Trial Outcomes & Findings for Randomized Trial of Chlorambucil Versus Chlorambucil Plus Rituximab Versus Rituximab in MALT Lymphoma (NCT NCT00210353)

NCT ID: NCT00210353

Last Updated: 2019-06-06

Results Overview

Percentage of patients without events (failure of treatment or Death from any cause) after 5 years from trial registration

Recruitment status

COMPLETED

Study phase

PHASE3

Target enrollment

454 participants

Primary outcome timeframe

5 years

Results posted on

2019-06-06

Participant Flow

Subjects were enrolled from 10 January 2003 to 07 July 2010

Participant milestones

Participant milestones
Measure
ARM B - Rituximab + Chlorambucil
rituximab 375 mg/m2 iv, d1, d8, d15, d22 chlorambucil 6 mg/m2 os, daily during the first 6 weeks of treatment two weeks rest chlorambucil 6 mg/m2 os daily during the first two of a four weeks cycles (total of 4 cycles) rituximab 375 mg/m2 iv at day 1 of each cycle
ARM C (Since April 2006) - Rituximab
Rituximab 375 mg/m2 iv on days 1, 8, 15, 22, 56, 84, 112, 140
ARM A - Chlorambucil
Chlorambucil 6 mg/m2 daily during the first 6 weeks of treatment; two weeks rest; chlorambucil 6 mg/m2 daily during the first two of a four weeks cycles (total of 4 cycles)
Overall Study
STARTED
152
151
151
Overall Study
COMPLETED
107
125
113
Overall Study
NOT COMPLETED
45
26
38

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

Randomized Trial of Chlorambucil Versus Chlorambucil Plus Rituximab Versus Rituximab in MALT Lymphoma

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
ARM A - Chlorambucil
n=131 Participants
Chlorambucil 6 mg/m2 daily during the first 6 weeks of treatment; two weeks rest; chlorambucil 6 mg/m2 daily during the first two of a four weeks cycles (total of 4 cycles)
ARM B - Rituximab + Chlorambucil
n=132 Participants
Rituximab 375 mg/m2 iv, d1, d8, d15, d22 Chlorambucil 6 mg/m2 os, daily during the first 6 weeks of treatment two weeks rest chlorambucil 6 mg/m2 os daily during the first two of a four weeks cycles (total of 4 cycles) rituximab 375 mg/m2 iv at day 1 of each cycle
ARM C (Since April 2006) - Rituximab
n=138 Participants
Rituximab 375 mg/m2 iv on days 1, 8, 15, 22, 56, 84, 112, 140
Total
n=401 Participants
Total of all reporting groups
Age, Continuous
60 years
n=5 Participants
59.5 years
n=7 Participants
62.5 years
n=5 Participants
61 years
n=4 Participants
Sex: Female, Male
Female
62 Participants
n=5 Participants
68 Participants
n=7 Participants
74 Participants
n=5 Participants
204 Participants
n=4 Participants
Sex: Female, Male
Male
69 Participants
n=5 Participants
64 Participants
n=7 Participants
64 Participants
n=5 Participants
197 Participants
n=4 Participants
Region of Enrollment
Belgium
8 participants
n=5 Participants
5 participants
n=7 Participants
15 participants
n=5 Participants
28 participants
n=4 Participants
Region of Enrollment
Italy
54 participants
n=5 Participants
52 participants
n=7 Participants
58 participants
n=5 Participants
164 participants
n=4 Participants
Region of Enrollment
United Kingdom
18 participants
n=5 Participants
23 participants
n=7 Participants
19 participants
n=5 Participants
60 participants
n=4 Participants
Region of Enrollment
France
39 participants
n=5 Participants
40 participants
n=7 Participants
41 participants
n=5 Participants
120 participants
n=4 Participants
Region of Enrollment
Switzerland
3 participants
n=5 Participants
3 participants
n=7 Participants
5 participants
n=5 Participants
11 participants
n=4 Participants
Region of Enrollment
Spain
9 participants
n=5 Participants
9 participants
n=7 Participants
0 participants
n=5 Participants
18 participants
n=4 Participants
Ann Arbor stage
Ann Arbor Stage > 2
53 Participants
n=5 Participants
59 Participants
n=7 Participants
63 Participants
n=5 Participants
175 Participants
n=4 Participants
Ann Arbor stage
Ann arbor stage ≤ 2
78 Participants
n=5 Participants
73 Participants
n=7 Participants
75 Participants
n=5 Participants
226 Participants
n=4 Participants
B-symptoms
Presence of B-symptoms
6 Participants
n=5 Participants
20 Participants
n=7 Participants
16 Participants
n=5 Participants
42 Participants
n=4 Participants
B-symptoms
Absence of B symptoms
125 Participants
n=5 Participants
112 Participants
n=7 Participants
122 Participants
n=5 Participants
359 Participants
n=4 Participants
International Prognostic Index (IPI) risk
Low
79 Participants
n=5 Participants
74 Participants
n=7 Participants
76 Participants
n=5 Participants
229 Participants
n=4 Participants
International Prognostic Index (IPI) risk
Low-intermediate
25 Participants
n=5 Participants
34 Participants
n=7 Participants
35 Participants
n=5 Participants
94 Participants
n=4 Participants
International Prognostic Index (IPI) risk
Intermediate-high
23 Participants
n=5 Participants
20 Participants
n=7 Participants
25 Participants
n=5 Participants
68 Participants
n=4 Participants
International Prognostic Index (IPI) risk
High
3 Participants
n=5 Participants
4 Participants
n=7 Participants
2 Participants
n=5 Participants
9 Participants
n=4 Participants
International Prognostic Index (IPI) risk
NA
1 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
1 Participants
n=4 Participants

