Stem Cell Transplantation With or Without Rituximab in Treating Patients With Relapsed or Progressive B-Cell Diffuse Large Cell Lymphoma
RATIONALE: Drugs used in chemotherapy work in different ways to stop tumor cells from dividing so they stop growing or die. Combining chemotherapy with stem cell transplantation may allow the doctor to give higher doses of chemotherapy drugs and kill more tumor cells. Monoclonal antibodies, such as rituximab, can locate tumor cells and either kill them or deliver tumor-killing substances to them without harming normal cells. It is not yet known whether stem cell transplantation is more effective with or without rituximab in treating relapsed or progressive B-cell diffuse large cell lymphoma.
PURPOSE: Randomized phase III trial to compare the effectiveness of stem cell transplantation with or without rituximab in treating patients who have relapsed or progressive B-cell diffuse large cell lymphoma.
Procedure: peripheral blood stem cell transplantation
Radiation: radiation therapy
|Study Design:||Allocation: Randomized
Primary Purpose: Treatment
|Official Title:||Randomized Phase III Trial Of Rituximab (NSC #687451) And Autologous Stem Cell Transplantation For B Cell Diffuse Large Cell Lymphoma|
- Progression-free survival [ Designated as safety issue: No ]
- Procedure-related mortality [ Designated as safety issue: No ]
- Overall survival [ Designated as safety issue: No ]
- Potential infectious complications of the addition of rituximab to autologous stem cell transplantation [ Designated as safety issue: No ]
|Study Start Date:||March 2003|
|Primary Completion Date:||June 2006 (Final data collection date for primary outcome measure)|
- Compare disease-free survival of patients with relapsed or progressive B-cell diffuse large cell lymphoma undergoing stem cell transplantation with or without post-transplant rituximab.
- Evaluate the effect of rituximab, administered post-transplant, on the procedure-related mortality of these patients.
- Determine the potential infectious complications of the addition of this drug to autologous stem cell transplantation in these patients.
- Compare overall survival of patients treated with these regimens.
OUTLINE: This is a randomized, multicenter study. Patients are stratified according to relapse (relapsed more than 6 months after either initial complete remission [CR] or CR with positive positron emission tomography or MRI [gallium] vs failed to achieve initial CR or relapsed within 6 months after either initial CR or CR with positive PET or MRI [gallium]) and prior rituximab (yes vs no).
Stem cell mobilization
- Patients receive rituximab IV over 4-8 hours on days 1 and 5. Patients also receive cyclophosphamide IV over 2 hours on day 8 and filgrastim (G-CSF) subcutaneously (SC) beginning on day 9 and continuing until the last day of apheresis. Stem cells are collected over 1-3 days.
- Regimen A (patients who have received prior radiotherapy or are ≥ 61 years of age): Patients receive carmustine IV over 2 hours on day -6, etoposide IV over 4 hours on day -4, and cyclophosphamide IV over 2 hours on day -2.
- Regimen B (all other patients): Patients undergo total body irradiation twice daily on days -8 to -5. Patients receive etoposide IV over 4 hours on day -4 and cyclophosphamide IV over 2 hours on day -2.
Stem cells are reinfused on day 0. Patients are then randomized to one of two post-transplant treatment arms.
- Arm I (rituximab): Patients receive G-CSF SC beginning on day 6 and continuing until blood counts recover. Patients receive rituximab IV over 4-8 hours every 7 days for 4 doses, starting on day 45 post-transplant. Course of rituximab is repeated beginning on day 180 post-transplant.
- Arm II (no rituximab): Patients receive G-CSF as in arm I. Patients are followed for 10 years.
PROJECTED ACCRUAL: A total of 427 patients will be accrued for this study within 3.5 years.
|Study Chair:||Ian W. Flinn, MD, PhD||Sidney Kimmel Comprehensive Cancer Center|
|Study Chair:||Charles A. Linker, MD||University of California, San Francisco|