Clinical trial NCT00860171: Iodine I 131 Monoclonal Antibody BC8 Before Autologous Stem Cell Transplant in Treating Patients With Relapsed or Refractory Hodgkin Lymphoma or Non-Hodgkin Lymphoma
Official title: A Study Evaluating Escalating Doses of 131I-BC8 (Anti-CD45) Antibody Followed by Autologous Stem Cell Transplantation for Relapsed or Refractory Lymphoid Malignancies
Study type: INTERVENTIONAL
Overall status: TERMINATED
Phase: PHASE1
Conditions: Recurrent B-Cell Non-Hodgkin Lymphoma
Recurrent Hodgkin Lymphoma
Recurrent T-Cell Non-Hodgkin Lymphoma
Refractory B-Cell Non-Hodgkin Lymphoma
Refractory Hodgkin Lymphoma
Refractory T-Cell Non-Hodgkin Lymphoma
Lead sponsor: Fred Hutchinson Cancer Center
Sponsor class: OTHER
Collaborators: name: National Cancer Institute (NCI)
First posted: 2009-03-12
Enrollment: 16
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Intervention model description: A single site, open label clinical trial.
Primary purpose: TREATMENT

Brief summary: This phase I trial studies the side effects and best dose of iodine I 131 monoclonal antibody BC8 when given before autologous stem cell transplant in treating patients with Hodgkin lymphoma or non-Hodgkin lymphoma that has returned after a period of improvement or does not respond to treatment. Radiolabeled monoclonal antibodies, such as iodine I 131 monoclonal antibody BC8, can find cancer cells and carry cancer-killing substances to them without harming normal cells. Giving iodine I 131 monoclonal antibody BC8 before an autologous stem cell transplant may kill more cancer cells.

Detailed description: PRIMARY OBJECTIVES:

I. To estimate the maximally tolerated dose of 131I-BC8 (anti-cluster of differentiation \[CD\]45) (iodine I 131 monoclonal antibody BC8) that can be delivered prior to autologous stem cell transplantation for patients with relapsed/refractory B-non-Hodgkin lymphoma (NHL), T-NHL, or Hodgkin lymphoma (HL).

SECONDARY OBJECTIVES:

I. To optimize the protein dose (antibody \[Ab\]) to deliver a favorable biodistribution in the majority of patients.

II. To assess the radiation dose delivered to tumor sites and normal organs by the above therapy.

III. To evaluate the dose-response relationship of radiation-dose to tumor and clinical response.

IV. To estimate the overall and progression-free survival of the above regimen in such patients.

V. To evaluate the toxicity and tolerability of the above therapy.

VI. To evaluate the feasibility of delivering high-dose 131I-BC8 and autologous stem cell transplantation (ASCT) to B-Cell NHL, T-NHL, and HL patients.

VII. To evaluate the ability to reduce infusion reactions via unlabeled BC8 preinfusion.

OUTLINE: This is a dose-escalation study.

Patients receive a dosimetric dose of iodine I 131 monoclonal antibody BC8 intravenously (IV) on day -20 and a therapeutic dose on day -11. Before day -20, patients may also receive up to 2 additional dosimetric doses of iodine I 131 monoclonal antibody BC8 IV approximately 1-2 weeks apart. Patients then undergo autologous stem cell transplantation on day 0.

After completion of study treatment, patients are followed up at 1, 3, 6, and 12 months and then annually thereafter.

Eligibility criteria: Inclusion Criteria:

* Patients must have a histologically confirmed diagnosis of B-NHL, T-NHL, or HL; CD45 antigen expression must be documented on tumor specimens in all cases except HL, in whom histologic demonstration of CD45+ cells adjacent to the Reed Sternberg cells is required
* Patients must have received at least one prior standard systemic therapy with documented recurrent or refractory disease
* Mantle cell lymphoma (MCL), T-NHL, or other high-risk malignancies may be enrolled/transplanted in complete remission (CR)/first partial remission (PR1)
* Patients are preferred to have either a tumor mass amenable to core needle biopsy during the dosimetry phase, or a measurable tumor mass with at least one site of involvement measuring 2.0 cm in largest dimension on computed tomography (CT) imaging for purposes of planar and/or single-photon emission CT (SPECT)/CT tumor dosimetry (patients with disease that does not allow tumor dosimetry will be allowed on study since they still can contribute toward achieving the primary endpoint, but these patients will be given a lower priority over those with evaluable disease)
* Creatinine \[Cr\] \< 2.0
* Bilirubin \< 1.5 mg/dL, with the exception of patients thought to have Gilbert's syndrome, who may have a total bilirubin above 1.5 mg/dL
* All patients eligible for therapeutic study must have a minimum of \>= 4 x10\^6 CD34/kg autologous hematopoietic stem cells harvested and cryopreserved and divided into 2 aliquots of at least \>= 2 x10\^6 CD34/kg each; patients with a history of prior autologous hematopoietic cell transplant (HCT) are only required to have \>= 2x10\^6 CD34/kg stored
* Patients must have an expected survival of \> 60 days and must be free of major infection

Exclusion Criteria:

* Circulating human anti-mouse antibody (HAMA), to be determined before each infusion
* Systemic anti-lymphoma therapy given in the previous 30 days before the scheduled therapy dose with the exception of rituximab
* Inability to understand or give an informed consent
* Lymphoma involving the central nervous system
* Other serious medical conditions considered to represent contraindications to bone marrow transplant (BMT) (e.g. abnormally decreased cardiac ejection fraction, diffusion capacity of the lung for carbon monoxide (DLCO) \< 50% predicted, forced expiratory volume in one second (FEV1) \< 70% predicted, acquired immune deficiency syndrome \[AIDS\], etc.)
* Known human immunodeficiency virus (HIV) seropositivity
* Pregnancy or breast feeding
* Prior allogeneic bone marrow or stem cell transplant
* Prior autologous bone marrow or stem cell transplant or prior radiation therapy (RT) \> 20 Gy to a critical organ within 1 year of enrollment
* Presence of circulating lymphoma cells by morphology or flow cytometry (\> 0.1%) at or near the time of peripheral blood stem cell (PBSC) collection if unpurged/unselected PBSC are to be used (patients with cryopreserved stem cells which are negative \[=\< 0.1% involved\] by flow cytometry will also be considered eligible)
* Southwest Oncology Group (SWOG) performance status \>= 2.0
* Unable to perform self-care during radiation isolation
* Expected survival if untreated less than 60 days

Primary outcomes:
measure: Maximum Tolerated Dose (MTD) of I-131-BC8 That Can be Delivered Prior to Transplant
timeFrame: Within 30 days post-transplant
measure: I-131 Activity Administered
timeFrame: At time of I-131 therapy
Secondary outcomes:
measure: Adverse Events
timeFrame: Up to 6 years
measure: Overall Survival
timeFrame: Up to 6 years
measure: Progression-free Survival
timeFrame: Up to 6 years
measure: Relapse Rate
timeFrame: Up to 6 years
Other outcomes:
Locations:
city: Seattle
country: United States
facility: Fred Hutch/University of Washington Cancer Consortium
state: Washington
Study officials:
affiliation: Fred Hutch/University of Washington Cancer Consortium
name: Ajay Gopal
role: PRINCIPAL_INVESTIGATOR
References: