RATIONALE: Drugs used in chemotherapy, such as fludarabine and pixantrone, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Monoclonal antibodies, such as rituximab, can block cancer growth in different ways. Some block the ability of cancer cells to grow and spread. Others find cancer cells and help kill them or carry cancer-killing substances to them. It is not yet known whether giving fludarabine together with rituximab is more effective with or without pixantrone in treating indolent non-Hodgkin lymphoma. PURPOSE: This randomized phase III trial is studying fludarabine and rituximab to compare how well they work with or without pixantrone in treating patients with relapsed or refractory indolent non-Hodgkin lymphoma.
OBJECTIVES: Primary * To compare the progression-free survival (PFS) of patients with relapsed or refractory indolent non-Hodgkin lymphoma treated with fludarabine phosphate and rituximab with vs without pixantrone. Secondary * To compare the overall objective response rate (complete response \[CR\], unconfirmed complete response \[CRu\], and partial response \[PR\]) in these patients. * To compare the CR and CRu rate in these patients. * To compare the duration of response and time to progression in these patients. * To compare the overall survival and disease-specific survival of these patients. * To compare the safety (including cardiac safety) and tolerability of these regimens in these patients. OUTLINE: This is a multicenter study. Patients are stratified by Follicular Lymphoma International Prognostic Index (FLIPI) score (0 or 1 vs ≥ 2), number of prior treatments (1 or 2 vs \> 2), and prior anti-CD20 regimen (yes vs no). Patients are randomized to 1 of 2 treatment arms. * Arm I (control): Patients receive rituximab IV on day 1 and fludarabine phosphate IV on days 2-4. Treatment repeats every 28 days for up to 6 courses\* in the absence of unacceptable toxicity or disease progression. * Arm II: Patients receive rituximab and fludarabine phosphate as in arm I. Patients also receive pixantrone IV on day 2. Treatment repeats every 28 days for up to 6 courses\* in the absence of unacceptable toxicity or disease progression. NOTE: \*Only patients achieving complete response, unconfirmed complete response, or partial response after 4 courses receive courses 5 and 6. After completion of study therapy, patients are followed periodically for up to 5 years.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Cell Therapeutics, Incorporated
Seattle, Washington, United States
Progression-free survival
Complete response and unconfirmed complete response rate at the end of course 4 and at end of treatment
Overall objective response rate at the end of course 4 and at the end of treatment
Duration of response
Time to progression
Overall survival
Disease-specific survival
Safety
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