Reduced-Intensity Regimen Before Allogeneic Transplant for Patients With Relapsed Non-Hodgkin's or Hodgkin's Lymphoma
RATIONALE: Photopheresis allows patient white blood cells to be treated with ultraviolet (UV) light and drugs outside the body to inactivate T cells. Pentostatin may suppress the immune system and reduce the chance of developing graft-versus-host disease (GVHD) following bone marrow transplantation. Combining photopheresis with pentostatin and total-body irradiation may be effective in killing cancer cells before bone marrow transplantation.
PURPOSE: This phase II trial is studying how well giving photophoresis together with pentostatin and total-body irradiation as a reduced-intensity regimen before allogeneic bone marrow transplantation works in treating patients with relapsed non-Hodgkin's or Hodgkin's lymphoma.
Procedure: Extracorporeal Photopheresis
Radiation: Total body irradiation (TBI)
Procedure: Allogeneic bone marrow transplantation
Drug: Cyclosporin (CSA)
Drug: Mycophenolate mofetil (MMF)
Drug: Methotrexate (MTX)
|Study Design:||Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||A Phase II Study of Reduced Intensity Allogeneic Bone Marrow Transplantation for the Treatment of Relapsed Non-Hodgkin and Hodgkin Lymphoma|
- Proportion of Participants With Successful Engraftment [ Time Frame: Assessed daily during inpatient stay ] [ Designated as safety issue: No ]
- 100-day Overall Survival [ Time Frame: Assessed at least twice a week for the first 60 days and weekly until day 100. ] [ Designated as safety issue: No ]Proportion of patients who survived 100 days or more after enrolled on the study
- Progression-free Survival [ Time Frame: Assessed day 100 post transplant and every 3 months during year 1, every 6 months during years 2-3, then every 12 months during years 4-5 or through diagnosis of disease progression ] [ Designated as safety issue: No ]Progression-free survival was defined as time from enrollment to disease progression or death from any cause, whichever occurred first. Patients who did not have progression-free survival events were censored at last date of disease assessment.
|Study Start Date:||June 2005|
|Study Completion Date:||May 2011|
|Primary Completion Date:||April 2008 (Final data collection date for primary outcome measure)|
Reduced toxicity conditioning regimen followed by allogeneic sibling or unrelated transplant. The conditioning regimen includes Extracorporeal Photopheresis, Pentostatin and total body irradiation (TBI). After allogeneic bone marrow transplantation, cyclosporin, mycophenolate mofetil (MMF), and methotrexate (MTX) will be given to prevent graft-versus-host disease (GVHD).
Procedure: Extracorporeal Photopheresis
Day -7 to -4: Extracorporeal Photopheresis may be given as an outpatient therapy on two consecutive days any time between days -7 to -4. This must be performed on UVAR or XTS photopheresis machines (Therakos, Inc.) according to standard procedure as per manufacturer's guidelines.
Other Name: extracorporeal photochemotherapyDrug: Pentostatin
Day -3, -2: Pentostatin 4 mg/m²/d by continuous IV infusion (Total dose = 8 mg/m²)
Other Names:Radiation: Total body irradiation (TBI)
Day -1: TBI 400 cGy total dose given in two 200cGy doses. Patients who have received TBI for a previous transplant or radiation as part of previous treatment for a lymphoid malignancy will receive only 200 cGy in 1 dose.
Other Name: radiation therapyProcedure: Allogeneic bone marrow transplantation
Day 0: Infusion of unmanipulated allogeneic bone marrow or stem cells. Minimum cell dose of 2 x 106 CD34 cells/kg recipient and no more than 10 x 10^6 CD34/kg
Other Name: allogeneic stem cell transplantationDrug: Cyclosporin (CSA)
Cyclosporin A or tacrolimus will be administered according to institutional GVHD prophylaxis protocols. Therapeutic levels will be maintained and patients will be switched to oral agents when they can tolerate
Other Names:Drug: Mycophenolate mofetil (MMF)
At day 100 MMF will be introduced at a dose of 250 mg po BID and cyclosporine or tacrolimus will be tapered according to the discretion of the investigator. The dosage will be escalated to a maximum of 2 g/d at the discretion of the attending physician and will be tapered and discontinued at 12 months if there is no active cGVHD. Doses should be given on an empty stomach
Other Names:Drug: Methotrexate (MTX)
The dose of Methotrexate is based on the corrected ideal body weight for patients with > 33% above ideal weight.
