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Radiolabeled Monoclonal Antibody in Treating Patients With Relapsed or Refractory Non-Hodgkin's Lymphoma

Primary Purpose

Lymphoma

Status
Terminated
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
rituximab
yttrium Y 90 ibritumomab tiuxetan
Sponsored by
University of Alabama at Birmingham
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Lymphoma focused on measuring recurrent grade 1 follicular lymphoma, recurrent grade 2 follicular lymphoma, recurrent grade 3 follicular lymphoma, recurrent marginal zone lymphoma, recurrent small lymphocytic lymphoma, extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue, nodal marginal zone B-cell lymphoma, splenic marginal zone lymphoma

Eligibility Criteria

19 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

DISEASE CHARACTERISTICS: Histologically confirmed low-grade, follicular, or transformed CD20-positive B-cell non-Hodgkin's lymphoma (NHL) Relapsed after prior chemotherapy OR chemotherapy-resistant disease Failed at least 1 prior chemotherapy regimen CD20-positive B-cell population in lymph nodes or bone marrow for International Working Formulation A (small lymphocytic lymphoma) and transformed NHL Bone marrow involvement with lymphoma less than 25% bilaterally No impaired bone marrow reserve defined as at least 1 of the following criteria: Prior myeloablative therapies with bone marrow transplantation or peripheral blood stem cell rescue Platelet count less than 100,000/mm3 Bone marrow cellularity no greater than 15% Marked reduction in bone marrow precursors of one or more cell lines (e.g., granulocytic, megakaryocytic, or erythroid) Failed prior stem cell collection No CNS lymphoma, chronic lymphocytic lymphoma, or HIV or AIDS-related lymphoma No diffuse small lymphocytic/marginal zone lymphoma with lymphocyte count greater than 5,000/mm^3 No pleural effusion NOTE: A new classification scheme for adult non-Hodgkin's lymphoma has been adopted by PDQ. The terminology of "indolent" or "aggressive" lymphoma will replace the former terminology of "low", "intermediate", or "high" grade lymphoma. However, this protocol uses the former terminology. PATIENT CHARACTERISTICS: Age: 19 and over Performance status: WHO 0-2 Life expectancy: At least 6 months Hematopoietic: See Disease Characteristics Absolute neutrophil count at least 1,500/mm^3 Platelet count at least 100,000/mm^3 Hematocrit greater than 30% Hemoglobin greater than 9.0 g/dL Hepatic: Bilirubin no greater than 1.5 mg/dL Renal: Creatinine no greater than 1.5 mg/dL Other: Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception during and for 6 months after study participation No anti-murine antibody reactivity if prior exposure to murine antibodies or proteins No other primary malignancy No other serious nonmalignant disease or infection that would preclude study participation PRIOR CONCURRENT THERAPY: Biologic therapy: See Disease Characteristics No prior radioimmunotherapy Prior rituximab allowed if more than 6 months to progression after an objective response At least 6 weeks since prior rituximab At least 3 weeks since prior filgrastim (G-CSF) or sargramostim (GM-CSF) Recovered from prior immunotherapy Chemotherapy: See Disease Characteristics No prior fludarabine At least 3 weeks since prior anticancer chemotherapy (6 weeks for nitrosoureas or mitomycin) and recovered No concurrent chemotherapy Endocrine therapy: At least 3 weeks since prior anticancer endocrine therapy No concurrent high-dose systemic corticosteroids (e.g., 50 mg or more of prednisone as a single dose or 50 mg or less of prednisone for more than 6 doses) Radiotherapy: No prior radiotherapy to more than 25% of active bone marrow (involved field or regional) At least 3 weeks since prior anticancer radiotherapy and recovered Surgery: At least 4 weeks since prior surgery (except diagnostic surgery) and recovered Other: No other concurrent anticancer therapy Concurrent oral anticoagulant therapy allowed if platelet count is at least 30,000/mm3

Sites / Locations

  • Lurleen Wallace Comprehensive Cancer at University of Alabama-Birmingham
  • Stanford Comprehensive Cancer Center - Stanford
  • Mayo Clinic Cancer Center

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm Type

Experimental

Experimental

Experimental

Experimental

Experimental

Arm Label

Cohort 1

Cohort II

Cohort III

Cohort IV

Cohort V

Arm Description

First radiation dose regimen of yttrium Y 90 ibritumomab tiuxetan

Second radiation dose regimen of yttrium Y 90 ibritumomab tiuxetan

Third radiation dose regimen of yttrium Y 90 ibritumomab tiuxetan

Fourth radiation dose regimen of yttrium Y 90 ibritumomab tiuxetan

MTD radiation dose regimen of yttrium Y 90 ibritumomab tiuxetan

Outcomes

Primary Outcome Measures

Determine the maximum tolerated dose of yttrium Y 90 ibritumomab tiuxetan when administered in combination with rituximab in patients with relapsed or refractory low-grade, follicular, or transformed CD20-positive B-cell non-Hodgkin's lymphoma (NHL).

