Education and Training
Phase 2 Poor Risk DLBCL of TLI and ATG Followed by Matched Allogeneic HT as Consolidation to Autologous HCT
The purpose of this study is to determine if double autologous then allogeneic hematopoietic cell transplant may offer an improved treatment option for patients with relapsed diffuse large B-cell lymphoma (DLBCL) who are not likely to be cured by the conventional transplantation regimen.
Stanford is currently not accepting patients for this trial.
Stanford Investigator(s):
Intervention(s):
- procedure: Total lymphoid irradiation (TLI)
- drug: Anti-thymocyte globulin (ATG)
- procedure: Autologous hematopoietic stem cell transplantation (auto-HSCT)
- procedure: Allogeneic hematopoietic stem cell transplantation (allo-HSCT)
- drug: Rituximab
- drug: Carmustine
- drug: Etoposide
- drug: Filgrastim
- drug: Cyclosporine
- drug: Mycophenolate mofetil (MMF)
- drug: Cyclophosphamide
- drug: Acetaminophen
- drug: Diphenhydramine
- drug: Hydrocortisone
- drug: Methylprednisolone
Eligibility
INCLUSION CRITERIA
- Age 18 to 70 years.
- Histologically-proven diffuse large B-cell lymphoma (DLBCL) by the World Health
Organization (WHO) classification.
- Relapse after achieving initial remission or failure to achieve initial remission.
Patients with residual radiographic abnormalities after primary therapy are eligible
if abnormalities are postive by fluorodeoxyglucose (FDG)-positron emission tomography
(PET) (FDG-PET).
- Receipt of 2 cycles of second-line therapy and FDG-PET positive per Stanford (central)
review. FDG-PET to be done 2 weeks after cycle 2 of second line chemotherapy.
- Eastern Cooperative Oncology Group (ECOG) performance status < 2
- Matched related or unrelated donor identified and available
- Bone marrow biopsy and cytogenetic analysis within 8 weeks of registration
- Pretreatment serum bilirubin < 2 x the institutional upper limit of normal (ULN)
- Serum creatinine < 2 x the institutional ULN and measured or estimated creatinine
clearance > 60 mL/min by the following formula (all tests must be performed within 28
days prior to registration):
- Estimated Creatinine Clearance = (140 age) x weight (kg) x 0.85 if female 72 x
serum creatinine (mg/dL).
- EKG within 42 days prior to registration with no significant abnormalities suggestive
of active cardiac disease
- Patients must have a radionuclide ejection fraction within 42 days of registration. If
the ejection fraction is < 40%, the patient will not be eligible. If the ejection
fraction is 40-50%, the patient will have a cardiology consult.
- Corrected diffusion capacity > 55%.
- Sexually active males are advised to use an accepted and effective method of birth
control
- Women of child-bearing potential are advised to use an accepted and effective method
of birth control
- Patients must sign and give written informed consent in accordance with institutional
and federal guidelines. Patients must be informed of the investigational nature of
this study.
EXCLUSION CRITERIA
- Known allergy to etoposide or a history of Grade 3 hemorrhagic cystitis with
cyclophosphamide
- Greater than Grade 2 sensory or motor peripheral neuropathy from prior vinca alkaloid
use
- Requiring therapy for coronary artery disease, cardiomyopathy, dysrhythmia, or
congestive heart failure
- Known to be human immunodeficiency virus (HIV)-positive. The antibody test for HIV
must be performed within 42 days of registration.
- Prior chemotherapy other than corticosteroids administered within 2 weeks of the
initiation of protocol therapy.
- Prior malignancy, except adequately treated basal cell or squamous cell skin cancer,
in situ cervical cancer or other cancer for which the patients has been disease-free
for five years.
- Prior diagnosis of non-Hodgkin's lymphoma
- Active infection requiring oral or intravenous antibiotics
- Prior autologous or allogeneic hematopoietic cell transplantation
- Prior radioimmunotherapy
- Pregnant
- Lactating
DONOR ELIGIBILITY
- Related or unrelated HLA-identical donors who are in good health and have no
contra-indication to donation
- No contra-indication for the donor to collection by apheresis of mononuclear cells
mobilized by G-CSF at a dose of 16 µg/kg of body weight.
- Donors will be evaluated with a full history and physical examination.
- Virology testing including HIV; cytomegalovirus (CMV); Epstein-Barr virus (EBV); human
T-lymphotropic virus (HTLV); rapid plasma reagin (RPR); Hepatitis A, B and C be
performed within 30 days of donation.
- Prospective donors will be screened for CMV seroreactivity and seronegative donors
will be utilized if available.
- If more than one human leukocyte antigen (HLA)-matched related donor exists, then the
donor will be selected on the basis of CD31 allotype.
Ages Eligible for Study
18 Years - 70 Years
Genders Eligible for Study
All
Not currently accepting new patients for this trial
Contact Information
Stanford University
School of Medicine
300 Pasteur Drive
Stanford,
CA
94305
BMT Referrals
6507230822
Not Recruiting