Study of Pralatrexate in Patients With Relapsed or Refractory Cutaneous T-cell Lymphoma

Inclusion Criteria:

   - Confirmed relapsed or refractory cutaneous T-cell lymphoma (CTCL):

      1. Mycosis fungoides Stage IB or higher

      2. Sézary syndrome

      3. Primary cutaneous anaplastic large cell

   - No curative treatment options.

   - Progression of disease (PD) or relapse of disease after at least 1 previous systemic
   therapy, PD after last prior treatment regimen, and recovered from the toxic effects
   of prior therapy.

   - Eastern Cooperative Oncology Group (ECOG) Performance Status ≤ 2.

   - Life expectancy ≥ 3 months.

   - Adequate blood, liver, and kidney function as determined by laboratory tests.

   - Methylmalonic acide (MMA) serum concentration < 200 nmol/L and homocysteine (Hcy)
   concentration < 10 μmol/L at screening, or receipt of 1 mg daily oral folic acid for
   at least 10 days prior to the planned start of pralatrexate and 1 mg intramuscular
   vitamin B12 within 10 weeks of the planned start of pralatrexate.

   - Women of childbearing potential must use a medically acceptable contraceptive regimen
   from study treatment initiation until at least 30 days after the last dose of
   pralatrexate and must have a negative serum pregnancy test within 14 days prior to the
   first day of study treatment. Serum pregnancy test not required for patients who are
   postmenopausal (greater than 12 months since last menses) or are surgically
   sterilized.

   - Women who are breastfeeding.

   - Men who are not surgically sterile must use a medically acceptable contraceptive
   regimen from start of pralatrexate until at least 90 days after the last
   administration of pralatrexate.

   - Written informed consent and privacy authorization.

Exclusion Criteria:

   - Active concurrent malignancy (except non-melanoma skin cancer or carcinoma in situ of
   the cervix). If there is a history of prior malignancy, the patient must be
   disease-free for ≥ 5 years. Patients with other prior malignancies < 5 years before
   study entry may be enrolled if treatment resulted in complete resolution of the cancer
   and currently have no clinical, radiologic, or laboratory evidence of active or
   recurrent disease.

   - Congestive heart failure Class III/IV per the New York Heart Association Heart Failure
   Guidelines.

   - Uncontrolled hypertension.

   - Human immunodeficiency virus (HIV)-positive diagnosis with a CD4 count of <100 mm3 or
   detectable viral load within the past 3 months, and is receiving combination
   anti-retroviral therapy.

   - Symptomatic central nervous system metastases or lesions for which treatment is
   required.

   - Active uncontrolled infection, underlying medical condition that would impair ability
   to receive protocol treatment.

   - Major surgery within 2 weeks of planned start of treatment.

   - Receipt of any conventional chemotherapy or radiation therapy (RT) encompassing >10%
   of bone marrow within 4 weeks (6 weeks for nitrosoureas or mitomycin C) prior to study
   treatment or planned use during the study.

   - Receipt of systemic corticosteroids within 3 weeks of study treatment, unless on a
   continuous dose of ≤10 mg/day of prednisone for at least 1 month.

   - Initiation of or change in dosage of topical corticosteroids within 3 weeks of study
   treatment (topical steroid use within 3 weeks is allowed if strength/use has been
   stable for at least 1 month; topical corticosteroids cannot be started during the
   study).

   - Use of investigational drugs, biologics, or devices within 4 weeks prior to study
   treatment or planned use during the study.

   - Receipt of a monoclonal antibody within 3 months without evidence of progression.

   - Use of oral retinoids within 4 weeks of study treatment or high-dose vitamin A.

   - Previous exposure to pralatrexate, unless the patient was on this study, achieved a
   complete or partial response, and was taken off study treatment because of
   investigator decision, and subsequently experienced disease recurrence or progressive
   disease.

   - Re-entering patients: must not have received subsequent therapy for CTCL during the
   time off initial study treatment.