Lenalidomide and Rituximab in Treating Patients With Previously Untreated Stage II, Stage III, or Stage IV Follicular Non-Hodgkin Lymphoma
Condition: Ann Arbor Stage II Grade 1 Contiguous Follicular Lymphoma; Ann Arbor Stage II Grade 1 Non-Contiguous Follicular Lymphoma; Ann Arbor Stage II Grade 2 Contiguous Follicular Lymphoma; Ann Arbor Stage II Grade 2 Non-Contiguous Follicular Lymphoma; Ann Arbor Stage II Grade 3 Contiguous Follicular Lymphoma; Ann Arbor Stage II Grade 3 Non-Contiguous Follicular Lymphoma; Ann Arbor Stage III Grade 1 Follicular Lymphoma; Ann Arbor Stage III Grade 2 Follicular Lymphoma; Ann Arbor Stage III Grade 3 Follicular Lymphoma; Ann Arbor Stage IV Grade 1 Follicular Lymphoma; Ann Arbor Stage IV Grade 2 Follicular Lymphoma; Ann Arbor Stage IV Grade 3 Follicular Lymphoma
MeSH terms: Lymphoma; Lymphoma, Follicular; Lymphoma, Non-Hodgkin
Intervention: Laboratory Biomarker Analysis; Lenalidomide; Rituximab
Intervention description: Correlative studies; Given PO; Given IV
Intervention MeSH terms: Rituximab; Antineoplastic Agents, Immunological; Lenalidomide; Antibodies; Immunoglobulins; Antibodies, Monoclonal
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 66.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No

Summary:

      This phase II trial studies how well lenalidomide and rituximab work in treating patients
      with previously untreated stage II, stage III, or stage IV follicular non-Hodgkin lymphoma.
      Biological therapies, such as lenalidomide, may stimulate or suppress the immune system in
      different ways and stop cancer cells from growing. Monoclonal antibodies, such as rituximab,
      may interfere with the ability of cancer cells to grow and spread. Giving lenalidomide
      together with rituximab may kill more cancer cells.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Previously untreated, histologically confirmed follicular lymphoma, World Health
             Organization (WHO) classification grade 1, 2, or 3a (> 15 centroblasts per high power
             field with centrocytes present) that is stage III, IV, or bulky (i.e., single mass >=
             7 cm in any uni-dimensional measurement) stage II

               -  Bone marrow biopsies as the sole means of diagnosis are not acceptable, but they
                  may be submitted in conjunction with nodal biopsies; fine needle aspirates are
                  not acceptable for diagnosis

               -  Failure to submit pathology specimens within 60 days of patient registration will
                  be considered a major protocol violation

          -  Institutional flow cytometry or immunohistochemistry must confirm CD20 antigen
             expression

          -  Low or intermediate risk by Follicular Lymphoma International Prognostic Index
             (FLIPI): 0-2 risk factors

          -  No prior systemic therapy for NHL, including chemotherapy or immunotherapy (e.g.,
             monoclonal antibody-based therapy); patients may have received involved-field
             radiation therapy

          -  No corticosteroids within two weeks prior to study entry, except for maintenance
             therapy for a non-malignant disease

          -  Eastern Cooperative Oncology Group (ECOG) performance status =< 2

          -  Measurable disease must be present either on physical examination or imaging studies;
             non-measurable disease alone is not acceptable; any tumor mass > 1 cm is acceptable

               -  Lesions that are considered non-measurable include the following:

                    -  Bone lesions (lesions if present should be noted)

                    -  Ascites

                    -  Pleural/pericardial effusion

                    -  Lymphangitis cutis/pulmonis

                    -  Bone marrow (involvement by NHL should be noted)

          -  No known central nervous system (CNS) involvement by lymphoma

          -  Patients with human immunodeficiency virus (HIV) infection are eligible, provided they
             meet the following

               -  No evidence of coinfection with hepatitis B or C

               -  CD4+ cell count >= 400/mm^3

               -  No evidence of resistant strains of HIV

               -  If not on anti-HIV therapy, HIV viral load < 10,000 copies HIV RNA/mL

               -  If on anti-HIV therapy, HIV viral load < 50 copies HIV RNA/mL

               -  No history of acquired immune deficiency syndrome (AIDS)-defining conditions

          -  No evidence of active hepatitis B or C infection (i.e., no positive serology for
             anti-hepatitis B core [HBc] or anti-hepatitis C virus [HCV] antibodies); hepatitis B
             virus (HBV) seropositive patients (hepatitis B surface antigen positive [HBsAg +]) are
             eligible if they are closely monitored for evidence of active HBV infection by HBV
             deoxyribonucleic acid (DNA) testing and receive suppressive therapy with lamivudine or
             other HBV suppressive therapy until 6 months after the last rituximab dose

          -  Patients with a history of erythema multiforme, toxic epidermal necrolysis or
             Stevens-Johnson syndrome are not eligible

          -  Patients with uncontrolled seizures are not eligible

          -  Patients with an autoimmune disorder requires active immunosuppression are not
             eligible

          -  Non-pregnant and non-nursing; females of childbearing potential (FCBP) must have a
             negative serum or urine pregnancy test with a sensitivity of at least 25 mIU/mL within
             10-14 days prior to registration; further, they must either commit to continued
             abstinence from heterosexual intercourse or begin TWO acceptable methods of birth
             control: one highly effective method and one additional effective method AT THE SAME
             TIME, at least 28 days before starting lenalidomide; FCBP must also agree to ongoing
             pregnancy testing; men must agree to use a latex condom during sexual contact with a
             FCBP, even if they have had a successful vasectomy; a FCBP is a sexually mature woman
             who: 1) has not undergone a hysterectomy or bilateral oophorectomy; or 2) has not been
             naturally postmenopausal for at least 24 consecutive months (i.e., has had menses at
             any time preceding 24 consecutive months); all patients must be counseled by a trained
             counselor every 28 days about pregnancy precautions and risks of fetal exposure

          -  No known human anti-chimeric antibody (HACA) positivity

          -  Absolute neutrophil count (ANC) >= 1,000/microliter

          -  Platelet count >= 75,000/microliter

          -  Creatinine clearance >= 30 mL/min unless attributable to NHL; to be calculated by
             method of Cockcroft-Gault, using actual weight; maximum creatinine clearance (CrCl)
             125 mL/min

          -  Total bilirubin =< 2 times upper limit of normal (ULN) unless attributable to NHL or
             Gilbert disease