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Bendamustine, Cytarabine, Etoposide and Melphalan (BeEAM) as Conditioning for Autologous Stem Cell Transplant (ASCT) in Aggressive Non Hodgkin's Lymphoma (NHL). (BeEAM2010-01)

Primary Purpose

Bendamustine, Conditioning Therapy, Autologous Stem Cell Transplant

Status
Completed
Phase
Phase 2
Locations
Spain
Study Type
Interventional
Intervention
Bendamustine-EAM
Sponsored by
Grupo Español de Linfomas y Transplante Autólogo de Médula Ósea
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Bendamustine focused on measuring Bendamustine, Conditioning Therapy, Autologous Stem Cell Transplant, Aggressive Non Hodgkin's Lymphoma

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Patients being able to meet all requirements of the clinical trial, according to the investigator's criteria,
  2. Patient giving voluntarily written informed consent before performing any essay test that is not part of routine care of patients.
  3. Age >o=18 years and >0=70 years
  4. Candidate for chemotherapy (QT) at high doses and ASCT

    1. Histologically confirmed aNHL:
    2. Patients with DLBCL or grade 3 b Follicular lymphoma or PTCL (including anaplastic ALK +) in sensitive relapse, so, in second complete or partial response, after a minimum of 2 cycles of the rescue regimen.
    3. Patients with DLBCL or grade 3 b Follicular lymphoma or PTCL (including anaplastic ALK +) in first complete or partial response, if more than one treatment line have been required to reach this first complete or partial response.
    4. Transformed B cell lymphoma in first CR
    5. Patients with PTCL (other than anaplastic ALK +) in first CR
  5. Performance status (ECOG) <0=2.
  6. Adequate renal, hepatic, and bone marrow function (assessed < 14 days before initiation of the study treatment):

    1. Neutrophil count <o=1.5 x 109/L
    2. Platelet count <o=100 x 109/L
    3. Haemoglobin <o=8.0 g/dL
    4. Creatinine serum >o=1,5 x ULN mg/dl
    5. Serum bilirubin <o=1.5 x ULN and alkaline phosphatase <o=2.5 x ULN
    6. AST, ALT <o=2.5 x ULN (<o=5 x ULN in case of liver metastasis).
  7. Adequate pulmonary function: forced expiratory volume at 1 second > 65% of predicted or a diffusing capacity of the lung for CO >o=50%.
  8. Cardiac ejection fraction or greater than 50% by echocardiogram or FEVI.
  9. A woman capable of gestation (see definition below) should:

    • Have two medically supervised negative pregnancy test (minimum sensitivity of 25 mIU / ml) before starting study therapy (the first pregnancy test should be completed in 10 to 14 days prior to initiating bendamustine and the latter pregnancy test 24 hours before the start of this drug).
    • Commit to a continued abstinence of heterosexual relationship or agree to use reliable contraception without interruption, 28 days before starting the study therapy, during the study therapy and for 28 days after stopping therapy study.

A woman capable of gestation is defined as sexually mature woman who:

  1. has not undergone hysterectomy or bilateral oophorectomy and
  2. is not naturally postmenopausal (amenorrhea as a result of cancer treatment does not rule the reproductive potential) for at least 24 consecutive months (i.e., menses at any time during the previous 24 consecutive months).

Exclusion Criteria:

  1. Impossibility of collecting, via apheresis, a number of CD34+ cells >o=2 x 106/kg
  2. To receive any of the following treatments in the 28 days before the start the study treatment:

    i.chemotherapeutic or antitumor agents ii.radiation therapy, except in limited fields, to a maximum dose of <o=10 Gy to control serious life-threatening symptoms iii.glucocorticoids, except doses equivalent to <o=1 mg / kg of prednisolone / day with a duration <o=7 days iv.any therapeutic agent under investigation.

