Rituxan + BEAM and Auto Stem Cell Transplant for High Risk Lymphoma or Hodgkin's Disease

NCT ID: NCT01702961

Last Updated: 2018-12-19

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 75 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2002-06-30
• Study Completion Date: 2017-01-31

Brief Summary

High-dose chemotherapy followed by autologous (the patient's own) peripheral blood (circulating blood) stem cell (cells that divide to form white cells, red cells and cells that help clot) transplantation is a conventional treatment for patients with lymphoma (cancer of lymph glands) and Hodgkin's disease (cancer of lymph glands) after first relapse (recurrence of disease). For patients who did not have a complete response after traditional chemotherapy, the chance is high that the tumor will return even after high-dose chemotherapy. To improve the response and decrease the chance of relapse, doctors have used rituximab, an antibody that kills lymphoma cells, both before and after transplantation. These doctors have reported that more patients had control of the tumor for an extended period of time using rituximab with high-dose chemotherapy with autologous stem cell transplantation. How widely this is applicable is not known.

The purpose of this clinical research trial is to confirm that there is a good control of tumor in patients with lymphoma or Hodgkin's disease treated with rituximab and conventional stem cell transplantation.

Detailed Description

Subjects will receive the chemotherapy through a plastic tube (catheter) placed into a vein under the collarbone. The antibody rituximab is given on the day of admission. The subject will also start a six-day course of chemotherapy at that time. The chemotherapy will consist of the following drugs: BCNU, etoposide also called VP-16, Ara-C also called cytosine arabinoside, and melphalan. BCNU is given on the first day, Ara-C and VP-16 on the second, third, fourth and fifth days, and melphalan on the sixth day. The infusion of blood stem cells is given through the catheter the day after the last dose of chemotherapy. This is called Day 0. A week later the subject will receive shots under the skin of Neupogen to help the stem cells grow quickly. Three additional doses of rituximab are given weekly starting 2 weeks later. If the subject recovers and is discharged from the hospital before getting all the doses of rituximab, they can receive the remainder in clinic.

Patients will remain in the hospital for approximately 3-4 weeks, and in the Houston area for about 30 days from the infusion of the donor cells. The patient will have blood, urine, bone marrow, and x-ray examinations performed as necessary to monitor the results of treatment. They will have blood tests daily while hospitalized.

As an outpatient, the patient will be monitored to make sure their immune system (system in the body that helps protect the body and fights bacterial, viral and fungal infections) is recovering, and the patient may require additional infusions of immunoglobulins (infection-fighting blood proteins) until the blood protein levels are safe. The patient will also be taking antibiotic pills for about 6 months to prevent infections. They will have x-rays and other diagnostic tests (PET scans) every 6-12 months during the next 5 years to make sure the tumor stays under control.

Conditions

Lymphoma; Hodgkin's Disease

Keywords

Lymphoma; Hodgkin's Disease

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

BEAM+R: Autologous Stem Cell Transplant

Ara-C, VP-16, BCNU, Melphalan, Rituxan and Stem Cells

Group Type: OTHER

Melphalan

Intervention Type: DRUG

Given on Day -1

Melphalan is administered according to the current SOP.

Ara-C

Intervention Type: DRUG

200 mg/m2 IB BID given on Days -5, -4, -3, -2

VP-16

Intervention Type: DRUG

200 mg/m2 IV BID given on Days -5, -4, -3, -2

BCNU

Intervention Type: DRUG

BCNU 300 mg/m2 IV given on Day -6

Rituxan

Intervention Type: DRUG

375 mg/m2 IB given on Days -6, +14, +21, +28

Stem Cells

Intervention Type: DRUG

Stem cells given on Day 0

Interventions

Melphalan

Given on Day -1

Melphalan is administered according to the current SOP.

Intervention Type: DRUG

Ara-C

200 mg/m2 IB BID given on Days -5, -4, -3, -2

Intervention Type: DRUG

VP-16

200 mg/m2 IV BID given on Days -5, -4, -3, -2

Intervention Type: DRUG

BCNU

BCNU 300 mg/m2 IV given on Day -6

Intervention Type: DRUG

Rituxan

375 mg/m2 IB given on Days -6, +14, +21, +28

Intervention Type: DRUG

Stem Cells

Stem cells given on Day 0

Intervention Type: DRUG

Other Intervention Names

Alkeran; Cytarabine; Cytosar-u; Etoposide; Carmustine; Rituxamib; Autologous Blood Stem Cells

Eligibility Criteria

Inclusion Criteria

• Patients with biopsy-proven, relapsed, or refractory CD20+ lymphoma, or HD.
• At least 2e6 CD34+/kg autologous PBSC stored. If patients are non-mobilizers, then at least 2e8 TNC/kg autologous marrow should be stored.
• Patient is not pregnant.
• Zubrod performance status less than or equal to 2.
• Life expectancy is not severely limited by concomitant illness.
• Left ventricular ejection fraction greater than or equal to 50%.
• No uncontrolled arrhythmias or symptomatic cardiac disease.
• FEV1, FVC and DLCO greater than or equal to 50%.
• No symptomatic pulmonary disease.
• Serum creatinine less than or equal to 1.5 mg/dL.
• Serum bilirubin less than or equal to 2X upper limit of normal, SGPT less than or equal to 3X upper limit of normal.
• No evidence of chronic active hepatitis or cirrhosis.
• No effusion or ascites greater than or equal to 1L prior to drainage.
• HIV negative.
• Patient or guardian able to sign informed consent.
• Patients of any age may be enrolled on this protocol.

Exclusion Criteria

• Anyone not meeting the above criteria.

• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

The Methodist Hospital Research Institute

OTHER

Sponsor Role: collaborator

Center for Cell and Gene Therapy, Baylor College of Medicine

OTHER

Sponsor Role: collaborator

Baylor College of Medicine

OTHER

Sponsor Role: lead

Responsible Party

George Carrum

Associate Professor; Director-Adult Outpatient Clinic

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

George Carrum, MD

Role: PRINCIPAL_INVESTIGATOR

Associate Professor; Director-Adult Outpatient Clinic

Locations

Texas Children's Hospital

Houston, Texas, United States

The Methodist Hospital

Houston, Texas, United States

Countries

United States

Other Identifiers

Rituxan+BEAM

Identifier Type: OTHER

Identifier Source: secondary_id

H-11892

Identifier Type: -

Identifier Source: org_study_id