Day +1 MTX 15 mg/m² IV push; Day +3 MTX 10 mg/m² IV push (May be omitted if patient develops mouth sores.)
- Determine the rate of stable engraftment of donor cells in patients with relapsed non-Hodgkin's or Hodgkin's lymphoma treated with a reduced toxicity conditioning regimen followed by allogeneic (sibling or unrelated) bone marrow transplantation.
- Determine the extent and duration of acute and chronic graft-versus-host disease in patients treated with this regimen.
- Determine the 100-day overall survival and long-term progression-free survival of patients treated with this regimen.
- Evaluate the feasibility of collection of molecular chimerism studies at baseline, days 30, 100, 6 months and one and two years and at relapse.
OUTLINE: This is a multicenter study.
- Conditioning regimen: Patients undergo extracorporeal photopheresis using methoxsalen and UV light on 2 consecutive days between days -7 to -4. Patients receive pentostatin intravenously (IV) continuously on days -3 to -2 and undergo total body irradiation on day -1.
- Allogeneic bone marrow transplantation: Patients undergo infusion of allogeneic bone marrow or stem cells on day 0.
- Graft-versus-host disease prophylaxis: Patients receive oral or IV cyclosporine beginning on day -1 and continuing until 6 months after transplantation, oral mycofenolate mofetil beginning on day 100 and continuing for 1 year, and methotrexate IV on days 1 and 3.
Patients are followed at day 100, every 3 months for 1 year, every 6 months for 2 years, and then annually for 2 years.
PROJECTED ACCRUAL: A total of 36 patients will be accrued for this study within 1.8 years.
|United States, Colorado|
|Aurora Presbyterian Hospital|
|Aurora, Colorado, United States, 80012|
|Boulder Community Hospital|
|Boulder, Colorado, United States, 80301-9019|
|Penrose Cancer Center at Penrose Hospital|
|Colorado Springs, Colorado, United States, 80933|
|St. Joseph Hospital|
|Denver, Colorado, United States, 80218|
|CCOP - Colorado Cancer Research Program|
|Denver, Colorado, United States, 80224-2522|
|Presbyterian - St. Luke's Medical Center|
|Denver, Colorado, United States, 80218|
|Rose Medical Center|
|Denver, Colorado, United States, 80220|
|Porter Adventist Hospital|
|Denver, Colorado, United States, 80210|
|Swedish Medical Center|
|Englewood, Colorado, United States, 80110|
|St. Mary's Regional Cancer Center at St. Mary's Hospital and Medical Center|
|Grand Junction, Colorado, United States, 81502|
|Sky Ridge Medical Center|
|Lone Tree, Colorado, United States, 80124|
|Hope Cancer Care Center at Longmont United Hospital|
|Longmont, Colorado, United States, 80502|
|St. Mary - Corwin Regional Medical Center|
|Pueblo, Colorado, United States, 81004|
|North Suburban Medical Center|
|Thornton, Colorado, United States, 80229|
|United States, Florida|
|Mayo Clinic - Jacksonville|
|Jacksonville, Florida, United States, 32224|
|United States, Massachusetts|
|Tufts-NEMC Cancer Center|
|Boston, Massachusetts, United States, 02111|
|United States, Minnesota|
|Mayo Clinic Cancer Center|
|Rochester, Minnesota, United States, 55905|
|United States, New Jersey|
|Cancer Institute of New Jersey at UMDNJ - Robert Wood Johnson Medical School|
|New Brunswick, New Jersey, United States, 08903|
|United States, Ohio|
|Case Comprehensive Cancer Center|
|Cleveland, Ohio, United States, 44106-5065|
|Study Chair:||Francine M. Foss, MD||Yale University|