Autologous or Donor Stem Cell Transplantation in Treating Patients With Recurrent Non-Hodgkin's Lymphoma (BMT CTN 0202)

This study has been terminated.
(lower than anticipated accrual)
Sponsor:
Collaborators:
Blood and Marrow Transplant Clinical Trials Network
Information provided by (Responsible Party):
Medical College of Wisconsin
ClinicalTrials.gov Identifier:
NCT00096460
First received: November 9, 2004
Last updated: February 22, 2013
Last verified: February 2013
  Purpose

This study is designed as a Phase II/III, multi-center trial, comparing two transplant strategies to determine whether non-myeloablative allogeneic Hematopoietic Stem Cell Transplantation (HSCT) will improve long-term progression-free survival compared to autologous HSCT. Recipients will be biologically assigned to the appropriate treatment arm depending on the availability of a Human Leukocyte Antigen (HLA) matched sibling.


Condition Intervention Phase
Recurrent Grades 1-3 Follicular Lymphoma
Follicular Lymphoma
Drug: carmustine
Drug: cyclophosphamide
Drug: etoposide
Drug: filgrastim
Drug: fludarabine
Drug: methotrexate
Drug: rituximab
Drug: tacrolimus
Procedure: bone marrow ablation with stem cell support
Procedure: chemotherapy
Procedure: graft versus host disease (GVHD) prophylaxis/therapy
Procedure: peripheral blood stem cell transplantation
Procedure: radiation therapy
Procedure: supportive care/therapy
Phase 2
Phase 3

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Autologous Versus Non-Myeloablative Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) for Patients With Chemosensitive Follicular Non-Hodgkin's Lymphoma Beyond First Complete Response or First Partial Response (BMT CTN #0202)

Resource links provided by NLM:


Further study details as provided by Medical College of Wisconsin:

Primary Outcome Measures:
  • Lymphoma Progression-free Survival [ Time Frame: Three years post-Hematopoietic Stem Cell Transplant (HSCT) ] [ Designated as safety issue: No ]

Enrollment: 30
Study Start Date: August 2004
Study Completion Date: March 2009
Primary Completion Date: March 2006 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Autologous Hematopoietic Stem Cell Transplant (HSCT) Drug: carmustine
autologous HSCT - 15 mg/kg prior to HSCT
Drug: cyclophosphamide
all patients - 4 gm/m^2 on Day 2 Autologous HSCT arm - 100 mg/kg prior to HSCT Allogeneic HSCT arm - 750 mg/m^2/day from Day -6 to -4
Drug: etoposide
60 mg/kg prior to HSCT
Drug: filgrastim
10 mcg/kg/day (autologous HSCT patients) or 5 mcg/kg/day (allogeneic HSCT patients) subcutaneous (SQ) or intravenous (IV) will be given starting 2 days after the initiation of cyclophosphamide
Drug: rituximab
all patients receive 375 mg/m^2 on Days 1 and 8 autologous HSCT group receives 375 mg/m^2 x 4 weekly doses, to begin on approximately Day +42 allogeneic HSCT group receives 375 mg/m^2 will be administered on Day -13, -6, +1 and +8
Procedure: bone marrow ablation with stem cell support
ablation with drugs specified followed by HSCT
Procedure: chemotherapy
chemo agents listed specifically elsewhere in this posting
Procedure: peripheral blood stem cell transplantation
autologous or HLA-matched sibling donor
Procedure: radiation therapy
autologous patients will then receive either fractionated total body irradiation (FTBI) 1200 cGy or Carmustine (BCNU) 15 mg/kg
Procedure: supportive care/therapy
according to institutional procedures
Active Comparator: Allogeneic Hematopoietic Stem Cell Transplant (HSCT) Drug: cyclophosphamide
all patients - 4 gm/m^2 on Day 2 Autologous HSCT arm - 100 mg/kg prior to HSCT Allogeneic HSCT arm - 750 mg/m^2/day from Day -6 to -4
Drug: filgrastim
10 mcg/kg/day (autologous HSCT patients) or 5 mcg/kg/day (allogeneic HSCT patients) subcutaneous (SQ) or intravenous (IV) will be given starting 2 days after the initiation of cyclophosphamide
Drug: fludarabine
30 mg/m^2/day from Day -6 to -4
Drug: methotrexate
5 mg/m^2 IV on Day +1, +3, and +6 post-HSCT
Drug: rituximab
all patients receive 375 mg/m^2 on Days 1 and 8 autologous HSCT group receives 375 mg/m^2 x 4 weekly doses, to begin on approximately Day +42 allogeneic HSCT group receives 375 mg/m^2 will be administered on Day -13, -6, +1 and +8
Drug: tacrolimus
(IV or orally(PO)) until Day +90 followed by a taper
Procedure: bone marrow ablation with stem cell support
ablation with drugs specified followed by HSCT
Procedure: chemotherapy
chemo agents listed specifically elsewhere in this posting
Procedure: graft versus host disease (GVHD) prophylaxis/therapy
GVHD prophylaxis will consist of tacrolimus (IV or PO) until Day +90 followed by a taper and methotrexate 5 mg/m^2 IV on Day +1, +3, and +6 post-HSCT
Procedure: peripheral blood stem cell transplantation
autologous or HLA-matched sibling donor
Procedure: supportive care/therapy
according to institutional procedures

