Efficacy of R-CHOP vs R-CHOP/R-DHAP in Untreated MCL

NCT ID: NCT00209222

Last Updated: 2012-09-10

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

UNKNOWN

Clinical Phase

PHASE3

Total Enrollment

360 participants

Study Classification

INTERVENTIONAL

Study Start Date

2004-07-31

Study Completion Date

2014-12-31

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

The aim of this study is to determine whether alternating courses of cyclophosphamide, doxorubicin, vincristine, prednisone/dexamethasone, cytarabine, cisplatin (CHOP/DHAP) plus rituximab followed by total body irradiation \[TBI\]/high dose cytarabine \[ARA-C\]/melphalan-peripheral blood stem cell transplantation (TAM-PBSCT) can improve the time to treatment failure compared to CHOP plus rituximab followed by standard PBSCT (dexamethasone, carmustine, cytarabine, etoposide, and melphalan \[Dexa-BEAM\]/TBI/high dose cyclophosphamide) in patients with untreated mantle cell lymphoma.

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

Recently, a prospective randomized intergroup trial of the European MCL Network has shown that a myeloablative radio-chemotherapy followed by autologous stem cell transplantation (PBSCT) improves event-free survival (EFS) when compared to a interferon alpha maintenance therapy after a CHOP-like induction. However, the CR rate after the CHOP induction was still low (\<20%). Thus, several studies have been conducted to increase the CR rate of induction therapy to further improve event-free and overall survival. Two recent phase II trials suggest that induction regimens containing high dose Ara-C may significantly improve the CR rate up to 80%. In addition, a number of studies provide evidence that the humanized anti-CD20 antibody Rituximab may induce significant responses in relapsed MCL. A prospective randomized study of the GLSG demonstrated that a combined immuno-chemotherapy (CHOP plus Rituximab) induces a significantly higher response rate than CHOP alone.

The aim of this study is the comparison of the current standard (R-CHOP followed by myeloablative radio-chemotherapy and subsequent blood stem cell transplantation) to a new alternating induction regimen containing high dose Ara-C (R-CHOP/DHAP) followed by a high dose ARA-C containing myeloablative radio-chemotherapy and PBSCT.

This study will be performed as a prospective, randomized, open-label multicenter phase III trial. All patients will be initial randomized for standard treatment versus experimental treatment.

REFERENCE ARM:

The induction therapy consists of 6 cycles of a CHOP chemotherapy in combination with Rituximab. If the mantle cell lymphoma is progressive after 4 cycles of chemotherapy, patients will be taken off study. Patients achieving at least a partial remission after 6 cycles R-CHOP will proceed to intensified consolidation (Dexa-BEAM) with stem cell collection and subsequent myelo-ablative radio-chemotherapy (TBI/High Dose Cyclophosphamide) with autologous stem cells transplantation

EXPERIMENTAL ARM:

Initial cytoreductive chemotherapy comprises of alternating cycles of 3xCHOP and 3x DHAP plus Rituximab. Patients with progressive disease after 2 treatment cycles R-CHOP and 2x R-DHAP will be off study. Patients achieving at least a partial remission after 3x CHOP and 3x DHAP plus Rituximab will proceed to with stem cell collection. The subsequent myeloablative radio-chemotherapy with stem cell transplantation consists of a radiotherapy (TBI), high dose Ara-C and Melphalan.

The primary end point in this study is the time to treatment failure. The time to treatment failure will be defined as time from start of initial therapy until first failure. A failure will be defined as failure of initial therapy or progression of the lymphoma or death of the patient.

Using the data of the PBSCT group in the former European mantle cell study as baseline in a proportional hazard model, the improvement for the time to treatment failure expected by the new strategy can be expressed by reduction of relative risk (rr). A risk reduction to 52% which would correspond to a improvement of 20% in failure free survival after 3 years seems to be a clinical relevant improvement. For a working significance level alpha=0.05 and a power of 95% the number of events necessary for a one sided fixed sample trial is about 105. During this study the time to treatment failure will be monitored using an equivalent one-sided triangular sequential test.

In order to evaluate the impact of therapy on overall survival in this patients, a total follow up of about 12 years for this study is expected.

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Lymphoma, Mantle-Cell

Keywords

Explore important study keywords that can help with search, categorization, and topic discovery.