  3. Known involvement of the central nervous system (CNS) by lymphoma
  4. Abnormalities in cardiac function or clinically significant heart disease such as acute myocardial infarction or unstable angina within 6 months prior to the start of study treatment, heart failure NYHA class III or IV, uncontrolled hypertension or a history of antihypertensive treatment poor compliance, uncontrolled arrhythmias with treatment, except extrasystoles or minor conduction disorders.
  5. Other serious or uncontrolled medical condition, such as uncontrolled diabetes, uncontrolled active infection, significant cerebrovascular disease or poorly controlled psychiatric disease.
  6. Known or suspected hypersensitivity to any of the agents or excipients of the regime under evaluation.
  7. Presence of any limitations that compromise the patient's ability to comply with the study treatment.
  8. Positive serology for HIV, HCV or HBV surface antigen (HBsAg). If the HBsAg is negative but anti-core antibodies (HBcAb) are positive and antibody against surface antigen (HBsAb) are negative, there will be a HBV DNA test; If positive results the patient may not be included in the trial. If both types of antibodies HBcAb and HBsAb are positive (indicative of past infection), the patient may be included in the study.
  9. Previous history of malignancies other than lymphoma (except basal cell or squamous cell skin carcinoma and carcinoma in situ of the cervix or breast) unless the patient is free of disease beyond 5 years.
  10. Major surgery procedure within 30 days prior to entering this study.
  11. Pregnant or nursing females.

Sites / Locations

  • Complejo Hospitalario Universitario de Santiago
  • Hospital Central de Asturias
  • Hospital de Jerez
  • Hospital Son Llátzer
  • Hospital Universitario Virgen de Arrixaca
  • Clinica Universitaria de Navarra
  • Hospital Universitario de Canarias
  • Hospital Vall d´Hebron
  • Hospital Clinic i Provincial
  • H. de la Santa Creu i Sant Pau
  • H.U. 12 de Octubre,
  • H.U. Gregorio Marañón,
  • H.U. La Paz
  • H.U. La Princesa
  • Hospital Ramon y Cajal
  • H. Clínico Universitario de Salamanca
  • H. U. Marqués de Valdecilla.
  • Hospital Clinico de Valencia
  • Hospital Arnau de Vilanova
  • H. La Fe
  • Hospital Clínico Lozano Blesa

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Bendamustine-EAM

Arm Description

Outcomes

Primary Outcome Measures

Evaluate the progression free survival using techniques of image (PET and TC)of Bendamustine in combination with Etoposide, Cytarabine and Melphalan (BeEAM) as conditioning followed by ASCT in patients with aggressive lymphoma.

Secondary Outcome Measures

Evaluate safety BeEAM chemotherapy followed of reinfusion of autologous hematopoietic stem cells by considering the incidence of adverse event (with CTCAE).Evaluate % patients in CR.Evaluate response of ASCT using PET, TC.Evaluate overall survival

Full Information

First Posted
February 13, 2011
Last Updated
February 15, 2016
Sponsor
Grupo Español de Linfomas y Transplante Autólogo de Médula Ósea
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1. Study Identification

Unique Protocol Identification Number
NCT01296256
Brief Title
Bendamustine, Cytarabine, Etoposide and Melphalan (BeEAM) as Conditioning for Autologous Stem Cell Transplant (ASCT) in Aggressive Non Hodgkin's Lymphoma (NHL).
Acronym
BeEAM2010-01
Official Title
Bendamustine, Cytarabine, Etoposide and Melphalan as Conditioning for Autologous Stem Cell Transplant in Patients With Aggressive Non Hodgkin's Lymphoma.
Study Type
Interventional

2. Study Status

Record Verification Date
February 2016
Overall Recruitment Status
Completed
Study Start Date
May 2011 (undefined)
Primary Completion Date
November 2015 (Actual)
Study Completion Date
November 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Grupo Español de Linfomas y Transplante Autólogo de Médula Ósea

