Ofatumumab and Bendamustine Followed by Maintenance Ofatumumab for Rituximab Relapsed Indolent B-cell Non-Hodgkin's Lymphoma (B-NHL)
Condition: Lymphoma, Non-Hodgkin
MeSH terms: Lymphoma; Lymphoma, Non-Hodgkin; Lymphoma, B-Cell
Intervention: Ofatumumab; Bendamustine
Intervention description: 1000 mg intravenous (IV) on day 1 of each cycle (cycles 1-6) for induction phase
1000 mg IV every 2 months for 2 years; 90 mg/m2 on day 1 (after the ofatumumab infusion) and day 2 of each cycle (cycles 1-6)
Intervention MeSH terms: Bendamustine Hydrochloride; Ofatumumab
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Masking: None (Open Label)
Enrollment: 49.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: Non-Hodgkin's Lymphoma; Ofatumumab; Relapsed; Rituximab; Bendamustine

Summary:

      The purpose of this phase II open label study was is to evaluate the safety and efficacy of
      ofatumumab and bendamustine followed by maintenance ofatumumab in subjects with indolent
      B-NHL who had relapsed after Rituximab treatment. A maximum of 53 subjects at least 18 years
      old with Small lymphocytic, lymphoplasmacytic, marginal zone lymphoma, or follicular
      lymphoma; Grades 1, 2 and 3a, would have been enrolled (34 in Stage 1 and 19 in Stage 2).
      Subjects should have had Rituximab-sensitive disease, defined as a Partial Remission (PR) or
      Complete Remission (CR) to the last rituximab-containing therapy lasting at least 6 months
      following completion of therapy or subjects should have relapsed or have had disease
      progression following response to prior rituximab-based therapy a Eastern Cooperative
      Oncology Group (ECOG) Performance status of 0 1 or 2. During the induction phase, ofatumumab
      1000 mg IV on day 1 of each cycle (cycles 1-6) were followed by Bendamustine 90 mg/m2 IV on
      days 1, 2 of each cycle (cycles 1-6).During the maintenance phase, subjects with a PR or CR
      after the induction phase received ofatumumab 1000 mg IV every 2 months for 2 years.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Signed written informed consent

          -  Small lymphocytic, lymphoplasmacytic, marginal zone lymphoma, and follicular lymphoma;
             Grades 1, 2 and 3a, defined according to World Health organization (WHO) guidelines.
             [Tefferi, 2008]

          -  Tumor was verified to be CD20+ (based on local evaluation), from a current or previous
             tissue biopsy. Tissue biopsy should be repeated if no report or specimen is available,
             CD20 staining was not previously performed, or there is clinical suspicion that the
             indolent lymphoma has transformed to aggressive lymphoma/higher malignancy grade.

          -  Rituximab-sensitive disease, defined as a Partial Remission (PR) or Complete Remission
             (CR) to the last rituximab-containing therapy lasting at least 6 months following
             completion of therapy. Last rituximab-containing therapy is defined as the last
             therapy regimen containing at least one full dose of rituximab.

          -  Relapse or disease progression following response to prior rituximab-based therapy,
             that requiried treatment by 2007 Revised Response Criteria for Malignant Lymphoma
             (RRCML) guidelines.

          -  CT imaging in screening (based on local evaluation) showing 2 or more clearly
             demarcated lesions with a largest diameter > 1.5 cm, or 1 clearly demarcated lesion
             with a largest diameter > 2.0 cm.

          -  ECOG Performance Status of 0, 1, or 2.

          -  Age ≥ 18 years.

          -  Life expectancy of at least 6 months in the opinion of the investigator.

          -  Women of childbearing potential must have had a negative serum pregnancy test within
             14 days of first dose of study treatment and agree to use effective contraception
             during the study and for one year following the last dose of study drug.

          -  Men with a female partner of childbearing potential must have had either had a prior
             vasectomy or agree to use effective contraception from 2 weeks prior to administration
             of the first dose of study treatment until one year after the last dose of study
             treatment.

          -  Must not have been on any prohibited medications.

          -  Subjects who had received prior bendamustine were eligible if they had achieved a
             response (CR/PR) which lasted > 6 months after the end of bendamustine containing
             treatment.