PRIMARY outcome

Timeframe: 5 years

Population: Evaluable patients

Percentage of patients without events (failure of treatment or Death from any cause) after 5 years from trial registration

Outcome measures

Outcome measures
Measure
ARM A - Chlorambucil
n=131 Participants
Chlorambucil 6 mg/m2 daily during the first 6 weeks of treatment; two weeks rest; chlorambucil 6 mg/m2 daily during the first two of a four weeks cycles (total of 4 cycles)
ARM B - Rituximab + Chlorambucil
n=132 Participants
Rituximab 375 mg/m2 iv, d1, d8, d15, d22 chlorambucil 6 mg/m2 os, daily during the first 6 weeks of treatment two weeks rest chlorambucil 6 mg/m2 os daily during the first two of a four weeks cycles (total of 4 cycles) rituximab 375 mg/m2 iv at day 1 of each cycle
ARM C (Since April 2006) - Rituximab
n=138 Participants
Rituximab 375 mg/m2 iv on days 1, 8, 15, 22, 56, 84, 112, 140
Event-free-survival (EFS)
51 percentage of patients
Interval 42.0 to 60.0
68 percentage of patients
Interval 60.0 to 76.0
51 percentage of patients
Interval 42.0 to 60.0

SECONDARY outcome

Timeframe: End of treatment (after 24 weeks of therapy)

Population: Evaluable patients

Response criteria were defined according to the NCI standardized response criteria for non-Hodgkin's lymphoma. Complete response. Disappearance of all detectable clinical and radiographic evidence of disease, disappearance of all disease-related symptoms, if present before therapy, and normalization of those biochemical abnormalities definitely assignable to NHL. Regression of all lymph nodes and nodal masses to normal (≤ 1.5 cm in their greatest transverse diameter for nodes \> 1.5 cm before therapy and to ≤ 1 cm for nodes that were 1.1-1.5 cm. Regression by more than 75% in the sum of the products of the greatest diameters). Partial response. Decrease by at least 50% in SPD of the six largest measurable lesions. It is not necessary for all lesions to have regressed to qualify for partial response, but no lesion should have progressed and no new lesion should appear. For primary gastric sites, response was based on GELA histologic grading system.

