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Lenalidomide as Maintenance Therapy After Combination Chemotherapy With or Without Rituximab and Stem Cell Transplant in Treating Patients With Persistent or Recurrent Non-Hodgkin Lymphoma That Is Resistant to Chemotherapy

NCT01035463

Description:

This phase I/II trial studies the side effects and best dose of lenalidomide when given after combination chemotherapy with or without rituximab and stem cell transplant and to see how well it works in treating patients with non-Hodgkin lymphoma that has not responded to treatment or has returned after a period of improvement and is resistant to chemotherapy. Biological therapies, such as lenalidomide, may stimulate the immune system in different ways and stop cancer cells from growing. Drugs used in chemotherapy, such as carmustine, etoposide, cytarabine, and melphalan, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Monoclonal antibodies, such as rituximab, may block cancer growth by targeting certain cells. Giving lenalidomide after combination chemotherapy with or without rituximab may work better in treating patients with non-Hodgkin lymphoma.

Related Conditions:
  • Anaplastic Large Cell Lymphoma
Recruiting Status:

Completed

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Lenalidomide as Maintenance Therapy After Combination Chemotherapy With or Without Rituximab and Stem Cell Transplant in Treating Patients With Persistent or Recurrent Non-Hodgkin Lymphoma That Is Resistant to Chemotherapy
  • Official Title: Phase I/II Study of Lenalidomide Maintenance Following BEAM (+/- Rituximab) for Chemo-Resistant or High Risk Non-Hodgkin?s Lymphoma

Clinical Trial IDs

  • ORG STUDY ID: 446-08
  • SECONDARY ID: NCI-2009-01436
  • SECONDARY ID: RV-LYM-PI-0328
  • SECONDARY ID: 446-08
  • SECONDARY ID: P30CA036727
  • NCT ID: NCT01035463

Conditions

  • Anaplastic Large Cell Lymphoma, ALK-Negative
  • Recurrent Anaplastic Large Cell Lymphoma
  • Recurrent Mantle Cell Lymphoma
  • Recurrent Mature T- and NK-Cell Non-Hodgkin Lymphoma
  • Recurrent Non-Hodgkin Lymphoma
  • Recurrent Transformed Non-Hodgkin Lymphoma

Interventions

DrugSynonymsArms
CarmustineBCNU, Becenum, Becenun, BiCNU, Bis(chloroethyl) Nitrosourea, Bis-Chloronitrosourea, Carmubris, Carmustin, Carmustinum, FDA 0345, Gliadel, N,N'-Bis(2-chloroethyl)-N-nitrosourea, Nitrourean, Nitrumon, SK 27702, SRI 1720, WR-139021Treatment (stem cell transplantation)
Cytarabine.beta.-Cytosine arabinoside, 1-.beta.-D-Arabinofuranosyl-4-amino-2(1H)pyrimidinone, 1-.beta.-D-Arabinofuranosylcytosine, 1-Beta-D-arabinofuranosyl-4-amino-2(1H)pyrimidinone, 1-Beta-D-arabinofuranosylcytosine, 1.beta.-D-Arabinofuranosylcytosine, 2(1H)-Pyrimidinone, 4-Amino-1-beta-D-arabinofuranosyl-, 2(1H)-Pyrimidinone, 4-amino-1.beta.-D-arabinofuranosyl-, Alexan, Ara-C, ARA-cell, Arabine, Arabinofuranosylcytosine, Arabinosylcytosine, Aracytidine, Aracytin, Aracytine, Beta-cytosine Arabinoside, CHX-3311, Cytarabinum, Cytarbel, Cytosar, Cytosine Arabinoside, Cytosine-.beta.-arabinoside, Cytosine-beta-arabinoside, Erpalfa, Starasid, Tarabine PFS, U 19920, U-19920, Udicil, WR-28453Treatment (stem cell transplantation)
EtoposideDemethyl Epipodophyllotoxin Ethylidine Glucoside, EPEG, Lastet, Toposar, Vepesid, VP 16-213, VP-16, VP-16-213Treatment (stem cell transplantation)
LenalidomideCC-5013, CC5013, CDC 501, RevlimidTreatment (stem cell transplantation)
MelphalanAlanine Nitrogen Mustard, CB-3025, L-PAM, L-Phenylalanine Mustard, L-sarcolysin, L-Sarcolysin Phenylalanine mustard, L-Sarcolysine, Melphalanum, Phenylalanine Mustard, Phenylalanine nitrogen mustard, Sarcoclorin, Sarkolysin, WR-19813Treatment (stem cell transplantation)
RituximabABP 798, BI 695500, C2B8 Monoclonal Antibody, Chimeric Anti-CD20 Antibody, CT-P10, IDEC-102, IDEC-C2B8, IDEC-C2B8 Monoclonal Antibody, MabThera, Monoclonal Antibody IDEC-C2B8, PF-05280586, Rituxan, Rituximab Biosimilar ABP 798, Rituximab Biosimilar BI 695500, Rituximab Biosimilar CT-P10, Rituximab Biosimilar GB241, Rituximab Biosimilar IBI301, Rituximab Biosimilar PF-05280586, Rituximab Biosimilar RTXM83, Rituximab Biosimilar SAIT101, RTXM83Treatment (stem cell transplantation)