Lymphoma, Mantle-Cell younger patients chemotherapy high dose therapy C04.557.386.480.300.725.500 C15.604.515.569.480.300.725.500 C20.683.515.761.480.300.725.500

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

1

induction: R-CHOP consoldiation : TBI/Cyclo

Group Type ACTIVE_COMPARATOR

Rituximab

Intervention Type DRUG

antibody

Cyclophosphamide

Intervention Type DRUG

chemotherapy

Doxorubicin

Intervention Type DRUG

chemotherapy

Vincristine

Intervention Type DRUG

chemotherapy

Prednisone

Intervention Type DRUG

corticosteroide

BCNU

Intervention Type DRUG

chemotherapy

Melphalan

Intervention Type DRUG

chemotherapy

Etoposide

Intervention Type DRUG

chemotherapy

G-CSF

Intervention Type DRUG

growth factor

chemotherapy: R-CHOP

Intervention Type PROCEDURE

immuno-chemotherapy

chemotherapy: Dexa-BEAM

Intervention Type PROCEDURE

chemotherapy

stem cell harvest

Intervention Type PROCEDURE

procedure

total body irradiation

Intervention Type PROCEDURE

radiation

high-dose chemotherapy: Cyclophosphamide

Intervention Type PROCEDURE

chemotherapy

2

induction: R-CHOP/DHAP consolditaion: TBI/TAM

Group Type EXPERIMENTAL

Rituximab

Intervention Type DRUG

antibody

Cyclophosphamide

Intervention Type DRUG

chemotherapy

Doxorubicin

Intervention Type DRUG

chemotherapy

Vincristine

Intervention Type DRUG

chemotherapy

Prednisone

Intervention Type DRUG

corticosteroide

Cisplatinum

Intervention Type DRUG

chemotherapy

Ara-C

Intervention Type DRUG

chemotherapy

Dexamethasone

Intervention Type DRUG

corticosteroide

Melphalan

Intervention Type DRUG

chemotherapy

G-CSF

Intervention Type DRUG

growth factor

chemotherapy: R-CHOP

Intervention Type PROCEDURE

immuno-chemotherapy

chemotherapy: R-DHAP

Intervention Type PROCEDURE

immuno-chemotherapy

stem cell harvest

Intervention Type PROCEDURE

procedure

total body irradiation

Intervention Type PROCEDURE

radiation

high-dose chemotherapy: Ara-C /Melphalan

Intervention Type PROCEDURE

chemotherapy

Interventions

Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.

Rituximab

antibody

Intervention Type DRUG

Cyclophosphamide

chemotherapy

Intervention Type DRUG

Doxorubicin

chemotherapy

Intervention Type DRUG

Vincristine

chemotherapy

Intervention Type DRUG

Prednisone

corticosteroide

Intervention Type DRUG

Cisplatinum

chemotherapy

Intervention Type DRUG

Ara-C

chemotherapy

Intervention Type DRUG

Dexamethasone

corticosteroide

Intervention Type DRUG

BCNU

chemotherapy

Intervention Type DRUG

Melphalan

chemotherapy

Intervention Type DRUG

Etoposide

chemotherapy

Intervention Type DRUG

G-CSF

growth factor

Intervention Type DRUG

chemotherapy: R-CHOP

immuno-chemotherapy

Intervention Type PROCEDURE

chemotherapy: R-DHAP

immuno-chemotherapy

Intervention Type PROCEDURE

chemotherapy: Dexa-BEAM

chemotherapy

Intervention Type PROCEDURE

stem cell harvest

procedure

Intervention Type PROCEDURE

total body irradiation

radiation

Intervention Type PROCEDURE

high-dose chemotherapy: Cyclophosphamide

chemotherapy

Intervention Type PROCEDURE

high-dose chemotherapy: Ara-C /Melphalan

chemotherapy

Intervention Type PROCEDURE

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

* Histologically proven diagnosis of mantle cell lymphoma (World Health Organization \[WHO\] classification)
* Clinical stage II - IV (Ann Arbor)
* Previously untreated patients
* Age 18 - 65 years
* WHO performance \< 2
* Measurable disease (also: patients with isolated bone marrow involvement)
* Informed consent according to International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use/European Union Good Clinical Practice (ICH/EU GCP) and national/local regulations

Exclusion Criteria

* Age \> 65 years
* WHO performance status \> 2
* Known anti-murine antibody (HAMA) reactivity or known hypersensitivity to murine antibodies
* Previous lymphoma therapy with radiation, cytostatic drugs, anti-CD20 antibody or interferon
* Serious disease interfering with a regular therapy according to the study protocol:

