LNH2007-3B: A Study of Two Associations of Rituximab and Chemotherapy, With a PET-driven Strategy, in Lymphoma
Study Details
Study Description
Brief Summary
This Phase II study randomized R-ACVBP and R-CHOP as induction treatment in patients from 18 to 59 with DLBCL CD20+ lymphoma and 2 or 3 adverse prognostic factors of the age-adjusted IPI. The consolidation treatment is allocated according to the response to induction treatment assessed by PET after the 2nd and 4th induction cycles.
Condition or Disease | Intervention/Treatment | Phase |
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Phase 2 |
Detailed Description
- Induction Arm A: 4 cycles of R-ACVBP, 2 weeks interval. After the 3rd cycle, if PET 2+ (fixing), collection of peripheral blood stem cell progenitors will be organized at the time of hematological recovery under support with G-CSF.
The consolidation treatment will depend on results of PET evaluation after cycle 2 (PET2) and cycle 4 (PET4).
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Consolidation 1A (in case of PET 2- PET 4 -):
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High-dose Methotrexate with folinic acid rescue; 2 cycles spaced out 14 days.
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Rituximab-Ifosfamide-Etoposide : 4 cycles spaced out 14 days
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Cytarabine sub-cutaneous, during 4 days; 2 cycles spaced out 14 days.
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Consolidation 2 A (in case of PET 2+ PET4 -):
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2 cycles high-dose Methotrexate with folinic acid rescue
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High dose with Z- BEAM conditioning regimen followed by autologous transplant.
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Salvage(in case of PET 4 +):
The patient will be treated with a salvage regimen, after a biopsy of the residual mass whenever possible.
- Induction arm B: 4 cycles of R-CHOP, 2 weeks interval. After the 3rd cycle, if PET 2+ (fixing), collection of peripheral blood stem cell progenitors will be organized at the time of hematological recovery under support with G-CSF.
The consolidation treatment will depend on results of PET evaluation after cycle 2 (PET2) and cycle 4 (PET4).
- Consolidation 1B(in case of PET 2- PET 4 -):
4 additional cycles of R-CHOP, 2-weeks interval
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Consolidation 2 B(in case of PET 2+ PET 4 -):
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2 cycles high-dose Methotrexate with folinic acid rescue
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High dose with Z- BEAM conditioning regimen followed by autologous transplant
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Salvage(in case of PET 4 +):
The patient will be treated with a salvage regimen, after a biopsy of the residual mass whenever possible
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Experimental: R-CHOP-14 R-CHOP14 induction regimen |
Drug: R-CHOP14 induction regimen
R-CHOP14 induction regimen
|
Experimental: R-ACVBP14 R-ACVBP14 induction regimen |
Drug: R-ACVBP14 induction regimen
R-ACVBP14 induction regimen
|
Outcome Measures
Primary Outcome Measures
- Complete response rate after 4 inductive cycles with R-ACVBP14 or R-CHOP14, in DLBCL CD 20 (+) patients, presenting with 2 or 3 adverse prognostic factors of the aa-IPI Test a Pet-driven strategy Complete response rate after the 4 inductive cycles [4 inductive cycles with R-ACVBP14 or R-CHOP14]
Secondary Outcome Measures
- Response according to PET after 2 cycles, 4 cycles Induction toxicities Response duration Disease-, progression-, event-free and overall survival after autologous transplant Biological factors for prognosis Pharmacokinetic of rituximab [2 cycles and 4 cycles Induction]
Eligibility Criteria
Criteria
Inclusion Criteria:
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Patient with histologically proven CD20+ diffuse large B-cell lymphoma (WHO classification).
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Age from18 to 59 years, eligible for transplant.
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Patient not previously treated.
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Baseline FDG-PET Scan (PET0) performed before any treatment with at least one hypermetabolic lesion.
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Index prognostic factors (IPI) 2 or 3.
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With a minimum life expectancy of 3 months.
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Negative HIV, HBV and HCV serologies £ 4 weeks (except after vaccination).
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Having previously signed a written informed consent.
Exclusion Criteria:
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Any other histological type of lymphoma.
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Any history of treated or non-treated indolent lymphoma. However, patients not previously diagnosed and having a diffuse large B-cell lymphoma with some small cell infiltration in bone marrow or lymph node may be included.
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Central nervous system or meningeal involvement by lymphoma.
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Contra-indication to any drug contained in the chemotherapy regimens.
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Poor renal function (creatinin level >150 mmol/l), poor hepatic function (total bilirubin level >30 mmol/l, transaminases >2.5 maximum normal level) unless these abnormalities are related to the lymphoma.
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Poor bone marrow reserve as defined by neutrophils <1.5 G/l or platelets <100 G/l, unless related to bone marrow infiltration.
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Any history of cancer during the last 5 years with the exception of non-melanoma skin tumors or stage 0 (in situ)cervical carcinoma.
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Any serious active disease (according to the investigator's decision).
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Treatment with any investigational drug within 30 days before planned first cycle of chemotherapy.
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Pregnant or lactating women or women of childbearing potential not currently practicing an adequate method of contraception
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Adult patient under tutelage.
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Impossibility to performed a baseline PET scan (PET0) before randomization and treatment beginning
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | René Olivier Casasnovas | Dijon | France | 21000 |
Sponsors and Collaborators
- Hospices Civils de Lyon
Investigators
- Principal Investigator: Bertrand Coiffier, MD, Hospices Civils de Lyon
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 2007.462