Phase I/II Trial of Redox Regulation in Patients With Relapsed or Refractory CD20+ NHL

• Anti-lymphoma efficacy [ Time Frame: At 1, 3 and 6 months ] [ Designated as safety issue: No ]
  To assess the anti-lymphoma efficacy of the combination of MGd and 90Yttrium-Zevalin therapy.
• Study location of tumor through MRIs [ Time Frame: At 1,3 and 6 months ] [ Designated as safety issue: No ]
  To study the tumor-specific bio-localization of MGd in lymphoma through magnetic resonance imaging (MRI) in a subset of patients
• Correlative laboratory studies [ Time Frame: On Day 1 and 4 ] [ Designated as safety issue: No ]
  To explore correlative laboratory studies of MGd (ie, uptake of MGd by peripheral mononuclear cells, effect of MGd upon peripheral lymphocyte subset populations).

Monoclonal antibodies such as rituximab and yttrium Y 90 ibritumomab tiuxetan can locate cancer cells and either kill them or deliver radioactive cancer-killing substances to them without harming normal cells. Motexafin gadolinium may increase the effectiveness of yttrium Y 90 ibritumomab tiuxetan by making the cancer cells more sensitive to the drug.

This phase I/II trial is studying the side effects and best dose of motexafin gadolinium when administered with rituximab and yttrium Y 90 ibritumomab tiuxetan and to see how well they work in treating patients with stage II, stage III, or stage IV relapsed or refractory non-Hodgkin's lymphoma.

This is a phase I, dose-escalation study of motexafin gadolinium followed by a phase II study. Patients are stratified according to extent of lymphomatous involvement (≤ 5% vs > 5 but ≤ 24% of cellular elements).

Cohorts of 3-6 patients in each stratum receive escalating doses of motexafin gadolinium until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose at which 2 of 6 patients experience dose-limiting toxicity (DLT) OR the dose preceding that at which 2 of 3 or 3 of 6 patients experience DLT.

• Once the MTD is determined, additional patients are treated at that dose level as in phase I.

Patients are followed weekly for 3 months and then monthly for 5 years.

• Drug: Rituxan
  Patients receive motexafin gadolinium IV over 30-60 minutes on days 1-4 and 8-11. At least 1 hour after motexafin gadolinium administration, patients receive rituximab IV over 3-4 hours on days 1 and 8. After rituximab administration, patients receive indium In 111 ibritumomab tiuxetan IV over 10 minutes on day 1. Patients undergo gamma camera scanning on days 1, 2*, 4*, and 7 and dosimetry on days 2, 4, and 7. If safe biodistribution is demonstrated, patients receive yttrium Y 90 ibritumomab tiuxetan IV over 10 minutes (after rituximab administration) on day 8.
  Other Name: rituximab IDEC-C2B8
• Drug: motexafin gadolinium
  Patients receive motexafin gadolinium IV over 30-60 minutes on days 1-4 and 8-11. At least 1 hour after motexafin gadolinium administration, patients receive rituximab IV over 3-4 hours on days 1 and 8. After rituximab administration, patients receive indium In 111 ibritumomab tiuxetan IV over 10 minutes on day 1. Patients undergo gamma camera scanning on days 1, 2*, 4*, and 7 and dosimetry on days 2, 4, and 7. If safe biodistribution is demonstrated, patients receive yttrium Y 90 ibritumomab tiuxetan IV over 10 minutes (after rituximab administration) on day 8.
  Other Names:

  • MGd, Xcytrin® (motexafin gadolinium) Injection,
  • NSC 695238
• Drug: 111Indium-Zevalin and 90Yttrium-Zevalin
  Patients receive motexafin gadolinium IV over 30-60 minutes on days 1-4 and 8-11. At least 1 hour after motexafin gadolinium administration, patients receive rituximab IV over 3-4 hours on days 1 and 8. After rituximab administration, patients receive indium In 111 ibritumomab tiuxetan IV over 10 minutes on day 1. Patients undergo gamma camera scanning on days 1, 2*, 4*, and 7 and dosimetry on days 2, 4, and 7. If safe biodistribution is demonstrated, patients receive yttrium Y 90 ibritumomab tiuxetan IV over 10 minutes (after rituximab administration) on day 8.
  Other Name: Ibritumomab-tiuxetan

DISEASE CHARACTERISTICS:

• Histologically confirmed diagnosis of one of the following:

  • Low-grade or follicular B-cell non-Hodgkin's lymphoma (NHL)

    • The following histologies are eligible:

      • Small lymphocytic lymphoma
      • Lymphoplasmacytoid lymphoma
      • Follicular center grades 1, 2, or 3 lymphoma
      • Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue type
      • Nodal marginal zone B-cell lymphoma
    • Relapsed or refractory after 2 prior treatment regimens or 1 anthracycline regimen
  • Diffuse large B-cell NHL or mantle cell lymphoma in first or second relapse
  • Transformed NHL, defined as low-grade NHL transformed to diffuse large B-cell lymphoma, with no more than 1 relapse since transformation

Age 18 and over Recovered from prior immunotherapy Life expectancy At least 3 months Recovered from prior chemotherapy

• More than 4 weeks since prior major surgery and recovered
• More than 4 weeks since prior anticancer therapy recovered from prior radiotherapy

Exclusion criteria:

No major bleeding within the past 4 weeks No uncontrolled hypertension No stroke within the past 4 weeks

• No active infection
• No other active nonmalignant disease
• No known G6PD deficiency
• No history of porphyria
• No other condition that would preclude study participation
• No human anti-mouse antibodies
• No known history of HIV
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception
• No prior radioimmunoconjugate therapy
• No prior exposure to murine antibodies other than rituximab
• More than 4 weeks since prior rituximab
• No history of failed stem cell collection