Combination Chemotherapy Followed by Bone Marrow or Peripheral Stem Cell Transplantation in Treating Patients With Relapsed or Refractory Hodgkin's Lymphoma
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Purpose
RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining chemotherapy with bone marrow or peripheral stem cell transplantation may allow the doctor to give higher doses of chemotherapy drugs and kill more tumor cells.
PURPOSE: Phase II trial to study the effectiveness of combination chemotherapy followed by bone marrow or peripheral stem cell transplantation in treating patients with relapsed or refractory Hodgkin's lymphoma.
| Condition | Intervention | Phase |
|---|---|---|
|
Lymphoma |
Drug: cisplatin Drug: cyclophosphamide Drug: etoposide Procedure: autologous bone marrow transplantation Procedure: bone marrow ablation with stem cell support Procedure: peripheral blood stem cell transplantation Procedure: syngeneic bone marrow transplantation Radiation: radiation therapy |
Phase 2 |
| Study Type: | Interventional |
| Study Design: | Allocation: Non-Randomized Intervention Model: Single Group Assignment Masking: Open Label Primary Purpose: Treatment |
| Official Title: | HIGH-DOSE CYCLOPHOSPHAMIDE, ETOPOSIDE, AND CISPLATIN (CEP) WITH RESCUE BY AUTOLOGOUS BONE MARROW OR AUTOLOGOUS PERIPHERAL BLOOD STEM CELLS IN PATIENTS WITH RELAPSED OR REFRACTORY HODGKIN'S DISEASE |
| Study Start Date: | February 1993 |
| Study Completion Date: | February 2002 |
| Primary Completion Date: | February 2002 (Final data collection date for primary outcome measure) |
OBJECTIVES:
- Determine the curative potential of high-dose cyclophosphamide, etoposide, and cisplatin (CEP) followed by syngeneic or autologous bone marrow and/or autologous peripheral blood stem cell (PBSC) rescue in patients with relapsed or refractory stage I-IV Hodgkin's lymphoma.
- Determine the overall response rate and survival of patients treated with this regimen.
- Determine the toxicity of this regimen in these patients.
- Determine the differences in the rate of engraftment, response, and survival of patients treated with bone marrow vs PBSC transplantation.
- Determine the response rate and survival of patients treated with late consolidative radiotherapy after recovery from transplantation.
- Determine the toxicity of late consolidative radiotherapy after recovery from transplantation in these patients.
OUTLINE: Syngeneic or autologous bone marrow and/or autologous peripheral blood stem cells (PBSC) are harvested. Syngeneic bone marrow transplantation is preferred for patients with a qualifying identical twin donor. Patients without a syngeneic donor who have a history of lymphomatous involvement of the bone marrow or are profoundly hypocellular undergo harvest of PBSC alone. Patients without a syngeneic donor who have no history of lymphomatous involvement of the bone marrow undergo harvest of autologous bone marrow or PBSC.
Patients receive conditioning comprising cyclophosphamide IV over 1 hour on days -6 to -3 and etoposide IV over 1 hour every 12 hours and cisplatin IV continuously on days -6 to -4. Bone marrow and/or PBSC are infused on day 0. (Patients requiring more than 25 bags of stem cells receive bone marrow transplantation on day 0 and PBSC transplantation on day 1.)
After recovery from transplantation, eligible patients receive consolidative radiotherapy to any site of prior bulk disease (greater than 5 cm) present at any time before transplantation and any site of disease present at the time of transplantation.
Patients are followed at 3, 6, and 12 months and then annually thereafter.
PROJECTED ACCRUAL: A maximum of 30 patients will be accrued for this study.
Eligibility| Ages Eligible for Study: | 15 Years to 70 Years |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
DISEASE CHARACTERISTICS:
- Histologically proven stage I-IV Hodgkin's lymphoma
Must have refractory or relapsed disease, defined by 1 of the following:
- Failure to achieve a complete remission (CR) after 4 courses of conventional-dose front-line chemotherapy
Disease in second or greater remission
- Patients should be encouraged to undergo transplantation prior to a third salvage regimen
- Patients previously treated with multiple regimens considered on a case-by-case basis
No chemoresistant disease, defined as active progression with tumor growth greater than 25% by volume during first-line chemotherapy
- Patients who respond to second-line chemotherapy may be eligible
Stable residual masses after conventional-dose chemotherapy not considered treatment failures
- Active (refractory or relapsed) disease must be proven histologically or documented by gallium nitrate uptake
- Syngeneic marrow transplantation offered to patients with consenting identical twin donor
- No CNS involvement by lymphoma
PATIENT CHARACTERISTICS:
Age:
- 15 to 60 (selected patients up to age 70 may be eligible)
Performance status:
- ECOG 0-2
Life expectancy:
- Not specified
Hematopoietic:
- WBC greater than 4,000/mm^3
- Absolute neutrophil count greater than 2,000/mm^3
- Platelet count greater than 100,000/mm^3
Hepatic:
- Bilirubin less than 2.0 mg/dL
- SGOT and SGPT less than 2 times upper limit of normal
- Albumin greater than 3.0 g/dL
Renal:
Must meet 1 of the following criteria:
- Creatinine less than 1.8 mg/dL
- Creatinine clearance greater than 60 mL/min
- BUN less than 20 mg/dL
Cardiovascular:
- Left ventricular ejection fraction at least 50%
Pulmonary:
- DLCO, FEV_1, and FVC greater than 50% of predicted OR
- Resting pO_2 greater than 70 mm Hg on room air
Other:
- HIV negative
- No severe neurologic or emotional disorders
- No active infection
- No other disease that would limit life expectancy
- Not pregnant
- Fertile patients must use effective contraception
- Adequate psychosocial support required
PRIOR CONCURRENT THERAPY:
Biologic therapy
- Not specified
Chemotherapy
- See Disease Characteristics
Endocrine therapy
- Not specified
Radiotherapy
- Not specified
Surgery
- Not specified
Contacts and Locations| United States, Pennsylvania | |
| Fox Chase - Temple Cancer Center | |
| Philadelphia, Pennsylvania, United States, 19111-2442 | |
| Study Chair: | Kenneth F. Mangan, MD, FACP | Fox Chase Cancer Center |
More Information
Additional Information:
No publications provided
| Responsible Party: | Temple University Bone Marrow Transplant Program, Temple University Health Systems |
| ClinicalTrials.gov Identifier: | NCT00002522 History of Changes |
| Other Study ID Numbers: | CDR0000078283, TUHSC-2162, NCI-V93-0249 |
| Study First Received: | November 1, 1999 |
| Last Updated: | September 30, 2010 |
| Health Authority: | United States: Federal Government |
Keywords provided by Temple University:
|
stage I adult Hodgkin lymphoma stage II adult Hodgkin lymphoma stage III adult Hodgkin lymphoma stage IV adult Hodgkin lymphoma recurrent adult Hodgkin lymphoma |
Additional relevant MeSH terms:
|
Hodgkin Disease Lymphoma Neoplasms by Histologic Type Neoplasms Lymphoproliferative Disorders Lymphatic Diseases Immunoproliferative Disorders Immune System Diseases Etoposide phosphate Cisplatin Cyclophosphamide Etoposide Antineoplastic Agents |
Therapeutic Uses Pharmacologic Actions Radiation-Sensitizing Agents Physiological Effects of Drugs Immunosuppressive Agents Immunologic Factors Antirheumatic Agents Antineoplastic Agents, Alkylating Alkylating Agents Molecular Mechanisms of Pharmacological Action Myeloablative Agonists Antineoplastic Agents, Phytogenic |
ClinicalTrials.gov processed this record on June 17, 2013