Busulfan, Melphalan, and Thiotepa in Treating Patients Who Are Undergoing an Autologous Stem Cell Transplant for Hodgkin's or Non-Hodgkin's Lymphoma
NCT ID: NCT00238433
Last Updated: 2017-09-27
Study Results
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View full resultsBasic Information
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COMPLETED
PHASE2
37 participants
INTERVENTIONAL
2005-03-31
2016-12-31
Brief Summary
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PURPOSE: This phase II trial is studying how well busulfan, melphalan, and thiotepa work in treating patients who are undergoing an autologous stem cell transplant for Hodgkin's or non-Hodgkin's lymphoma.
Detailed Description
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* Determine the therapeutic efficacy of a myeloablative preparative regimen comprising busulfan, melphalan, and thiotepa followed by autologous peripheral blood stem cell (PBSC) transplantation in patients with Hodgkin's or non-Hodgkin's lymphoma.
* Determine the toxic effects of this preparative regimen in these patients.
OUTLINE:
* Myeloablative preparative regimen: Patients receive busulfan IV over 3 hours on days -8 to -6, melphalan IV over 15-30 minutes on days -5 and -4, and thiotepa IV over 2 hours on days -3 and -2.
* Peripheral blood stem cell (PBSC) transplantation: Patients undergo PBSC transplantation on day 0 followed by filgrastim (G-CSF) IV over 30 minutes beginning on day 5 and continuing until blood counts recover.
* Intrathecal chemotherapy: Patients with a history of treated Central Nervous System (CNS) disease or at high-risk for CNS relapse receive methotrexate and cytarabine intrathecally (IT) for 2 doses each within 10 days prior to transplantation and 4-6 doses each beginning on day 32 post-transplantation.
* Consolidation therapy: Patients with residual bulk disease at 80-100 days post-transplantation that is \> 2.5 cm by CT scan may undergo local radiotherapy to residual scar/disease provided it can be encompassed in a single radiation port and the volume of lung to be irradiated is ≤ 20%.
After completion of study treatment, patients are followed weekly for 1 month, monthly for 6 months, every 3 months for 6 months, every 6 months for 1 year, and then annually thereafter.
PROJECTED ACCRUAL: A total of 30 patients will be accrued for this study.
Conditions
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Study Design
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NA
SINGLE_GROUP
TREATMENT
NONE
Study Groups
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Filgrastim/Melphalan/Thiotepa
Biological/Vaccine: filgrastim
5mcg/kg intravenous piggyback (IVPB) will be administered beginning on day +5 and continued until absolute neutrophil count (ANC) \> 1500 for 2 consecutive days.
Drug: busulfan
3.2mg/kg/day for 3 days starting on day -8. Each dose of intravenous busulfan will be mixed in a concentration of 0.54 mg/ml of 0.9% saline and infused over 3 hours.
Drug: melphalan
50mg/m2/day/iv, infused over 30 minutes on days -5 and -4. The reconstituted melphalan is diluted in 250cc normal saline to a concentration not greater than 0.4 mg/ml.
Drug: thiotepa
250 mg/m2/day/iv on days -3 and -2 Procedure/Surgery: bone marrow ablation with stem cell support
The transplant therapy should begin within 2 weeks of registration, but no sooner then 30 days after the last dose of chemotherapy.
Procedure/Surgery: peripheral blood stem cell transplantation
Performed 36-48 hours following last chemotherapy dose.
filgrastim
5mcg/kg IVPB will be administered beginning on day +5 and continued until ANC\> 1500 for 2 consecutive days.
busulfan
3.2mg/kg/day for 3 days starting on day -8. Each dose of intravenous busulfan will be mixed in a concentration of 0.54 mg/ml of 0.9% saline and infused over 3 hours.
melphalan
50mg/m2/day/iv, infused over 30 minutes on days -5 and -4. The reconstituted melphalan is diluted in 250cc normal saline to a concentration not greater than 0.4 mg/ml.
thiotepa
250 mg/m2/day/iv on days -3 and -2
bone marrow ablation with stem cell support
The transplant therapy should begin within 2 weeks of registration, but no sooner then 30 days after the last dose of chemotherapy.
peripheral blood stem cell transplantation
Performed 36-48 hours following last chemotherapy dose.
Interventions
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filgrastim
5mcg/kg IVPB will be administered beginning on day +5 and continued until ANC\> 1500 for 2 consecutive days.
busulfan
3.2mg/kg/day for 3 days starting on day -8. Each dose of intravenous busulfan will be mixed in a concentration of 0.54 mg/ml of 0.9% saline and infused over 3 hours.
melphalan
50mg/m2/day/iv, infused over 30 minutes on days -5 and -4. The reconstituted melphalan is diluted in 250cc normal saline to a concentration not greater than 0.4 mg/ml.
thiotepa
250 mg/m2/day/iv on days -3 and -2
bone marrow ablation with stem cell support
The transplant therapy should begin within 2 weeks of registration, but no sooner then 30 days after the last dose of chemotherapy.
peripheral blood stem cell transplantation
Performed 36-48 hours following last chemotherapy dose.
Eligibility Criteria
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Inclusion Criteria
* Diagnosis of 1 of the following:
* Intermediate- or high-grade non-Hodgkin's lymphoma (NHL), meeting 1 of the following criteria:
* In first complete remission (CR) AND at high-risk for relapse, as defined by all of the following criteria:
* High age-adjusted International Prognostic Index category AND meets the following criteria at diagnosis:
* Stage III or IV disease
* Lactic dehydrogenase abnormal
* Eastern Cooperative Oncology Group (ECOG) score 0-2
* Mantle cell histology
* Primary refractory disease
* Beyond first CR
* Low-grade NHL
* Beyond second relapse
* Hodgkin's lymphoma
* Primary refractory disease OR beyond first CR
* Must have an adequate number of stored autologous peripheral blood stem cells (PBSCs) (i.e., 2.0 x 10\^6 hematopoietic progenitor cell antigen (CD34)-positive cells/kg)
* Patients who are not able to mobilize a sufficient number of PBSCs may use bone marrow instead
* No active CNS disease 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
* 0 to 70
Performance status
* ECOG 0-2
Life expectancy
* Not specified
Hematopoietic
* Not specified
Hepatic
* Bilirubin \< 2 times upper limit of normal (ULN)
* Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) \< 3 times ULN
Renal
* Creatinine ≤ 2.0 mg/dL
* Creatinine clearance ≥ 50 mL/min
Pulmonary
* No significant pulmonary dysfunction, defined as Diffusing Capacity the Lung for Carbon monoxide (DLCO) \< 60% of predicted
Other
* Not pregnant or nursing
* Negative pregnancy test
* Fertile patients must use effective contraception for ≥ 2 months before and during study participation
* HIV negative
* No significant active infection that would preclude PBSC transplantation
PRIOR CONCURRENT THERAPY:
Biologic therapy
* No prior transplantation
* No other concurrent blood products during PBSC transplantation
Chemotherapy
* Not specified
Endocrine therapy
* Not specified
Radiotherapy
* More than 60 days since prior local or regional radiotherapy
Surgery
* Not specified
Other
* More than 30 days since prior investigational drugs
* No concurrent amphotericin
70 Years
ALL
No
Sponsors
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National Cancer Institute (NCI)
NIH
OHSU Knight Cancer Institute
OTHER
Responsible Party
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Richard Maziarz
Principal Investigator
Principal Investigators
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Richard Maziarz, MD
Role: STUDY_CHAIR
OHSU Knight Cancer Institute
Locations
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Knight Cancer Institute at Oregon Health and Science University
Portland, Oregon, United States
Countries
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Other Identifiers
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OHSU-HEM-04083-L
Identifier Type: -
Identifier Source: secondary_id
OHSU-IRB-248
Identifier Type: -
Identifier Source: secondary_id
IRB00000248
Identifier Type: -
Identifier Source: org_study_id