High Dose Chemotherapy and Stem Cell Transplant for Non-Hodgkin's Lymphoma or Central Nervous System (CNS) Lymphoma
Condition: Non-Hodgkin's Lymphoma; CNS Lymphoma
MeSH terms: Lymphoma; Lymphoma, Non-Hodgkin
Study type: Interventional
Phase: Phase 2

Summary: 
      Current standard treatments for lymphoma involving the central nervous system include
      chemotherapy or whole brain radiation therapy (WBRT). However, many patients do not respond
      to this treatment, and some of the patients who do respond relapse after treatment.

      Previous research has shown that a stem cell transplant of a patient's own cells (autologous
      stem cell transplant) may be more effective for some patients with lymphoma involving the
      CNS. In previous research using autologous stem cell transplants for lymphoma involving the
      CNS, a conditioning regimen consisting of the drugs thiotepa, busulfan and cyclophosphamide
      (TCE) was used. These drugs have been shown to enter the nervous system.

      In this research study, the investigators are adding the drug rituximab (Rituxan) to the drug
      cytarabine for the stem cell mobilization process. Cytarabine is a standard drug for
      mobilization. In addition, rituximab will be added to the conditioning regimen of thiotepa,
      busulfan and cyclophosphamide. Rituximab is approved by the FDA for the treatment of some
      types of lymphomas, but is not approved for use in lymphomas that involve the CNS. Rituximab
      is known to be able to enter the CNS. Previous research has suggested that it may help treat
      lymphoma that involves the CNS.

      The goal of this research study is to see if adding rituximab to the stem cell mobilization
      and conditioning regimens helps treat lymphoma that involves the central nervous system.
    

Detailed description: 
      If the screening procedures confirm that you are eligible to participate in the research
      study you will have the following procedures.

      Stem cell mobilization - this will take place over at least 9 days to prepare you to donate
      your stem cells for your autologous transplant. The drugs cytarabine, rituximab and Neupogen
      (G-CSF) will be given. You will be in the hospital for 2 days to receive the cytarabine
      infusions (and the 1st rituximab infusion of day 1 of stem cell mobilization). Then you will
      be discharged. You will receive the Neupogen injections as an outpatient.

      Stem cell collection (leukapheresis) - When your doctor determines that your stem cell count
      is high enough you will have your stem cells collected by a procedure called leukapheresis.
      Leukapheresis is performed by collecting blood from a vein and processing it through a
      machine that removes the stem cells that are needed to produce bone marrow. The rest of the
      blood is returned to you through another vein. The harvested stem cells will be frozen and
      stored. These cells will be returned to you after you complete the conditioning regimen with
      high dose chemotherapy.

      Conditioning regimen (high dose chemotherapy) - You will enter the hospital for the
      conditioning regimen and stay for about 30 days after you receive your stem cell transplant.
      The conditioning regimen to help kill cancer cells before your stem cell transplant will take
      place over 9 days. All drugs will be given intravenous (through an IV).

      Infusion of stem cells (stem cell transplant) - Your cells will be given to you through your
      vein, similar to an IV infusion. The infusion usually takes several hours.

      After you are discharged, you will be asked to return at about 4 weeks, 8 weeks, 12 weeks and
      14 weeks after the stem cell transplant. At each visit you will have a physical exam,
      questions to measure your mental functioning, blood tests. About 14 weeks after the stem cell
      transplant you will have an eye exam, echocardiogram, lung function tests, whole body PET-CT
      scan, brain MRI or CT scan, MRI or CT of spinal cord (for patients who may have lymphoma in
      the spinal cord), collection of cerebral spinal fluid, and bone marrow aspiration.

      You will have follow-up visits for 6 month to up to 4 years after the stem cell transplant.
    

Intervention name(s): Autologous stem cell transplant; High-dose chemotherapy
Intervention type(s): Procedure; Drug
Intervention description(s): Autologous stem cell transplant following high-dose chemotherapy; High-dose chemotherapy with rituximab, thiotepa, busulfan, and cyclosphosphamide
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: CNS involvement