Vaccine Therapy and GM-CSF in Treating Patients With CNS Lymphoma - Full Text View

Purpose

RATIONALE: Vaccines made from a person's cancer proteins may help the body build an effective immune response to kill cancer cells. Colony-stimulating factors, such as GM-CSF, may increase the number of immune cells found in bone marrow or peripheral blood. Giving vaccine therapy together with GM-CSF may make a stronger immune response and kill more cancer cells.

PURPOSE: This phase II trial is studying the side effects and how well giving vaccine therapy together with GM-CSF works in treating patients with CNS lymphoma.

Condition	Intervention	Phase
Brain and Central Nervous System Tumors Lymphoma Lymphoproliferative Disorder Small Intestine Cancer	Biological: autologous immunoglobulin idiotype-KLH conjugate vaccine Biological: sargramostim Drug: methotrexate Drug: thiotepa Radiation: radiation therapy	Phase 2


Study Type:	Interventional
Study Design:	Masking: Open Label Primary Purpose: Treatment
Official Title:	A Phase 2, Open-Label Study to Evaluate the Efficacy and Safety of Patient-Specific Immunotherapy, Recombinant Idiotype Conjugated to KLH (Id-KLH) and Administered With GM-CSF, in Patients With CNS Lymphoma

Resource links provided by NLM:

MedlinePlus related topics: Lymphoma

Genetic and Rare Diseases Information Center resources: Lymphosarcoma Follicular Lymphoma B-cell Lymphoma Diffuse Large B-Cell Lymphoma Marginal Zone Lymphoma Chronic Lymphocytic Leukemia Leukemia, B-cell, Chronic Mantle Cell Lymphoma Hodgkin Lymphoma Hodgkin Lymphoma, Childhood Lymphoma, Large-cell Anaplastic Large Cell Lymphoma Waldenstrom Macroglobulinemia Cutaneous T-cell Lymphoma Small Intestine Cancer Lymphoblastic Lymphoma Burkitt Lymphoma Leukemia, T-cell, Chronic Adult T-cell Leukemia/lymphoma Angioimmunoblastic T-cell Lymphoma Angioimmunoblastic Lymphadenopathy With Dysproteinemia Mycosis Fungoides Extranodal Nasal NK/T Cell Lymphoma Sezary Syndrome Plasmablastic Lymphoma Lymphoma, Large-cell, Immunoblastic

U.S. FDA Resources

Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:

Anti-idiotype (Id) and anti-keyhole limpet hemocyanin (KLH) immune response rate in the CSF
Safety and tolerability

Secondary Outcome Measures:

Progression-free survival (PFS)
Time to receipt of first subsequent anti-lymphoma therapy after initiating immunization with the Id-KLH conjugate vaccine
Correlation of anti-Id immune response in the CSF and/or serum with PFS and overall survival
Kinetics of humoral immune response development


Estimated Enrollment:	30
Study Start Date:	November 2007
Estimated Primary Completion Date:	June 2009 (Final data collection date for primary outcome measure)

Detailed Description:

OBJECTIVES:

Primary

To determine the proportion of patients with CNS lymphoma who develop anti-idiotype (Id) and anti-keyhole limpet hemocyanin (KLH) humoral immune responses in the serum and/or CSF following patient-specific immunotherapy comprising recombinant tumor-derived immunoglobulin Id-KLH conjugate vaccine and sargramostim (GM-CSF).
To assess the safety and tolerability of this regimen in these patients.

Secondary

To evaluate the progression-free survival (PFS) of patients treated with this regimen.
To determine the time to receipt of first subsequent anti-lymphoma therapy after initiating immunization with the Id-KLH conjugate vaccine.
To assess the correlation of anti-Id immune response in the CSF and/or serum with PFS and overall survival.

Tertiary

To evaluate the kinetics of humoral immune response development in patients treated with this regimen.

OUTLINE:

Pre-immunotherapy: Patients submit a tumor sample for manufacturing of the idiotype (Id)-keyhole limpet hemocyanin (KLH) conjugate vaccine and undergo placement of an Ommaya reservoir. Patients then receive induction therapy comprising methotrexate IV once every 2 weeks until a maximum radiographic response is achieved, as assessed by MRI of the brain. Patients then receive methotrexate IV once a month for 6 months. Patients with leptomeningeal or CSF involvement also receive intraventricular thiotepa twice a week until the CSF is clear on three evaluations and then once a week until the CSF is clear on four evaluations. Patients under 55 years of age also undergo whole brain radiotherapy (or craniospinal radiotherapy when extensive leptomeningeal disease is present). Patients who achieve a stable response to induction therapy proceed to immunotherapy.
Immunotherapy: Patients receive recombinant tumor-derived immunoglobulin Id-KLH conjugate vaccine subcutaneously (SC) on day 1 of weeks 0, 2, 4, 6, 8, 10, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 52, 56, 60, 64, 68, 72, and 76. Patients also receive sargramostim (GM-CSF) SC on days 1-4 of the same weeks as the Id-KLH conjugate vaccine.

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

Eligibility


Ages Eligible for Study:	18 Years and older (Adult, Senior)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

DISEASE CHARACTERISTICS:

Histologically or CSF cytologically confirmed CNS lymphoma with any of the following clinical histories:
- Primary CNS lymphoma at initial diagnosis
- Primary CNS lymphoma at relapse
- Systemic lymphoma with CNS disease at initial diagnosis or at relapse
Adequate fresh tissue or cell pellet available for analysis by Genitope Corporation to determine adequacy for idiotype (Id) manufacturing
Tumor must express both functional light and heavy chain genes
No tumors known or found to be surface immunoglobulin negative
Not in leukemic phase (i.e., > 5,000/mm³ circulating tumor cells)

PATIENT CHARACTERISTICS:

ECOG performance status (PS) 0-2 OR Karnofsky PS 70-100%
WBC ≥ 1,500/mm³
Platelet count ≥ 75,000/mm³
Hemoglobin ≥ 10 g/dL
Serum bilirubin ≤ 1.5 times upper limit of normal (ULN) (unless due to Gilbert's disease)
Creatinine ≤ 1.5 times ULN
Able to undergo placement of an Ommaya reservoir
Able to receive induction therapy (chemotherapy with or without brain radiotherapy) with intent to induce remission
Speaks English or Spanish
No other malignancy within the past 3 years, except adequately treated basal cell or squamous cell carcinoma of the skin or cervical carcinoma in situ
Not pregnant or nursing
No immunosuppressive viral infections as evidenced by HIV antibody or antigen, hepatitis B antigen, or hepatitis C antibody or antigen positivity
No history of autoimmune disease that required treatment within the past 5 years, including previously treated autoimmune hemolytic anemia or immune thrombocytopenia

PRIOR CONCURRENT THERAPY:

More than 30 days since prior and no concurrent participation in another therapeutic clinical trial
More than 2 weeks since prior steroids
No concurrent immunosuppressives, including corticosteroids
- Transient use of optical or nasal steroid solutions is allowed
No other concurrent anticancer therapy or therapy for non-Hodgkin lymphoma

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: NCT00621036

Locations


United States, Texas
Simmons Comprehensive Cancer Center at University of Texas Southwestern Medical Center - Dallas	Recruiting
Dallas, Texas, United States, 75390
Contact: Clinical Trials Office - Simmons Comprehensive Cancer Center a 866-460-4673; 214-648-7097

Sponsors and Collaborators

Simmons Cancer Center

Investigators


Principal Investigator:	Elizabeth Maher, MD, PhD	Simmons Cancer Center

More Information


ClinicalTrials.gov Identifier:	NCT00621036 History of Changes
Other Study ID Numbers:	CDR0000587504 SCCC-102007-035 SCCC-02F07
Study First Received:	February 21, 2008
Last Updated:	April 1, 2010

Keywords provided by National Cancer Institute (NCI):


primary central nervous system non-Hodgkin lymphoma primary central nervous system Hodgkin lymphoma stage IV adult T-cell leukemia/lymphoma adult nasal type extranodal NK/T-cell lymphoma anaplastic large cell lymphoma angioimmunoblastic T-cell lymphoma extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue stage IV adult Burkitt lymphoma stage IV adult diffuse large cell lymphoma stage IV adult diffuse mixed cell lymphoma stage IV adult diffuse small cleaved cell lymphoma stage IV adult Hodgkin lymphoma stage IV adult immunoblastic large cell lymphoma stage IV adult lymphoblastic lymphoma stage IV childhood Hodgkin lymphoma	stage IV childhood large cell lymphoma stage IV childhood lymphoblastic lymphoma stage IV childhood small noncleaved cell lymphoma stage IV cutaneous T-cell non-Hodgkin lymphoma stage IV mycosis fungoides/Sezary syndrome stage IV grade 1 follicular lymphoma stage IV grade 2 follicular lymphoma stage IV grade 3 follicular lymphoma stage IV mantle cell lymphoma stage IV marginal zone lymphoma stage IV small lymphocytic lymphoma intraocular lymphoma post-transplant lymphoproliferative disorder cutaneous B-cell non-Hodgkin lymphoma Waldenstrom macroglobulinemia

primary central nervous system non-Hodgkin lymphoma
primary central nervous system Hodgkin lymphoma
stage IV adult T-cell leukemia/lymphoma
adult nasal type extranodal NK/T-cell lymphoma
anaplastic large cell lymphoma
angioimmunoblastic T-cell lymphoma
extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue
stage IV adult Burkitt lymphoma
stage IV adult diffuse large cell lymphoma
stage IV adult diffuse mixed cell lymphoma
stage IV adult diffuse small cleaved cell lymphoma
stage IV adult Hodgkin lymphoma
stage IV adult immunoblastic large cell lymphoma
stage IV adult lymphoblastic lymphoma
stage IV childhood Hodgkin lymphoma

stage IV childhood large cell lymphoma
stage IV childhood lymphoblastic lymphoma
stage IV childhood small noncleaved cell lymphoma
stage IV cutaneous T-cell non-Hodgkin lymphoma
stage IV mycosis fungoides/Sezary syndrome
stage IV grade 1 follicular lymphoma
stage IV grade 2 follicular lymphoma
stage IV grade 3 follicular lymphoma
stage IV mantle cell lymphoma
stage IV marginal zone lymphoma
stage IV small lymphocytic lymphoma
intraocular lymphoma
post-transplant lymphoproliferative disorder
cutaneous B-cell non-Hodgkin lymphoma
Waldenstrom macroglobulinemia

Additional relevant MeSH terms:


Lymphoma Nervous System Neoplasms Central Nervous System Neoplasms Lymphoproliferative Disorders Intestinal Neoplasms Neoplasms by Histologic Type Neoplasms Lymphatic Diseases Immunoproliferative Disorders Immune System Diseases Neoplasms by Site Nervous System Diseases Gastrointestinal Neoplasms Digestive System Neoplasms Digestive System Diseases	Gastrointestinal Diseases Intestinal Diseases Vaccines Methotrexate Immunoglobulins Antibodies Thiotepa Immunoglobulin Idiotypes Immunologic Factors Physiological Effects of Drugs Abortifacient Agents, Nonsteroidal Abortifacient Agents Reproductive Control Agents Antimetabolites, Antineoplastic Antimetabolites

ClinicalTrials.gov processed this record on July 19, 2017