Outcome measures

Outcome measures
Measure
ARM A - Chlorambucil
n=131 Participants
Chlorambucil 6 mg/m2 daily during the first 6 weeks of treatment; two weeks rest; chlorambucil 6 mg/m2 daily during the first two of a four weeks cycles (total of 4 cycles)
ARM B - Rituximab + Chlorambucil
n=132 Participants
Rituximab 375 mg/m2 iv, d1, d8, d15, d22 chlorambucil 6 mg/m2 os, daily during the first 6 weeks of treatment two weeks rest chlorambucil 6 mg/m2 os daily during the first two of a four weeks cycles (total of 4 cycles) rituximab 375 mg/m2 iv at day 1 of each cycle
ARM C (Since April 2006) - Rituximab
n=138 Participants
Rituximab 375 mg/m2 iv on days 1, 8, 15, 22, 56, 84, 112, 140
Complete and Partial Remission Rate - Percentage of Patients With Complete and Partial Response at the End of Treatment
85.5 percentage of patients
Interval 78.3 to 91.0
94.7 percentage of patients
Interval 89.4 to 97.8
78.3 percentage of patients
Interval 70.4 to 84.8

SECONDARY outcome

Timeframe: 5 years

Population: Evaluable patients

Response criteria were defined according to the NCI standardized response criteria for non-Hodgkin's lymphoma. Complete response (CR). Disappearance of all detectable clinical and radiographic evidence of disease, disappearance of all disease-related symptoms, if present before therapy, and normalization of those biochemical abnormalities definitely assignable to NHL. Regression of all lymph nodes and nodal masses to normal (≤ 1.5 cm in their greatest transverse diameter for nodes \> 1.5 cm before therapy and to ≤ 1 cm for nodes that were 1.1-1.5 cm. Regression by more than 75% in the sum of the products of the greatest diameters).

Outcome measures

Outcome measures
Measure
ARM A - Chlorambucil
n=131 Participants
Chlorambucil 6 mg/m2 daily during the first 6 weeks of treatment; two weeks rest; chlorambucil 6 mg/m2 daily during the first two of a four weeks cycles (total of 4 cycles)
ARM B - Rituximab + Chlorambucil
n=132 Participants
Rituximab 375 mg/m2 iv, d1, d8, d15, d22 chlorambucil 6 mg/m2 os, daily during the first 6 weeks of treatment two weeks rest chlorambucil 6 mg/m2 os daily during the first two of a four weeks cycles (total of 4 cycles) rituximab 375 mg/m2 iv at day 1 of each cycle
ARM C (Since April 2006) - Rituximab
n=138 Participants
Rituximab 375 mg/m2 iv on days 1, 8, 15, 22, 56, 84, 112, 140
Response Duration (Time to Relapse or Progression) - Percentage of Patients in Continuous Remission at Five Years From Trial Registration
70 percentage of patients
Interval 60.0 to 78.0
79 percentage of patients
Interval 71.0 to 85.0
66 percentage of patients
Interval 56.0 to 74.0

SECONDARY outcome

Timeframe: 5 years

Population: Evaluable Patients

Percentage of patients without disease progression after 5 years from trial registration

Outcome measures

Outcome measures
Measure
ARM A - Chlorambucil
n=131 Participants
Chlorambucil 6 mg/m2 daily during the first 6 weeks of treatment; two weeks rest; chlorambucil 6 mg/m2 daily during the first two of a four weeks cycles (total of 4 cycles)
ARM B - Rituximab + Chlorambucil
n=132 Participants
Rituximab 375 mg/m2 iv, d1, d8, d15, d22 chlorambucil 6 mg/m2 os, daily during the first 6 weeks of treatment two weeks rest chlorambucil 6 mg/m2 os daily during the first two of a four weeks cycles (total of 4 cycles) rituximab 375 mg/m2 iv at day 1 of each cycle
ARM C (Since April 2006) - Rituximab
n=138 Participants
Rituximab 375 mg/m2 iv on days 1, 8, 15, 22, 56, 84, 112, 140
Progression-free-survival (PFS)
59 percentage of patients
Interval 50.0 to 68.0
72 percentage of patients
Interval 63.0 to 79.0
57 percentage of patients
Interval 48.0 to 65.0

