Combination Chemotherapy in Treating Patients With AIDS-Related Lymphoma

NCT ID: NCT00002524

Last Updated: 2012-07-30

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

46 participants

Study Classification

INTERVENTIONAL

Study Start Date

1993-06-30

Study Completion Date

2005-10-31

Brief Summary

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RATIONALE: Drugs used in chemotherapy use different ways to stop cancer cells from dividing so they stop growing or die. Combining more than one drug may kill more cancer cells.

PURPOSE: Phase II trial to study the effectiveness of combination chemotherapy in treating patients with AIDS-related lymphoma.

Detailed Description

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OBJECTIVES: I. Develop an effective chemotherapy regimen with mild immunosuppressive and myelosuppressive properties to treat patients with AIDS-related lymphoma (ARL) who have severe T4 lymphopenia. II. Estimate the CR rate, lymphoma-free survival, and overall survival of non-T4 lymphopenic patients and patients who present with nonbulky Ann Arbor stage I ARL treated with standard regimens of known effectiveness. III. Evaluate the effects on long-term outlook of concurrent antiretroviral therapy, prophylactic antibiosis with trimethoprim/sulfamethoxazole or aerosolized pentamidine, and prn use of granulocyte colony-stimulating factor for severe myelosuppression.

OUTLINE: Patients are assigned to Regimens A, B, and C according to histology and extent of disease and the degree of immunosuppression as follows: Regimen A: Patients with Ann Arbor stage I intermediate grade or immunoblastic lymphoma with measurable nonbulky disease (less than 7 cm), low LDH (less than 686), and no prior opportunistic infection irrespective of T4 count; also those with nonmeasurable stage I extranodal primaries (infiltration of less than 2/3 of an organ site, e.g., stomach, rectum, esophagus, sinus cavity) irrespective of T4 count. Regimen B: All patients (except primary brain lymphoma patients) not assigned to Regimen A who have T4 counts of at least 200 and no history of opportunistic infection; includes all stages of small noncleaved cell lymphoma and bulky stage I and stages II-IV intermediate grade and immunoblastic lymphoma. Regimen C: Patients not assigned to Regimen A or B, i.e., those with T4 counts less than 200 and/or a history of opportunistic infection and those with primary brain lymphoma. The following acronyms are used: ARA-C Cytarabine, NSC-63878 BLEO Bleomycin, NSC-125066 CDDP Cisplatin, NSC-119875 CF Leucovorin calcium, NSC-3590 CTX Cyclophosphamide, NSC-26271 DOX Doxorubicin, NSC-123127 5-FU Fluorouracil, NSC-19893 G-CSF Granulocyte Colony-Stimulating Factor (Amgen), NSC-614629 IFF Ifosfamide, NSC-109723 MePRDL Methylprednisolone succinate Mesna Mercaptoethane sulfonate, NSC-113891 MTX Methotrexate, NSC-740 PRED Prednisone, NSC-10023 VCR Vincristine, NSC-67574 VP-16 Etoposide, NSC-141540 ZDV Zidovudine, NSC-602670 Regimen A: 5-Drug Combination Chemotherapy followed by Radiotherapy. CHOP-BLEO: CTX; DOX; VCR; PRED; BLEO; followed by involved-field irradiation with megavoltage equipment. Regimen B: 4-Drug Combination Chemotherapy alternating with 3-Drug Combination Chemotherapy followed, as indicated, by Radiotherapy. ASHAP: DOX; MePRDL; ARA-C; CDDP; alternating with IMVP-16: IFF/Mesna; MTX/CF; VP-16; followed, in selected patients with initially bulky localized disease, by involved-field irradiation with megavoltage equipment. Regimen C: 2-Drug Combination Chemotherapy with Drug Modulation followed, as indicated, by Radiotherapy. FLEP: 5-FU/CF/CDDP; followed, in selected patients with initially bulky localized disease, by involved-field irradiation with megavoltage equipment. Prior to starting chemotherapy, patients with primary brain lymphoma receive a course of cranial irradiation using accelerator beams with photon energies of 6-15 MV.

PROJECTED ACCRUAL: Up to 92 patients (10 for Regimen A, 28 for Regimen B, 54 for Regimen C) will be entered over 3 years. If there are no CRs among the first 6 patients on Regimens A and B or the first 19 patients on Regimen C, accrual to that regimen will cease. If more than 4 infectious deaths occur among the first 10 patients or if the rate of disease progression exceeds 20% on any regimen, further accrual to that regimen will cease.

Conditions

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Lymphoma

Keywords

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AIDS-related peripheral/systemic lymphoma AIDS-related primary CNS lymphoma AIDS-related diffuse large cell lymphoma AIDS-related immunoblastic large cell lymphoma AIDS-related small noncleaved cell lymphoma AIDS-related diffuse mixed cell lymphoma AIDS-related diffuse small cleaved cell lymphoma

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Regimen A

Regimen A: 5-Drug Combination Chemotherapy followed by Radiotherapy.

