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Brief Title: Combination Chemotherapy Followed By Stem Cell Transplant in Treating Young Patients With Progressive or Relapsed Anaplastic Large Cell Lymphoma
Official Title: Treatment Protocol for Relapsed Anaplastic Large Cell Lymphoma of Childhood and Adolescence
Study ID: NCT00317408
Brief Summary: RATIONALE: Giving combination chemotherapy and total-body irradiation before a peripheral stem cell transplant that uses the patient's or a donor's stem cells, helps stop both the growth of cancer cells and the patient's immune system from rejecting the stem cells. When the stem cells are infused into the patient they may help the patient's bone marrow make stem cells, red blood cells, white blood cells, and platelets. Giving combination chemotherapy and total-body irradiation followed by a stem cell transplant may be an effective treatment for anaplastic large cell lymphoma. PURPOSE: This clinical trial is studying how well combination chemotherapy followed by stem cell transplant works in treating young patients with progressive or relapsed anaplastic large cell lymphoma.
Detailed Description: OBJECTIVES: Primary * Improve the probability of event-free survival in children and adolescents with early progression of anaplastic large cell lymphoma (ALCL) and/or relapse of ALCL with CD3-positive immunophenotype treated with reinduction combination chemotherapy followed by allogeneic or autologous stem cell transplantation. * Determine whether a conditioning regimen comprising carmustine, etoposide phosphate, cytarabine, and melphalan (BEAM) (without total body irradiation) for autologous stem cell transplantation is an effective treatment for patients with relapsed CD3-negative ALCL occurring after the intensive phase of treatment. * Determine the impact of vinblastine in patients with late relapse of CD3-negative ALCL who have not received vinblastine during frontline therapy. Secondary * Determine overall survival and treatment-related mortality in patients treated with these regimens. * Determine acute and long-term toxicity in patients treated with these regimens. * Determine the rate of acute and chronic graft-vs-host disease in patients treated with allogeneic stem cell transplantation. OUTLINE: This is a multicenter, prospective, nonrandomized study. Patients are stratified according to time from initial diagnosis to progression/relapse, immunophenotype of lymphoma cells (CD3-positive + vs CD3-negative), stem cell donor availability (matched sibling donor vs 9/10 or 10/10 matched unrelated donor), and vinblastine during frontline therapy (yes vs no). * Group 1 (early progression): Patients receive 1 course of ICM chemotherapy followed by 1 course of ICI chemotherapy. * ICM chemotherapy: Patients receive methotrexate, cytarabine, and prednisolone intrathecally (IT) on day 1, mitoxantrone hydrochloride IV over 5 hours on days 1 and 2, carboplatin IV continuously on days 2-5 and ifosfamide IV continuously on days 2-6. * ICI chemotherapy: Patients receive methotrexate, cytarabine, and prednisolone intrathecally on day 1, idarubicin IV over 4 hours on days 1 and 2, carboplatin IV continuously on days 2-5, and ifosfamide IV continuously on days 2-6. Patients then proceed to allogeneic stem cell transplantation. * Group 2 (relapsed disease and CD3-positive lymphoma cells): Patients are stratified according to stem cell donor availability (yes vs no). * Available donor: Patients receive 2 courses of CC chemotherapy and then proceed to allogeneic stem cell transplantation. * Unavailable donor : Patients receive 2 courses of CC chemotherapy comprising dexamethasone orally or IV on days 1-5, vindesine IV on day 1, cytarabine IV over 3 hours on days 1 and 2, etoposide phosphate IV over 2 hours on days 3-5, and methotrexate, cytarabine, and prednisolone IT on day 5. Patients then receive 1 course of CVA chemotherapy comprising oral lomustine on day 1, vinblastine IV on days 1, 8, 15, and 22, and cytarabine IV over 1 hour on days 1-5. Patients undergo leukapheresis for collection of autologous peripheral blood stem cells after the first and/or second course of CC chemotherapy. Patients then proceed