Patient case: 14-year-old female with Li-Fraumeni syndrome; genetic feature: TP53

Clinical trial: Combination Chemotherapy in Treating Children With Refractory or Relapsed Hodgkin's Lymphoma

Summary: RATIONALE: Drugs used in chemotherapy, such as ifosfamide and vinorelbine, work in different ways to stop cancer cells from dividing so they stop growing or die. Combining more than one drug may kill more cancer cells.
  PURPOSE: Phase II trial to study the effectiveness of combination chemotherapy in treating children who have refractory or relapsed Hodgkin's lymphoma.

Detailed description: OBJECTIVES:
  -  Determine the response rate (overall and within strata) in both minimally pretreated, low-risk and heavily pretreated, high-risk children with refractory or relapsed Hodgkin's lymphoma treated with ifosfamide and vinorelbine with filgrastim (G-CSF).
  -  Determine the cardiac, hepatic, renal, and hematologic toxicity of this regimen in minimally-pretreated, low-risk patients.
  -  Determine the toxic death rate in minimally pretreated, low-risk patients treated with this regimen.
  -  Determine whether this treatment regimen can mobilize sufficient hematopoietic stem cells (CD34) for subsequent stem cell transplantation in minimally pretreated, low-risk patients.
  -  Determine the incidence of hypermutability by longitudinal genotoxic biomonitoring of patients treated with this regimen.
  -  Determine the prognostic significance of biological markers, including serum interleukin (IL)-10 receptor, serum IL-2 receptor, p53, and mdm-2 in patients treated with this regimen.
  OUTLINE: This is a multicenter study. Patients are stratified by prior therapy (minimally pretreated, low-risk vs heavily pretreated, high-risk).
  Patients receive ifosfamide IV over 24 hours on days 1-4 and vinorelbine IV over 6-10 minutes on days 1 and 5. Patients also receive filgrastim (G-CSF) subcutaneously or IV over 15-30 minutes beginning 24-36 hours after completion of vinorelbine and continuing daily until blood counts recover. Treatment repeats at least every 21 days for 2 courses in the absence of disease progression or unacceptable toxicity. Patients may receive a third course of therapy at the discretion of the investigator.
  Heavily pretreated, high-risk patients who achieve a complete response are eligible for stem cell transplantation. Patients undergo peripheral blood stem cell (PBSC) collection during hematopoietic recovery after the second course of chemotherapy. Patients with sufficient PBSCs collected may undergo PBSC transplantation on protocol COG-AHOD0121.
  Patients are followed at 1, 6, and 12 months and then periodically thereafter.
  PROJECTED ACCRUAL: A total of 66 patients will be accrued for this study within 1.5 years.

Eligibility: DISEASE CHARACTERISTICS:
  -  Histologically confirmed refractory or relapsed Hodgkin's lymphoma
  -  Mixed cellularity, not otherwise specified (NOS)
  -  Lymphocytic depletion, NOS
  -  Lymphocytic depletion, diffuse fibrosis
  -  Lymphocytic depletion, reticular
  -  Lymphocytic predominance, NOS
  -  Lymphocytic predominance, diffuse
  -  Lymphocytic predominance, nodular
  -  Hodgkin's paragranuloma NOS
  -  Hodgkin's granuloma
  -  Hodgkin's sarcoma
  -  Nodular sclerosis, NOS
  -  Nodular sclerosis, cellular phase
  -  Nodular sclerosis, lymphocytic predominance
  -  Nodular sclerosis, mixed cellularity
  -  Nodular sclerosis, lymphocytic depletion
  -  Other (type not specified)
  -  In first relapse
  -  Metastasis to bone marrow with granulocytopenia, anemia, and/or thrombocytopenia allowed
  -  Not enrolled on POG-9426 unless there is an extranodal site of recurrence
  PATIENT CHARACTERISTICS:
  Age:
  -  Under 30 at diagnosis
  Performance status:
  -  Lansky 60-100% (for patients 16 years and under)
  -  Karnofsky 60-100% (for patients over 16 years)
  Life expectancy:
  -  At least 2 months
  Hematopoietic:
  -  See Disease Characteristics
  -  Absolute neutrophil count at least 1,000/mm^3
  -  Platelet count at least 75,000/mm^3 (transfusion independent)
  Hepatic:
  -  Bilirubin no greater than 1.5 times normal
  -  SGOT or SGPT less than 2.5 times normal
  Renal:
  -  Creatinine no greater than 1.5 times normal
  -  Creatinine clearance or radioisotope glomerular filtration rate at least 70 mL/min
  Cardiovascular:
  -  Shortening fraction at least 27% by echocardiogram OR
  -  Ejection fraction at least 50% by gated radionuclide
  Other:
  -  No other concurrent serious illness
  -  No known hypersensitivity to E. coli-derived proteins, filgrastim (G-CSF), or any other component of study drugs
  PRIOR CONCURRENT THERAPY:
  Biologic therapy:
  -  No concurrent immunomodulating agents
  Chemotherapy:
  -  At least 2 weeks since prior chemotherapy (3 weeks for nitrosoureas) and recovered
  -  No other concurrent anticancer chemotherapy
  Endocrine therapy:
  -  No concurrent steroids
  -  No concurrent corticosteroids (e.g., dexamethasone)
  Radiotherapy:
  -  Recovered from prior radiotherapy
  Surgery:
  -  Not specified

Relevance to patient case: not relevant