Clinical trial NCT01325194: CHemoImmunotherapy With Early Central Nervous System (CNS) Prophylaxis
Official title: Dose Densified Chemoimmunotherapy With Early CNS Prophylaxis in Patients Less Than 65 Years With High Risk (aaIPI≥ 2) Diffuse Large B-Cell Lymphoma
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Primary Disease
Keywords: DLBCL
FL grade 3B
high risk
CNS prophylaxis
chemoimmunotherapy
Lead sponsor: Nordic Lymphoma Group
Sponsor class: NETWORK
Collaborators: name: Mundipharma Pte Ltd.
name: Amgen
First posted: 2011-03-29
Enrollment: 143
Sex: ALL
Minimum age (years): 18
Maximum age (years): 64
Standard ages: ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: The purpose is to test whether early central nervous system (CNS) prophylaxis given at the beginning of therapy for young high risk diffuse large B-cell lymphoma (DLBCL) patients is feasible and could reduce the risk of CNS relapses. Early CNS prophylaxis with two courses high dose methotrexate (HD-MTX) in combination with rituximab-cyclophosphamide-doxorubicin-vincristine-prednison (R-CHOP) is followed by four courses of R-CHOP14 and etoposide (E) and one course of HD-Ara-C. In addition the patients will receive three courses of liposomal cytarabine intrathecally. The results will be compared to a recent Nordic CRY-04 study. Shifting of CNS prophylaxis to the beginning of the therapy offers a potential to overcome the subclinical disease and thus reduce the risk of early clinical CNS recurrence. As flow cytometry (FCM) can improve the sensitivity for detecting occult leptomeningeal disease over cytology , FCM from cerebrospinal fluid will be incorporated into the staging procedures.


Eligibility criteria: Inclusion Criteria:

* Age ≥ 18 - \< 65 years. Histologically confirmed CD20+ diffuse large B-cell lymphoma (DLBCL) based on WHO 2008 Lymphoma Classification
* Follicular lymphomas (FLs) grade 3b is allowed

Patients in at least stage II with age adjusted international prognostic score (IPI score) of 2 or 3:

* Stage III /IV and elevated LDH
* Stage III/IV and WHO performance status 2 - 3
* Stage II and elevated LDH and WHO performance status 2 - 3 And/or patients with
* More than one extranodal site
* Testicular lymphoma, stage IIE and higher
* Paranasal sinus and orbital lymphoma with destruction of bone
* Large cell infiltration of the bone marrow

Exclusion Criteria:

* Severe cardiac disease: cardiac function grade 3-4
* Impaired liver, renal or other organ function not caused by lymphoma, which will interfere with the treatment schedule
* Pregnancy/lactation
* Men and women of reproductive potential not agreeing to use an acceptable method of birth control during treatment and for six months after completion of treatment
* Patients with other severe medical problems and with an expected short survival for non-lymphoma reasons
* Known HIV positivity
* Uncontrolled infectious disease, including meningeal infection
* Active cancer except basal cell carcinoma and cervical carcinoma in situ during the last five years
* Earlier treatment containing anthracyclins
* Psychiatric or mental disorder which make the patient unable to give an informed consent and/or adhere to the protocol
* CNS disease as diagnosed by MRI or cerebrospinal fluid (CSF) cytology. Positive CSF flow cytometry below diagnostic threshold level by cytology is allowed
* Pleural or peritoneal fluid that cannot be drained safely
* Hypersensitivity to the active substance or any of the other ingredients
* Patients participating in other clinical studies, unless followed for survival

Primary outcomes:
measure: Time to treatment failure
timeFrame: 3 and 5 years
Secondary outcomes:
measure: Maximal hematological, gastrointestinal, neuronal and other toxicities
timeFrame: Treatment period (5 years)
measure: Clinical response rate
timeFrame: Treatment period (5 years)
measure: Incidence of central nervous system(CNS) relapse in cerebrospinal fluid (CSF )cytology neg/flow cytometry positive cases
timeFrame: 3 and 5 years
measure: Incidence of CNS relapse in a subgroup of patients with more than one extranodal site and elevated lactate dehydrogenase (LDH)
timeFrame: 3 and 5 years
measure: Progression free survival
timeFrame: 3 and 5 years
measure: Overall survival
timeFrame: 3 and 5 years
measure: Molecular predictors
timeFrame: 3 years
measure: CNS relapse rate
timeFrame: 1,5 years
Other outcomes:
Locations:
city: Århus
country: Denmark
facility: Department of Hematology, Århus University Hospital
city: Helsinki
country: Finland
facility: Department of Oncology, Helsinki University Central Hospital
city: Oslo
country: Norway
facility: Department of Oncology, Oslo University Hospital
city: Lund
country: Sweden
facility: Department of Oncology, Lund University Hospital
Study officials:
References:
citation: Vajavaara H, Leivonen SK, Jorgensen J, Holte H, Leppa S. Low lymphocyte-to-monocyte ratio predicts poor outcome in high-risk aggressive large B-cell lymphoma. EJHaem. 2022 Jun 23;3(3):681-687. doi: 10.1002/jha2.409. eCollection 2022 Aug.
citation: Leppa S, Jorgensen J, Tierens A, Meriranta L, Ostlie I, de Nully Brown P, Fagerli UM, Larsen TS, Mannisto S, Munksgaard L, Maisenholder M, Vasala K, Meyer P, Jerkeman M, Bjorkholm M, Fluge O, Jyrkkio S, Liestol K, Ralfkiaer E, Spetalen S, Beiske K, Karjalainen-Lindsberg ML, Holte H. Patients with high-risk DLBCL benefit from dose-dense immunochemotherapy combined with early systemic CNS prophylaxis. Blood Adv. 2020 May 12;4(9):1906-1915. doi: 10.1182/bloodadvances.2020001518.
citation: Autio M, Leivonen SK, Bruck O, Mustjoki S, Meszaros Jorgensen J, Karjalainen-Lindsberg ML, Beiske K, Holte H, Pellinen T, Leppa S. Immune cell constitution in the tumor microenvironment predicts the outcome in diffuse large B-cell lymphoma. Haematologica. 2021 Mar 1;106(3):718-729. doi: 10.3324/haematol.2019.243626.