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of this study is to determine whether Bendamustine in combination with Etoposide, Cytarabine and Melphalan (BeEAM) are effective as conditioning followed by ASCT in patients with aggressive lymphoma.
Detailed Description
BCNU (carmustine is a nitrosurea alkylating agent used for many years in the conditioning of patients with lymphoma however this drug is hardly available in some countries in Europe, moreover to improve conditioning regimens in autologous stem cell transplant is important because the anti-tumoral effect of high dose therapy are responsible for this procedure efficacy. Although for many years few advances have been achieved in this area now new drugs can be tested in these patients. Bendamustine is a unique cytotoxic agent with structural similarities to alkylating agents and antimetabolites, but which is non-cross-resistant with alkylating agents and other drugs in vitro and in the clinic. Early clinical studies conducted in the German Democratic Republic more than 30 years ago suggested promising activity in indolent non-Hodgkin's lymphoma (NHL). Two North American trials reported responses in more than 70% of patients with chemotherapy- and rituximab-refractory disease, suggesting that bendamustine may be the most effective drug available for this patient population. Response rates of 90% to 92%, with complete remission in 55% to 60%, have been reported in patients with follicular and mantle-cell lymphoma with the combination of bendamustine and rituximab.(Cheson 2009) Leone et all have recently reported results on the characterization of the mechanisms of action of bendamustine and its comparison with structurally related compounds as chlorambucil and phosphoramide mustard have demonstrated that bendamustine displays a distinct mechanisms of action including activation of DNA-damage stress response and apoptosis, inhibition of mitotic checkpoints, and induction of mitotic catastrophe. Also bendamustine activates a base excision DNA repair pathway rather than an alkyltransferase DNA repair mechanism. These data suggest that bendamustine possesses mechanistic features that differentiate it from other alkylating agents and makes this old new drug an attractive one to combine with other agents in the conditioning transplant setting (Leone 2008).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Bendamustine, Conditioning Therapy, Autologous Stem Cell Transplant, Aggressive Non Hodgkin's Lymphoma
Keywords
Bendamustine, Conditioning Therapy, Autologous Stem Cell Transplant, Aggressive Non Hodgkin's Lymphoma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
60 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Bendamustine-EAM
Arm Type
Experimental
Intervention Type
Drug
Intervention Name(s)
Bendamustine-EAM
Intervention Description
Bendamustine 200 mg/m2 starting dose on day -7 and -6 Etoposide 200 mg/m2 from day -5 to day -2 Ara-C 400 mg/m2 from day -5 to day -2 Melphalan 140 mg/m2 on day -1
Primary Outcome Measure Information:
Title
Evaluate the progression free survival using techniques of image (PET and TC)of Bendamustine in combination with Etoposide, Cytarabine and Melphalan (BeEAM) as conditioning followed by ASCT in patients with aggressive lymphoma.
Time Frame
18 months follow-up
Secondary Outcome Measure Information:
Title
Evaluate safety BeEAM chemotherapy followed of reinfusion of autologous hematopoietic stem cells by considering the incidence of adverse event (with CTCAE).Evaluate % patients in CR.Evaluate response of ASCT using PET, TC.Evaluate overall survival
Time Frame
18 months follow-up