Secondary Outcome Measures

Determine the toxicity of different doses of yttrium Y 90 ibritumomab tiuxetan in patients treated with this regimen
Determine the frequency of reversal of bone marrow involvement with NHL in patients treated with this regimen.
Determine the antitumor response in patients treated with this regimen.

Full Information

First Posted
April 9, 2002
Last Updated
December 12, 2013
Sponsor
University of Alabama at Birmingham
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00033423
Brief Title
Radiolabeled Monoclonal Antibody in Treating Patients With Relapsed or Refractory Non-Hodgkin's Lymphoma
Official Title
Phase I, Multicenter, Open Label, Dose Escalation Of 90Y-Zevalin Radioimmunotherapy Using A Modified Treatment Regimen For Relapsed Or Refractory CD20+ B-Cell (Follicular/Transformed) Non-Hodgkin's Lymphoma
Study Type
Interventional

2. Study Status

Record Verification Date
December 2013
Overall Recruitment Status
Terminated
Study Start Date
August 2001 (undefined)
Primary Completion Date
May 2009 (Actual)
Study Completion Date
May 2009 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Alabama at Birmingham
Collaborators
National Cancer Institute (NCI)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
RATIONALE: Monoclonal antibodies can locate tumor cells and either kill them or deliver tumor-killing substances to them without harming normal cells. PURPOSE: Phase I trial to study the effectiveness of radiolabeled monoclonal antibody in treating patients who have relapsed or refractory non-Hodgkin's lymphoma.
Detailed Description
OBJECTIVES: Determine the maximum tolerated dose of yttrium Y 90 ibritumomab tiuxetan when administered in combination with rituximab in patients with relapsed or refractory low-grade, follicular, or transformed CD20-positive B-cell non-Hodgkin's lymphoma (NHL). Determine the toxicity of different doses of yttrium Y 90 ibritumomab tiuxetan in patients treated with this regimen. Determine the frequency of reversal of bone marrow involvement with NHL in patients treated with this regimen. Determine the antitumor response in patients treated with this regimen. OUTLINE: This is a multicenter, dose-escalation study of yttrium Y 90 ibritumomab tiuxetan. Patients receive rituximab IV once weekly on weeks 1-4. After 4 doses of rituximab, patients without bone marrow involvement and cellularity greater than 50% expected receive rituximab IV once weekly on weeks 6 and 7 and yttrium Y 90 ibritumomab tiuxetan IV over 10 minutes with the final dose of rituximab (day 43). Cohorts of 5-6 patients receive escalating dose of yttrium Y 90 ibritumomab tiuxetan until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 4 of 5 or 3 of 6 patients experience dose-limiting toxicity. Patients are followed at 6 and 12 weeks, every 2-3 months for 2 years, and then every 6 months for 2 years. PROJECTED ACCRUAL: Approximately 6-30 patients will be accrued for this study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Lymphoma
Keywords
recurrent grade 1 follicular lymphoma, recurrent grade 2 follicular lymphoma, recurrent grade 3 follicular lymphoma, recurrent marginal zone lymphoma, recurrent small lymphocytic lymphoma, extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue, nodal marginal zone B-cell lymphoma, splenic marginal zone lymphoma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
18 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Cohort 1
Arm Type
Experimental
Arm Description
First radiation dose regimen of yttrium Y 90 ibritumomab tiuxetan
Arm Title
Cohort II
Arm Type
Experimental
Arm Description
Second radiation dose regimen of yttrium Y 90 ibritumomab tiuxetan
Arm Title
Cohort III
Arm Type
Experimental
Arm Description
Third radiation dose regimen of yttrium Y 90 ibritumomab tiuxetan
Arm Title
Cohort IV
Arm Type
Experimental
Arm Description
Fourth radiation dose regimen of yttrium Y 90 ibritumomab tiuxetan
Arm Title
Cohort V
Arm Type
Experimental
Arm Description
MTD radiation dose regimen of yttrium Y 90 ibritumomab tiuxetan
Intervention Type
Biological
Intervention Name(s)
rituximab
Intervention Type
Radiation
Intervention Name(s)
yttrium Y 90 ibritumomab tiuxetan
Primary Outcome Measure Information:
Title
Determine the maximum tolerated dose of yttrium Y 90 ibritumomab tiuxetan when administered in combination with rituximab in patients with relapsed or refractory low-grade, follicular, or transformed CD20-positive B-cell non-Hodgkin's lymphoma (NHL).
Time Frame
baseline through 4 years
Secondary Outcome Measure Information:
Title
Determine the toxicity of different doses of yttrium Y 90 ibritumomab tiuxetan in patients treated with this regimen
Time Frame
baseline through 4 years
Title