Detailed Description:

BACKGROUND:

Although patients with follicular non-Hodgkin's lymphoma (NHL) typically experience a relatively indolent course, the disease is rarely curable with conventional chemotherapy. Patients with follicular NHL are usually treated only when symptoms require palliation or if bulky disease exists since no survival advantage has been shown as compared to administering conventional treatment at initial diagnosis. While most patients achieve a remission with initial chemotherapy, a continuous pattern of relapse occurs, resulting in progressively shorter remission durations. Additionally, the increased response rates conferred by anthracycline-containing regimens have not translated into improved survival and thus the median survival time of 6 to 10 years has not been significantly impacted over the last decade.

DESIGN NARRATIVE:

The overall study design is a comparison of two treatment arms determined by biologic assignment, based on the availability of an HLA-matched sibling, in patients diagnosed with relapsed follicular non-Hodgkin's lymphoma. Patients without an HLA-matched sibling will receive an autologous HSCT. Patients with an HLA-matched sibling will receive a non-myeloablative allogeneic HSCT.

The overall study design is that of biologic assignment, based on the availability of an HLA-matched sibling, to one of two strategies to improve the outcome for follicular lymphoma patients with chemosensitive disease. All patients will undergo cytoreduction with cyclophosphamide 4 gm/m^2 and rituximab 375 mg/m^2 x 2 doses. Rituximab will be given in two doses, approximately 1 week apart, with the cyclophosphamide administered the day after the first dose of rituximab. Patients assigned to the autologous arm will have their hematopoietic stem cells mobilized from this cytoreductive regimen. Patients with an HLA-matched sibling will undergo a non-myeloablative allogeneic HSCT. Pre-transplant conditioning will consist of fludarabine 30 mg/m^2/day and cyclophosphamide 750 mg/m^2/day x 3 days with rituximab 375 mg/m^2/day on Days -13 and -6 pre-HSCT and on Days +1 and +8 post-HSCT. The immunosuppressive regimen will consist of tacrolimus and methotrexate (MTX) to control graft-versus-host and host-versus-graft reactions. Patients without an HLA-matched sibling who have collected an adequate autologous hematopoietic cell graft, defined as at least 2.0 * 10^6 CD34+ cells/kg, will receive a preparative regimen of total body irradiation (TBI) 1200 cGy or Carmustine (BCNU) 15 mg/kg. In addition, VP-16 60 mg/kg and cyclophosphamide 100 mg/kg will be given for both autologous preparative regimens. Post-autologous HSCT therapy with rituximab 375 mg/m^2 weekly x 4 doses will commence between Days 42-75 post-HSCT.

