Alemtuzumab and Combination Chemotherapy in Treating Patients With Stage I, Stage II, Stage III, or Stage IV Peripheral T-Cell Lymphoma

• Immediate toxicity (incidence of infusion-related reactions) [ Designated as safety issue: Yes ]
  
• Hematopoietic toxicity (number of cycles of therapy associated with neutrophils < 0.5e9/L or platelets < 50e9/L) [ Designated as safety issue: Yes ]
  
• Incidence of infection (number of days with fever ≥ 38 degrees C, days of intravenous antibiotics, number of inpatient days, number of episodes of cytomegalovirus reactivation) [ Designated as safety issue: No ]
  

• Disease response (remission rate [complete response and partial response]) [ Designated as safety issue: No ]
  
• Disease outcome (time to progression and overall survival at 2 years from completion of therapy) [ Designated as safety issue: No ]
  
• Immune reconstitution (time to recover peripheral blood CD4 count to 0.2 e9/L) [ Designated as safety issue: No ]
  
• Relative dose intensity [ Designated as safety issue: No ]
  
• Pharmacokinetics assessment of alemtuzumab trough levels before each cycle of treatment [ Designated as safety issue: No ]
  
• Epstein-Barr virus copy number (measured retrospectively) [ Designated as safety issue: No ]
  

OBJECTIVES:

Primary

• To determine the feasibility of adding alemtuzumab to standard cyclophosphamide, doxorubicin hydrochloride, vincristine, and oral prednisolone (CHOP) chemotherapy in patients with stage I-IV peripheral T-cell lymphoma (PTCL).
• To assess the side effect profile and early and late toxicities of this regimen in a standard dose-escalation design, and to establish an appropriate dose level for future studies.

Secondary

• To document response rates and disease-free survival of patients treated with this regimen, and to compare these findings with those of historical controls.
• To monitor immune reconstitution after therapy.
• To determine the pharmacokinetics of subcutaneous alemtuzumab when given in combination with CHOP chemotherapy.
• To more clearly define the CD52 expression profile in these tumors and to investigate phenotypic variations in PTCL.
• To document changes (if any) in levels of Epstein-Barr virus copy number by polymerase chain reaction during CHOP-alemtuzumab therapy.

OUTLINE: This is a multicenter, dose escalation of alemtuzumab study.

Patients receive CHOP chemotherapy comprising cyclophosphamide IV, doxorubicin hydrochloride IV, and vincristine IV on day 1 and oral prednisone on days 1-5. Patients also receive alemtuzumab subcutaneously (SC) 1-3 times a week for up to 6 doses per course. Treatment repeats every 3 weeks for up to 8 courses in the absence of disease progression or unacceptable toxicity.

Patients undergo blood collection at baseline, periodically during study treatment, and after completion of study therapy for pharmacokinetics and other correlative studies to monitor cellular immunity. Blood samples are examined by polymerase chain reaction to detect cytomegalovirus antigen and to monitor Epstein-Barr virus copy number. Samples are also analyzed by flow cytometry to quantify circulating B- and T-cells, NK-cells, monocytes, and dendritic-cells.

After completion of study therapy, patients are followed every 3 months for the first year, every 6 months for the second year, and then yearly thereafter.