Intensive Chemo-immunotherapy as First Line Treatment in Adult Patients With Peripheral T- Cell Lymphoma
Condition: Lymphoma, T-Cell, Peripheral
MeSH terms: Lymphoma; Lymphoma, T-Cell; Lymphoma, T-Cell, Peripheral
Study type: Interventional
Phase: Phase 2

Summary: 
      Peripheral T cell lymphomas (PTCL) are a rare hematologic disease. Five-year overall survival
      (OS) of PTCL patients (pts) ranges between 20 and 30%. Allogeneic stem cell transplantation
      (allo-STC) may have a curative role for these pts but its toxicity is high when myeloablative
      conditioning is used. Reduced intensity conditionings (RIC) can decrease transplant related
      toxicity and mortality. The investigators have recently proved feasibility and potential
      efficacy of a RIC regimen in relapsed PTCL patients.

      We want to investigate whether it is possible to improve the outcome of alk negative PTCL
      pts, stage II-IV at diagnosis, by intensifying the therapeutic approach.

      The intensification will be obtained by combining intensive chemotherapy, alemtuzumab
      (anti-CD52 humanised antibody) and auto- or allo-SCT in pts aged between 18 and 60 years
      (Clinical Study A) or adding alemtuzumab to standard chemotherapy (CHOP) in pts aged between
      61 and 70 years(Clinical Study B).
    

Detailed description: 
      Inclusion criteria Clin A

        -  Age ≥18 < or =60 years (patients older than 60 years are excluded because of the
           intensive chemotherapy and transplant procedures)

        -  Histologically proven diagnosis of PTCL, including the following categories: PTCL-U
           (peripheral T-cell lymphoma, unspecified), AILD-T (angioimmunoblastic-like T-cell
           lymphoma), ALKneg ALCL (ALK-negative anaplastic large cell lymphoma),intestinal T - NHL

        -  Advanced stage disease (stage II-IV) or stage I and aaIPI score ≥ 2

        -  Written informed consent

      Inclusion criteria Clin B

        -  Age >60 and ≤75 years (patients older than 75 years are excluded because of the
           intensive chemo-immunotherapy program)

        -  Histological proven diagnosis of PTCL, including the following categories: PTCL-U
           (peripheral T-cell lymphoma, unspecified), AILD-T (angioimmunoblastic-like T-cell
           lymphoma), ALKneg ALCL (ALK-negative anaplastic large cell lymphoma), intestinal T - NHL

        -  Advanced-stage disease (stage II-IV) or stage I and aaIPI score ≥ 2

        -  Informed written consent

      In clinical study A (Clin A) we are planning to evaluate the efficacy and the feasibility of
      an intensified chemo-immunotherapy program including auto-SCT or RIC allo-SCT in advanced
      stage PTCL pts ≥ 18 and < or = 60 years.

      In clinical study B (Clin B) we intend to verify the efficacy and the feasibility of a
      combined immuno-chemotherapy approach in a subset of elderly pts aged > 60 and < or = 75
      years.
    

Intervention name(s): Clin A. CHOP-CAMPATH (Chemo-immunotherapy) + SCT; Clin B (CHOP- CAMPATH) Chemo-immunotherapy
Intervention type(s): Procedure; Drug
Intervention description(s): Clin A:
CHOP-Campath (CHOP-C) for 2 cycles (every 21 days): Doxorubicin 50mg/m2 day +1, Vincristin 1.4mg/m2 day +1, Cyclophosphamide 750mg/m2 day +1, prednisone 100mg/m2 PO on days +1 to +5; Campath-1H (alemtuzumab) dose escalation 3-10-20mg IV days - 2, - 1, 0 (first CHOP-C) or 30mg SC day 0 (second CHOP-C). Methotrexate 12.5mg IT, Ara-C 40mg IT, Dexamethasone 4mg IT on days + 1 and 21 (first and second CHOP-C).
HYPER-C-HiDAM for 2 cycles: Methotrexate 1.5gr/m2 day +1; Cyclophosphamide 300mg/m2 every 12 hours days +2-3-4; ARA-C 2gr/m2 every 12 hours days +2-3-4; G-CSF 5μcg/kg/day starting from day +5 until peripheral blood stem cell harvest
Myeloablative regimen followed by autologous transplantation or Reduced intensity conditioning followed by allogeneic transplantation.; Clin B:
CHOP-Campath (CHOP-C) for 6 cycles (every 21 days): Doxorubicin 50mg/m2 day +1, Vincristin 1.4mg/m2 day +1, Cyclophosphamide 750mg/m2 day +1, prednisone 100mg/m2 PO from day +1 to day +5¸ Campath-1H (alemtuzumab) 3-10mg IV on days - 1 and 0 ( first CHOP-C course) or 10mg SC on day 0 (for the following 5 C-CHOP courses). Methotrexate 12.5mg IT, Ara-C 40mg IT, Dexamethasone 4mg IT on day +1 of each CHOP-C course.
Other intervention name(s): Mab - Campath (Alemtuzumab); Mab- Campath (Alemtuzumab)
Intervention MeSH terms: Alemtuzumab; Immunomodulating Agents; Immunologic Factors
Allocation: Non-Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment