Rituximab, Ifosfamide, Carboplatin, and Etoposide (RICE) Followed by Gallium Nitrate, Rituximab and Dexamethasone (GARD) for Relapsed or Refractory Diffuse Large B-Cell Lymphoma
Diffuse Large B-cell Lymphoma
About this trial
This is an interventional treatment trial for Diffuse Large B-cell Lymphoma focused on measuring CARBOPLATIN, DEXAMETHASONE, DIFFUSE LARGE B-CELL LYMPHOMA, ETOPOSIDE, GALLIUM NITRATE, IFOSFAMIDE, PHASE II, RELAPSED OR REFRACTORY, RITUXIMAB
Eligibility Criteria
Inclusion Criteria:
- Must have histologically or cytologically confirmed diffuse, large B-cell lymphoma (WHO classification diffuse large B-cell lymphoma or mediastinal large B-cell lymphoma), immunoblastic B cell lymphoma or Burkitts lymphoma. Transformed, large B-cell lymphoma will be excluded.
- Must have measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) as >10 mm with spiral CT scan.
- Must be refractory to initial therapy or have disease relapse from prior therapy and must be at least 3 weeks post treatment from prior chemotherapy or radiation therapy.
- Age >18 years.
- Life expectancy >24 weeks
- SWOG performance status <1 (Karnofsky >80%).
Must have normal organ function (or impaired marrow function) as defined below:
- leukocytes > or equal to 1,500/mcL
- absolute neutrophil count >or equal to 1,000/mcL
- platelets >or equal to 50,000/mcL
- total bilirubin within normal institutional limits
- AST(SGOT)/ALT(SGPT)<or equal to 2.5 X institutional upper limit of normal unless due to lymphoma involvement
- creatinine clearance > than or equal to 60 mL/min
- Must agree not to become pregnant for the duration of study participation.
- Ability to understand and the willingness to sign a written informed consent document.
Exclusion Criteria:
- Patients who have had chemotherapy or radiotherapy within 3 weeks (6 weeks for nitrosoureas or mitomycin C) prior to entering the study.
- Follicular B-cell lymphomas, small lymphocytic lymphomas, chronic lymphocytic leukemia, lymphoblastic lymphomas and all T-cell lymphomas.
- Patients may not be receiving any other investigational agents, within trials in the previous 4 weeks.
- Patients with known CNS metastases are excluded from this clinical trial.
- History of allergic reactions attributed to compounds of similar chemical or biologic composition to gallium nitrate, rituximab, dexamethasone, ifosfamide, carboplatin, and/or etoposide.
- Prior therapy with gallium nitrate, ifosfamide, carboplatin and/or etoposide
- Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
- Pregnant and women who are nursing are excluded from this study.
- Because patients with immune deficiency are at increased risk of lethal infections when treated with marrow-suppressive therapy, HIV-positive patients receiving combination anti-retroviral therapy are excluded from the study because of possible pharmacokinetic interactions with RICE and/or GaRD.
Sites / Locations
- Loyola Univeristy Medical Center, Cardinal Bernardin Cancer Center
Arms of the Study
Arm 1
Experimental
RICE followed by GARD
RICE treatment: Rituximab by intravenous infusion over 6-8 hours on day 1, Eptoposide by intravenous infusion over 2 hours on day 3-5, a 1-hour infusion of Carboplatin on day 4 and a 24-hour infusion of Ifosfamide on day 4, for 3 cycles. GaRD treatment: After RICE treatment, gallium nitrate will be given continuously over a 7 day period. In addition rituximab will be given on day 1 of each cycle. Dexamethasone will be given for the first 4 days of each cycle. The length of each cycle is 21 days.