Group Type EXPERIMENTAL

Bleomycin Sulfate

Intervention Type BIOLOGICAL

Cyclophosphamide

Intervention Type DRUG

Doxorubicin Hydrochloride (DOX)

Intervention Type DRUG

Pentamidine

Intervention Type DRUG

Prednisone

Intervention Type DRUG

Trimethoprim-Sulfamethoxazole

Intervention Type DRUG

Vincristine Sulfate

Intervention Type DRUG

Zidovudine (AZT)

Intervention Type DRUG

Radiation Therapy

Intervention Type RADIATION

Regimen B

Regimen B: 4-Drug Combination Chemotherapy alternating with 3-Drug Combination Chemotherapy followed, as indicated, by Radiotherapy

Group Type EXPERIMENTAL

Filgrastim

Intervention Type BIOLOGICAL

Cytarabine

Intervention Type DRUG

Doxorubicin Hydrochloride (DOX)

Intervention Type DRUG

Etoposide

Intervention Type DRUG

Ifosfamide

Intervention Type DRUG

Methotrexate

Intervention Type DRUG

Methylprednisolone

Intervention Type DRUG

Pentamidine

Intervention Type DRUG

Trimethoprim-Sulfamethoxazole

Intervention Type DRUG

Zidovudine (AZT)

Intervention Type DRUG

Radiation Therapy

Intervention Type RADIATION

Regimen C

Regimen C: 2-Drug Combination Chemotherapy with Drug Modulation followed, as indicated, by Radiotherapy.

Group Type EXPERIMENTAL

Filgrastim

Intervention Type BIOLOGICAL

Cisplatin

Intervention Type DRUG

Fluorouracil

Intervention Type DRUG

Leucovorin calcium

Intervention Type DRUG

Pentamidine

Intervention Type DRUG

Trimethoprim-Sulfamethoxazole

Intervention Type DRUG

Zidovudine (AZT)

Intervention Type DRUG

Radiation Therapy

Intervention Type RADIATION

Interventions

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Bleomycin Sulfate

Intervention Type BIOLOGICAL

Filgrastim

Intervention Type BIOLOGICAL

Cisplatin

Intervention Type DRUG

Cyclophosphamide

Intervention Type DRUG

Cytarabine

Intervention Type DRUG

Doxorubicin Hydrochloride (DOX)

Intervention Type DRUG

Etoposide

Intervention Type DRUG

Fluorouracil

Intervention Type DRUG

Ifosfamide

Intervention Type DRUG

Leucovorin calcium

Intervention Type DRUG

Methotrexate

Intervention Type DRUG

Methylprednisolone

Intervention Type DRUG

Pentamidine

Intervention Type DRUG

Prednisone

Intervention Type DRUG

Trimethoprim-Sulfamethoxazole

Intervention Type DRUG

Vincristine Sulfate

Intervention Type DRUG

Zidovudine (AZT)

Intervention Type DRUG

Radiation Therapy

Intervention Type RADIATION

Other Intervention Names

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Blenoxane BLM G-CSF Neupogen Platinol Plationol-AQ CDDP Cytoxan Neosar Ara-C Cytosar DepoCyt Cytarabine arabinosine hydrochloride Adriamycin PFS Adriamycin RDF VePesid 5-FU Adrucil Efudex 5-Fluorouracil Ifex Citrovorum Wellcovorin Depo-Medrol Medrol Solu-Medrol Pentam-300 SMX Bactrim Cotrim Septra Sulfamethoprim Sulfatrim Sulfoxaprim Trisulfam Uroplus Co-trimoxazole SMX-TMP Retrovir RT Radiotherapy

Eligibility Criteria

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Inclusion Criteria

DISEASE CHARACTERISTICS: Previously untreated, HIV-related intermediate- and high-grade lymphoma with no previous diagnosis of Kaposi's sarcoma Pathology reviewed at M.D. Anderson Cancer Center

PATIENT CHARACTERISTICS: Age: Over 15 Performance status: Not specified Hematopoietic: Not specified Hepatic: Not specified Renal: For patients with T4 less than 200 and those with primary brain lymphoma: Creatinine no greater than 2.0 mg/dL (unless entry approved by principal investigator) Other: Serious intercurrent illness must be discussed with the principal investigator Infectious disease consultation required for complex infections Medications for other conditions allowed provided no adverse interaction with protocol therapy occurs No previously diagnosed Kaposi's sarcoma or other malignancy

PRIOR CONCURRENT THERAPY: No prior therapy for lymphoma No concurrent chemotherapy
Minimum Eligible Age

15 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Cancer Institute (NCI)

NIH

Sponsor Role collaborator

M.D. Anderson Cancer Center

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Peter W. McLaughlin, MD

Role: STUDY_CHAIR

M.D. Anderson Cancer Center

Locations

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MD Anderson Cancer Center Orlando

Orlando, Florida, United States

Site Status

University of Texas - MD Anderson Cancer Center

Houston, Texas, United States

Site Status

Countries

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United States

Related Links

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http://www.mdanderson.org

UT MD Anderson Cancer Center Website

Other Identifiers

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P30CA016672

Identifier Type: NIH

Identifier Source: secondary_id

View Link

MDA-DM-93058

Identifier Type: OTHER

Identifier Source: secondary_id

NCI-T93-0088D

Identifier Type: -

Identifier Source: secondary_id

CDR0000078316

Identifier Type: REGISTRY

Identifier Source: secondary_id

DM93-058

Identifier Type: -

Identifier Source: org_study_id