* cardiac (e.g. manifest heart failure, coronary heart disease, uncontrolled hypertension)
* pulmonary (e.g. chronic lung disease with hypoxemia)
* endocrine (e.g. severe, not sufficiently controlled diabetes mellitus)
* renal insufficiency (unless caused by the lymphoma): creatinine \> 2x normal value and/or creatinine clearance \< 50 ml/min)
* impairment of liver function (unless caused by the lymphoma): transaminases \> 3x normal or bilirubin \> 2,0 mg/dl
* Patients with unresolved hepatitis B or C infection or known HIV infection
* Prior organ, bone marrow or peripheral blood stem cell transplantation
* Concomitant or previous malignancies within the last 5 years other than basal cell skin cancer or in situ uterine cervix cancer.
* Pregnancy or lactation
* Any psychological, familiar, sociological, or geographical condition potentially hampering compliance with the study protocol and follow up schedule
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

Meet the organizations funding or collaborating on the study and learn about their roles.

German Low Grade Lymphoma Study Group

OTHER

Sponsor Role collaborator

Lymphoma Study Association

OTHER

Sponsor Role collaborator

European Mantle Cell Lymphoma Network

OTHER

Sponsor Role lead

Responsible Party

Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.

University Hospital Grosshadern/European MCLNetwork

Principal Investigators

Learn about the lead researchers overseeing the trial and their institutional affiliations.

Olivier Hermine, PhD

Role: PRINCIPAL_INVESTIGATOR

University Hospital Necker, Dept. of Adult Hematology

Wolfgang Hiddemann, PhD

Role: STUDY_CHAIR

University Hospital Großhadern/LMU, Dept. of Medicine III

Locations

Explore where the study is taking place and check the recruitment status at each participating site.

Groupe D´Etudes des Lymphomes De l´Adulte (GELA)

Paris, , France

Site Status RECRUITING

German Low Grade Study Group (Glsg)

Munich, , Germany

Site Status RECRUITING

The Maria Sklodowska Memorial, Cancer Center - Inst. of Oncology

Warsaw, , Poland

Site Status RECRUITING

Countries

Review the countries where the study has at least one active or historical site.

France Germany Poland

Central Contacts

Reach out to these primary contacts for questions about participation or study logistics.

Michael Unterhalt, Dr.

Role: CONTACT

Phone: +49-89-7095

Email: [email protected]

Martin Dreyling, PhD

Role: CONTACT

Phone: +49-89-7095

Email: [email protected]

Facility Contacts

Find local site contact details for specific facilities participating in the trial.

Guylène Chartier

Role: primary

Olivier Hermine, PhD

Role: backup

Michael Unterhalt, Dr.

Role: primary

Martin Dreyling, PhD

Role: backup

Jan Walewski, MD

Role: primary

Marek P Nowacki, MD

Role: backup

References

Explore related publications, articles, or registry entries linked to this study.

Dreyling M, Lenz G, Hoster E, Van Hoof A, Gisselbrecht C, Schmits R, Metzner B, Truemper L, Reiser M, Steinhauer H, Boiron JM, Boogaerts MA, Aldaoud A, Silingardi V, Kluin-Nelemans HC, Hasford J, Parwaresch R, Unterhalt M, Hiddemann W. Early consolidation by myeloablative radiochemotherapy followed by autologous stem cell transplantation in first remission significantly prolongs progression-free survival in mantle-cell lymphoma: results of a prospective randomized trial of the European MCL Network. Blood. 2005 Apr 1;105(7):2677-84. doi: 10.1182/blood-2004-10-3883. Epub 2004 Dec 9.

Reference Type BACKGROUND
PMID: 15591112 (View on PubMed)

Lenz G, Dreyling M, Hoster E, Wormann B, Duhrsen U, Metzner B, Eimermacher H, Neubauer A, Wandt H, Steinhauer H, Martin S, Heidemann E, Aldaoud A, Parwaresch R, Hasford J, Unterhalt M, Hiddemann W. Immunochemotherapy with rituximab and cyclophosphamide, doxorubicin, vincristine, and prednisone significantly improves response and time to treatment failure, but not long-term outcome in patients with previously untreated mantle cell lymphoma: results of a prospective randomized trial of the German Low Grade Lymphoma Study Group (GLSG). J Clin Oncol. 2005 Mar 20;23(9):1984-92. doi: 10.1200/JCO.2005.08.133. Epub 2005 Jan 24.

