Testing Whether High Dose Chemotherapy and Infusion of the Patients' Own Stem Cells Improves Survival in Patients With Peripheral T-cell Lymphoma Who Achieved a Complete Response at the End of the Initial Chemotherapy

NCT ID: NCT06724237

Last Updated: 2024-12-09

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

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

PHASE3

Total Enrollment

294 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-12-01

Study Completion Date

2033-12-01

Brief Summary

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This phase III trial compares the effect of high dose chemotherapy and the patients' own (autologous) stem cells to observation only in patients with peripheral T-cell lymphoma who achieved a complete response after initial chemotherapy. Usual treatment after a complete response may include observation or high dose chemotherapy followed by an autologous stem cell transplant, however, it is not known if a transplant if beneficial. Giving chemotherapy before a stem cell transplant helps kill cancer cells in the body and helps make room in the patient's bone marrow for new blood-forming cells (stem cells) to grow. Stem cells removed prior to treatment are then returned to the patient to replace the blood forming cells that were destroyed by the chemotherapy. Giving high dose chemotherapy followed by an autologous stem cell transplant may be more effective compared to observation only in treating patients with peripheral T-cell lymphoma who have achieved a complete response after initial chemotherapy.

Detailed Description

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PRIMARY OBJECTIVE:

I. To demonstrate improvement in progression free survival (PFS) in the autologous stem cell transplant (ASCT) arm compared to the observation arm.

SECONDARY OBJECTIVES:

I. To assess difference in overall survival (OS) between the observation and autologous stem cell transplant (ASCT) arm.

II. To evaluate the differences in study intervention benefit for PFS and OS by the randomization stratification factors (histology and choice of induction chemotherapy).

III. To evaluate the cumulative incidence of relapse and mortality between the observational and autologous stem cell transplant (ASCT) arm.

EXPLORATORY OBJECTIVE:

I. To determine the impact of minimal residual disease (MRD) on the benefit of autologous stem cell transplant (ASCT).

OUTLINE: Patients are randomized to 1 of 2 arms.

ARM I: Patients receive standard of care observation on study. Patients also undergo blood sample collection and optional bone marrow aspiration and biopsy on study, and computed tomography (CT) or positron emission tomography (PET)/CT throughout the study.

ARM II: Patients receive stem cell mobilization and then undergo leukapheresis per standard of care. Patients also receive high dose chemotherapy followed by ASCT per standard of care. Additionally, patients undergo blood sample collection and optional bone marrow aspiration and biopsy on study, and CT or PET/CT throughout the study.

After completion of study treatment, patients are followed up every 3 months for 2 years, every 6 months for 3 years, and then yearly for up to 7 years for a total of 12 years from the date of randomization.

Conditions

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Anaplastic Large Cell Lymphoma, ALK-Negative Follicular Helper T-Cell Lymphoma Follicular Helper T-Cell Lymphoma, Angioimmunoblastic-Type Peripheral T-Cell Lymphoma, Not Otherwise Specified

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Arm I (observation)

Patients receive standard of care observation on study. Patients also undergo blood sample collection and optional bone marrow aspiration and biopsy on study, and CT or PET/CT throughout the study.

Group Type ACTIVE_COMPARATOR

Best Practice

Intervention Type OTHER

Receive standard of care observation

Biospecimen Collection

Intervention Type PROCEDURE

Undergo blood sample collection

Bone Marrow Aspiration

Intervention Type PROCEDURE

Undergo bone marrow aspiration and biopsy

Bone Marrow Biopsy

Intervention Type PROCEDURE

Undergo bone marrow aspiration and biopsy

Computed Tomography

Intervention Type PROCEDURE

Undergo CT or PET/CT

Positron Emission Tomography

Intervention Type PROCEDURE

Undergo PET/CT

Arm II (high dose chemotherapy and ASCT)

Patients receive stem cell mobilization and then undergo leukapheresis per standard of care. Patients also receive high dose chemotherapy followed by ASCT per standard of care. Additionally, patients undergo blood sample collection and optional bone marrow aspiration and biopsy on study, and CT or PET/CT throughout the study.

Group Type EXPERIMENTAL

Autologous Hematopoietic Stem Cell Transplantation

Intervention Type PROCEDURE

Undergo ASCT

Biospecimen Collection

Intervention Type PROCEDURE

Undergo blood sample collection

Bone Marrow Aspiration

Intervention Type PROCEDURE

Undergo bone marrow aspiration and biopsy

Bone Marrow Biopsy

Intervention Type PROCEDURE

Undergo bone marrow aspiration and biopsy

Computed Tomography

Intervention Type PROCEDURE

Undergo CT or PET/CT

High Dose Chemotherapy

Intervention Type DRUG

Receive high dose chemotherapy

Leukapheresis

Intervention Type PROCEDURE

Undergo leukapheresis

Positron Emission Tomography

Intervention Type PROCEDURE

Undergo PET/CT

Stem Cell Mobilization Therapy

Intervention Type DRUG

Receive stem cell mobilization therapy

Interventions

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Autologous Hematopoietic Stem Cell Transplantation

