Chemotherapy and Radiation Therapy Plus Bone Marrow or Peripheral Stem Cell Transplantation in Treating Patients With Relapsed or Refractory T-cell Lymphoma, Hodgkin's Lymphoma, or Non-Hodgkin's Lymphoma
Condition: Lymphoma
MeSH terms: Lymphoma
Study type: Interventional
Phase: Phase 1/Phase 2

Summary: 
      RATIONALE: Drugs used in chemotherapy use different ways to stop cancer cells from dividing
      so they stop growing or die. Radiation therapy uses high-energy x-rays to damage cancer
      cells. Bone marrow or peripheral stem cell transplantation may allow the doctor to give
      higher doses of chemotherapy drugs and radiation therapy and kill more cancer cells.

      PURPOSE: Phase I/II trial to study the effectiveness of chemotherapy and radiation therapy
      plus bone marrow or peripheral stem cell transplantation in treating patients who have
      refractory or relapsed T-cell lymphoma, Hodgkin's lymphoma, or non-Hodgkin's lymphoma.
    

Detailed description: 
      OBJECTIVES:

        -  Determine the toxicity of an intensive program of chemoradiotherapy followed by HLA
           identical related bone marrow or peripheral blood stem cell transplantation in patients
           with relapsed or refractory cutaneous T-cell lymphoma, Hodgkin's lymphoma, or
           non-Hodgkin's lymphoma.

        -  Determine the response rate and disease free survival in patients treated with this
           regimen.

      OUTLINE: HLA identical related donors undergo harvest of bone marrow or peripheral blood stem
      cells (PBSC).

      Patients are assigned to one of two treatment groups based on prior radiation to abdomen or
      mediastinum:

        -  Group A (prior radiation no greater than 2,000 cGy): Patients with complete response
           (CR) or partial response (PR) after completion of chemotherapy receive cyclophosphamide
           IV over 1 hour on days -6 and -5, followed by total body irradiation twice daily on days
           -4 to -1. Patients with minimal response after completion of chemotherapy receive
           cyclophosphamide IV over 1 hour on days -8 and -7, followed by etoposide IV over 30
           hours beginning on day -6, followed by total body irradiation twice daily on days -4 to
           -1.

        -  Group B (prior radiation greater than 2,000 cGy): Patients with CR or PR after
           completion of chemotherapy receive oral busulfan every 6 hours on days -7 to -4,
           followed by cyclophosphamide IV over 1 hour on days -3 and -2. Patients with minimal
           response after completion of chemotherapy receive oral busulfan every 6 hours on days -9
           to -6, followed by cyclophosphamide IV over 1 hour on days -5 and -4, followed by
           etoposide IV over 30 hours beginning on day -3.

        -  Both groups: Bone marrow or PBSC are reinfused on day 0. Patients with bulky nodal
           disease (greater than 5 cm) may undergo involved field radiotherapy two weeks before
           transplantation.

      Patients are followed every month for 1 year.

      PROJECTED ACCRUAL: Not specified
    

Intervention name(s): busulfan; cyclophosphamide; etoposide; allogeneic bone marrow transplantation; bone marrow ablation with stem cell support; peripheral blood stem cell transplantation; radiation therapy
Intervention type(s): Drug; Drug; Drug; Procedure; Procedure; Procedure; Radiation
Intervention MeSH terms: Cyclophosphamide; Busulfan; Etoposide
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: recurrent adult Hodgkin lymphoma; recurrent cutaneous T-cell non-Hodgkin lymphoma; recurrent grade 1 follicular lymphoma; recurrent grade 2 follicular lymphoma; recurrent grade 3 follicular lymphoma; recurrent adult diffuse small cleaved cell lymphoma; recurrent adult diffuse mixed cell lymphoma; recurrent adult diffuse large cell lymphoma; recurrent adult immunoblastic large cell lymphoma; recurrent mycosis fungoides/Sezary syndrome; recurrent marginal zone lymphoma; recurrent small lymphocytic lymphoma; extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue; nodal marginal zone B-cell lymphoma; splenic marginal zone lymphoma