  Eligibility

Ages Eligible for Study:   up to 75 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Initial Patient Inclusion Criteria:

  • Histologically confirmed recurrent Revised European American Lymphoma (REAL) classification follicle center lymphoma, follicular grades I and II, OR histologically confirmed World Health Organization (WHO) classification follicular lymphoma grades 1, 2, 3a or 3b; for either classification, the diffuse component or presence of large cleaved cells (if present) cannot be more than 50% of high power field; patients do not have to express t(14;18) to be eligible
  • Received three or fewer prior regimens of chemotherapy; monoclonal antibody therapy and involved field radiation therapy will not be counted as a prior therapy
  • Beyond first Complete Remission (CR) or first Partial Remission (PR) AND demonstrate chemosensitive disease; chemosensitive disease will be defined as less than 20% bone marrow involvement in the aspirate or core biopsy with follicular lymphoma AND lymph node size in axial diameter of less than 3 cm or a greater than 50% reduction in estimated lymph node volume to be measured as product of bi-dimensional measurements; Positron Emission Tomography (PET) scanning will not be used for staging or response purposes

    • Patients with adequate organ function as measured by:

      1. Cardiac: left ventricular ejection fraction at rest at least 45%
      2. Hepatic: bilirubin less than 2 times the upper limit of normal and alanine transaminase (ALT) and aspartate aminotransferase (AST) less than 3 times the upper limit of normal
      3. Renal: creatinine clearance greater than 40 mL/min
      4. Pulmonary: Diffusing capacity of the lung for carbon monoxide (DLCO), Forced expiratory volume in one second (FEV1), and Forced vital capacity (FVC) greater than 50% of predicted (corrected for hemoglobin)
    • If the patient is younger than 18 years of age and they have reached the age of assent, then they must have completed the local Institutional Review Board (IRB) assent process.
    • Able to receive cyclophosphamide and rituximab mobilization chemotherapy no earlier than 3 weeks from the beginning of the most recent cycle of salvage chemotherapy and no later than 6 weeks from enrollment

Patient Inclusion Criteria for Proceeding to Hematopoietic Stem Cell Transplant (HSCT):

  • Collection of an autologous or allogeneic graft of at least 2.0 * 10^6 CD34+ cells/kg
  • Blood count recovery defined as Absolute Neutrophil Count (ANC) greater than 1000/mm3 and platelets greater than 100 * 10^9/L

Patient Inclusion Criteria for Maintenance Therapy:

  • Liver and renal function tests within the inclusion criteria for initial autograft
  • Off intravenous antibiotics and off amphotericin B formulations for proven, probable or possible fungal infections
  • No active Cytomegalovirus (CMV) infections or for patients with CMV infection post-autograft, treated with ganciclovir, valganciclovir, or foscarnet per institutional guidelines and CMV antigenemia negative
  • Mucositis resolved and off hyperalimentation

Exclusion Criteria:

  • Karnofsky performance score less than 70%
  • Follicular lymphoma that show histologic evidence of transformation
  • Uncontrolled hypertension
  • Patients with uncontrolled bacterial, viral or fungal infection (currently taking medication and progression without clinical improvement).
  • Prior malignancies except resected basal cell carcinoma or treated cervical carcinoma in situ; cancer treated with curative intent more than 5 years previously will be reviewed on a case-by-case basis by a Protocol Chair or Medical Monitor.
  • Pregnant (positive Beta Human chorionic gonadotropin (β-HCG)) or breastfeeding
  • Seropositive for Human immunodeficiency virus (HIV)
  • Unwilling to use contraceptive techniques during treatment
  • Prior autologous or allogeneic HSCT
  • Known anaphylactic reaction to rituximab
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00096460

  Show 30 Study Locations
Sponsors and Collaborators
Medical College of Wisconsin
Blood and Marrow Transplant Clinical Trials Network
Investigators
Study Chair: Ginna G. Laport, MD Stanford Hospital and Clinics
Principal Investigator: Auayporn Nademanee, MD City of Hope National Medical Center
Principal Investigator: Edward Ball, MD UCSD Medical Center
Principal Investigator: James Mason, MD Scripps Clinic
Principal Investigator: Teresa Field, MD, PhD H. Lee Moffitt Cancer Center
Principal Investigator: John Wingard, MD University of Florida College of Medicine (Shands)
Principal Investigator: Scott Solomon, MD BMT Group of Georgia
Principal Investigator: Christopher Flowers, MD Emory University
Principal Investigator: Tulio Rodriguez, MD Loyola University
Principal Investigator: Jan Jansen, MD Indiana BMT at Beech Grove
Principal Investigator: Arnold Freedman, MD Dana-Farber Cancer Institute
Principal Investigator: Muneer Abidi, MD Karmanos Cancer Institute/BMT
Principal Investigator: James Ferrara, MD University of Michigan
Principal Investigator: Linda Burns, MD University of Minnesota - Clinical and Translational Science Institute
Principal Investigator: Joseph McGuirk, MD Kansas City Cancer Centers
Principal Investigator: John DiPersio, MD Washington University/Barnes Jewish Hospital
Principal Investigator: Julie Vose, MD University of Nebraska
Principal Investigator: Scott Rowley, MD Hackensack University Medical Center (A)
Principal Investigator: Joanne Kurtzberg, MD Duke University
Principal Investigator: Hillard Lazarus, MD University Hospitals of Cleveland/Case Western
Principal Investigator: Richard Maziarz, MD Oregon Health and Science University
Principal Investigator: Stacy Lewis, MD Providence Health & Services
Principal Investigator: Steven Goldstein, MD University of Pennsylvania
Principal Investigator: Mounzer Agha, MD University of Pittsburgh
Principal Investigator: Stacey Goodman, MD Vanderbilt University
Principal Investigator: Brian Berryman, MD Baylor Health Care System
Principal Investigator: Chitra Hosing, MD University of Texas/MD Anderson CRC
Principal Investigator: John McCarty, MD Virginia Commonwealth University MCV Hospitals
Principal Investigator: James Wade, MD Medical College of Wisconsin
Principal Investigator: Walter Longo, MD University of Wisconsin Hospital & Clinics
  More Information

Additional Information:
Publications:
Responsible Party: Medical College of Wisconsin
ClinicalTrials.gov Identifier: NCT00096460     History of Changes
Other Study ID Numbers: 419, U01HL069294, BMTCTN-0202, FMLH-04-143, HRRC-301-04
Study First Received: November 9, 2004
Results First Received: August 16, 2011
Last Updated: February 22, 2013
Health Authority: United States: Federal Government

Additional relevant MeSH terms:
Lymphoma
Lymphoma, Follicular
Lymphoma, Non-Hodgkin
Immune System Diseases
Immunoproliferative Disorders
Lymphatic Diseases
Lymphoproliferative Disorders
Neoplasms
Neoplasms by Histologic Type
Carmustine
Cyclophosphamide
Methotrexate
Tacrolimus
Abortifacient Agents
Abortifacient Agents, Nonsteroidal
Alkylating Agents
Antimetabolites
Antimetabolites, Antineoplastic
Antineoplastic Agents
Antineoplastic Agents, Alkylating
Antirheumatic Agents
Dermatologic Agents
Enzyme Inhibitors
Folic Acid Antagonists
Immunologic Factors
Immunosuppressive Agents
Molecular Mechanisms of Pharmacological Action
Myeloablative Agonists
Nucleic Acid Synthesis Inhibitors
Pharmacologic Actions

ClinicalTrials.gov processed this record on October 21, 2014