Autologous Followed by Non-myeloablative Allogeneic Transplantation for Non-Hodgkin's Lymphoma
|ClinicalTrials.gov Identifier: NCT00481832|
Recruitment Status : Terminated (Accrual Factor)
First Posted : June 4, 2007
Results First Posted : February 14, 2018
Last Update Posted : February 14, 2018
|Condition or disease||Intervention/treatment||Phase|
|Lymphoma, Non-Hodgkin||Drug: Cyclophosphamide Drug: BCNU Drug: Etoposide Drug: Filgrastim Drug: Antithymocyte globulin Drug: Cyclosporine Drug: Mycophenolate mofetil Drug: Rituximab Procedure: Autologous hematopoietic stem cell transplantation (auto-HSCT) Procedure: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) Procedure: Total lymphoid irradiation Drug: CD34+ Cells Drug: Solu-Medrol||Phase 2|
Currently, patients with recurrent or primary refractory non-Hodgkin's lymphoma are treated with second-line chemotherapy (usually 2-3 courses) for the purpose of cytoreduction and to establish sensitivity to chemotherapy. Thereafter, peripheral blood progenitor cells are mobilized with cyclophosphamide and granulocyte colony stimulating factor, apheresed and cryopreserved. The standard high dose regimen consists of augmented carmustine, etoposide and cyclophosphamide. Unfortunately, there are subgroups of patients with poor outcomes using autologous transplantation including those with transformed lymphoma as well as patients who do not attain a minimal disease state due to chemoresistant disease.
These groups of patients have limited disease control and survival with standard chemotherapy regimens, and although they often have excellent cytoreduction with the high-dose chemotherapy regimen, relapse remains the primary cause of treatment failure. The current trial utilizes a similar approach that has been taken with patients with multiple myeloma, who appear to benefit from an allogeneic graft-versus-tumor effect, using a combined autologous and non-myeloablative allogeneic transplant regimen to reduce transplant-related complications. Eligible patients will be treated with high-dose chemotherapy using BCNU, etoposide and cyclophosphamide with autologous hematopoietic cell support as a method of cytoreduction. Approximately 60-120 days after the autologous transplant, patients will receive an allogeneic transplant using a preparative regimen of total lymphoid irradiation and anti-thymocyte globulin in an attempt to develop a graft-versus-lymphoma effect.
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||50 participants|
|Intervention Model:||Single Group Assignment|
|Masking:||None (Open Label)|
|Official Title:||Autologous Followed by Non-myeloablative Allogeneic Transplantation for Non-Hodgkin's Lymphoma|
|Study Start Date :||January 2007|
|Primary Completion Date :||October 27, 2014|
|Study Completion Date :||March 30, 2017|
Experimental: T & B Cell Mobilization Auto & Allo HCT
A transplant regimen that conditions the subjects using total lymphoid irradiation (TLI) and anti-thymocyte globulin(ATG) which will reduce acute graft-vs-host disease to negligible rates while maintaining the anti-tumor graft vs lymphoma GvL benefit. Along with TLI/ATG regiment; Solumedrol will be used as pre-medication and anti-emetic for any side effects. For stem cell mobilization, participants will be given either B Cell NLH or T Cell NHL. Before the filgrastim (G-CSF) mobilized PBPC infusion: acetaminophen, diphenhydramine and hydrocortisone will also be given as another set of pre-medications. BCNU, Etoposide, and Cyclophosphamide will be used as a preparative regimen. Cyclosporine and mycophenolate mofetil will be administered as an immunosuppressant after transplantation. Lastly, rituximab will be infused at the end of the transplantation regimen.
4 gm /m² IV over 2 hours on day 8
Other Names:Drug: BCNU
The dose of BCNU will be based on actual body weight unless the actual body weight is more than 15 kg greater than the ideal body weight in which case the adjusted ideal body weight will be used:
Males IBW = 50 kg + 2.3 kg/inch over 5 feet Females IBW = 45.5 kg + 2.3 kg/inch over 5 feet Adjusted IBW = IBW + 50% (actual weight - IBW)
Other Names:Drug: Etoposide
60mg/kg, IV over 4 hours on day -4 pre-transplant and for preparative regimen. The dose of etoposide for mobilization is 2 gm/ m².
Other Names:Drug: Filgrastim
10µg/kg sc qd starting day following cyclosphamide (or VP-16) until last day of apheresis
Other Names:Drug: Antithymocyte globulin
1.5 mg/kg/d, IV from day -11 to -7
Other Name: ATGDrug: Cyclosporine
5mg/kgbid,variable, po or IV
Other Names:Drug: Mycophenolate mofetil
15 mg/kg po on day 0, at 5-10 hours after mobilized PBPC infusion is complete. Thereafter, beginning on day +1 MMF is taken at 15 mg/kg po b.i.d. (30 mg/kg/day) if transplantation was using a matched related donor and 15 mg/kg po t.i.d if from a matched unrelated donor or a one antigen mismatched donor. Doses will be rounded up to the nearest 250 mg (capsules are 250 mg). MMF will be stopped on day +28 for matched related donors. For one antigen mismatched related or unrelated donors, the taper will begin on day +40. MMF will be tapered by 10% weekly till off, typically by day +96. If there is nausea and vomiting at any time preventing the oral administration of MMF, MMF should be administered intravenously at an equal dose. MMF dosing is based on actual body weight.
Other Names:Drug: Rituximab
375 mg/m2 IV (calculated based on actual body weight) on day 1 and day 7. Administered per current standard of care..
Other Names:Procedure: Autologous hematopoietic stem cell transplantation (auto-HSCT)
Auto-HCT involves an intravenous infusion of a participant's previously collected and frozen white blood cells collected after treatment with mobilizing agents
Other Name: Autologous peripheral blood progenitor cell (PBPC) transplantationProcedure: Allogeneic hematopoietic stem cell transplantation (allo-HSCT)
Allo-HCT involves an intravenous infusion of a donor's white blood cells collected after treatment with mobilization with filgrastim (G-CSF)
Other Name: Allogeneic peripheral blood progenitor cell (PBPC) transplantationProcedure: Total lymphoid irradiation
TLI is administered in 80cGy fractions on Days -11 to Day-7 relative to allo-HSCT
Other Name: TLIDrug: CD34+ Cells
2 x 10e6 CD34+ cells per kg actual body weight on Day 0Drug: Solu-Medrol
1 mg/kg, Day-11 to Day-7
Other Name: Methylprednisolone
- Event-free Survival (EFS) [ Time Frame: 3 years ]
Event-free survival (EFS) as determined for participants who receive both planned transplants, for a minimum of 3 years.
Events are defined as "disease progression/relapse" and "death of all causes".
- Incidence of Chemotherapy-associated Pneumonitis [ Time Frame: 3 years ]Interstitial pneumonitis (IP) is a risk associated with high-dose carmustine (BCNU) or other chemotherapy drugs used for transplantation. IP is diagnosed by 1) a decrease of >25% in DLCO compared with pre-transplant PFT DLCO values or 2) a drop of 7% or more in oxygen saturation after exertion.
- Relapse Rate [ Time Frame: 3 years ]Relapse rate (disease recurrence) 3 years after transplant, for participants who received both transplants, as determined by Kaplan-Meier estimation.
- Overall Survival (OS) [ Time Frame: 3 years ]Overall Survival (OS) 3 years after transplant, for participants who received both transplants, as determined by Kaplan-Meier estimation.
- Incidence of Acute Graft Versus Host Disease (GvHD) [ Time Frame: 6 Months ]The development of GvHD in vaccinated patients of any grade and at 6 months.
- Incidence of Chronic Graft Versus Host Disease (GvHD) [ Time Frame: 3 years ]The development of GvHD in vaccinated patients of any grade at 6 months.
- Overall Mortality Rate [ Time Frame: 3 years ]Overall mortality is determined by Kaplan-Meier estimation. The overall morality rate is expressed as the percentage of patients who died for any reason, including disease-related death.
- Median Time to Neutrophile Engraftment [ Time Frame: up to 45 days ]Complete blood counts were measured daily after allogeneic transplant. Time to neutrophil engraftment is defined as the number of days it takes to reach an absolute neutrophils count (ANC) >500, counting from the day of transplant.
- Achieving Full Donor Chimerism [ Time Frame: Up to 1 year ]Achieving full donor chimerism (donor T cells >95%): Blood was sent for donor cell percentage measured by short tandem repeat (STR) at post-transplant Day 30; Day 60; Day 90; Day 120; Day 180; Day 270; and Day 360. Full donor chimerism is defined as donor CD3+ cells > 95%.
- Median Time to Platelet Engraftment [ Time Frame: Up to 45 days ]Complete blood counts were measured daily after allogeneic transplant. Time to platelet engraftment is defined as the number of days it takes to reach platelet count >20,000, counting from the day of transplant.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00481832
|United States, California|
|Stanford University School of Medicine|
|Stanford, California, United States, 94305|
|Principal Investigator:||Wen-Kai Weng||Stanford University|