R-ICE and High-Dose Cyclophosphamide With PET/CT for Diffuse Large B-Cell Non-Hodgkin's Lymphoma

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00809341
Recruitment Status : Terminated (Low accrual)
First Posted : December 17, 2008
Last Update Posted : November 2, 2015
Genentech, Inc.
Information provided by (Responsible Party):
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

Brief Summary:

This research is being done to see if a PET scan that is obtained after 3 cycles of a standard chemotherapy regimen can help guide treatment for patients with a blood disease called Non-Hodgkin's Lymphoma.

The standard treatment for newly diagnosed lymphoma is 6 to 8 cycles of chemotherapy like the CHOP combination (Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone). This regimen can cure about half of patients with lymphoma, but in many others disease relapses (comes back). Relapses are generally treated with more chemotherapy.

We believe that a PET scan (a type of imaging study that "lights up" in areas of cells with high activity such as lymphoma), may identify patients early who are at high risk of relapse.

The purpose of this research study is to find out if people whose treatment is changed early to an intensification regimen (high dose chemotherapy) based on a positive PET scan will have longer remissions than they would if they did not receive that high dose chemotherapy.

Condition or disease Intervention/treatment Phase
Non-Hodgkin's Lymphoma Drug: R-CHOP, R-CHOEP, R-EPOCH Drug: R-ICE, Cyclophosphamide Phase 2

Detailed Description:

Patients will receive 3 cycles of chemotherapy prior to mid-treatment PET-CT. Rituximab-CHOP, or an equivalent regimen must be used. During the third cycle of Rituximab-CHOP chemotherapy, a PET-CT scan will be performed. The PET scan will be designated as negative or positive. Based on the results, patients will either complete standard dose therapy or receive two cycles of R-ICE followed by high dose cyclophosphamide and rituximab.

A repeat PET-CT is required between 4 to 6 weeks following treatment completion. Patients will be followed-up every 4 months for 2 years, then every 6 months for one year, then annually until 5 years.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 26 participants
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Treatment Intensification With R-ICE and High-Dose Cyclophosphamide for Diffuse Large B-Cell Non-Hodgkin's Lymphoma Based on Early [18F] FDG-PET Scanning
Study Start Date : January 2009
Actual Primary Completion Date : April 2014
Actual Study Completion Date : April 2014

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Active Comparator: PET Negative
PET negative patients will complete conventional therapy under a treatment plan formulated by their primary oncologist. Decisions regarding subsequent therapy, including BMT for disease relapse, will also be at the discretion of the primary oncologist.
Based on the PET-CT scan results patients will complete standard chemotherapy consisting of R-CHOP (or equivalent anthracycline-containing regimen (e.g. R-CHOEP, R-EPOCH)
Other Names:
  • R-CHOP

Active Comparator: PET Positive
R-ICE x 2 cycles (outpatient regimen; Pre-high dose therapy evaluations during R-ICE cycles; Cyclophosphamide 50mg/kg/day day2-5; rituximab d1, 30, 37
Drug: R-ICE, Cyclophosphamide
Two cycles of R-ICE, followed by high dose cyclophosphamide and Rituximab
Other Names:
  • R-ICE
  • Hi CY
  • Rituxan

Primary Outcome Measures :
  1. Estimate survival in patient receiving early treatment intensification based on a positive mid-treatment PET scan compared to the historical event-free survival of mid-treatment PET positive patients not given early treatment intensification. [ Time Frame: 2 years ]

Secondary Outcome Measures :
  1. Estimate overall survival in patients whose treatment is determined on the basis of a mid-treatment [18F] FDG-PET scan result. [ Time Frame: 5 years ]

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

Inclusion Criteria:

  • One of the following Biopsy-confirmed, aggressive non-Hodgkin's lymphoma

    1. Diffuse large B-cell lymphoma
    2. Mediastinal (thymic) B-cell lymphoma
  • Any stage (I through IV) as defined by the Ann Arbor staging system
  • ECOG performance status of 0 to 2
  • Radiographically measurable disease
  • No more than 3 cycles of chemotherapy for lymphoma
  • Greater than or equal to 18 years
  • Adequate pulmonary, cardiac, hepatic, or renal function
  • HIV antibody negative
  • Women- Not pregnant or breastfeeding
  • Men of reproductive potential must agree to use contraception

Exclusion Criteria:

  • Patients with the following aggressive lymphomas are not eligible:

    1. Mantle cell
    2. Lymphoblastic
    3. Burkitt's
    4. Mycosis fungoides/Sezary's syndrome
    5. HTLV-1 associated T-cell leukemia/lymphoma
    6. Primary CNS lymphoma
    7. HIV-associated lymphoma
    8. Transformed lymphomas
    9. Immunodeficiency-associated lymphomas
  • Previous diagnosis of another hematologic malignancies
  • Progressive disease on CHOP or Rituximab-CHOP
  • Active CNS involvement by lymphoma
  • Serious co-morbid disease that could preclude full participation in study

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00809341

United States, Maryland
The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Baltimore, Maryland, United States, 21231
Sponsors and Collaborators
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Genentech, Inc.
Principal Investigator: Lode Swinnen, MD Johns Hopkins University

Responsible Party: Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Identifier: NCT00809341     History of Changes
Other Study ID Numbers: J0802
NA_00013656 ( Other Identifier: JHMIRB )
J0802 ( Other Identifier: SKCCCRO )
First Posted: December 17, 2008    Key Record Dates
Last Update Posted: November 2, 2015
Last Verified: October 2015

Keywords provided by Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins:

Additional relevant MeSH terms:
Lymphoma, Non-Hodgkin
Lymphoma, B-Cell
Neoplasms by Histologic Type
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Antirheumatic Agents
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Myeloablative Agonists