Chemotherapy Plus Radiation Therapy in Treating Patients With Refractory or Relapsed Hodgkin's Lymphoma - Article Cancer Chemotherapy
Clinical Trial: Chemotherapy Plus Radiation Therapy in Treating Patients With Refractory or Relapsed Hodgkin's Lymphoma
This study is no longer recruiting patients.
RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Radiation therapy uses high-energy x-rays to damage tumor cells. Combining radiation therapy with chemotherapy may kill more tumor cells. Peripheral stem cell transplantation may be able to replace immune cells that were destroyed by chemotherapy and radiation therapy used to kill tumor cells.
|Condition||Treatment or Intervention||Phase|
|recurrent adult Hodgkin's lymphoma |
recurrent/refractory childhood Hodgkin's lymphoma
| Drug: carboplatin |
Procedure: biological response modifier therapy
Procedure: bone marrow ablation with stem cell support
Procedure: colony-stimulating factor therapy
Procedure: cytokine therapy
Procedure: high-dose chemotherapy
Procedure: peripheral blood stem cell transplantation
Procedure: radiation therapy
|Phase II |
MedlinePlus related topics: Hodgkin's Disease
Study Type: Interventional
Study Design: Treatment
- Assess the efficacy of a high-dose chemoradiotherapy regimen in patients with refractory or relapsed Hodgkin's lymphoma.
OUTLINE: Patients are stratified into 1 of 3 treatment arms (0-1 adverse prognostic factors vs 2 adverse prognostic factors vs 3 adverse prognostic factors).
- Patients receive ifosfamide by 24 hour infusion on day 2. Carboplatin is administered on day 2. Etoposide IV is administered once daily on days 1-3. Patients then receive filgrastim (G-CSF) subcutaneously or IV on days 5-12. Patients receive another course of ICE chemotherapy 2-3 weeks after the first course. Leukapheresis is performed once WBC reaches at least 3000/mm^3 and continues until enough peripheral blood stem cells are collected.
Patients who have never received prior radiotherapy will receive accelerated hyperfractionated total lymphoid irradiation (TLI) twice a day for 5 days (days -10 to -6). Cyclophosphamide IV is then administered on days -5 and 4. Etoposide IV is administered by continuous infusion over 4 days (days -5 to -2).
Patients who have had prior radiotherapy receive high dose chemotherapy. Cyclophosphamide IV is administered on days -6 and -5. Etoposide IV is administered by continuous infusion over 4 days (days -6 to -3). Carmustine IV is administered on day -2.
- Patients receive the first course of ICE as in Arm I. Apheresis is performed once WBC is greater than 3000/mm^3 and continues until enough cells are collected. The second course of ICE is then administered.
Ifosfamide is administered by 48 hour continuous infusion on days 1-2. Carboplatin is administered on day 3. Etoposide IV is administered every 12 hours for 3 doses beginning on day 1. Patients receive G-CSF on days 5-14.
Patients who have never received prior radiotherapy will receive accelerated hyperfractionated TLI for 5 days (days -10 to -6). Cyclophosphamide IV is then administered every 12 hours on days -5 to -2. Etoposide IV is administered by continuous infusion over 4 days (days -5 to -2).
Patients who have had prior radiotherapy receive high-dose chemotherapy. Cyclophosphamide IV is administered every 12 hours on days -6 to -3. Etoposide IV is administered by continuous infusion over 4 days (days -6 to -3). Carmustine IV is administered on day -2.
- Patients receive cyclophosphamide IV daily for 2 days, then G-CSF beginning on day 4 until blood stem cells are collected. Patients then undergo apheresis until enough cells are collected.
Patients receive high-dose chemotherapy. Ifosfamide IV is administered for 1 hour. Etoposide is administered by continuous infusion for 12 hours. Carboplatin IV is administered for 1 hour. Etoposide is again administered by continuous infusion for 12 hours. Treatment is repeated daily for 5 days.
Patients who have never received prior radiation will now receive accelerated hyperfractionated TLI twice daily for 5 days. Patients receive a second course of high dose chemotherapy 45-90 days after reinfusion of cells. Etoposide IV and cytarabine IV are administered every 12 hours for 4 days (days -6 to -3). Melphalan IV is administered on day -2.
Patients who have received prior radiation therapy receive a second course of high-dose chemotherapy. Carmustine IV is administered on day -7. Etoposide IV and cytarabine IV are administered every 12 hours for 4 days (days -6 to -3). Melphalan IV is administered on day -2.
Patients are followed every 3 months for the first 2 years, every 4 months during years 3-5, and every 6 months thereafter.
PROJECTED ACCRUAL: This study will accrue 80 patients within 4 years.
Genders Eligible for Study: Both
- Histologically confirmed residual or relapsed Hodgkin's lymphoma following conventional dose standard chemotherapy
- Presence of the following prognostic factors are allowed:
- B symptoms (fever, weight loss, night sweats)
- Extranodal disease
- Complete remission of less than 1 year duration
PATIENT CHARACTERISTICS: Age:
- Not specified
- Not specified
- Not specified
- Not specified
- Bilirubin less than 2.0 mg/dL unless history of Gilbert's disease
- No chronic active or persistent hepatitis
- No history of chronic renal insufficiency
- Creatinine no greater than 1.5 mg/dL OR
- Creatinine clearance at least 60 mL/min
- No myocardial infarction within the past 6 months
- No unstable angina
- No significant cardiac arrhythmias other than chronic atrial fibrillation
- Ejection fraction at least 50%
- DLCO at least 50%
- No uncontrolled infection
- HIV negative
- At least 5 years since prior malignancy except:
- Curatively treated cutaneous basal cell carcinoma
- Carcinoma in situ of the cervix
- Not pregnant or nursing
- Fertile women must use effective contraception
PRIOR CONCURRENT THERAPY:
- Must have failed conventional dose standard chemotherapy
Memorial Sloan-Kettering Cancer Center, New York, New York, 10021, United States
Joachim Yahalom, MD, Study Chair, Memorial Sloan-Kettering Cancer Center
Record last reviewed: November 2004
Last Updated: November 4, 2004
Record first received: November 1, 1999
ClinicalTrials.gov Identifier: NCT00003631
Health Authority: Unspecified
ClinicalTrials.gov processed this record on 2005-04-08
Cache Date: April 9, 2005