Rituxan + BEAM and Auto Stem Cell Transplant for High Risk Lymphoma or Hodgkin's Disease
| Status: | Completed |
|---|---|
| Conditions: | Lymphoma |
| Therapuetic Areas: | Oncology |
| Healthy: | No |
| Age Range: | Any |
| Updated: | 12/21/2018 |
| Start Date: | June 2002 |
| End Date: | January 2017 |
A Current Practice Study of Rituxan in Patient Receiving BEAM Chemotherapy and Autologous Blood Stem Cell Transplantation for High Risk Lymphoma or Hodgkin's Disease
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.
(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.
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.
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.
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.
We found this trial at
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Texas Children's Hospital Texas Children's Hospital, located in Houston, Texas, is a not-for-profit organization whose...
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