Undergo ASCT

Intervention Type PROCEDURE

Best Practice

Receive standard of care observation

Intervention Type OTHER

Biospecimen Collection

Undergo blood sample collection

Intervention Type PROCEDURE

Bone Marrow Aspiration

Undergo bone marrow aspiration and biopsy

Intervention Type PROCEDURE

Bone Marrow Biopsy

Undergo bone marrow aspiration and biopsy

Intervention Type PROCEDURE

Computed Tomography

Undergo CT or PET/CT

Intervention Type PROCEDURE

High Dose Chemotherapy

Receive high dose chemotherapy

Intervention Type DRUG

Leukapheresis

Undergo leukapheresis

Intervention Type PROCEDURE

Positron Emission Tomography

Undergo PET/CT

Intervention Type PROCEDURE

Stem Cell Mobilization Therapy

Receive stem cell mobilization therapy

Intervention Type DRUG

Other Intervention Names

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AHSCT Autologous Autologous Hematopoietic Cell Transplantation Autologous Stem Cell Transplant Autologous Stem Cell Transplantation Stem Cell Transplantation, Autologous standard of care standard therapy Biological Sample Collection Biospecimen Collected Specimen Collection Biopsy of Bone Marrow Biopsy, Bone Marrow CAT CAT Scan Computed Axial Tomography Computerized Axial Tomography Computerized axial tomography (procedure) Computerized Tomography Computerized Tomography (CT) scan CT CT Scan tomography high-dose chemotherapy Leukocyte Adsorptive Apheresis Leukocytopheresis Therapeutic Leukopheresis White Blood Cell Reduction Apheresis Medical Imaging, Positron Emission Tomography PET PET Scan Positron emission tomography (procedure) Positron Emission Tomography Scan Positron-Emission Tomography proton magnetic resonance spectroscopic imaging PT Chemomobilization Hematopoietic Stem Cell Mobilization Mobilization Therapy Stem-cell mobilization

Eligibility Criteria

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Inclusion Criteria

* Patient must be 18 to 75 years of age
* Patient must have an Eastern Cooperative Oncology Group (ECOG) performance status 0-2
* Patient must have histologically proven peripheral T-cell lymphoma (PTCL) in one of the following categories:

* Anaplastic large cell lymphoma (ALCL) ALK-negative
* Angioimmunoblastic T-cell lymphoma (AITL)
* Nodal PTCL with follicular helper T cell (TFH) phenotype
* Peripheral T-cell lymphoma not otherwise specified (PTCL-NOS)
* Patient must have undergone induction treatment with an anthracycline based chemotherapy.

* NOTE: Patients who discontinued anthracycline during treatment are eligible as long as they received at least one dose and achieved complete remission
* Patient must have achieved radiologic complete remission following induction therapy as defined by the Lugano criteria with a Deauville score between 1-3 by PET-CT

* NOTE: There is no central review required. Confirmation of complete remission status is determined by the enrolling institution's review
* NOTE: If a patient had a positive bone marrow biopsy at the time of initial diagnosis (pre-induction), a repeat biopsy must be completed post induction to confirm complete remission (CR)
* Patient must be eligible for high dose chemotherapy and autologous stem cell transplant (ASCT) per the enrolling institutional guidelines at the transplant center and be ready to proceed with ASCT if randomized to the ASCT arm
* Patient must not have active infection requiring intravenous systemic antimicrobial at time of randomization. Antibiotic prophylaxis is acceptable as long as the dose of the medication has been stable for at least 7 days prior to randomization
* Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial
* Patient must not be pregnant or breast-feeding due to the potential harm to an unborn fetus and possible risk for adverse events in nursing infants with the treatment regimens being used. All patients of childbearing potential must have a blood test or urine study within 14 days prior to randomization to rule out pregnancy. A patient of childbearing potential is defined as anyone, regardless of sexual orientation or whether they have undergone tubal ligation, who meets the following criteria: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy; or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months)
* Patient must not expect to conceive or father children by using accepted and effective method(s) of contraception or by abstaining from sexual intercourse during the treatment phase of the study and thereafter according to institutional guidelines
* Absolute neutrophil count (ANC) ≥ 1000/mcL (obtained ≤ 14 days prior to protocol randomization)
* Platelets ≥ 75,000/mcL (obtained ≤ 14 days prior to protocol randomization)
* Total bilirubin ≤ 1.5 x institutional upper limit of normal (ULN) (obtained ≤ 14 days prior to protocol randomization)
* Aspartate aminotransferase (AST)(serum glutamic oxaloacetic transaminase \[SGOT\])/alanine aminotransferase (ALT)(serum glutamic pyruvic transaminase \[SGPT\]) ≤ 3.0 x institutional ULN (obtained ≤ 14 days prior to protocol randomization)
* Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months of randomization are eligible for this trial
* For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated
* Patients with a history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Cancer Institute (NCI)

NIH

Sponsor Role collaborator

Eastern Cooperative Oncology Group

NETWORK

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Nabila N Bennani

Role: PRINCIPAL_INVESTIGATOR

ECOG-ACRIN Cancer Research Group

Central Contacts

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Pamela Cogliano

Role: CONTACT

Phone: 857-504-2900

Email: [email protected]

Other Identifiers

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NCI-2024-06604

Identifier Type: REGISTRY

Identifier Source: secondary_id

EA4232

Identifier Type: OTHER

Identifier Source: secondary_id

EA4232

Identifier Type: OTHER

Identifier Source: secondary_id

U10CA180820

Identifier Type: NIH

Identifier Source: secondary_id

View Link

EA4232

Identifier Type: -

Identifier Source: org_study_id