Lenalidomide Combined With R-CHOP(R2-CHOP) in Newly Diagnosed Double-expressor Diffuse Large B-Cell Lymphoma Patients

Study Overview
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Brief Summary
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In this phase II study, the investigators are aiming to explore lenalidomide combined with R-CHOP (R2-CHOP) in newly diagnosed double-expressor Diffuse Large B-Cell Lymphoma patients (DLBCL)

Detailed Description
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Double expressor lymphoma is a subtype of diffuse large B-cell lymphoma defined as having increased expression of MYC and BCL-2 by immunohistochemistry. Patients with double-expressor lymphomas have a poor prognosis when treated with standard chemoimmunotherapy and have increased risk of progression and recurrence. The investigators conducted this study to evaluate the efficacy of lenalidomide combined with R-CHOP (R2-CHOP) in newly diagnosed double-expressor, untreated Diffuse Large B-Cell Lymphoma patients (DLBCL). Lenalidomide is the second-generation immunomodulatory drug, and its anti-tumor mechanism may involve immunomodulatory, antiinflammatory, and antiangiogenic effects and suppression of tumor necrosis factor-alpha (TNF-α) from peripheral blood mononuclear cells. In this phase II study, the investigators are aiming to explore lenalidomide combined with R-CHOP (R2-CHOP) in newly diagnosed double-expressor Diffuse Large B-Cell Lymphoma patients (DLBCL), in order to find a potential promising way to treat this kind of disease.

Official Title
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Lenalidomide Combined With R-CHOP in Newly Diagnosed Double-expressor Diffuse Large B-Cell Lymphoma Patients

Conditions
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Double Expressor Lymphoma

Intervention / Treatment
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* Drug: Lenalidomide combined with R-CHOP


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age range 18-75 years old Eastern Cooperative Oncology Group performance status 0 to 2; Newly diagnosed, untreated, histological confirmed diffuse large B cell lymphoma, and Myc≥40% as well as Bcl-2≥50% through immunohistochemistry； Measurable disease was defined as at least one lesion ≥1.5 cm in length-diameter and ≥1.0cm in short-diameter by CT or MRI. White blood cell ≥ 3.5×109/L, absolute neutrophil count ≥ 1.5×109/L，platelet ≥ 80×109/L，hemoglobin ≥ 90 g/L. If abnormal factors of peripheral blood caused by bone marrow or spleen involvement of lymphoma, whether to enroll depends on the judgment of researchers Total bilirubin < 1.5×upper limit of normal(ULN), ALT and AST < 1.5× ULN serum creatine <1.5×ULN, and creatinine clearance rate (CCR) ≥ 40 ml/min Ultrasonic cardiogram or nuclide cardiac function showed left ventricle ejection fraction ≥ 50% Women of childbearing potential and men who are sexually active are consent to practicing a highly effective method of birth control. Women of childbearing potential must have a negative serum β-hCG within 2 weeks of enrollment Patients have written informed consent to participate in the study. Exclusion Criteria: Prior sever allergy to humanized or mouse derived monoclonal antibody. Unable to receive either lenalidomide or R-CHOP background chemotherapy. History of myocardial diseases, such as unstable angina pectoris, acute myocardial infarction within 6 months of enrollment, congenital heart failure NYHA III/IV Particular kind of DLBCL，such as primary mediastinal/thymic B-cell lymphoma, EBV positive DLBCL, primary cutaneous large B lymphoma, leg type. Presence of CNS involvement Having surgeries ≥ grade 2 within 3 weeks of enrollment. History or now in the treatment process of other malignancies except cured basal cell carcinoma of skin (melanoma not included), and carcinoma in-situ of uterine cervix. More than grade 3 neurotoxicity within 2 two weeks of enrollment Receiving any treatment for lymphoma except short use of corticosteroid (no more than 10 days) History of deep vein thrombosis or pulmonary embolism within 12 months of enrollment Unable or reject to receive antithrombotic treatment Presence of active HBV infection (HBsAg positive and HBV-DNA≥ 104), HCV infection, acquired and congenital immunodeficiency diseases include but not limited to HIV Pregnant or lactating women Previously received organ transplant Serious uncontrolled infection Having contraindications to the use of large doses of hormone, such as uncontrolled hyperglycemia, gastric ulcer, mental disorder. Severe neurol of mental illness, including dementia and epilepsy. Drug abuse, medical, psychological or social conditions which may interfering with subjects' participation in the study or evaluation of the results Patients considered unsuitable to participate in the study by the researchers

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: R2-CHOP<br>Lenalidomide combined with rituximab, cyclophosphamide, vincristine, doxorubicin, prednisone | Drug: Lenalidomide combined with R-CHOP<br>* rituximab 375 mg/m2,ivgtt D1 cyclophosphamide 750 mg/m2 iv D2 vincristine 1.4 mg/m2 [capped at 2.0 mg], iv D2 doxorubicin 50 mg/m2 iv D2 prednisone 100 mg/m2 per day PO D2-6 Lenalidomide 25mg PO QD D2-11<br>* Other names: R2-CHOP;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 2-year progression free survival | the period from the date of patients sign informed consent to the observed progression of the disease or the occurrence of death for any reason | From date of patients sign informed consent until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 2 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| objective response rate | the ratio of numbers of patients with complete response and partial response to all the participants receiving treatment | at the end of Cycle 6 (each cycle is 21 days) | 
| overall survival | time between the date of patients sign informed consent and the date of death or the date of last follow-up time | From date of patients sign informed consent until the date of death or the date of last follow-up time, whichever came first, assessed up to 2 years | 
| Hematology and non hematology toxicity | number of participants with treatment-related adverse events as assessed by CTCAE v4.0 | Throughout the treatment period，up to 6 months |