Yttrium-90-labeled Daclizumab With Chemotherapy and Stem Cell Transplant for Hodgkin s Lymphoma
This trial is active, not recruiting.
|Conditions||hodgkin disease, hodgkin lymphoma|
|Treatments||auto stem cell transplant, beam, 111in-daclizumab, 90y-daclizumab|
|Phase||phase 1/phase 2|
|Sponsor||National Cancer Institute (NCI)|
|Start date||October 2011|
|End date||September 2020|
|Trial size||6 participants|
|Trial identifier||NCT01468311, 12-C-0003, 120003|
- Hodgkin s lymphoma (HL) is a highly treatable cancer. However, if HL does not respond to chemotherapy or returns after chemotherapy, further treatments often are not successful.
- Some HL cells have a molecule called CD25 on the surface. Daclizumab is a drug that can detect CD25 on cells. In a treatment study for HL that did not respond to chemotherapy, daclizumab plus a radioactive atom called Yttrium 90 helped kill these HL cells. Researchers want to combine this 90Y daclizumab with high-dose chemotherapy and stem cell transplant. This treatment may be more effective than the daclizumab alone.
- To see if yttrium-90 daclizumab, high-dose chemotherapy, and stem cell transplants can treat HL that has not responded to earlier treatments.
- Individuals at least 18 years of age who have Hodgkin s lymphoma that has not responded to chemotherapy.
- Participants will be screened with a physical exam and medical history. They will also have blood and urine tests.
- Participants will have filgrastim and plerixafor to move stem cells into the blood. Stem cells will be collected with apheresis.
- Four weeks after stem cells are collected, participants will have the 90Y daclizumab and normal daclizumab to treat the HL. Chemotherapy will start 9 days after the first treatment.
- Most participants will have a second dose of 90Y daclizumab 6 weeks after the first dose.
- After each daclizumab treatment, participants will have several imaging studies of the chest and abdomen. Blood samples will also be collected.
- On the day after the last day of chemotherapy, participants will receive the stem cells collected earlier. Filgrastim injections will help stimulate stem cell growth....
|Endpoint classification||safety study|
|Intervention model||single group assignment|
safe tolerated dose of 90Y-daclizumab w BEAM and ASCT
time frame: after 1st dose of 90Y-daclizumab
Male or female participants from 18 years up to 99 years old.
- INCLUSION CRITERIA: 184.108.40.206 All patients must have a pathologically confirmed diagnosis of classical Hodgkin's lymphoma (HL) as outlined in the WHO Classification System of Lymphoid Tumours. Patients with nodular lymphocyte-predominant HL (NLPHL) are not eligible. 220.127.116.11 Refractory or relapsed HL patients that are also candidates for ASCT. 18.104.22.168 At least one adverse prognostic factor: (1) initial relapse less than or equal to 12 months after primary chemotherapy, (2) staged as Ann Arbor Classification initial stage III or IV disease, (3) chemotherapy resistant disease, (4) Failure to achieve a complete response (CR) with cytoreductive chemotherapy or persistent positive (18)FDGPET imaging. 22.214.171.124 At least 10% of the cells obtained from lymph node, or extranodal sites must react with anti-CD25 (anti-Tac) on immunofluorescent or immunoperoxidase staining. Because of the high frequency of CD25 positivity of the infiltrating Tcells in HL tumors, patients with CD25-positive infiltrating T cells will be eligible even if their Hodgkin s (Reed-Sternberg) cells are CD25-negative. 126.96.36.199 Measurable disease as defined by the Cheson Response Criteria for Malignant Lymphoma detailed in section 6.2 with at least one lesion greater than or equal to 1.0 cm in longest diameter by CT scan. 188.8.131.52 Omission of cytotoxic chemotherapy or other systemic therapy of the malignancy for greater than or equal to 4 weeks prior to entry into the trial. Patients must be greater than or equal to 4 weeks since major surgery, radiotherapy, or biotherapy/targeted therapies and recovered from the toxicity of prior treatment to less than or equal to CTC grade 1, exclusive of grade 2 alopecia, fatigue, lymphopenia, CD4+ circulating T cells, WBC or bilirubin. 184.108.40.206 Patients must be greater than or equal to 18-years old. 220.127.116.11 Patients must have a life expectancy of greater than 3 months. 18.104.22.168 Patients must have an ECOG performance status of less than or equal to 1. 22.214.171.124 The patient must have a granulocyte count of at least 1,500/microL and a platelet count of greater than 100,000/microL. 