Reference Type BACKGROUND
PMID: 15668467 (View on PubMed)

Hermine O, Jiang L, Walewski J, Bosly A, Thieblemont C, Szymczyk M, Pott C, Salles G, Feugier P, Hubel K, Haioun C, Casasnovas RO, Schmidt C, Bouabdallah K, Ribrag V, Kanz L, Durig J, Metzner B, Sibon D, Cheminant M, Burroni B, Klapper W, Hiddemann W, Unterhalt M, Hoster E, Dreyling M; European Mantle Cell Lymphoma Network. High-Dose Cytarabine and Autologous Stem-Cell Transplantation in Mantle Cell Lymphoma: Long-Term Follow-Up of the Randomized Mantle Cell Lymphoma Younger Trial of the European Mantle Cell Lymphoma Network. J Clin Oncol. 2023 Jan 20;41(3):479-484. doi: 10.1200/JCO.22.01780. Epub 2022 Dec 5.

Reference Type DERIVED
PMID: 36469833 (View on PubMed)

Hermine O, Hoster E, Walewski J, Bosly A, Stilgenbauer S, Thieblemont C, Szymczyk M, Bouabdallah R, Kneba M, Hallek M, Salles G, Feugier P, Ribrag V, Birkmann J, Forstpointner R, Haioun C, Hanel M, Casasnovas RO, Finke J, Peter N, Bouabdallah K, Sebban C, Fischer T, Duhrsen U, Metzner B, Maschmeyer G, Kanz L, Schmidt C, Delarue R, Brousse N, Klapper W, Macintyre E, Delfau-Larue MH, Pott C, Hiddemann W, Unterhalt M, Dreyling M; European Mantle Cell Lymphoma Network. Addition of high-dose cytarabine to immunochemotherapy before autologous stem-cell transplantation in patients aged 65 years or younger with mantle cell lymphoma (MCL Younger): a randomised, open-label, phase 3 trial of the European Mantle Cell Lymphoma Network. Lancet. 2016 Aug 6;388(10044):565-75. doi: 10.1016/S0140-6736(16)00739-X. Epub 2016 Jun 14.

Reference Type DERIVED
PMID: 27313086 (View on PubMed)

Delfau-Larue MH, Klapper W, Berger F, Jardin F, Briere J, Salles G, Casasnovas O, Feugier P, Haioun C, Ribrag V, Thieblemont C, Unterhalt M, Dreyling M, Macintyre E, Pott C, Hermine O, Hoster E; European Mantle Cell Lymphoma Network. High-dose cytarabine does not overcome the adverse prognostic value of CDKN2A and TP53 deletions in mantle cell lymphoma. Blood. 2015 Jul 30;126(5):604-11. doi: 10.1182/blood-2015-02-628792. Epub 2015 May 28.

Reference Type DERIVED
PMID: 26022239 (View on PubMed)

Hoster E, Klapper W, Hermine O, Kluin-Nelemans HC, Walewski J, van Hoof A, Trneny M, Geisler CH, Di Raimondo F, Szymczyk M, Stilgenbauer S, Thieblemont C, Hallek M, Forstpointner R, Pott C, Ribrag V, Doorduijn J, Hiddemann W, Dreyling MH, Unterhalt M. Confirmation of the mantle-cell lymphoma International Prognostic Index in randomized trials of the European Mantle-Cell Lymphoma Network. J Clin Oncol. 2014 May 1;32(13):1338-46. doi: 10.1200/JCO.2013.52.2466. Epub 2014 Mar 31.

Reference Type DERIVED
PMID: 24687837 (View on PubMed)

Pott C, Hoster E, Delfau-Larue MH, Beldjord K, Bottcher S, Asnafi V, Plonquet A, Siebert R, Callet-Bauchu E, Andersen N, van Dongen JJ, Klapper W, Berger F, Ribrag V, van Hoof AL, Trneny M, Walewski J, Dreger P, Unterhalt M, Hiddemann W, Kneba M, Kluin-Nelemans HC, Hermine O, Macintyre E, Dreyling M. Molecular remission is an independent predictor of clinical outcome in patients with mantle cell lymphoma after combined immunochemotherapy: a European MCL intergroup study. Blood. 2010 Apr 22;115(16):3215-23. doi: 10.1182/blood-2009-06-230250. Epub 2009 Dec 23.

Reference Type DERIVED
PMID: 20032498 (View on PubMed)

Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

MCL2004-2

Identifier Type: -

Identifier Source: org_study_id