Lymphoma Clinical Trial
Official title:
Prognostic Significance of Early Positron Emission Tomography (PET) With Fluorine-18 Fluorodeoxyglucose ([18F] FDG) in Intermediate and High Grade Non-Hodgkin's Lymphoma
RATIONALE: Diagnostic procedures, such as positron emission tomography (PET) using
fludeoxyglucose F 18, may help in learning how well chemotherapy works to kill cancer cells
and allow doctors to plan better treatment. Comparing results of diagnostic procedures done
before, during, and after chemotherapy may help doctors predict a patient's response to
treatment and help plan the best treatment.
PURPOSE: This clinical trial is studying positron emission tomography using fludeoxyglucose
F 18 to see how well it works in predicting response to treatment in patients who are
receiving rituximab and combination chemotherapy for newly diagnosed non-Hodgkin's lymphoma.
OBJECTIVES:
- Determine the positive and negative predictive values of early positron emission
tomography (PET) scanning using fludeoxyglucose F 18 in terms of the probability of
patients with newly diagnosed intermediate- or high-grade non-Hodgkin's lymphoma who
achieve or do not achieve complete remission, after treatment with 1 course of
rituximab and combination chemotherapy comprising cyclophosphamide, doxorubicin,
vincristine, and prednisone.
- Determine event free and overall survival of patients with an early positive and
negative PET scan treated with this regimen.
- Determine the predictive value of early PET scan response ratio as a continuous
variable in terms of response to therapy (assessed at the end of therapy), disease-free
survival, and overall survival, in patients treated with this regimen.
- Correlate International Prognostic Index score at presentation with early PET scan
results and overall outcome in patients treated with this regimen.
- Correlate the degree of neutropenia 7 to 10 days after the first course of treatment
with rituximab and combination chemotherapy with PET scan response and pre-treatment
blood CD34-positive cell concentration in these patients.
OUTLINE: This is a multicenter study.
Patients receive fludeoxyglucose F 18 (^18FDG) IV. Beginning 1 hour later, patients undergo
whole-body positron emission tomography (PET) scanning. Patients also undergo conventional
radiographic staging of their disease.
Patients then receive standard R-CHOP (or an alternative regimen) comprising rituximab IV
over 3-6 hours, cyclophosphamide IV over 30 minutes, doxorubicin IV over 5 minutes, and
vincristine IV over 5 minutes on day 1 and oral prednisone once daily on days 1-5. Treatment
repeats every 14-21 days for up to 4 courses in the absence of unacceptable toxicity.
Patients undergo repeat ^18FDG-PET scanning between days 7-10 of course 1, between courses 3
and 4, and then at the completion of R-CHOP. Patients also undergo radiographic restaging of
their disease between courses 3 and 4 and at the completion of R-CHOP.
After completion of study treatment, patients are followed every 3-4 months for 2 years,
every 6 months for 1 year, and then annually for 3 years.
PROJECTED ACCRUAL: A total of 30 patients will be accrued for this study within 2 years.
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Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Diagnostic
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