high-dose y-90-ibritumomab tiuxetan added to reduced-intensity allogeneic stem cell transplant regimen for relapsed or refractory aggressive b-cell lymphoma

Conditions: Post-Transplant Lymphoproliferative Disorder; Recurrent Adult Diffuse Large Cell Lymphoma; Recurrent B-Cell Non-Hodgkin Lymphoma; Recurrent Burkitt Lymphoma; Refractory B-Cell Non-Hodgkin Lymphoma; Refractory Burkitt Lymphoma; Refractory Diffuse Large B-Cell Lymphoma

Summary: this phase ii trial studies the side effects and how well high-dose yttrium-90 (y-90)-ibritumomab tiuxetan (anti-cluster of differentiation \[cd\]20) followed by fludarabine phosphate, low-dose total body irradiation (tbi), and donor peripheral blood stem cell transplant (pbsct) work in treating patients with aggressive b-cell lymphoma that has returned after a period of improvement (relapsed) or has not responded to previous treatment (refractory). radiolabeled monoclonal antibodies, such as y-90-ibritumomab tiuxetan, can find cancer cells and carry cancer-killing substances to them with less effect on normal cells. giving chemotherapy, such as fludarabine phosphate, and tbi before a donor pbsct helps stop the growth of cancer cells. it may also stop the patient's immune system from rejecting the donor's stem cells. however, high-dose radiolabeled antibodies also destroy healthy blood cells in the patient's body. when healthy stem cells from a donor are infused into the patient (stem cell transplant), they may help the patient's body replace these blood cells. giving high-dose y-90-ibritumomab tiuxetan followed by fludarabine phosphate, tbi, and donor pbsct may be an effective treatment for patients with b-cell lymphoma.

primary objectives: i. to assess the safety and efficacy of 1.5 mci/kg (max 120 mci) 90y-ibritumomab tiuxetan (yttrium y 90 ibritumomab tiuxetan) (anti-cd20) combined with fludarabine (fludarabine phosphate) (30 mg/m\^2 x 3) and 2 gray (gy) total body irradiation followed by human leukocyte antigens (hla) matched allogeneic hematopoietic transplantation for patients with relapsed or refractory aggressive b-cell lymphoma. outline: beginning 24-48 hours prior to therapy infusion, patients receive rituximab intravenously (iv) over 4-6 hours and then receive a therapy-dose of high-dose yttrium y 90 ibritumomab tiuxetan iv over 30 minutes on day -14 prior to transplant. patients also receive fludarabine phosphate iv on days -4 to -2 and undergo tbi followed by allogeneic pbsct on day 0. patients also receive cyclosporine orally (po) twice daily (bid) on days -3 to 56 with taper to day 180 (related donor) or -3 to 100 with taper over 11 weeks (unrelated donor) and mycophenolate mofetil po bid on days 0-27 (related donor) or po thrice daily (tid) on days 0-40 with taper to day 96 (unrelated donor). after completion of study treatment and assessments through \~day 100 following transplant, patients are followed up at 1, 3, 6, and 12 months and then annually up to 2 years thereafter.

Eligibility criteria:
inclusion criteria: * patients must have a histologically confirmed diagnosis of aggressive b-cell lymphoma (diffuse large b-cell lymphoma \[dlbcl\], burkitt lymphoma \[bl\], etc.) expressing the cd20 antigen and have failed at least one prior standard systemic therapy * patients must have relapsed after high-dose therapy and autologous transplantation or be ineligible for high-dose therapy and autologous transplantation; patients that have failed autologous transplantation are those with persistent disease \> 30 days after transplant; those ineligible for autologous transplant include those with chemoresistant disease (i.e., patients who have not achieved a partial response or better with their most recent chemotherapy regimen), are expected to have a poor outcome from autologous transplant (e.g., dlbcl relapsing within one year of rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, prednisone \[r-chop\]-like chemotherapy, double hit lymphoma, v-myc myelocytomatosis viral oncogene homolog (avian) positive \[myc+\] lymphoma, persistent positron emission tomography \[pet\] positivity after chemotherapy), are unable to collect sufficient or tumor-free autologous stem cells per seattle cancer care alliance (scca) standard practice, are unable to tolerate the high-dose autologous conditioning regimens, or who refuse a high-dose autologous transplant regimen * 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 * aspartate aminotransferase (ast)/alanine aminotransferase (alt) \< 3 x upper limit of normal (uln) * patients must have an expected survival without treatment of \> 60 days and must be free of major infection including human immunodeficiency virus (hiv) * patients must have an hla-identical related or hla-matched unrelated donor exclusion criteria: * receipt of systemic anti-lymphoma therapy withinthe following intervals prior to the therapeutic 90y-ibritumomab tiuxetan dose: * \< 30 days for intravenously-administered cytotoxic chemotherapy and/or monoclonal antibodies * \< 5 half-lives for all other anti-cancer agents (e.g., targeted therapies, corticosteroids, immunomodulatory agents, etc.) * inability to understand or give an informed consent * active central nervous system lymphoma * pregnancy * fertile men or women unwilling to use contraceptive techniques during and for 12 months following treatment * southwest oncology group (swog)/eastern cooperative oncology group (ecog) performance score \>= 2 * high-dose chemotherapy or external beam radiation therapy to lung, liver, or kidneys \> 20 gy within the previous 100 days prior to therapeutic 90y-ibritumomab tiuxetan dose * medical condition that would contraindicate allogeneic transplantation as per standard practice guidelines (e.g., impaired cardiopulmonary function, hepatitis, etc)