126.96.36.199 Patients must have a creatinine of less than 2.0 mg/dL, or if the patient has a serum creatinine greater than or equal to 2.0, a measured creatinine clearance (Ccr) must be greater than 60 mL/min/1.73m(2). 188.8.131.52 Patients must have a serum alkaline phosphatase, ALT (SGOT), and AST (SGPT) less than 3 times the upper limit of normal (ULN), unless due to liver or bone involvement by HL. Under these circumstances, serum alkaline phosphatase, SGPT and SGOT must be less than 5 times ULN. 184.108.40.206 Patients must have a total serum bilirubin less than 2.5 times ULN. 220.127.116.11 Patients must have a cardiac ejection fraction greater than 45% on 2D echocardiography or MUGA obtained within 28 days of study enrollment. 18.104.22.168 Lung diffusion capacity for carbon monoxide (DLCO) greater than 50%, or forced expiratory volume at 1.0 seconds (FEV1.0) greater than 65% of predicted on pulmonary function testing (PFT) obtained within 28 days of study enrollment. 22.214.171.124 Women of childbearing potential must have a negative serum Beta-HCG pregnancy test at initial screening and within 3 days prior to registration. 126.96.36.199 The effects of (90)Y-daclizumab on the developing human fetus are unknown. Women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, while receiving treatment and for 4 months after undergoing ASCT. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately. 188.8.131.52 Patients receiving a stable dose (greater than 4 weeks) of corticosteroid therapy equivalent to 20 mg of prednisone per day or less are eligible. 184.108.40.206 Patients must be able to understand and sign informed consent. EXCLUSION CRITERIA: 220.127.116.11 Patients who have relapsed from their initial ABVD or similar standard treatment regimen and have not received any other chemotherapy or salvage systemic treatment. 18.104.22.168 Patients that have received prior radioimmunotherapy. 22.214.171.124. Patients enrolled on another therapeutic study. 126.96.36.199 Patients that have received prior radioimmunotherapy. 188.8.131.52 Patients that have received a prior autologous or allogeneic stem cell transplant 184.108.40.206.Patients that have received prior radiation to the lung, excluding prior mediastinal radiation. 220.127.116.11 Patients with greater than 25% involvement of the bone marrow with HL. 18.104.22.168 Patients with evidence of myelodysplasia, leukemia by morphology, immunostains flow cytometry or abnormal cytogenetics on a bone- marrow aspirate or biopsy. The diagnosis of myelodysplasia will be made by an independent investigator of the Laboratory of Pathology, NCI taking into consideration the totality of the clinical, pathological, flow cytometric and cytogenetic information described in Appendix E and present in a particular individual s evaluation. 22.214.171.124 Patients with history of CNS involvement or active CNS involvement by malignancy. 126.96.36.199 Patients with an active second primary cancer will not be eligible. Patients curatively treated for a second cancer greater than 5 years prior to enrollment without a recurrence are eligible. Patients curatively treated for a second primary cancer within the last 5 years with a less than or equal to 5% risk of recurrence are eligible. Patients with a history of curatively treated basal cell carcinoma or intraepithelial neoplasia of the uterine cervix will be allowed on study. 188.8.131.52 Patients with serum human anti-human antibody (HAHA) against daclizumab. 184.108.40.206 Patients with HIV infection (antibody positive with positive confirmatory molecular test). 220.127.116.11 Patients who have chronic hepatitis B or hepatitis C. 18.104.22.168 Patients with an uncontrolled serious infection. 22.214.171.124 Pregnant or breastfeeding women. 126.96.36.199 Patients with significant medical comorbidities, including uncontrolled hypertension (diastolic BP greater than 115 mmHg), unstable angina, congestive heart failure (greater than NYHA class II), poorly controlled diabetes, severe chronic pulmonary disease, coronary angioplasty or myocardial infarction within the last 6 months, or uncontrolled atrial or ventricular cardiac arrhythmias. 188.8.131.52 Patients with a history of a psychiatric disorder that may interfere with the understanding and compliance with this protocol and the required follow up. 184.108.40.206 Exclusion at the discretion of the PI or delegate if participation to the study is deemed too risky (e.g. clinically significant pleural or pericardial effusion or ascites with possibly increased radio-toxicity).