Purpose

This phase I/II trial studies the side effects and best dose of lenalidomide when given after combination chemotherapy with or without rituximab and stem cell transplant and to see how well it works in treating patients with non-Hodgkin lymphoma that has not responded to treatment or has returned after a period of improvement and is resistant to chemotherapy. Biological therapies, such as lenalidomide, may stimulate the immune system in different ways and stop cancer cells from growing. Drugs used in chemotherapy, such as carmustine, etoposide, cytarabine, and melphalan, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Monoclonal antibodies, such as rituximab, may block cancer growth by targeting certain cells. Giving lenalidomide after combination chemotherapy with or without rituximab may work better in treating patients with non-Hodgkin lymphoma.

Detailed Description

      PRIMARY OBJECTIVES:

      I. To establish the maximum tolerated dose (MTD) of lenalidomide given in the post-transplant
      setting for a 12 month maintenance period.

      SECONDARY OBJECTIVES:

      I. To obtain preliminary estimates of the 1-year response rate, event-free and overall
      survival using this regimen.

      OUTLINE: This is a phase I, dose-escalation study of lenalidomide followed by a phase II
      study.

      PRE-CONDITIONING (patients with cluster of differentiation [CD]20+ non-Hodgkin lymphoma):
      Patients receive rituximab intravenously (IV) per standard of care.

      PREPARATIVE REGIMEN: Patients receive carmustine IV on day -6, etoposide IV twice daily (BID)
      and cytarabine IV BID on days -5 through -2, and melphalan IV on day -1.

      AUTOLOGOUS HEMATOPOIETIC STEM CELL TRANSPLANTATION: Patients undergo stem cell infusion on
      day 0.

      MAINTENANCE THERAPY: Beginning approximately 100 days post-transplant, patients receive
      lenalidomide orally (PO) on days 1-21. Treatment repeats every 28 days for 12 courses in the
      absence of disease progression or unacceptable toxicity.

      After completion of study treatment, patients are followed up periodically.
    

Trial Arms

NameTypeDescriptionInterventions
Treatment (stem cell transplantation)ExperimentalPRE-CONDITIONING (patients with CD20+ NHL): Patients receive rituximab IV per standard of care. PREPARATIVE REGIMEN: Patients receive carmustine IV on day -6, etoposide IV BID and cytarabine IV BID on days -5 through -2, and melphalan IV on day -1. AUTOLOGOUS HEMATOPOIETIC STEM CELL TRANSPLANTATION: Patients undergo stem cell infusion on day 0. MAINTENANCE THERAPY: Beginning approximately 100 days post-transplant, patients receive lenalidomide PO on days 1-21. Treatment repeats every 28 days for 12 courses in the absence of disease progression or unacceptable toxicity.
  • Carmustine
  • Cytarabine
  • Etoposide
  • Lenalidomide
  • Melphalan
  • Rituximab

Eligibility Criteria

        Inclusion Criteria:

          -  Persistent, or relapsed non-Hodgkin's lymphoma (NHL) (any histology) that is
             chemo-resistant (< a partial response [PR]), subjects who have received >= 3 prior
             chemotherapy regimens, or subjects with lymphomas that have a high relapse rate
             following autologous or syngeneic stem cell transplantation (transformed NHL,
             peripheral T-cell lymphoma [PTCL], mantle cell lymphoma, anaplastic lymphoma kinase
             [ALK]-negative anaplastic large cell lymphoma [ALCL, alk neg]), intermediate
             International Prognostic Index (IPI) or high risk IPI or subjects with a positive
             positron emission tomography (PET) scan prior to transplant, and otherwise eligible
             for transplantation with adequate end-organ function

          -  Subjects that relapse within one year of diagnosis

          -  Able to collect >= 1.5 x 10^6 CD34+/kg cell for transplantation

          -  Absolute neutrophil count (ANC) >= 1000 cells/mm^3 and platelet count >= 60 K when
             maintenance lenalidomide is started (day 100 post-transplant)

          -  Subjects must have calculated creatinine clearance >= 30 ml/min

          -  Total bilirubin =< 1.5 x upper limit of normal (ULN)

          -  Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT]) and
             alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 3 x
             ULN

          -  Subjects who are seropositive because of hepatitis B virus vaccine

          -  Subjects must be willing to give written informed consent, and sign an institutionally
             approved consent form before performance of any study-related procedure not part of
             normal medical care, with the understanding that consent may be withdrawn by the
             subject at any time without prejudice to future medical care