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients being able to meet all requirements of the clinical trial, according to the investigator's criteria, Patient giving voluntarily written informed consent before performing any essay test that is not part of routine care of patients. Age >o=18 years and >0=70 years Candidate for chemotherapy (QT) at high doses and ASCT Histologically confirmed aNHL: Patients with DLBCL or grade 3 b Follicular lymphoma or PTCL (including anaplastic ALK +) in sensitive relapse, so, in second complete or partial response, after a minimum of 2 cycles of the rescue regimen. Patients with DLBCL or grade 3 b Follicular lymphoma or PTCL (including anaplastic ALK +) in first complete or partial response, if more than one treatment line have been required to reach this first complete or partial response. Transformed B cell lymphoma in first CR Patients with PTCL (other than anaplastic ALK +) in first CR Performance status (ECOG) <0=2. Adequate renal, hepatic, and bone marrow function (assessed < 14 days before initiation of the study treatment): Neutrophil count <o=1.5 x 109/L Platelet count <o=100 x 109/L Haemoglobin <o=8.0 g/dL Creatinine serum >o=1,5 x ULN mg/dl Serum bilirubin <o=1.5 x ULN and alkaline phosphatase <o=2.5 x ULN AST, ALT <o=2.5 x ULN (<o=5 x ULN in case of liver metastasis). Adequate pulmonary function: forced expiratory volume at 1 second > 65% of predicted or a diffusing capacity of the lung for CO >o=50%. Cardiac ejection fraction or greater than 50% by echocardiogram or FEVI. A woman capable of gestation (see definition below) should: Have two medically supervised negative pregnancy test (minimum sensitivity of 25 mIU / ml) before starting study therapy (the first pregnancy test should be completed in 10 to 14 days prior to initiating bendamustine and the latter pregnancy test 24 hours before the start of this drug). Commit to a continued abstinence of heterosexual relationship or agree to use reliable contraception without interruption, 28 days before starting the study therapy, during the study therapy and for 28 days after stopping therapy study. A woman capable of gestation is defined as sexually mature woman who: has not undergone hysterectomy or bilateral oophorectomy and is not naturally postmenopausal (amenorrhea as a result of cancer treatment does not rule the reproductive potential) for at least 24 consecutive months (i.e., menses at any time during the previous 24 consecutive months). Exclusion Criteria: Impossibility of collecting, via apheresis, a number of CD34+ cells >o=2 x 106/kg To receive any of the following treatments in the 28 days before the start the study treatment: i.chemotherapeutic or antitumor agents ii.radiation therapy, except in limited fields, to a maximum dose of <o=10 Gy to control serious life-threatening symptoms iii.glucocorticoids, except doses equivalent to <o=1 mg / kg of prednisolone / day with a duration <o=7 days iv.any therapeutic agent under investigation. Known involvement of the central nervous system (CNS) by lymphoma Abnormalities in cardiac function or clinically significant heart disease such as acute myocardial infarction or unstable angina within 6 months prior to the start of study treatment, heart failure NYHA class III or IV, uncontrolled hypertension or a history of antihypertensive treatment poor compliance, uncontrolled arrhythmias with treatment, except extrasystoles or minor conduction disorders. Other serious or uncontrolled medical condition, such as uncontrolled diabetes, uncontrolled active infection, significant cerebrovascular disease or poorly controlled psychiatric disease. Known or suspected hypersensitivity to any of the agents or excipients of the regime under evaluation. Presence of any limitations that compromise the patient's ability to comply with the study treatment. Positive serology for HIV, HCV or HBV surface antigen (HBsAg). If the HBsAg is negative but anti-core antibodies (HBcAb) are positive and antibody against surface antigen (HBsAb) are negative, there will be a HBV DNA test; If positive results the patient may not be included in the trial. If both types of antibodies HBcAb and HBsAb are positive (indicative of past infection), the patient may be included in the study. Previous history of malignancies other than lymphoma (except basal cell or squamous cell skin carcinoma and carcinoma in situ of the cervix or breast) unless the patient is free of disease beyond 5 years. Major surgery procedure within 30 days prior to entering this study. Pregnant or nursing females.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Mª Dolores Caballero, MD
Organizational Affiliation
University of Salamanca
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Alejandro Martín, MD
Organizational Affiliation
University of Salamanca
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Javier Briones, MD
Organizational Affiliation
Hospital Santa Creu i Sant Pau
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Juan Manuel Sancho, MD
Organizational Affiliation
Germans Trias i Pujol Hospital
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Cristina Barrenetxea, MD
Organizational Affiliation
Hospital Vall d'Hebrón
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Javier López, MD
Organizational Affiliation
Hospital Universitario Ramon y Cajal
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Mª José Rodríguez, MD
Organizational Affiliation
Hospital Universitario de Canarias
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Jorge Gayoso, MD
Organizational Affiliation
Gregorio Marañón Hospital
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Miguel Ángel Canales, MD
Organizational Affiliation
Hospital Universitario La Paz
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Carlos Grande, MD
Organizational Affiliation
Hospital Universitario 12 de Octubre
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Isidro Jarque, MD
Organizational Affiliation
Hospital La Fe
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
José Rifón, MD
Organizational Affiliation
Clínica Universitaria Navarra
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Andres Sánchez, MD
Organizational Affiliation
Hospital Virgen de la Arrixaca
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Cristina Castilla, MD
Organizational Affiliation
Hospital Morales Meseguer
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
José Luis Bello, MD
Organizational Affiliation
Complejo Hospitalario Universitario de Santiago de Compostela
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Armando López, MD
Organizational Affiliation
Hospial Clínic de Barcelona
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Eulogio Conde, MD
Organizational Affiliation
Hospital Marqués de Valdecilla
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Reyes Arranz, MD
Organizational Affiliation
Hospital La Princesa
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Encarnación Monzó, MD
Organizational Affiliation
Hospital Arnau de Vilanova de Valencia
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Rosario Varela, MD
Organizational Affiliation
Complejo Hospitalario Universitario de A Coruña
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Mª José Ramírez, MD
Organizational Affiliation
Hospital Jerez de la Frontera
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Fátima de la Cruz, MD
Organizational Affiliation
Hospital Virgen del Rocío
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Ana Pilar González, MD
Organizational Affiliation
Hospital Central de Asturias
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Luis Palomera, MD
Organizational Affiliation
Hospital Clínico de Zaragoza "Lozano Blesa"
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Raquel del Campo, MD
Organizational Affiliation
Hospital Son Llátzer
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Mª José Terol, MD
Organizational Affiliation
Hospital Clínico de Valencia
Official's Role
Principal Investigator
Facility Information:
Facility Name
Complejo Hospitalario Universitario de Santiago
City
Santiago
State/Province
A Coruña
ZIP/Postal Code
15706
Country
Spain
Facility Name
Hospital Central de Asturias
City
Oviedo
State/Province
Asturias
ZIP/Postal Code
33006
Country
Spain
Facility Name
Hospital de Jerez
City
Jerez de la Frontera
State/Province
Cádiz
ZIP/Postal Code
11407
Country
Spain
Facility Name
Hospital Son Llátzer
City
Palma de Mallorca
State/Province
Mallorca
ZIP/Postal Code
07198
Country
Spain
Facility Name
Hospital Universitario Virgen de Arrixaca
City
El Palmar
State/Province
Murcia
ZIP/Postal Code
30120
Country
Spain
Facility Name
Clinica Universitaria de Navarra
City
Pamplona
State/Province
Navarra
Country
Spain
Facility Name
Hospital Universitario de Canarias
City
Santa Cruz de Tenerife
State/Province
Tenerife
Country
Spain
Facility Name
Hospital Vall d´Hebron
City
Barcelona
ZIP/Postal Code
08035
Country
Spain
Facility Name
Hospital Clinic i Provincial
City
Barcelona
ZIP/Postal Code
08036
Country
Spain
Facility Name
H. de la Santa Creu i Sant Pau
City
Barcelona
Country
Spain
Facility Name
H.U. 12 de Octubre,
City
Madrid
Country
Spain
Facility Name
H.U. Gregorio Marañón,
City
Madrid
Country
Spain
Facility Name
H.U. La Paz
City
Madrid
Country
Spain
Facility Name
H.U. La Princesa
City
Madrid
Country
Spain
Facility Name
Hospital Ramon y Cajal
City
Madrid
Country
Spain
Facility Name
H. Clínico Universitario de Salamanca
City
Salamanca
Country
Spain
Facility Name
H. U. Marqués de Valdecilla.
City
Santander
Country
Spain
Facility Name
Hospital Clinico de Valencia
City
Valencia
ZIP/Postal Code
46010
Country
Spain
Facility Name
Hospital Arnau de Vilanova
City
Valencia
ZIP/Postal Code
46015
Country
Spain
Facility Name
H. La Fe
City
Valencia
Country
Spain
Facility Name
Hospital Clínico Lozano Blesa
City
Zaragoza
ZIP/Postal Code
50009
Country
Spain

12. IPD Sharing Statement

Learn more about this trial

Bendamustine, Cytarabine, Etoposide and Melphalan (BeEAM) as Conditioning for Autologous Stem Cell Transplant (ASCT) in Aggressive Non Hodgkin's Lymphoma (NHL).

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