|Official title||Phase I/II Trial of Yttrium-90-labeled Daclizumab (Anti-CD25) Radioimmunotherapy With High-dose BEAM Chemotherapy and Autologous Hematopoietic Stem Cell Rescue in Recurrent and Refractory Hodgkin s Lymphoma|
|Principal investigator||Thomas A Waldmann, M.D.|
|Description||Background: - Although Hodgkin s lymphoma (HL) is considered a highly treatable cancer, patients with relapsed and chemotherapy refractory disease represent a major therapeutic challenge. - Only 30-65% of relapsed patients will achieve long-term disease free survival with the current standard of care high-dose chemotherapy with autologous hematopoietic stem cell transplant (ASCT). - The malignant Reed-Sternberg cells of HL and the surrounding benign T cell infiltrates often express CD25, the high affinity interleukin-2 receptor (IL-2R alpha). - In study NCI-97-C-0110, we treated 30 patients with CD25-expressing relapsed or refractory HL with radioimmunotherapy (RIT) using (90)Y-labeled daclizumab (anti-CD25), and achieved a 63% response rate including 12 complete responses with few serious adverse events other than MDS in 4 patients. - We propose integrating (90)Y-labeled daclizumab RIT into the induction regimen of ASCT in an effort to improve the response and disease-free survival in relapsed and refractory HL. Objectives: Phase I Primary Objectives: - To assess the safety and adverse events associated with (90)Y-daclizumab (humanized anti-CD25) radioimmunotherapy (RIT) in combination with high-dose BEAM (carmustine, etoposide, cytarabine, [Ara-C, cytosine arabinoside] and melphalan) chemotherapy and autologous hematopoietic stem cell transplantation (ASCT) in patients with relapsed or refractory Hodgkin s lymphoma (HL) with adverse prognostic factors. - To determine the maximum tolerated dose in mCi of (90)Y-daclizumab RIT in combination with high-dose BEAM chemotherapy and ASCT in patients with relapsed or refractory HL. Phase II Primary Objectives: - To assess the frequency of the failure to engraft, myelodysplastic syndrome (MDS), secondary leukemia for the development of abnormal bone-marrow cytogenetics in refractory or relapsed HL patients treated with (90)Y-daclizumab RIT in combination with high-dose BEAM chemotherapy and ASCT. - To estimate the response rate (the number of complete and partial responses) in patients with refractory or relapsed HD to (90)Y-daclizumab RIT administered in combination with high-dose BEAM chemotherapy and ASCT. Eligibility: - Patients must have a confirmed diagnosis of relapsed or refractory HL with at least 10% of malignant Reed-Sternberg cells or infiltrating T-cells expressing CD25 (IL-2R alpha). A. Patients must have at least one of the following: (1) had an initial relapse less than 12 months after achieving a CR with primary chemotherapy for HL; (2) were Staged at III/IV at diagnosis; (3) exhibited chemotherapy resistant disease or (4) did not achieve a CR with cytoreductive chemotherapy prior to a planned transplant. B. Patient must have a lesion of at least 1.0 cm in its greatest diameter. C. Patients with lymphocyte predominant HL are excluded. D. Patients with pre-existing MDS or marrow cytogenic abnormalities will not be eligible to participate. - Omission of cytotoxic chemotherapy or other systemic therapy of HL for at least 4 weeks prior to entry into the trial. - No prior ASCT or allogeneic stem cell transplant. Design: - A single institution non-randomized open-label phase I/II trial. - Patients will undergo peripheral blood stem cell (PBSC) mobilization with granulocyte-colony stimulating factor (G-CSF, filgrastim) and Plerixafor followed by apheresis to collect a target dose of 4 x 106 CD34 cells/kg (minimal dose of 2 x 106 CD34+ cells/kg) of actual body weight. - Phase I study will be carried out using a standard 3 + 3 cohort dose-escalation design: - Dose level 1: Patients will receive a single dose of 15 mCi 90Y-daclizumab RIT (day -15 2 days) followed by high-dose BEAM chemotherapy (beginning Day -6) and ASCT (Day 0). - Dose levels 2-7: Patients will receive two doses of 90Y-daclizumab RIT 6 weeks apart (Day -56 and -15 2 days) followed by high-dose BEAM chemotherapy (beginning day -6) and ASCT (Day 0). The first dose of 90Y-daclizumab will be fixed at 15 mCi. The second dose will be escalated in 15 mCi increments from 15 mCi until maximum tolerated dose, not to exceed 90 mCi. - Phase II: All patients will receive two doses of 90Y-daclizumab (Day -56 and -15 2 days) followed by high-dose BEAM chemotherapy (beginning Day -6) and ASCT (Day 0). The first dose of RIT will be 15 mCi. The second dose will be the maximum tolerated dose as determined from phase I. 111In-daclizumab (5 mCi) imaging may be performed concurrently with each 90Ydaclizumab RIT and at day 100 after ASCT.|
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