          -  Able to adhere to the study visit schedule and other protocol requirements

          -  Expected survival duration of >= six months

          -  Karnofsky performance status >= 70

          -  Subjects > age 60 or with clinical signs of heart disease must have ejection fraction
             >= 45% left ventricular ejection fraction (LVEF) pre-transplant

          -  Subjects with clinical signs of pulmonary insufficiency must have diffusion capacity
             of the lung for carbon monoxide (DLCO) to be measured at >= 50% of predicted value

          -  No serious disease or condition that, in the opinion of the investigator, would
             compromise the subject's ability to participate in the study

          -  Disease free of prior malignancies for >= 2 years with exception of currently treated
             basal cell, squamous cell carcinoma of the skin, or carcinoma "in situ" of the cervix
             or breast or low risk prostate cancer after curative therapy

          -  All study participants must be registered into the mandatory Revlimid Risk Evaluation
             and Mitigation Strategy (REMS) program, and be willing and able to comply with the
             requirements of Revlimid REMS program

          -  Females of childbearing potential (FCBP) must have a negative serum or urine pregnancy
             test with a sensitivity of at least 50 mIU/mL within 10 - 14 days prior to and again
             within 24 hours of prescribing lenalidomide (prescriptions must be filled within 7
             days) and must either commit to continued abstinence from heterosexual intercourse or
             begin TWO acceptable methods of birth control, one highly effective method and one
             additional effective method AT THE SAME TIME, as least 28 days before she starts
             taking lenalidomide; FCBP must also agree to ongoing pregnancy testing; men must agree
             to use a latex condom during sexual contact with a FCBP even if they have had a
             successful vasectomy

          -  Females of reproductive potential must adhere to the scheduled pregnancy testing as
             required in the Revlimid REMS program

          -  Able to take aspirin (81 or 325 mg) daily as prophylactic anticoagulation (subjects
             intolerant to acetylsalicylic acid [ASA] may use warfarin or low molecular weight
             heparin)

          -  Male subject agrees to use an acceptable method for contraception for the duration of
             the study

        Exclusion Criteria:

          -  Chemosensitive NHL, except subjects receiving >= 3 prior chemotherapy regimens, or
             subjects having transformed NHL, PTCL, mantle cell lymphoma (MCL) or ALCL, alk neg

          -  End-organ function not appropriate for transplantation

          -  Inability to collect adequate stem cells

          -  Known positive for human immunodeficiency virus (HIV) or infectious hepatitis, type B
             (HBV) or C (HCV) or active hepatitis

          -  Any serious medical condition, laboratory abnormality, or psychiatric illness that
             would prevent the subject from signing the informed consent form

          -  Pregnant or breast feeding females; (lactating females must agree not to breast feed
             while taking lenalidomide)

          -  Known hypersensitivity to thalidomide or lenalidomide (if applicable)

          -  The development of erythema nodosum if characterized by a desquamating rash while
             taking thalidomide or similar drugs

          -  Any prior use of lenalidomide

          -  Concurrent use of other anti-cancer agents or treatments

          -  Serum creatinine > 2.0 mg/dL or calculated creatinine clearance < 30 ml/min

          -  Active infection at the start of lenalidomide

          -  Myocardial infarction within 6 months prior to enrollment or has New York Heart
             Association (NYHA) class III or IV heart failure uncontrolled angina, severe
             uncontrolled ventricular arrhythmias, or electrocardiographic evidence of acute
             ischemia or active conduction system abnormalities; prior to study entry, any
             electrocardiogram (ECG) abnormality at screening has to be documented by the
             investigator as not medically relevant

          -  History of life threatening or recurrent thrombosis/embolism; subjects may participate
             if they are adequately anticoagulated during the treatment

          -  Subject has > grade 2 peripheral neuropathy within 14 days before enrollment
      
Maximum Eligible Age:N/A
Minimum Eligible Age:19 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Maximum Tolerated Dose of Lenalidomide (Phase I)
Time Frame:Cycle 1, 28 days
Safety Issue:
Description:The Maximum Tolerated Dose (MTD) is defined to be the dose cohort below which 3 out of 6 subjects experience dose limiting toxicities during cycle 1. Dose limiting toxicities graded using the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0

Secondary Outcome Measures

Measure:Event-free Survival
Time Frame:1 year
Safety Issue:
Description:The Kaplan-Meier method will be used to estimate the event-free survival distribution.
Measure:Overall Survival
Time Frame:1 year
Safety Issue:
Description:The Kaplan-Meier method will be used to estimate the overall survival distribution. This outcome only reports data as it pertains to overall survival at one year. All-cause mortality includes survival for follow up for all subjects on the study.

Details

Phase:Phase 1/Phase 2
Primary Purpose:Interventional
Overall Status:Completed
Lead Sponsor:University of Nebraska

Last Updated

November 8, 2019