A Phase 2 Multicenter Study of High Dose Chemotherapy With Autologous Stem Cell Transplant Followed by Maintenance Therapy With Romidepsin for the Treatment of T Cell Non-Hodgkin Lymphoma
Primary Purpose
T Cell Non-Hodgkin Lymphoma
Status
Active
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
High Dose Chemotherapy with Autologous Stem Cell Transplant Followed by Maintenance Therapy with Romidepsin
Sponsored by
About this trial
This is an interventional treatment trial for T Cell Non-Hodgkin Lymphoma
Eligibility Criteria
Inclusion Criteria:
- Age: Patients over age 16 who are deemed eligible for transplant by their treating physician Disease status: CR or PR required. Remission status will be assessed at the completion of induction chemotherapy and prior to enrollment on protocol.
Diagnosis: The following histologies will need to be confirmed at MSK or locally for participating sites in order to be considered for HDT-ASCT and post-transplant maintenance romidepsin:
- PTCL
- AITL
- ALCL
- EaTCL
- Hepatosplenic Gamma Delta T cell lymphoma
- Adult T-cell leukemia/lymphoma
- Primary cutaneous gamma/delta T-cell lymphoma
- Extranodal NK/T-cell lymphoma, nasal type
- Primary cutaneous anaplastic large cell lymphoma
- Subcutaneous panniculitis-like T-cell lymphoma
- Mycosis fungoides/sezary syndrome Stem cell collection: A minimum of 2 x 106 CD34+ cells must have been collected
Laboratory test results within these ranges:
- Total bilirubin <= 1.5 x ULN
- AST (SGOT) and ALT (SGPT) <= 3 x ULN
Exclusion Criteria:
- Diagnosis: progressive disease at transplant work-up
- Prior therapy: prior autologous or allogeneic transplant
- Active and uncontrolled infection at time of transplantation including active infection with Aspergillus or other mold, or HIV infection
- Inadequate performance status/organ function defined by DLCO < 50% (adjusted for hgb), cardiac function as defined below, KPS < 60%.
- Pregnant or breast feeding. For males and females of child-producing potential, inability to use effective contraceptive methods during the study
- Prior therapy with romidepsin
- Central nervous system or meningeal involvement
Any known cardiac abnormalities such as:
- Congenital long QT syndrome
- QTc interval ≥ 500 milliseconds
- Myocardial infarction within 6 months of transplantation. Subjects with a history of myocardial infarction between 6 and 12 months prior to transplant who are asymptomatic and have had a negative cardiac risk assessment (treadmill stress test, nuclear medicine stress test, or stress echocardiogram) since the event may participate
- Other significant ECG abnormalities including 2nd degree atrio-ventricular (AV) block type II, 3rd degree AV block, or bradycardia (ventricular rate less than 50 beats/min)
- Symptomatic coronary artery disease (CAD), e.g., angina Canadian Class II-IV (see Appendix 1) In any patient in whom there is doubt, the patient should have a stress imaging study and, if abnormal, angiography to define whether or not CAD is present
- An ECG recorded at screening showing evidence of cardiac ischemia (ST depression of ≥2 mm, measured from isoelectric line to the ST segment). If in any doubt, the patient should have a stress imaging study and, if abnormal, angiography to define whether or not CAD is present
- Congestive heart failure (CHF) that meets New York Heart Association (NYHA) Class II to IV definitions (see Appendix 2) and/or ejection fraction <40% by MUGA scan or <50% by echocardiogram and/or MRI
- A known history of sustained ventricular tachycardia (VT), ventricular fibrillation (VF), Torsade de Pointes, or cardiac arrest unless currently addressed with an automatic implantable cardioverter defibrillator (AICD)
- Hypertrophic cardiomegaly or restrictive cardiomyopathy from prior treatment or other causes
- Uncontrolled hypertension, defined as blood pressure (BP) of ≥160/95; patients who have a history of hypertension controlled by medication must be on a stable dose (for at least one month) and meet all other inclusion criteria
- Any cardiac arrhythmia requiring an anti-arrhythmic medication (excluding stable doses of beta-blockers)
- Patients taking drugs leading to significant QT prolongation within the specified wash out period (See Appendix 3: Medications That May Cause QTc Prolongation).
- Concomitant use of CYP3A4 inhibitors
Sites / Locations
- Moffitt Cancer Center
- Memorial Sloan Kettering Cancer Center
- Memorial Sloan Kettering Monmouth
- Memorial Sloan Kettering Cancer Center @ Suffolk
- Memorial Sloan Kettering Westchester
- Memorial Sloan Kettering Cancer Center
- Weill Cornell Medical Center
- Memorial Sloan Kettering Nassau
- Fred Hutchinson Cancer Research Center (Data Collection Only)
- University of Washington (Data Collection Only)
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
high dose chemo w/asct + maintenance txt
Arm Description
High dose chemotherapy (Carmustine), VP-16 (etoposide, Vepesid®), Cytarabine (Ara-C), Melphalan (Alkeran)with autologous stem cell transplant followed by maintenance therapy with Romidepsin (Istodax)
Outcomes
Primary Outcome Measures
The progression-free survival of patients
The progression-free survival of patients with T NHL who receive maintenance romidepsin at 2 years post-transplant for patients transplanted in CR1 or PR1 with standard risk histologies.
Secondary Outcome Measures
Progression Free Survival for patients with high risk histologies
Determine PFS at 2 yrs for patients transplanted in ≥CR/PR2 or for patients with high risk histologies.
Toxicities
Determine the toxicities associated with romidepsin following autologous transplantation. Toxicities will be graded on a scale of 0 to 5 as described by the NCI- Common Terminology for Adverse Events (CTCAE), version 4.0
Probability of OS at 2 years post transplant
Determine the probability of OS at 2 years post transplant for all patients undergoing transplant
OS 1 year after Romidespin completion
OS 1 year after Romidespin completion
PFS 1 year after Romidespin completion
PFS 1 year after Romidespin completion
Full Information
NCT ID
NCT01908777
First Posted
July 17, 2013
Last Updated
June 29, 2023
Sponsor
Memorial Sloan Kettering Cancer Center
Collaborators
University of Washington, Weill Medical College of Cornell University, H. Lee Moffitt Cancer Center and Research Institute
1. Study Identification
Unique Protocol Identification Number
NCT01908777
Brief Title
A Phase 2 Multicenter Study of High Dose Chemotherapy With Autologous Stem Cell Transplant Followed by Maintenance Therapy With Romidepsin for the Treatment of T Cell Non-Hodgkin Lymphoma
Official Title
A Phase 2 Multicenter Study of High Dose Chemotherapy With Autologous Stem Cell Transplant Followed by Maintenance Therapy With Romidepsin for the Treatment of T Cell Non-Hodgkin Lymphoma
Study Type
Interventional
2. Study Status
Record Verification Date
June 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
July 16, 2013 (undefined)
Primary Completion Date
July 2024 (Anticipated)
Study Completion Date
July 2024 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Memorial Sloan Kettering Cancer Center
Collaborators
University of Washington, Weill Medical College of Cornell University, H. Lee Moffitt Cancer Center and Research Institute
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
The purpose of this study is to test the benefit of a chemotherapy drug called romidepsin in patients with T Cell Non-Hodgkin Lymphoma (T NHL) who have undergone autologous transplantation.
Detailed Description
The primary aim is to determine a preliminary estimate of the progression-free survival of patients with T NHL who receive maintenance romidepsin at 2 years post-transplant for patients transplanted in CR1 or PR1 with standard risk histologies.
Secondary aims include:
Determine PFS at 2 yrs for patients transplanted in ≥CR/PR2 or for patients with high risk histologies.
Determine the toxicities associated with romidepsin following autologous transplantation
Determine the probability of OS at 2 years post transplant for all patients undergoing transplant
Characterize the effect of romidepsin on immune recovery post HDT-ASCT
OS and PFS 1 year after Romidespin completion
Patients who receive romidepsin after transplant will be evaluable for the primary endpoint, and will be counted towards the accrual total. Any patient who does not receive romidepsin after transplant, regardless of reason, will be replaced. We will also accrue a second cohort of 8 patients who are transplanted in >CR/PR2 and for high risk histologies to be analyzed for secondary endpoints only. This cohort will not be part of the primary endpoint and will be analyzed for summary statistics only. Patients who receive romidepsin after transplant will be counted towards the accrual total for Cohort 2. Any patient who does not receive romidepsin after transplant, regardless of reason, will be replaced.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
T Cell Non-Hodgkin 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
47 (Actual)
8. Arms, Groups, and Interventions
Arm Title
high dose chemo w/asct + maintenance txt
Arm Type
Experimental
Arm Description
High dose chemotherapy (Carmustine), VP-16 (etoposide, Vepesid®), Cytarabine (Ara-C), Melphalan (Alkeran)with autologous stem cell transplant followed by maintenance therapy with Romidepsin (Istodax)
Intervention Type
Other
Intervention Name(s)
High Dose Chemotherapy with Autologous Stem Cell Transplant Followed by Maintenance Therapy with Romidepsin
Other Intervention Name(s)
Carmustine, VP-16 (etoposide, Vepesid®), Cytarabine (Ara-C), Melphalan (Alkeran), Romidepsin (Istodax)
Primary Outcome Measure Information:
Title
The progression-free survival of patients
Description
The progression-free survival of patients with T NHL who receive maintenance romidepsin at 2 years post-transplant for patients transplanted in CR1 or PR1 with standard risk histologies.
Time Frame
2 Years
Secondary Outcome Measure Information:
Title
Progression Free Survival for patients with high risk histologies
Description
Determine PFS at 2 yrs for patients transplanted in ≥CR/PR2 or for patients with high risk histologies.
Time Frame
2 Years
Title
Toxicities
Description
Determine the toxicities associated with romidepsin following autologous transplantation. Toxicities will be graded on a scale of 0 to 5 as described by the NCI- Common Terminology for Adverse Events (CTCAE), version 4.0
Time Frame
2 years
Title
Probability of OS at 2 years post transplant
Description
Determine the probability of OS at 2 years post transplant for all patients undergoing transplant
Time Frame
2 year post transplant
Title
OS 1 year after Romidespin completion
Description
OS 1 year after Romidespin completion
Time Frame
1 year
Title
PFS 1 year after Romidespin completion
Description
PFS 1 year after Romidespin completion
Time Frame
1 year
10. Eligibility
Sex
All
Minimum Age & Unit of Time
16 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Age: Patients over age 16 who are deemed eligible for transplant by their treating physician Disease status: CR or PR required. Remission status will be assessed at the completion of induction chemotherapy and prior to enrollment on protocol.
Diagnosis: The following histologies will need to be confirmed at MSK or locally for participating sites in order to be considered for HDT-ASCT and post-transplant maintenance romidepsin:
PTCL
AITL
ALCL
EaTCL
Hepatosplenic Gamma Delta T cell lymphoma
Adult T-cell leukemia/lymphoma
Primary cutaneous gamma/delta T-cell lymphoma
Extranodal NK/T-cell lymphoma, nasal type
Primary cutaneous anaplastic large cell lymphoma
Subcutaneous panniculitis-like T-cell lymphoma
Mycosis fungoides/sezary syndrome Stem cell collection: A minimum of 2 x 106 CD34+ cells must have been collected
Laboratory test results within these ranges:
Total bilirubin <= 1.5 x ULN
AST (SGOT) and ALT (SGPT) <= 3 x ULN
Exclusion Criteria:
Diagnosis: progressive disease at transplant work-up
Prior therapy: prior autologous or allogeneic transplant
Active and uncontrolled infection at time of transplantation including active infection with Aspergillus or other mold, or HIV infection
Inadequate performance status/organ function defined by DLCO < 50% (adjusted for hgb), cardiac function as defined below, KPS < 60%.
