Overview

Rituximab, Fludarabine, Cyclophosphamide, and Yttrium Y 90 Ibritumomab Tiuxetan in Treating Patients With Relapsed B-Cell Non-Hodgkin's Lymphoma

Status:
Unknown status
Trial end date:
2013-05-01
Target enrollment:
0
Participant gender:
All
Summary
RATIONALE: Monoclonal antibodies, such as rituximab, can block cancer growth in different ways. Some block the ability of cancer cells to grow and spread. Others find cancer cells and help kill them or carry cancer-killing substances to them. Drugs used in chemotherapy, such as fludarabine and cyclophosphamide, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Radiolabeled monoclonal antibodies, such as yttrium Y 90 ibritumomab tiuxetan, can find cancer cells and carry cancer-killing substances to them without harming normal cells. Giving rituximab and chemotherapy together with yttrium Y 90 ibritumomab tiuxetan may kill more cancer cells. PURPOSE: This phase I/II trial is studying the side effects and best dose of yttrium Y 90 ibritumomab tiuxetan when given together with rituximab, fludarabine, and cyclophosphamide and to see how well they work in treating patients with relapsed B-cell non-Hodgkin's lymphoma.
Phase:
Phase 1/Phase 2
Accepts Healthy Volunteers?
No
Details
Lead Sponsor:
Technische Universität München
Treatments:
Antibodies, Monoclonal
Cyclophosphamide
Fludarabine
Fludarabine phosphate
Rituximab
Vidarabine
Criteria
DISEASE CHARACTERISTICS:

- Histologically confirmed CD20-positive B-cell non-Hodgkin's lymphoma (NHL), including
any of the following subtypes:

- Indolent NHL, including any of the following:

- Follicular

- Lymphoplasmacytoid

- Marginal zone

- Mantle cell NHL

- Transformed B-cell NHL

- In at least first relapse with an indication for systemic antineoplastic treatment, as
defined by the following:

- Local or constitutional (B-) symptoms

- Hypersplenism due to splenic involvement

- Bulky disease (> 7.5 cm in diameter)

- Impending medical problems derived from rapid disease progression within the past
6 months, as defined by an observed or anticipated > 50% increase in the sum of
the areas calculated from multiplying the greatest perpendicular diameters of
each lesion

- Measurable lesions of lymphoma infiltration

- Medically ineligible for high-dose treatment followed by autologous stem cell support

- Adequate bone marrow cellularity (> 15% of marrow area covered by hematopoiesis)

- No CNS, leptomeningeal, spinal cord, or testes lymphoma involvement

- No lymphoma lesion mandating emergency radiotherapy

- No clinical, cytological, cytogenetic, or histopathologic indication of
myelodysplastic syndrome

- If there is bone marrow infiltration detected prior to chemoimmunotherapy, patient
must undergo a repeat bone marrow biopsy prior to planned treatment with
radioimmunotherapy to verify the level of bone marrow infiltration is < 25%

PATIENT CHARACTERISTICS:

- ECOG performance status 0-2

- Life expectancy ≥ 3 months

- Absolute neutrophil count > 1,500/mm³

- Platelet count > 150,000/mm³

- Hemoglobin > 9 g/dL

- Creatinine < 1.5 times upper limit of normal (ULN)

- Bilirubin < 2 times ULN

- ALT and AST < 2 times ULN

- Albumin > 2.5 g/dL

- INR < 1.5

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception during and for ≥ 12 months after
completion of study treatment

- No concurrent severe and/or uncontrolled medical disease that would preclude study
compliance, including any of the following:

- Uncontrolled diabetes

- Congestive heart failure

- Chronic renal disease

- Active uncontrolled infection

- No bleeding risks or disorders, including any of the following:

- CNS abnormalities suggesting an increased susceptibility for hemorrhage,
including recent history of stroke as demonstrated by cranial contrast-enhanced
CT scan

- Severe arrhythmia or uncontrolled hypertension

- Myocardial infarction within the past 6 months

- Diabetic retinopathy with history of symptomatic hemorrhage

- Known and potentially active gastrointestinal bleeding foci

- Concurrent anticoagulant medication that must be continued even with platelet
count < 20,000/mm³ (e.g., following mitral valve replacement, anti-phospholipid
syndrome, or recurrent venous thromboembolism)

- Other congenital or acquired hemorrhagic diatheses

- No ongoing autoimmune hemolytic anemia

- No known presence of anti-murine antibody reactivity

- No known hypersensitivity to murine or chimeric antibodies or proteins

- No known HIV infection

- No psychiatric illness that would preclude study requirements

- No other malignant disorder within the past 10 years except basal cell carcinoma of
the skin or carcinoma in situ of the cervix

PRIOR CONCURRENT THERAPY:

- See Disease Characteristics

- Recovered from prior therapy

- No more than 4 prior systemic anti-lymphoma regimens (including single-agent
rituximab)

- At least 2 months since prior systemic anti-lymphoma treatment (including single-agent
rituximab)

- No prior radioimmunotherapy

- No prior autologous or allogeneic hematopoietic stem cell transplantation

- No prior treatment with purine analogues that has not resulted in remission for > 1
year

- No prior anti-CD20 radioimmunoconjugate therapy

- More than 5 years since prior radiotherapy to extensive fields covering lymph node
regions on both sides of the diaphragm or > 50% of the spinal column

- More than 4 weeks since prior surgery

- No concurrent oral anticoagulant therapy