Yttrium Y 90 Basiliximab and Combination Chemotherapy Before Stem Cell Transplant in Treating Patients With Mature T-cell Non-Hodgkin Lymphoma
- Conditions
- Interventions
- Registration Number
- NCT02342782
- Lead Sponsor
- City of Hope Medical Center
- Brief Summary
This phase I trial studies the side effects and best dose of yttrium Y 90 basiliximab when given together with standard combination chemotherapy before a stem cell transplant in treating patients with mature T-cell non-Hodgkin lymphoma. Radioactive substances linked to monoclonal antibodies, such as yttrium Y 90 basiliximab, can bind to cancer cells and give...
- Detailed Description
PRIMARY OBJECTIVES:
I. To determine if administration of 90Y-basiliximab/DOTA (yttrium Y 90 basiliximab), when given in combination with standard dose BEAM, as conditioning for autologous hematopoietic cell transplant (AHCT), is safe, by evaluation of toxicities, including type, frequency, severity, attribution, time course and duration.
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Recruitment & Eligibility
- Status
- ACTIVE_NOT_RECRUITING
- Sex
- All
- Target Recruitment
- 20
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Patients with a pathologically confirmed diagnosis of systemic mature T-cell non-Hodgkin lymphoma (NHL) with City of Hope pathology review as per World Health Organization (WHO) classification of lymphomas 2008, who are deemed eligible for high dose therapy and AHCT including patients in:
* T-NHL histologies including peripheral T-cell lymphomas (PTCLs), cutaneous T-cell lymphomas (CTCLs) and natural killer (NK)/T cell lymphomas
- First remission after initial first-line therapy (CR1) in PTCL patients, except for anaplastic lymphoma receptor tyrosine kinase (ALK)+ anaplastic large cell lymphoma (ALCL) and CTCL; patients with minimal residual disease after induction therapy may also be eligible at the discretion of the principal investigator (PI)
- Relapsed/refractory disease, stable disease, partial remission (PR) or complete remission (CR), who have received at least 2 lines of therapy, and do not have an adequate allogenetic stem cell transplant option
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Life expectancy >= 6 months
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Karnofsky status >= 70%
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Women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control or abstinence) prior to study entry and for six months following duration of study participation; should a woman become pregnant or suspect that she is pregnant while participating on the trial, she should inform her treating physician immediately
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Cardiac ejection fraction of >= 50% by echocardiogram or multi gated acquisition scan (MUGA)
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Forced expiratory volume in one second (FEV1) > 65% of predicted measured, or diffusing capacity of the lung for carbon monoxide (DLCO) > 50% of predicted measured
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Bilirubin < 1.5 x normal except in cases where abnormal liver function tests (LFTS) are due to involvement with T-NHL
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Serum glutamic oxaloacetic transaminase (SGOT) AND serum glutamate pyruvate transaminase (SGPT) < 2 x normal except in cases where abnormal LFTS are due to involvement with T-NHL
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Serum creatinine of < 1.5 mg/dL, and a measured creatinine clearance of > 60 mL/min
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Patients will be enrolled at collection of at least 3.0 x 10^6 CD34 cells/kg of autologous hematopoietic progenitor cells (HPC-A) by apheresis; a minimum of 2 collection procedures is required, unless collection on day # 1 > 5.0 x 10^6, CD34 cells/kg; a maximum of 10 collections is allowed; bone marrow harvest to supplement apheresis is not allowed
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Recovery from non-hematologic toxicities of salvage cytoreductive chemotherapy to =< grade 2 (Common Terminology Criteria for Adverse Events [CTCAE] version 4 [v4])
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Body mass index (BMI) > 35% will be considered on a case-by-case basis by the Radiation Oncology principal investigator (P.I.)
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All subjects must have the ability to understand and the willingness to sign a written informed consent
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Systemic chemotherapy or radiation cannot have been given within 4 weeks prior to the Y-90 dose of radioimmunotherapy (RIT), with the exception of single agent cyclophosphamide priming chemotherapy administered for mobilization
- Progressive disease
- Patients should not have any uncontrolled illness including ongoing or active infection requiring therapy
- Patients may not be receiving any other investigational agents, or concurrent biological, chemotherapy, or radiation therapy; may have received an experimental agent prior to enrolling in the trial
- History of allergic reactions attributed to compounds of similar chemical or biologic composition to basiliximab
- Pregnant women are excluded from this study; breastfeeding should be discontinued if the mother is treated with indium In 111 (111In-) and 90Y-basiliximab-DOTA
- Prior high dose chemotherapy for autologous hematopoietic cell transplantation or prior allogeneic transplantation
- Significant prior external beam dose-limiting radiation to a critical organ based on review of the prior radiation treatment records by the Radiation Oncology PI; patients who have had prior external beam radiation > 2000 cGy (at 180 to 200 cGy per day) to the lung will be ineligible; patients with ANY prior radiation to the heart are ineligible; patients with > 500 cGy to the kidney will be excluded from the study; Note: patients who have had electron beam therapy are still eligible and will be evaluated on a case by case basis by the Radiation Oncology PI
- Presence of antibody against basiliximab in serum (only required for patients who have received prior antibody)
- Research participants with presence of other active malignancy; however, research participants with history of prior malignancy treated with curative intent and in complete remission are eligible; any history of myelodysplasia is excluded
- Active hepatitis B or C viral infection or hepatitis B surface antigen positive
- Patients with a detectable human immunodeficiency virus (HIV) viral load or who are HIV-positive AND have a resistant genotype
- Patients with psychosocial circumstances or illnesses that preclude protocol participation (to be determined by P.I.)
