Dose Dense Chemotherapy and Rituximab for Young High Risk Diffuse Large B-Cell Lymphoma Patients (CRY-04)
Condition: Diffuse Large B-Cell Lymphoma
MeSH terms: Lymphoma; Lymphoma, B-Cell; Lymphoma, Large B-Cell, Diffuse
Study type: Interventional
Phase: Phase 2

Summary: 
      The purpose is to test whether dose densified chemoimmunotherapy followed by central nervous
      system (CNS) prophylaxis for young high risk diffuse large B-cell lymphoma (DLBCL) patients
      is feasible and could improve time to treatment failure and reduce the risk of CNS relapses.
      Six courses of rituximab-cyclophosphamide-doxorubicin-etoposide-vincristine-prednison
      (R-CHOEP) given in two weeks intervals with the support of G-CSF is followed by one course of
      high dose methotrexate (HD-MTX) and high dose cytarabine (HD-Ara-C). The results will be
      compared to a historical Nordic study.
    

Detailed description: 
      Pathology:

      Patients may be included on the bases of the histological diagnosis of the local pathologist.
      The specimen will be reviewed by a central pathologist in each country

      Treatment:

      All patients receive CHOEP-14 with rituximab x 6 with the support of G-CSF followed by high
      dose cytarabine i.v. and high dose methotrexate i.v.Intrathecal (i.t.) CNS prophylaxis in
      combination with chemotherapy is not to be given, but i.t. methotrexate may be given once
      after initial liquid sampling. Radiotherapy will be given at the discretion of the individual
      centres.

      Investigations before, during and after treatment:

      The disease status will be assessed prior to treatment start, after 3 cycles of CHOEP +
      rituximab and after completion of the treatment schedule. Positron Emission Tomography (PET)
      using F18 deoxyglucose may be performed after fulfillment of treatment. Persistent, suspected
      lymphoma tissue should whenever possible be confirmed with a biopsy, otherwise the patient
      will be regarded as PR and second line therapy will be considered (see schematic outline).

      Clinical and radiological (CT) assessment are performed at pretreatment and subsequently on
      sites initially involved, and bone marrow biopsy if initially involved

        -  After the 3rd course

        -  After the last course (within one month) of chemotherapy (biopsy if indicated)

        -  After radiotherapy (for patient given radiotherapy as part of the primary treatment)

      Clinical follow-up:

        -  4x per year during the first and second year of follow-up

        -  2x per year during the third, fourth and fifth year of follow-up

      Radiological investigations at follow up:

      -CT after 6, 12 and 24 months of sites initially involved. CT abdomen in all cases after 12
      and 24 months. X-ray of the thorax (if CT thorax is performed) after 6, 12 and 24 months
    

Intervention name(s): R-CHOEP14x6+HD-AraC+HD-Mtx
Intervention type(s): Drug
Intervention description(s): rituximab 375 mg/m2 day 1 cyclophosphamide 750 mg/m2 day 1 doxorubicin 50 mg/m2 day 1 vincristine 1.4 mg/m2 day 1 etoposide 100mg/m2 days 1,2,3 Prednison 100 mg days 1,2,3,4,5 cycle repeated six times every two weeks followed by HD-AraC 3g/m2x4 and HD-mtx 3 g/m2 HD-AraC 3g/m2x4 times every 12 h
Other intervention name(s): R-CHOEP14x6; HD-MTXx1; HD-AraCx1
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: DLBCL; high risk; young