VELCADE (Bortezomib) for Injection - Phase II Study of Bortezomib and Rituximab in Relapsed or Refractory Non-Hodgkin's Lymphoma
Inclusion Criteria
DISEASE CHARACTERISTICS:
- Histologically confirmed B-cell non-Hodgkin's lymphoma (NHL) including the following
subtypes:
- B-cell small lymphocytic lymphoma
- Marginal zone lymphoma (extranodal, nodal, or splenic)
- Grade 1-3 follicular lymphoma
- Mantle cell lymphoma
- Waldenstrom's macroglobulinemia
- Bidimensionally measurable disease by CT scan with ≥ 1 lesion measuring > 1.5 cm in a
single dimension
- Relapsed or refractory disease after prior antineoplastic therapy, meeting 1 of the
following criteria:
- No response to prior treatment
- Relapsed disease after prior therapy
- Confirmed CD20-positive disease by immunohistochemistry on biopsy specimen
- Prior transformation allowed provided there is no evidence of aggressive
histology on recent biopsy
- No chronic lymphocytic lymphoma with absolute lymphocyte count > 5,000/mm³
- No CNS involvement
PATIENT CHARACTERISTICS:
- ECOG performance status 0-2
- Absolute neutrophil count ≥ 1,500/mm^3 (≥ 1,000/mm³ if due to extensive bone marrow
involvement with NHL or splenomegaly)
- Absolute lymphocyte count ≤ 5,000/mm³ (except mantle cell lymphoma with a leukemic
phase)
- Platelet count ≥ 50,000/mm^3
- Bilirubin ≤ 2.0 mg/dL
- AST and ALT ≤ 2.5 times upper limit of normal (ULN) (4 times ULN if liver involvement
with NHL)
- Creatinine ≤ 2.0 mg/dL
- Not pregnant or nursing
- Negative pregnancy test
- Fertile male and female patients must use effective contraception during study
- No serious nonmalignant disease
- No active infection
- No peripheral neuropathy ≥ grade 2 within past 14 days
- No myocardial infarction within the past 6 months
- No New York Heart Association class III or IV heart failure
- No uncontrolled angina pectoris
- No severe uncontrolled ventricular arrhythmias
- No EKG evidence of acute ischemia or active conduction system abnormalities
- Any EKG abnormality must be documented as not medically relevant
- No hypersensitivity to bortezomib, boron, or mannitol
- No known anaphylaxis or immunoglobulin E-mediated hypersensitivity to murine proteins
or any component of rituximab (including polysorbate 80 and sodium citrate dehydrate)
- No known infection or exposure to HIV
- No serious psychiatric or medical illness that would preclude study participation
- No active hepatitis B infection
- No other primary malignancy requiring active treatment
- More than 4 weeks since prior significant traumatic injury
PRIOR CONCURRENT THERAPY:
- At least 3 weeks since prior and no concurrent radiotherapy
- More than 4 weeks since prior major surgery or open biopsy
- Other diagnostic surgery allowed
- More than 4 weeks since prior cytotoxic chemotherapy (6 weeks for nitrosoureas)
- At least 3 months since prior unconjugated monoclonal antibody therapy
- At least 10 weeks since prior radioimmunoconjugates or toxin immunoconjugates (e.g.,
iodine I 131 tositumomab [Bexxar] or ibritumomab tiuxetan [Zevalin])
- More than 2 weeks since prior investigational agent
- No prior bortezomib
- No concurrent systemic corticosteroid at greater than the equivalent dose of 20
mg/day of prednisone, unless for treatment of allergic reactions to CT scan dye
- No concurrent major surgery
- No other immunosuppressive agents, unless for treatment of allergic reactions to CT
scan dye
- No other concurrent antilymphoma agents
- No other concurrent investigational agent
- Concurrent participation in another nontreatment study allowed if it does not
interfere with participation in this study