Determine the frequency of reversal of bone marrow involvement with NHL in patients treated with this regimen.
Time Frame
baseline through 4 years
Title
Determine the antitumor response in patients treated with this regimen.
Time Frame
baseline through 4 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
19 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically confirmed low-grade, follicular, or transformed CD20-positive B-cell non-Hodgkin's lymphoma (NHL) Relapsed after prior chemotherapy OR chemotherapy-resistant disease Failed at least 1 prior chemotherapy regimen CD20-positive B-cell population in lymph nodes or bone marrow for International Working Formulation A (small lymphocytic lymphoma) and transformed NHL Bone marrow involvement with lymphoma less than 25% bilaterally No impaired bone marrow reserve defined as at least 1 of the following criteria: Prior myeloablative therapies with bone marrow transplantation or peripheral blood stem cell rescue Platelet count less than 100,000/mm3 Bone marrow cellularity no greater than 15% Marked reduction in bone marrow precursors of one or more cell lines (e.g., granulocytic, megakaryocytic, or erythroid) Failed prior stem cell collection No CNS lymphoma, chronic lymphocytic lymphoma, or HIV or AIDS-related lymphoma No diffuse small lymphocytic/marginal zone lymphoma with lymphocyte count greater than 5,000/mm^3 No pleural effusion NOTE: A new classification scheme for adult non-Hodgkin's lymphoma has been adopted by PDQ. The terminology of "indolent" or "aggressive" lymphoma will replace the former terminology of "low", "intermediate", or "high" grade lymphoma. However, this protocol uses the former terminology. PATIENT CHARACTERISTICS: Age: 19 and over Performance status: WHO 0-2 Life expectancy: At least 6 months Hematopoietic: See Disease Characteristics Absolute neutrophil count at least 1,500/mm^3 Platelet count at least 100,000/mm^3 Hematocrit greater than 30% Hemoglobin greater than 9.0 g/dL Hepatic: Bilirubin no greater than 1.5 mg/dL Renal: Creatinine no greater than 1.5 mg/dL Other: Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception during and for 6 months after study participation No anti-murine antibody reactivity if prior exposure to murine antibodies or proteins No other primary malignancy No other serious nonmalignant disease or infection that would preclude study participation PRIOR CONCURRENT THERAPY: Biologic therapy: See Disease Characteristics No prior radioimmunotherapy Prior rituximab allowed if more than 6 months to progression after an objective response At least 6 weeks since prior rituximab At least 3 weeks since prior filgrastim (G-CSF) or sargramostim (GM-CSF) Recovered from prior immunotherapy Chemotherapy: See Disease Characteristics No prior fludarabine At least 3 weeks since prior anticancer chemotherapy (6 weeks for nitrosoureas or mitomycin) and recovered No concurrent chemotherapy Endocrine therapy: At least 3 weeks since prior anticancer endocrine therapy No concurrent high-dose systemic corticosteroids (e.g., 50 mg or more of prednisone as a single dose or 50 mg or less of prednisone for more than 6 doses) Radiotherapy: No prior radiotherapy to more than 25% of active bone marrow (involved field or regional) At least 3 weeks since prior anticancer radiotherapy and recovered Surgery: At least 4 weeks since prior surgery (except diagnostic surgery) and recovered Other: No other concurrent anticancer therapy Concurrent oral anticoagulant therapy allowed if platelet count is at least 30,000/mm3
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Andres Forero-Torres, MD, CSU
Organizational Affiliation
University of Alabama at Birmingham
Official's Role
Study Chair
Facility Information:
Facility Name
Lurleen Wallace Comprehensive Cancer at University of Alabama-Birmingham
City
Birmingham
State/Province
Alabama
ZIP/Postal Code
35294
Country
United States
Facility Name
Stanford Comprehensive Cancer Center - Stanford
City
Stanford
State/Province
California
ZIP/Postal Code
94305
Country
United States
Facility Name
Mayo Clinic Cancer Center
City
Rochester
State/Province
Minnesota
ZIP/Postal Code
55905
Country
United States

12. IPD Sharing Statement

Citations:
Citation
Forero-Torres A, Besh S, Knox S, et al.: Higher doses of Rituxan alter pharmacokinetics and biodistribution of Zevalin but may increase responses; a preliminary report of a phase I study of Zevalin using a modified treatment regimen for relapsed or refractory CD20+ B-Cell follicular/transformed non-Hodgkins lymphoma. [Abstract] Blood 102 (11 Pt 1): A-1483, 2003.
Results Reference
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Radiolabeled Monoclonal Antibody in Treating Patients With Relapsed or Refractory Non-Hodgkin's Lymphoma

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