to autologous stem cell transplantation. * Group 3 (relapsed disease, CD3-negative immunophenotype, and received vinblastine during frontline therapy): Patients receive 2 courses of CC chemotherapy and 1 course of CVA chemotherapy as described above. Patients undergo leukapheresis for collection of autologous peripheral blood stem cells (PBSC) after the first and/or second course of CC chemotherapy. Patients then proceed to autologous stem cell transplantation. * Group 4 (late relapse, CD3-negative immunophenotype, and did not receive vinblastine during frontline therapy): Patients receive vinblastine IV once weekly for 24 months. Patients with disease progression during or relapsed disease after vinblastine therapy undergo treatment as in group 3. * Autologous stem cell transplantation (SCT): Patients receive a conditioning regimen comprising carmustine IV over 1 hour on day -7, etoposide phosphate IV over 1 hour and cytarabine IV over 30 minutes on days -6 to -3, and melphalan IV over 15 minutes on day -2. Patients undergo autologous SCT on day 0. * Allogeneic SCT: Beginning 4-6 weeks after the start of the last chemotherapy course, patients receive 1 of the following conditioning regimens based on age: * Patients \> 2 years of age undergo total body irradiation on days -7 to -5 and receive thiotepa IV over 1 hour on day -4 and etoposide IV over 4 hours on day -3. Patients undergo allogeneic SCT on day 0. * Patients ≤ 2 years of age receive oral busulfan 4 times daily on days -8 to -5, thiotepa IV over 1 hour twice on day -4, and etoposide phosphate IV over 4 hours on day -3. Patients undergo allogeneic SCT on day 0. Patients undergoing SCT from an unrelated donor also receive antithymocyte globulin IV over 4 hours on days -3 to -1. All patients receive graft-versus-host (GVHD) prophylaxis as described below. * GVHD prophylaxis: GVHD prophylaxis is administered as per donor status. * Matched sibling donor: Patients receive cyclosporine IV over 2 hours or orally on day -1 to 60 followed by a taper. * 10/10 or 9/10 matched unrelated donor: Patients receive cyclosporine IV over 2 hours or orally on days -1 to 100 followed by a taper, methotrexate IV on days 1, 3, and 6, and leucovorin calcium IV on days 2, 4, and 7. * Mismatched donor: Patients do not receive GVHD prophylaxis, however, CD3-positive lymphocytes are extracted from donor stem cells. After completion of study treatment, patients are followed periodically for 10 years. PROJECTED ACCRUAL: A total of 96 patients will be accrued for this study.
Minimum Age:
Eligible Ages: CHILD, ADULT
Sex: ALL
Healthy Volunteers: No
St. Anna Children's Hospital, Vienna, , Austria
U.Z. Gasthuisberg, Leuven, , Belgium
University Hospital Brno, Brno, , Czech Republic
Charles University Hospital, Prague 5, , Czech Republic
Centre Leon Berard, Lyon, , France
Kinderklinik - Universitaetsklinikum Aachen, Aachen, , Germany
Klinikum Augsburg, Augsburg, , Germany
Helios Klinikum Berlin, Berlin, , Germany
Charite University Hospital - Campus Virchow Klinikum, Berlin, , Germany
Evangelisches Krankenhauus Bielfeld, Biefeld, , Germany
Kinderklinik der Universitaet Bonn, Bonn, , Germany
Staedtisches Klinikum - Howedestrase, Braunschweig, , Germany
Klinikum Bremen-Mitte, Bremen, , Germany
Klinikum Chemnitz gGmbH, Chemnitz, , Germany
Kliniken der Stadt Koeln gGmbH - Kinderkrankenhaus Riehl, Cologne, , Germany
Children's Hospital, Cologne, , Germany
Carl - Thiem - Klinkum Cottbus, Cottbus, , Germany
Vestische Kinderklinik, Datteln, , Germany
Klinikum Dortmund, Dortmund, , Germany
Universitatsklinikum Carl Gustav Carus, Dresden, , Germany
Universitaetsklinikum Duesseldorf, Duesseldorf, , Germany
Helios Klinikum Erfurt, Erfurt, , Germany
Universitaets - Kinderklinik, Erlangen, , Germany
Universitaetsklinikum Essen, Essen, , Germany
Klinikum der J.W. Goethe Universitaet, Frankfurt, , Germany
Universitaetskinderklinik - Universitaetsklinikum Freiburg, Freiburg, , Germany
Kinderklinik, Giessen, , Germany
Universitaetsklinikum Goettingen, Goettingen, , Germany
Klinik und Poliklinik Fuer Kinder-und Jugendmedizin - Universitaetsklinikum Greifswald, Greifswald, , Germany
University Medical Center Hamburg - Eppendorf, Hamburg, , Germany
