Yttrium Y 90 Ibritumomab Tiuxetan, Fludarabine, Radiation Therapy, and Donor Stem Cell Transplant in Treating Patients With Relapsed or Refractory Non-Hodgkin's Lymphoma
Condition: B-cell Chronic Lymphocytic Leukemia; Nodal Marginal Zone B-cell Lymphoma; Recurrent Adult Burkitt Lymphoma; Recurrent Adult Diffuse Large Cell Lymphoma; Recurrent Adult Diffuse Mixed Cell Lymphoma; Recurrent Adult Diffuse Small Cleaved Cell Lymphoma; Recurrent Adult Grade III Lymphomatoid Granulomatosis; Recurrent Adult Immunoblastic Large Cell Lymphoma; Recurrent Adult Lymphoblastic Lymphoma; Recurrent Grade 1 Follicular Lymphoma; Recurrent Grade 2 Follicular Lymphoma; Recurrent Grade 3 Follicular Lymphoma; Recurrent Mantle Cell Lymphoma; Recurrent Marginal Zone Lymphoma; Recurrent Small Lymphocytic Lymphoma; Splenic Marginal Zone Lymphoma; Waldenström Macroglobulinemia
MeSH terms: Burkitt Lymphoma; Lymphoma; Lymphoma, Follicular; Lymphoma, B-Cell; Lymphoma, Non-Hodgkin; Leukemia, Lymphocytic, Chronic, B-Cell; Lymphoma, Mantle-Cell; Lymphoma, B-Cell, Marginal Zone; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Lymphoma, Large B-Cell, Diffuse; Lymphoma, Large-Cell, Immunoblastic; Plasmablastic Lymphoma; Waldenstrom Macroglobulinemia; Lymphomatoid Granulomatosis; Recurrence
Intervention: rituximab; cyclosporine; fludarabine phosphate; mycophenolate mofetil; yttrium Y 90 ibritumomab tiuxetan; peripheral blood stem cell transplantation; allogeneic hematopoietic stem cell transplantation; total-body irradiation
Intervention description: Given IV; Given orally; Given IV; Given orally; Given IV; Undergo transplantation; Undergo transplantation; Undergo TBI
Intervention MeSH terms: Cyclosporine; Mycophenolic Acid; Rituximab; Fludarabine; Fludarabine phosphate; Cyclosporins; Antibodies, Monoclonal
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 42.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No

Summary:

      Monoclonal antibodies, such as yttrium Y 90 ibritumomab tiuxetan, can block find cancer cells
      and either kill them or carry cancer-killing substances to them without harming normal cells.
      Giving monoclonal antibodies, low doses of chemotherapy, such as fludarabine phosphate, and
      low dose total-body radiation therapy before a donor peripheral stem cell transplant helps
      stop the growth of cancer cells and also stops the patient's immune system from rejecting the
      donor's stem cells. The donated stem cells may replace the patient's immune cells and help
      destroy any remaining cancer cells (graft-versus-tumor effect). Sometimes the transplanted
      cells from a donor can also make an immune response against the body's normal cells. Giving
      cyclosporine or mycophenolate mofetil after the transplant may stop this from happening
    

Eligibility criteria:

        Inclusion Criteria:

          -  Patients must have a histologically confirmed diagnosis of a lymphoid malignancy
             expressing the cluster of differentiation (CD)20 antigen and have failed at least one
             prior standard systemic therapy

          -  Patients must have evidence of persistent lymphoma by physical examination,
             radiographic studies, bone marrow evaluation, flow cytometry, or polymerase chain
             reaction (PCR)

          -  Creatinine < 2.0

          -  Bilirubin < 1.5 mg/dL

          -  Patients must have an expected survival of > 60 days and must be free of major
             infection including human immunodeficiency virus (HIV)

          -  Patients must have an HLA-identical related or unrelated donor

          -  DONOR: Donor eligibility includes both HLA-matched relatives or HLA matched, unrelated
             volunteer donors; related donors should be matched by molecular methods at the
             intermediate resolution level at HLA-A, B, C, and DRB1 according to FHCRC Standard
             Practice Guidelines and to the allele level at DQB1; unrelated donors should be
             identified using matching criteria that follows the FHCRC Standard Practice Guidelines
             limiting the study to eligible donors that are allele matched for HLA-A, B, C, DRB1,
             and DQB1 (Grade1), and accepting up to one allele mismatch as per Standard Practice
             Grade 2.1 for HLA-A, B, or C

          -  Donor must consent to granulocyte colony-stimulating factor (G-CSF) (filgrastim)
             administration and leukapheresis

          -  Donor must have adequate veins for leukapheresis or agree to placement of central
             venous catheter (femoral, subclavian)

        Exclusion Criteria:

          -  Systemic anti-lymphoma therapy given in the previous 30 days

          -  Patients who have experienced progressive disease within 3 months of prior Bexxar or
             Zevalin

          -  Inability to understand or give an informed consent

          -  Central nervous system lymphoma

          -  Pregnancy

          -  Fertile men or women unwilling to use contraceptive techniques during and for 12
             months following treatment

          -  Southwest Oncology Group (SWOG)/Eastern Cooperative Oncology Group (ECOG) performance
             score > 2

          -  Eligible for radioimmunotherapy-based autologous transplant trial

          -  Medical condition that would contraindicate allogeneic transplantation

          -  Evidence of Human Anti-Mouse Antibody (HAMA) for patients with prior exposure to
             therapeutic murine antibodies

          -  Eligible for other therapeutic options that will be more likely to have a better
             long-term disease-free survival with lower potential toxicity (e.g., non-transplant
             therapy, autologous transplants, etc.) than this study

          -  Other grave medical conditions considered to represent contraindications to bone
             marrow transplant (BMT) (e.g. unstable angina, pulmonary dysfunction [diffusing
             capacity of the lung for carbon monoxide (DLCO) < 30%, total lung capacity (TLC) <
             30%, continuous supplemental oxygen], acquired immune deficiency syndrome [AIDS],
             etc.)

          -  DONOR: Identical twin

          -  DONOR: Age less than 12 years

          -  DONOR: Pregnancy

          -  DONOR: Infection with HIV

          -  DONOR: Inability to achieve adequate venous access

          -  DONOR: Known allergy to G-CSF

          -  DONOR: Current serious systemic illness or infection