Anti-CD20 Radioimmunotherapy Before Chemotherapy and Stem Cell Transplant in Treating Patients With High-Risk B-Cell Malignancies

PRIMARY OBJECTIVES:

I. To estimate the maximum tolerated dose (MTD) of 90Y activity that can be delivered via
pretargeted radioimmunotherapy (PRIT) using B9E9-fusion protein (B9E9-FP), clearing agent
(CA), and radiolabeled tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA)-biotin when
followed by carmustine, etoposide, cytarabine, and melphalan (BEAM) chemotherapy and
autologous stem cell transplantation.

SECONDARY OBJECTIVES:

I. To assess the overall and progression-free survival of the above regimen in such patients.

II. To evaluate the response rates of the above therapy.

III. To evaluate the toxicity and tolerability of the above therapy.

IV. To evaluate the feasibility of delivering sequential high-dose PRIT and chemotherapy.

TERTIARY OBJECTIVES:

I. Assess biodistribution and pharmacokinetics of B9E9-FP and radiolabeled DOTA-Biotin.

II. Assess ability of the clearing agent (CA) to remove excess B9E9-FP from the serum.

III. Evaluate the impact, if any, of circulating rituximab on biodistributions.

OUTLINE: This is a phase I, dose-escalation study of yttrium Y 90 DOTA-biotin followed by a
phase II study.

B9E9-FP INFUSION: Patients receive B9E9-fusion protein intravenously (IV) over a minimum of 2
hours on day -17.

CLEARING AGENT INFUSION: Patients receive clearing agent IV over a minimum of 30 minutes on
day -15.

RADIOBIOTIN INFUSION: Patients receive indium In 111-DOTA-biotin IV and yttrium Y 90
DOTA-biotin IV over 2-5 minutes on day -14.

BEAM CHEMOTHERAPY: Patients receive BEAM chemotherapy comprising carmustine IV over 3 hours
on day -7; etoposide IV over 2 hours twice daily (BID) and cytarabine IV over 4 hours BID on
days -6 to -3; and melphalan IV over 30 minutes on day -2.

STEM CELL INFUSION: Patients undergo autologous peripheral blood stem cell transplant (PBSCT)
on day 0 per standard of care.

After completion of study treatment, patients are followed up at 1, 3, 6, and 12 months, and
then annually thereafter.

Inclusion Criteria:

- Patients must have a histologically confirmed diagnosis of lymphoma expressing the
CD20 antigen and generally must have failed at least one prior standard systemic
therapy; the exception will be mantle cell lymphoma (MCL) patients, who may be
enrolled while in first complete remission (CR) as well as other select high-risk
lymphomas (e.g., Burkitt?s, double hit diffuse large B-cell lymphoma [DLBCL],
transformed indolent B-cell non-Hodgkin lymphoma [B-NHL], etc.) in accordance with
current transplant standard of care for these patients

- Creatinine (Cr) < 2.0

- Bilirubin < 1.5 mg/dL, with the exception of patients thought to have Gilbert?s
syndrome, who may have a total bilirubin above 1.5 mg/dL

- All patients eligible for therapeutic study must have (>= 2 x 10^6 CD34/kg) autologous
hematopoietic stem cells harvested and cryopreserved

- Patients must have an expected survival of > 60 days and must be free of major
infection

- Patients of childbearing potential must agree to abstinence or the use of effective
contraception

- DONOR SELECTION: Not applicable; this protocol employs autologous transplantation,
utilizing the patient?s own hematopoietic stem cells obtained from either the
peripheral blood or bone marrow

Exclusion Criteria:

- Systemic anti-lymphoma therapy given in the previous 30 days before the scheduled 90Y
therapy dose

- Inability to understand or give an informed consent

- Prior radiation > 20 Gy to any critical normal organ (e.g., lung, liver, spinal cord,
both kidneys) within 1 year of the treatment date

- Active central nervous system lymphoma

- Other serious medical conditions considered to represent contraindications to bone
marrow transplant (BMT) (e.g., abnormally decreased cardiac ejection fraction,
diffusion capacity of the lung for carbon monoxide [DLCO] < 50% predicted, patient on
supplemental oxygen, acquired immune deficiency syndrome [AIDS], etc.)

- Pregnancy or breast feeding

- Prior bone marrow or stem cell transplant

- Southwest Oncology Group (SWOG) performance status >= 2.0

- Known sensitivity to kanamycin and other aminoglycosides; patients with known
hypersensitivity to kanamycin or any other aminoglycoside antibiotic will be excluded