 g/dL
INR < 1.5
Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective contraception during and for ≥ 12 months after completion of study treatment
No concurrent severe and/or uncontrolled medical disease that would preclude study compliance, including any of the following:
Uncontrolled diabetes
Congestive heart failure
Chronic renal disease
Active uncontrolled infection
No bleeding risks or disorders, including any of the following:
CNS abnormalities suggesting an increased susceptibility for hemorrhage, including recent history of stroke as demonstrated by cranial contrast-enhanced CT scan
Severe arrhythmia or uncontrolled hypertension
Myocardial infarction within the past 6 months
Diabetic retinopathy with history of symptomatic hemorrhage
Known and potentially active gastrointestinal bleeding foci
Concurrent anticoagulant medication that must be continued even with platelet count < 20,000/mm³ (e.g., following mitral valve replacement, anti-phospholipid syndrome, or recurrent venous thromboembolism)
Other congenital or acquired hemorrhagic diatheses
No ongoing autoimmune hemolytic anemia
No known presence of anti-murine antibody reactivity
No known hypersensitivity to murine or chimeric antibodies or proteins
No known HIV infection
No psychiatric illness that would preclude study requirements
No other malignant disorder within the past 10 years except basal cell carcinoma of the skin or carcinoma in situ of the cervix

PRIOR CONCURRENT THERAPY:

See Disease Characteristics
Recovered from prior therapy
No more than 4 prior systemic anti-lymphoma regimens (including single-agent rituximab)
At least 2 months since prior systemic anti-lymphoma treatment (including single-agent rituximab)
No prior radioimmunotherapy
No prior autologous or allogeneic hematopoietic stem cell transplantation
No prior treatment with purine analogues that has not resulted in remission for > 1 year
No prior anti-CD20 radioimmunoconjugate therapy
More than 5 years since prior radiotherapy to extensive fields covering lymph node regions on both sides of the diaphragm or > 50% of the spinal column
More than 4 weeks since prior surgery
No concurrent oral anticoagulant therapy

Contacts and Locations

Locations

	Site	City	Country	Postal Code
1	Medizinische Klinik, Klinikum Augsburg	Augsburg	Germany	D-86156
2	Medizinische Klinik III - Universitaetsklinikum Erlangen	Erlangen	Germany	D-91054
3	Universitaetsklinikum Goettingen	Goettingen	Germany	D-37075
4	Universitaetsklinikum Schleswig-Holstein - Campus Luebeck	Luebeck	Germany	D-23538
5	Universitaetsklinkum Magdeburg der Otto-von-Guericke-Universitaet Magdeburg	Magdeburg	Germany	D-39120
6	Universitatsklinik Mainz	Mainz	Germany	D-55101
7	LMU-Klinikum Grosshadern	Munich	Germany	D-81366
8	Klinikum Rechts Der Isar - Technische Universitaet Muenchen	Munich	Germany	D-81675
9	Klinikum der Universitaet Regensburg	Regensburg	Germany	D-93042
10	Universitaetsklinikum Tuebingen	Tuebingen	Germany	D-72076
11	Comprehensive Cancer Center Ulm at Universitaetsklinikum Ulm	Ulm	Germany	D-89081
12	Medizinische Klinik und Poliklinik II - Universitaetsklinikum Wuerzburg	Wuerzburg	Germany	D-97080