SECONDARY outcome

Timeframe: 5 years

Population: Evaluable Patients

Percentage of patients alive after 5 years from trial registration

Outcome measures

Outcome measures
Measure
ARM A - Chlorambucil
n=131 Participants
Chlorambucil 6 mg/m2 daily during the first 6 weeks of treatment; two weeks rest; chlorambucil 6 mg/m2 daily during the first two of a four weeks cycles (total of 4 cycles)
ARM B - Rituximab + Chlorambucil
n=132 Participants
Rituximab 375 mg/m2 iv, d1, d8, d15, d22 chlorambucil 6 mg/m2 os, daily during the first 6 weeks of treatment two weeks rest chlorambucil 6 mg/m2 os daily during the first two of a four weeks cycles (total of 4 cycles) rituximab 375 mg/m2 iv at day 1 of each cycle
ARM C (Since April 2006) - Rituximab
n=138 Participants
Rituximab 375 mg/m2 iv on days 1, 8, 15, 22, 56, 84, 112, 140
Overall Survival
89 percentage of patients
Interval 82.0 to 93.0
90 percentage of patients
Interval 83.0 to 94.0
92 percentage of patients
Interval 86.0 to 96.0

Adverse Events

ARM A

Serious events: 4 serious events
Other events: 42 other events
Deaths: 20 deaths

ARM B

Serious events: 20 serious events
Other events: 77 other events
Deaths: 25 deaths

ARM C (Since April 2006)

Serious events: 13 serious events
Other events: 59 other events
Deaths: 13 deaths

