This phase I/II trial studies the side effects and best dose of lenalidomide when given after combination chemotherapy with or without rituximab and stem cell transplant and to see how well it works in treating patients with non-Hodgkin lymphoma that has not responded to treatment or has returned after a period of improvement and is resistant to chemotherapy. Biological therapies, such as lenalidomide, may stimulate the immune system in different ways and stop cancer cells from growing. Drugs used in chemotherapy, such as carmustine, etoposide, cytarabine, and melphalan, 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, may block cancer growth by targeting certain cells. Giving lenalidomide after combination chemotherapy with or without rituximab may work better in treating patients with non-Hodgkin lymphoma.
PRIMARY OBJECTIVES: I. To establish the maximum tolerated dose (MTD) of lenalidomide given in the post-transplant setting for a 12 month maintenance period. SECONDARY OBJECTIVES: I. To obtain preliminary estimates of the 1-year response rate, event-free and overall survival using this regimen. OUTLINE: This is a phase I, dose-escalation study of lenalidomide followed by a phase II study. PRE-CONDITIONING (patients with cluster of differentiation \[CD\]20+ non-Hodgkin lymphoma): Patients receive rituximab intravenously (IV) per standard of care. PREPARATIVE REGIMEN: Patients receive carmustine IV on day -6, etoposide IV twice daily (BID) and cytarabine IV BID on days -5 through -2, and melphalan IV on day -1. AUTOLOGOUS HEMATOPOIETIC STEM CELL TRANSPLANTATION: Patients undergo stem cell infusion on day 0. MAINTENANCE THERAPY: Beginning approximately 100 days post-transplant, patients receive lenalidomide orally (PO) on days 1-21. Treatment repeats every 28 days for 12 courses in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up periodically.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
74
Undergo autologous hematopoietic stem cell transplant
Given IV
Given IV
Given IV
Given PO
Given IV
Given IV
University of Kansas Hospital-Westwood Cancer Center
Westwood, Kansas, United States
University of Nebraska Medical Center
Omaha, Nebraska, United States
Seidman Cancer Center at University Hospitals Case Medical Center, Case Comprehensive Cancer Center
Cleveland, Ohio, United States
Maximum Tolerated Dose of Lenalidomide (Phase I)
The Maximum Tolerated Dose (MTD) is defined to be the dose cohort below which 3 out of 6 subjects experience dose limiting toxicities during cycle 1. Dose limiting toxicities graded using the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0
Time frame: Cycle 1, 28 days
Event-free Survival
The Kaplan-Meier method will be used to estimate the event-free survival distribution.
Time frame: 1 year
Overall Survival
The Kaplan-Meier method will be used to estimate the overall survival distribution. This outcome only reports data as it pertains to overall survival at one year. All-cause mortality includes survival for follow up for all subjects on the study.
Time frame: 1 year
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