- Any cytogenetic abnormality in the bone marrow that is known to be associated with or predictive of myelodysplasia is excluded; this includes, but is not limited to, del(5), del(7), del(11)
- Evidence of marrow disease by flow and morphology after upfront or salvage cytoreductive therapy and before stem cell mobilization
- Bone marrow (BM) harvest required to reach adequate cell dose for transplant
- Subjects, who in the opinion of the investigator, may not be able to comply with the safety monitoring requirements of the study
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Treatment (yttrium Y 90 basiliximab, BEAM, AHCT) Yttrium Y 90 Basiliximab Patients receive yttrium Y 90 basiliximab IV on days -21 and -14, carmustine IV over 1-2 hours on days -7 and -6, cytarabine IV BID on days -5 to -2, etoposide IV BID on days -5 to -2, and melphalan IV on day -1. Patients undergo autologous hematopoietic stem cell transplant on day 0. Treatment (yttrium Y 90 basiliximab, BEAM, AHCT) Carmustine Patients receive yttrium Y 90 basiliximab IV on days -21 and -14, carmustine IV over 1-2 hours on days -7 and -6, cytarabine IV BID on days -5 to -2, etoposide IV BID on days -5 to -2, and melphalan IV on day -1. Patients undergo autologous hematopoietic stem cell transplant on day 0. Treatment (yttrium Y 90 basiliximab, BEAM, AHCT) Etoposide Patients receive yttrium Y 90 basiliximab IV on days -21 and -14, carmustine IV over 1-2 hours on days -7 and -6, cytarabine IV BID on days -5 to -2, etoposide IV BID on days -5 to -2, and melphalan IV on day -1. Patients undergo autologous hematopoietic stem cell transplant on day 0. Treatment (yttrium Y 90 basiliximab, BEAM, AHCT) Autologous Hematopoietic Stem Cell Transplantation Patients receive yttrium Y 90 basiliximab IV on days -21 and -14, carmustine IV over 1-2 hours on days -7 and -6, cytarabine IV BID on days -5 to -2, etoposide IV BID on days -5 to -2, and melphalan IV on day -1. Patients undergo autologous hematopoietic stem cell transplant on day 0. Treatment (yttrium Y 90 basiliximab, BEAM, AHCT) Laboratory Biomarker Analysis Patients receive yttrium Y 90 basiliximab IV on days -21 and -14, carmustine IV over 1-2 hours on days -7 and -6, cytarabine IV BID on days -5 to -2, etoposide IV BID on days -5 to -2, and melphalan IV on day -1. Patients undergo autologous hematopoietic stem cell transplant on day 0. Treatment (yttrium Y 90 basiliximab, BEAM, AHCT) Pharmacological Study Patients receive yttrium Y 90 basiliximab IV on days -21 and -14, carmustine IV over 1-2 hours on days -7 and -6, cytarabine IV BID on days -5 to -2, etoposide IV BID on days -5 to -2, and melphalan IV on day -1. Patients undergo autologous hematopoietic stem cell transplant on day 0. Treatment (yttrium Y 90 basiliximab, BEAM, AHCT) Melphalan Patients receive yttrium Y 90 basiliximab IV on days -21 and -14, carmustine IV over 1-2 hours on days -7 and -6, cytarabine IV BID on days -5 to -2, etoposide IV BID on days -5 to -2, and melphalan IV on day -1. Patients undergo autologous hematopoietic stem cell transplant on day 0. Treatment (yttrium Y 90 basiliximab, BEAM, AHCT) Cytarabine Patients receive yttrium Y 90 basiliximab IV on days -21 and -14, carmustine IV over 1-2 hours on days -7 and -6, cytarabine IV BID on days -5 to -2, etoposide IV BID on days -5 to -2, and melphalan IV on day -1. Patients undergo autologous hematopoietic stem cell transplant on day 0.
- Primary Outcome Measures
Name Time Method MTD of yttrium Y 90 basiliximab defined as the highest dose in which fewer than 33% of patients experience dose limiting toxicity attributable to study treatment, among those evaluable for toxicity 30 days post-transplant Dose limiting toxicities will be graded by the Modified Bearman scale.
Incidence of toxicities assessed using National Cancer Institute (NCI) CTCAE version 4.03 Up to 100 days post-transplant Observed toxicities will be summarized by type (organ affected or laboratory determination such as absolute neutrophil count), severity (by NCI CTCAE version 4.03 and nadir or maximum values for lab measures), date of onset, duration, reversibility, and attribution.
- Secondary Outcome Measures
Name Time Method Disease response by Cheson 2007 criteria Up to 2 years post-transplant Engraftment: neutrophil and platelet recovery Up to 2 years post-transplant Overall survival From start of therapy (stem cell infusion) to death from any cause, assessed up to 2 years post-transplant Survival estimates will be calculated using the Kaplan-Meier method.
Progression-free survival From start of therapy (stem cell infusion) to the first observation of disease relapse/progression or death from any cause, assessed up to 2 years post-transplant Survival estimates will be calculated using the Kaplan-Meier method.
Non-relapse mortality From start of therapy until non-disease related death, or last follow-up, whichever comes first, assessed up to 2 years post-transplant The cumulative incidence of relapse/progression and non-relapse mortality will be calculated as competing risks using the Gray method.
Cumulative incidence of relapse/progression From start of therapy (stem cell infusion) to the first observation of disease relapse/progression, assessed up to 2 years post-transplant The cumulative incidence of relapse/progression and non-relapse mortality will be calculated as competing risks using the Gray method.
Absorbed radiation dose to organs assessed by nuclear scan images Up to day -14
Trial Locations
- Locations (1)
City of Hope Medical Center
🇺🇸Duarte, California, United States