        Exclusion Criteria:

          -  Lactating women

          -  CLL, Grade 3b follicular lymphoma or evidence that the indolent lymphoma had
             transformed to aggressive lymphoma. Subjects suspicious for transformation should have
             undergone a biopsy to exclude the possibility of transformation. Subjects with a
             previous diagnosis of small lymphocytic leukemia (SLL) and a screening monoclonal
             B-lymphocyte count of ≥ 5000/µl are defined by 2008 International Workshop on Chronic
             Lymphocytic Leukemia (IWCLL) criteria to have CLL; such patients were NOT eligible for
             this study.

          -  Rituximab-refractory disease, defined as failure to have responded to or progression
             within 6 months of completing rituximab or rituximab-containing combination therapy.

          -  Previous treatment with ofatumumab.

          -  Previous radioimmunotherapy (RIT) within 6 months of study entry. Subjects who have
             received RIT must have attained a PR or CR lasting at least 6 months, and must have
             recovered from any hematologic or other toxicity.

          -  Previous allogeneic stem cell transplantation at any time OR autologous stem cell
             transplantation within 6 months of study entry.

          -  Prior use of monoclonal antibody (other than anti CD20) within 3 months prior to
             randomization. Chemotherapy or other systemic lymphoma therapy within 4 weeks of study
             entry.

          -  Received treatment with an investigational agent within 4 weeks of study entry, or was
             actively participating in another interventional clinical study.

          -  Known Central Nervous System (CNS) involvement by lymphoma.

          -  Current or previous other malignancy within 2 years of study entry. Exception:
             Subjects who have been disease-free for 2 years or more, or subjects with a history of
             completely resected non-melanoma skin cancer or successfully treated in situ carcinoma
             are eligible.

          -  Chronic or currently active infectious disease requiring systemic antibiotics,
             antifungal, or antiviral treatment including, but not limited to: chronic renal
             infection, chronic chest infection with bronchiectasis, tuberculosis, active Hepatitis
             C, and known HIV disease. All Human Immunodeficient virus (HIV)-positive subjects are
             excluded from this study, regardless of whether they have an Acquired Immunodeficiency
             Syndrome (AIDS) defining disease and/or are on antiviral therapy.

          -  Clinically significant cardiac disease including unstable angina, acute myocardial
             infarction within 6 months of study entry, uncontrolled congestive heart failure, and
             uncontrolled arrhythmia. Subjects with congestive heart disease or arrhythmia such as
             atrial fibrillation whose cardiac disease is well controlled on a stable medical
             regimen are eligible.

          -  Other significant concurrent, uncontrolled medical conditions including, but not
             limited to, renal, hepatic, autoimmune, hematological, gastrointestinal, endocrine,
             pulmonary, neurological, cerebral or psychiatric disease which, in the Investigator's
             opinion, will impact study participation.

          -  Positive serology for Hepatitis B (HB) defined as a positive test for Hepatitis B
             surface antigen (HBsAg). In addition, if negative for HBsAg but (Hepatitis B core
             antibody (HBcAb) positive (regardless of Hepatitis B surface antibody [HBsAb] status),
             a HB DNA test had to have been performed and if positive the subject will be excluded.
             If HBV DNA is negative, subject may be included but must have undergone HBV DNA
             monitoring. Prophylactic antiviral therapy may have been initiated at the discretion
             of the investigator.

          -  Current active liver or biliary disease. Exception: Subjects with Gilbert's syndrome
             or asymptomatic gallstones, liver metastases related to indolent NHL or otherwise
             stable chronic liver disease per investigator assessment, are eligible.

          -  Screening laboratory values:

        Neutrophils < 1.5 x 109/L (unless due to NHL involvement of the bone marrow). Platelets <
        100 x 109/L (unless due to NHL involvement of the bone marrow). Serum creatinine ≥2.0
        mg/dL; subjects with serum creatinine ≥2.0 mg/dL were are eligible if the creatinine
        clearance (Cockcroft Gault equation [Cockcroft, 1976]) is ≥40 mL/min.

        Total bilirubin > 1.5 times ULN [upper normal limit] (unless due to liver involvement by
        NHL or Gilbert's disease).

        Transaminases > 3 times ULN (unless due to NHL involvement).

          -  Known or suspected inability to fully comply with study protocol.

          -  Known or suspected hypersensitivity to ofatumumab, bendamustine or mannitol.