Pregnant or breast feeding. For males and females of child-producing potential, inability to use effective contraceptive methods during the study
Prior therapy with romidepsin
Central nervous system or meningeal involvement
Any known cardiac abnormalities such as:
Congenital long QT syndrome
QTc interval ≥ 500 milliseconds
Myocardial infarction within 6 months of transplantation. Subjects with a history of myocardial infarction between 6 and 12 months prior to transplant who are asymptomatic and have had a negative cardiac risk assessment (treadmill stress test, nuclear medicine stress test, or stress echocardiogram) since the event may participate
Other significant ECG abnormalities including 2nd degree atrio-ventricular (AV) block type II, 3rd degree AV block, or bradycardia (ventricular rate less than 50 beats/min)
Symptomatic coronary artery disease (CAD), e.g., angina Canadian Class II-IV (see Appendix 1) In any patient in whom there is doubt, the patient should have a stress imaging study and, if abnormal, angiography to define whether or not CAD is present
An ECG recorded at screening showing evidence of cardiac ischemia (ST depression of ≥2 mm, measured from isoelectric line to the ST segment). If in any doubt, the patient should have a stress imaging study and, if abnormal, angiography to define whether or not CAD is present
Congestive heart failure (CHF) that meets New York Heart Association (NYHA) Class II to IV definitions (see Appendix 2) and/or ejection fraction <40% by MUGA scan or <50% by echocardiogram and/or MRI
A known history of sustained ventricular tachycardia (VT), ventricular fibrillation (VF), Torsade de Pointes, or cardiac arrest unless currently addressed with an automatic implantable cardioverter defibrillator (AICD)
Hypertrophic cardiomegaly or restrictive cardiomyopathy from prior treatment or other causes
Uncontrolled hypertension, defined as blood pressure (BP) of ≥160/95; patients who have a history of hypertension controlled by medication must be on a stable dose (for at least one month) and meet all other inclusion criteria
Any cardiac arrhythmia requiring an anti-arrhythmic medication (excluding stable doses of beta-blockers)
Patients taking drugs leading to significant QT prolongation within the specified wash out period (See Appendix 3: Medications That May Cause QTc Prolongation).
Concomitant use of CYP3A4 inhibitors
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Steven Horowitz, MD
Organizational Affiliation
Memorial Sloan Kettering Cancer Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Moffitt Cancer Center
City
Tampa
State/Province
Florida
ZIP/Postal Code
33612
Country
United States
Facility Name
Memorial Sloan Kettering Cancer Center
City
Basking Ridge
State/Province
New Jersey
Country
United States
Facility Name
Memorial Sloan Kettering Monmouth
City
Middletown
State/Province
New Jersey
ZIP/Postal Code
07748
Country
United States
Facility Name
Memorial Sloan Kettering Cancer Center @ Suffolk
City
Commack
State/Province
New York
ZIP/Postal Code
11725
Country
United States
Facility Name
Memorial Sloan Kettering Westchester
City
Harrison
State/Province
New York
ZIP/Postal Code
10604
Country
United States
Facility Name
Memorial Sloan Kettering Cancer Center
City
New York
State/Province
New York
ZIP/Postal Code
11065
Country
United States
Facility Name
Weill Cornell Medical Center
City
New York
State/Province
New York
Country
United States
Facility Name
Memorial Sloan Kettering Nassau
City
Uniondale
State/Province
New York
ZIP/Postal Code
11553
Country
United States
Facility Name
Fred Hutchinson Cancer Research Center (Data Collection Only)
City
Seattle
State/Province
Washington
ZIP/Postal Code
98109
Country
United States
Facility Name
University of Washington (Data Collection Only)
City
Seattle
State/Province
Washington
ZIP/Postal Code
98109
Country
United States
12. IPD Sharing Statement
Links:
URL
http://www.mskcc.org/
Description
Memorial Sloan Kettering Cancer Center
Learn more about this trial
A Phase 2 Multicenter Study of High Dose Chemotherapy With Autologous Stem Cell Transplant Followed by Maintenance Therapy With Romidepsin for the Treatment of T Cell Non-Hodgkin Lymphoma
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