Serious adverse events

Serious adverse events
Measure
ARM A
n=131 participants at risk
chlorambucil 6 mg/m2 daily during the first 6 weeks of treatment; two weeks rest; chlorambucil 6 mg/m2 daily during the first two of a four weeks cycles (total of 4 cycles) chlorambucil (drug): chlorambucil 6 mg/m2 daily during the first 6 weeks of treatment, two weeks rest, chlorambucil 6 mg/m2 daily during the first two of a four weeks cycles (total of 4 cycles)
ARM B
n=132 participants at risk
rituximab 375 mg/m2 iv, d1, d8, d15, d22 chlorambucil 6 mg/m2 os, daily during the first 6 weeks of treatment two weeks rest chlorambucil 6 mg/m2 os daily during the first two of a four weeks cycles (total of 4 cycles) rituximab 375 mg/m2 iv at day 1 of each cycle rituximab+chlorambucil: rituximab 375 mg/m2 iv, d1, 8, 15, 22, chlorambucil 6 mg/m2 os, daily during the first 6 weeks of treatment, ; two weeks rest; chlorambucil 6 mg/m2 os, daily during the first two of a four weeks cycles (total of 4 cycles) rituximab 375 mg/m2 iv at day 1 of each cycle
ARM C (Since April 2006)
n=138 participants at risk
rituximab 375 mg/m2 iv on days 1, 8, 15, 22, 56, 84, 112, 140 rituximab: rituximab 375 mg/m2 iv on days 1, 8, 15, 22, 56, 84, 112, 140
Respiratory, thoracic and mediastinal disorders
Pulmonary embolism
0.76%
1/131 • Number of events 1 • Seven years and eight months
0.00%
0/132 • Seven years and eight months
0.00%
0/138 • Seven years and eight months
Investigations
Transaminases increased
0.76%
1/131 • Number of events 1 • Seven years and eight months
0.76%
1/132 • Number of events 1 • Seven years and eight months
0.00%
0/138 • Seven years and eight months
Infections and infestations
Pneumonia
0.76%
1/131 • Number of events 1 • Seven years and eight months
0.76%
1/132 • Number of events 1 • Seven years and eight months
0.00%
0/138 • Seven years and eight months
Gastrointestinal disorders
Peptic ulcer
0.76%
1/131 • Number of events 1 • Seven years and eight months
0.00%
0/132 • Seven years and eight months
0.00%
0/138 • Seven years and eight months
Musculoskeletal and connective tissue disorders
Arthralgia
0.00%
0/131 • Seven years and eight months
0.76%
1/132 • Number of events 1 • Seven years and eight months
0.00%
0/138 • Seven years and eight months
Gastrointestinal disorders
Abdominal pain upper
0.00%
0/131 • Seven years and eight months
0.76%
1/132 • Number of events 1 • Seven years and eight months
0.00%
0/138 • Seven years and eight months
General disorders
Death NOS
0.00%
0/131 • Seven years and eight months
0.76%
1/132 • Number of events 1 • Seven years and eight months
0.00%
0/138 • Seven years and eight months
Injury, poisoning and procedural complications
Accident at home
0.00%
0/131 • Seven years and eight months
0.76%
1/132 • Number of events 1 • Seven years and eight months
0.00%
0/138 • Seven years and eight months
Injury, poisoning and procedural complications
Femur fracture
0.00%
0/131 • Seven years and eight months
0.76%
1/132 • Number of events 1 • Seven years and eight months
0.00%
0/138 • Seven years and eight months
Neoplasms benign, malignant and unspecified (incl cysts and polyps)
Pharyngeal Cancer stage unspecified
0.00%
0/131 • Seven years and eight months
0.76%
1/132 • Number of events 1 • Seven years and eight months
0.00%
0/138 • Seven years and eight months
Neoplasms benign, malignant and unspecified (incl cysts and polyps)
Pancreatic carcinoma
0.00%
0/131 • Seven years and eight months
0.76%
1/132 • Number of events 1 • Seven years and eight months
0.00%
0/138 • Seven years and eight months
Gastrointestinal disorders
Vomiting
0.00%
0/131 • Seven years and eight months
0.76%
1/132 • Number of events 1 • Seven years and eight months
0.00%
0/138 • Seven years and eight months
Eye disorders
Vision blurred
0.00%
0/131 • Seven years and eight months
0.76%
1/132 • Number of events 1 • Seven years and eight months
0.00%
0/138 • Seven years and eight months
Neoplasms benign, malignant and unspecified (incl cysts and polyps)
Acute myeloid leukemia
0.00%
0/131 • Seven years and eight months
0.76%
1/132 • Number of events 1 • Seven years and eight months
0.00%
0/138 • Seven years and eight months
Blood and lymphatic system disorders
Neutropenia
0.00%
0/131 • Seven years and eight months
2.3%
3/132 • Number of events 3 • Seven years and eight months
0.00%
0/138 • Seven years and eight months
General disorders
Injection site thrombosis
0.00%
0/131 • Seven years and eight months
0.76%
1/132 • Number of events 1 • Seven years and eight months
0.00%
0/138 • Seven years and eight months
Respiratory, thoracic and mediastinal disorders
Dyspnoea
0.00%
0/131 • Seven years and eight months
1.5%
2/132 • Number of events 2 • Seven years and eight months
1.4%
2/138 • Number of events 2 • Seven years and eight months
Infections and infestations
Urosepsis
0.00%
0/131 • Seven years and eight months
0.76%
1/132 • Number of events 1 • Seven years and eight months
0.00%
0/138 • Seven years and eight months
Surgical and medical procedures
Stent removal
0.00%
0/131 • Seven years and eight months
0.76%
1/132 • Number of events 1 • Seven years and eight months
0.00%
0/138 • Seven years and eight months
Cardiac disorders
Atrial fibrillation
0.00%
0/131 • Seven years and eight months
0.76%
1/132 • Number of events 1 • Seven years and eight months
0.00%
0/138 • Seven years and eight months
General disorders
Pyrexia
0.00%
0/131 • Seven years and eight months
0.76%
1/132 • Number of events 1 • Seven years and eight months
1.4%
2/138 • Number of events 2 • Seven years and eight months
Reproductive system and breast disorders
metrorrhagia
0.00%
0/131 • Seven years and eight months
0.00%
0/132 • Seven years and eight months
0.72%
1/138 • Number of events 1 • Seven years and eight months
Gastrointestinal disorders
gastrointestinal obstruction
0.00%
0/131 • Seven years and eight months
0.00%
0/132 • Seven years and eight months
0.72%
1/138 • Number of events 1 • Seven years and eight months
Musculoskeletal and connective tissue disorders
Chest wall pain
0.00%
0/131 • Seven years and eight months
0.00%
0/132 • Seven years and eight months
0.72%
1/138 • Number of events 1 • Seven years and eight months
Immune system disorders
Allergic reactions
0.00%
0/131 • Seven years and eight months
0.00%
0/132 • Seven years and eight months
0.72%
1/138 • Number of events 1 • Seven years and eight months
Blood and lymphatic system disorders
Febrile neutropenia
0.00%
0/131 • Seven years and eight months
0.00%
0/132 • Seven years and eight months
0.72%
1/138 • Number of events 1 • Seven years and eight months
Infections and infestations
Sepsis NOS
0.00%
0/131 • Seven years and eight months
0.00%
0/132 • Seven years and eight months
0.72%
1/138 • Number of events 1 • Seven years and eight months
Infections and infestations
Infection NOS
0.00%
0/131 • Seven years and eight months
0.00%
0/132 • Seven years and eight months
1.4%
2/138 • Number of events 2 • Seven years and eight months
Infections and infestations
Oesophageal candidiasis
0.00%
0/131 • Seven years and eight months
0.00%
0/132 • Seven years and eight months
0.72%
1/138 • Number of events 1 • Seven years and eight months
Respiratory, thoracic and mediastinal disorders
Bronchitis
0.00%
0/131 • Seven years and eight months
0.00%
0/132 • Seven years and eight months
0.72%
1/138 • Number of events 1 • Seven years and eight months
General disorders
Disease prpgression NOS
0.76%
1/131 • Number of events 1 • Seven years and eight months
0.00%
0/132 • Seven years and eight months
0.00%
0/138 • Seven years and eight months

Other adverse events

Other adverse events
Measure
ARM A
n=131 participants at risk
chlorambucil 6 mg/m2 daily during the first 6 weeks of treatment; two weeks rest; chlorambucil 6 mg/m2 daily during the first two of a four weeks cycles (total of 4 cycles) chlorambucil (drug): chlorambucil 6 mg/m2 daily during the first 6 weeks of treatment, two weeks rest, chlorambucil 6 mg/m2 daily during the first two of a four weeks cycles (total of 4 cycles)
ARM B
n=132 participants at risk
rituximab 375 mg/m2 iv, d1, d8, d15, d22 chlorambucil 6 mg/m2 os, daily during the first 6 weeks of treatment two weeks rest chlorambucil 6 mg/m2 os daily during the first two of a four weeks cycles (total of 4 cycles) rituximab 375 mg/m2 iv at day 1 of each cycle rituximab+chlorambucil: rituximab 375 mg/m2 iv, d1, 8, 15, 22, chlorambucil 6 mg/m2 os, daily during the first 6 weeks of treatment, ; two weeks rest; chlorambucil 6 mg/m2 os, daily during the first two of a four weeks cycles (total of 4 cycles) rituximab 375 mg/m2 iv at day 1 of each cycle
ARM C (Since April 2006)
n=138 participants at risk
rituximab 375 mg/m2 iv on days 1, 8, 15, 22, 56, 84, 112, 140 rituximab: rituximab 375 mg/m2 iv on days 1, 8, 15, 22, 56, 84, 112, 140
General disorders
Fatigue
12.2%
16/131 • Number of events 16 • Seven years and eight months
9.8%
13/132 • Number of events 13 • Seven years and eight months
11.6%
16/138 • Number of events 16 • Seven years and eight months
General disorders
Pyrexia
0.76%
1/131 • Number of events 1 • Seven years and eight months
4.5%
6/132 • Number of events 6 • Seven years and eight months
6.5%
9/138 • Number of events 9 • Seven years and eight months
Gastrointestinal disorders
Nausea
5.3%
7/131 • Number of events 7 • Seven years and eight months
13.6%
18/132 • Number of events 18 • Seven years and eight months
5.1%
7/138 • Number of events 7 • Seven years and eight months
Infections and infestations
Infection
13.0%
17/131 • Number of events 17 • Seven years and eight months
9.8%
13/132 • Number of events 13 • Seven years and eight months
10.1%
14/138 • Number of events 14 • Seven years and eight months
Gastrointestinal disorders
Abdominal pain upper
6.9%
9/131 • Number of events 9 • Seven years and eight months
8.3%
11/132 • Number of events 11 • Seven years and eight months
5.1%
7/138 • Number of events 7 • Seven years and eight months
General disorders
Infusion related reactions
0.00%
0/131 • Seven years and eight months
15.9%
21/132 • Number of events 21 • Seven years and eight months
14.5%
20/138 • Number of events 20 • Seven years and eight months

Additional Information

Prof. Emanuele Zucca MD, Scientific and Medical Director

International Extranodal Lymphoma Study Group (IELSG)

Phone: +41 91 811 9040

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place