Medizinische Hochschule Hannover, Hannover, , Germany
Universitaets-Kinderklinik Heidelberg, Heidelberg, , Germany
Gemeinschaftskrankenhaus, Herdecke, , Germany
Universitaetsklinikum des Saarlandes, Homburg, , Germany
Universitaets - Kinderklinik, Jena, , Germany
Staedtisches Klinikum Karlsruhe gGmbH, Karlsruhe, , Germany
Klinikum Kassel, Kassel, , Germany
University Hospital Schleswig-Holstein - Kiel Campus, Kiel, , Germany
Klinikum Kemperhof Koblenz, Koblenz, , Germany
Klinikum Krefeld GmbH, Krefeld, , Germany
Universitaets - Kinderklinik, Leipzig, , Germany
St. Annastift Krankenhaus, Ludwigshafen, , Germany
Universitaets - Kinderklinik - Luebeck, Luebeck, , Germany
Universitatsklinikum der MA, Magdeburg, , Germany
Johannes Gutenberg University, Mainz, , Germany
Staedtisches Klinik - Kinderklinik, Mannheim, , Germany
Universitaets - Kinderklinik, Marburg, , Germany
Klinikum Minden, Minden, , Germany
Klinik und Poliklinik fuer Kinder und Jugendmedizin - Universitaetsklinikum Muenster, Muenster, , Germany
Krankenhaus Muenchen Schwabing, Munich, , Germany
Dr. von Haunersches Kinderspital der Universitaet Muenchen, Munich, , Germany
Kinderklinik Kohlhof, Neunkirchen, , Germany
Cnopf'sche Kinderklinik, Nuremberg, , Germany
Klinikum Oldenburg, Oldenburg, , Germany
Klinik St. Hedwig-Kinderklinik, Regensburg, , Germany
Kinderklinik - Universitaetsklinikum Rostock, Rostock, , Germany
Saarbrucker Winterbergkliniken, Saarbrucken, , Germany
Klinikum Schwerin, Schwerin, , Germany
Kinderklink Siegen Deutsches Rotes Kreuz, Siegen, , Germany
Johanniter-Kinderklinik, St. Augustin, , Germany
Olgahospital, Stuttgart, , Germany
Krankenanstalt Mutterhaus der Borromaerinnen, Trier, , Germany
Universitaetsklinikum Tuebingen, Tuebingen, , Germany
Comprehensive Cancer Center Ulm at Universitaetsklinikum Ulm, Ulm, , Germany
Dr. Horst-Schmidt-Kliniken, Wiesbaden, , Germany
Universitaets - Kinderklinik Wuerzburg, Wuerzburg, , Germany
Helios Kliniken Wuppertal University Hospital, Wuppertal, , Germany
Our Lady's Hospital for Sick Children Crumlin, Dublin, , Ireland
Azienda Ospedaliera di Padova, Padova, , Italy
Erasmus MC - Sophia Children's Hospital, Rotterdam, , Netherlands
Akademia Medyczna im. Piastow Slaskich, Wroclaw, , Poland
Goeteborg University, Goeteborg, , Sweden
Kantonspital Aarau, Aarau, , Switzerland
Universitaets-Kinderspital beider Basel, Basel, , Switzerland
Ospedale "la Carita", Locarno, Locarno, , Switzerland
Kinderspital Luzern, Lucerne 16, , Switzerland
Ostschweizer Kinderspital, St. Gallen, , Switzerland
University Children's Hospital, Zurich, , Switzerland
Birmingham Children's Hospital, Birmingham, England, United Kingdom
Institute of Child Health at University of Bristol, Bristol, England, United Kingdom
Addenbrooke's Hospital, Cambridge, England, United Kingdom
Leeds Cancer Centre at St. James's University Hospital, Leeds, England, United Kingdom
Leicester Royal Infirmary, Leicester, England, United Kingdom
Royal Liverpool Children's Hospital, Alder Hey, Liverpool, England, United Kingdom
Middlesex Hospital, London, England, United Kingdom
Great Ormond Street Hospital for Children, London, England, United Kingdom
Royal Manchester Children's Hospital, Manchester, England, United Kingdom
Sir James Spence Institute of Child Health at Royal Victoria Infirmary, Newcastle-Upon-Tyne, England, United Kingdom
Queen's Medical Centre, Nottingham, England, United Kingdom
Oxford Radcliffe Hospital, Oxford, England, United Kingdom
Children's Hospital - Sheffield, Sheffield, England, United Kingdom
Southampton General Hospital, Southampton, England, United Kingdom
Royal Marsden - Surrey, Sutton, England, United Kingdom
Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland, United Kingdom
Royal Aberdeen Children's Hospital, Aberdeen, Scotland, United Kingdom
Royal Hospital for Sick Children, Edinburgh, Scotland, United Kingdom
Royal Hospital for Sick Children, Glasgow, Scotland, United Kingdom
Childrens Hospital for Wales, Cardiff, Wales, United Kingdom
Name: Alfred Reiter, MD
Affiliation: University Hospital Erlangen
Role: STUDY_CHAIR
Name: Denise Williams, MD
Affiliation: Cambridge University Hospitals NHS Foundation Trust
Role: