ASCT After a Rituximab/Ibrutinib/Ara-c Containing iNduction in Generalized Mantle Cell Lymphoma
Mantle Cell Lymphoma
About this trial
This is an interventional treatment trial for Mantle Cell Lymphoma focused on measuring MCL
Eligibility Criteria
Inclusion Criteria:
All patients must meet the following criteria:
- Histologically confirmed diagnosis of MCL according to WHO classification
- suitable for high-dose treatment including high-dose Ara-C
- Stage II-IV (Ann Arbor)
- Age ≥ 18 years and ≤ 65 years
- Previously untreated MCL
- At least 1 measurable lesion; in case of bone marrow infiltration only, bone marrow aspiration and biopsy is mandatory for all staging evaluations.
- ECOG/WHO performance status ≤ 2
The following laboratory values at screening (unless related to MCL):
- Absolute neutrophil count (ANC) ≥1000 cells/µL
- Platelets ≥100,000 cells/µL
- Transaminases (AST and ALT) ≤3 x upper limit of normal (ULN)
- Total bilirubin ≤2 x ULN unless due to known Morbus Meulengracht [Gilbert-Meulengracht-Syndrome])
- Creatinine ≤2 mg/dL or calculated creatinine clearance ≥ 50 mL/min
- Written informed consent form according to ICH/EU GCP and national regulations
- Sexually active men and women of child-bearing potential must agree to use highly effective contraceptives (eg, condoms, implants, injectables, combined oral contraceptives, intrauterine devices, sexual abstinence, or sterilized partner) while on study; this should be maintained for 90 days after the last dose of study drug.
Exclusion Criteria:
Any potential subject who meets any of the following criteria will be excluded from participating in the study.
- Major surgery within 4 weeks prior to randomization.
- Requires anticoagulation with warfarin or equivalent vitamin K antagonists (eg phenprocoumon).
- History of stroke or intracranial hemorrhage within 6 months prior to randomization.
- Requires treatment with strong CYP3A4/5 inhibitors.
- Any life-threatening illness, medical condition, or organ system dysfunction which, in the investigator's opinion, could compromise the subject's safety, interfere with the absorption or metabolism of ibrutinib capsules, or put the study outcomes at undue risk.
- Vaccinated with live, attenuated vaccines within 4 weeks prior to randomization.
- Known CNS involvement of MCL
- Clinically significant hypersensitivity (eg, anaphylactic or anaphylactoid reactions to the compound of ibrutinib itself or to the excipients in its formulation)
- Known anti-murine antibody (HAMA) reactivity or known hypersensitivity to murine antibodies
- Previous lymphoma therapy with radiation, cytostatic drugs, anti-CD20 antibody or interferon except prephase therapy according to trial protocol
Serious concomitant disease interfering with a regular therapy according to the study protocol:
- Cardiac (Clinically significant cardiovascular disease such as uncontrolled or symptomatic arrhythmias, congestive heart failure, or myocardial infarction within 6 months of Screening, or any Class 3 (moderate) or Class 4 (severe) cardiac disease as defined by the New York Heart Association Functional Classification or LVEF below LLN )
- Pulmonary (e.g. chronic lung disease with hypoxemia)
- Endocrinological (e.g. severe, not sufficiently controlled diabetes mellitus)
- Renal insufficiency (unless caused by the lymphoma): creatinine > 2x normal value and/or creatinin clearance < 50 ml/min)
- Impairment of liver function (unless caused by the lymphoma): transaminases > 3x normal or bilirubin > 2,0 mg/dl unless due to morbus Meulengracht (Gilbert-Meulengracht-Syndrome)
- Patients with unresolved hepatitis B or C infection or known HIV positive infection (mandatory test)
- Prior organ, bone marrow or peripheral blood stem cell transplantation
- Concomitant or previous malignancies within the last 3 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
- Subjects not able to give consent
- Subjects without legal capacity who are unable to understand the nature, scope, significance and consequences of this clinical trial
- Participation in another clinical trial within 30 days before randomization in this study.
Sites / Locations
- Aalborg University Hospital, Dept of Hematology
- Aarhus University Hospital, Dept of Hematology
- Rigshospitalet, Clinic of Hematology
- Herlev Hospital, Department of Hematology L121
- Odense University Hospital, Dept of Hematology X
- Sjaelland University Hospital, Dept of Hematology
- Zentralklinik Augsburg, II. Med. Klinik, Hämatologie int. OnkologieRecruiting
- Onkologische Gemeinschaftspraxis Dr. Janssen/Dr. Reichert in der Ubbo-Emmius-KlinikRecruiting
- Klinikum Bayreuth, Klinik f. Onkologie und HämatologieRecruiting
- Vivantes Klinikum Am Urban, Klinik f. Innere Medizin, Hämatologie und OnkologieRecruiting
- Charité Univ.-Medizin Berlin, Med. Klinik - Hämatologie, Onkologie und Tumorimmunologie
- Helios Klinikum Berlin-Buch, Hämatologie, Onkologie und TumorimmunologieRecruiting
- Knappschaftskrankenhaus Bochum-LangendreerRecruiting
- Universitätsklinikum BonnRecruiting
- Diako ev. Diakonie-KH gGmbH, Med. Klinik II, Hämatologie und OnkologieRecruiting
- Klinikum Chemnitz gGmbH, Klinik f. Innere Medizin IIRecruiting
- DONAUISAR Klinikum Deggendorf, Innere Medizin IIRecruiting
- St.-Johannes-HospitalRecruiting
- Gemeinschaftspraxis Dr. Mohm und Prange-Krex - Fachärzte für Innere Medizin und Hämatologie und OnkologieRecruiting
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität DresdenRecruiting
- Universitätsklinikum Düsseldorf, Klinik f. Hämatologie, Onkologie und klinische ImmunologieRecruiting
- Marien Hospital DüsseldorfRecruiting
- Helios Klinikum Erfurt GmbH, Zentrum f. Innere Medizin u. internistische Onkologie, HämostaseologieRecruiting
- Universitätsklinikum Erlangen, Med. Klinik 5, Hämatologie und internistische OnkologieRecruiting
- St.-Antonius-Hospital Eschweiler, Klinik für Hämatologie und OnkologieRecruiting
- Universitätsklinikum Essen, Klinik f. HämatologieRecruiting
- Universitätsklinikum Freiburg, Klinik f. Innere Medizin, Hämatologie, Onkologie u. StammzelltransplantationRecruiting
- Universitätsmedizin Greifswald, Klinik u. Poliklinik f. Innere Medizin C, Hämatologie u. Onkologie-, TransplantationszentrumRecruiting
- Universitätsmedizin Göttingen, Zentrum f. Innere Medizin, Klinik f. Hämatologie und Medizinische OnkologieRecruiting
- Katholisches Krankenhaus Hagen gGmbH, St.-Marien-Hospital, Klinik f. Hämatologie und OnkologieRecruiting
- Universitätsklinikum Hamburg-Eppendorf (UKE), II. Med. Klinik u. Poliklinik, Onkologie, Hämatologie, KMTRecruiting
- Asklepios Klinik Altona, II. Med.Abt. f. Hämatologie und internistische Onkologie, StammzelltransplantationRecruiting
- Universitätsklinikum Heidelberg, Med. Klinik - Innere Medizin V - Hämatologie, Onkologie und RheumatologieRecruiting
- Universitätsklinikum des Saarlandes, Klinik f. Innere Medizin I Hämatologie & OnkologieRecruiting
- Klinikum Idar-Oberstein GmbH, Medizinische Klinik IRecruiting
- Universitätsmedizin Jena, Klinik f. Innere Medizin II, Abteilung Hämatologie u. Internistische OnkologieRecruiting
- Städtisches Klinikum Karlsruhe, Med. Klinik III, Hämatologie und OnkologieRecruiting
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik f. Innere Medizin II - Hämatologie und OnkologieRecruiting
- Gemeinschaftsklinikum Mittelrhein gGmbH, Ev. Stift St. Martin, Klinik f. Innere MedizinRecruiting
- Praxisklinik f. Hämatologie und Onkologie KoblenzRecruiting
- Uniklinik Köln, Klinik I für Innere MedizinRecruiting
- Onkologisch-Hämatologische Praxis Dr. Vehling-KaiserRecruiting
- Klinikum Landshut gGmbH, Med. Klinik III, Hämatologie/Internistische OnkologieRecruiting
- Caritas-KHLebach, Gemeinschaftspraxis f. Hämatologie und Onkologie, Onkologisches Zentrum LebachRecruiting
- Universitätsklinikum Leipzig AöR, selbständige Abteilung f. Hämatologie und Internistische Onkologie, Hämostaseologische AmbulanzRecruiting
- Klinikum Lippe GmbH, Onkologie und HämatologieRecruiting
- Klinikum der Stadt Ludwigshafen am Rhein gGmbH, Med. Klinik ARecruiting
- Universitätsklinikum Magdeburg AöR, Klinik f. Hämatologie und OnkologieRecruiting
- Universitätsmedizin der Univ. Mainz, III. Med. Klinik u. PoliklinikRecruiting
- Johannes Wiesling Klinikum Minden, Klinik f. Hämatologie/Onkologie, Hämostaseologie und PalliativmedizinRecruiting
- Klinikum der Universität München, Med. Klinik und Poliklinik IIIRecruiting
- Klinikum Rechts der Isar, III. Med. Klinik - Hämatologie und OnkologieRecruiting
- Universitätsklinikum Münster, Med. Klinik A, Translationale Onkologie / LymphomeRecruiting
- Klinikum Nürnberg,5. Medizinische Klinik, Onkologie / HämatologieRecruiting
- Klinikum Oldenburg gGmbH, Med. Klinik IIRecruiting
- Klinikum Ernst von Bergmann Potsdam gGmbH, Zentrum f. Innere Medizin, Klinik f. Hämatologie und OnkologieRecruiting
- KH Barmherzige Brüder, Klinik f. Onkologie und HämatologieRecruiting
- Universitätsmedizin Rostock, Abt. f. Hämatologie und Onkologie, Klinik und Poliklinik für Innere MedizinRecruiting
- Klinikum Stuttgart - Katharinenhospital, Klinik f. Hämatologie und OnkologieRecruiting
- Robert-Bosch-Krankenhaus, Abt.f. Hämatologie und OnkologieRecruiting
- Klinikum Traunstein, Hämatologie - Onkologie- PalliativmedizinRecruiting
- Klinikum Mutterhaus der Borromäerinnen gGmbH, Okologisches ZentrumRecruiting
- Universitätsklinikum Tübingen, Med Klinik I, Innere Medizin IIRecruiting
- Universitätsklinikum Ulm, Klinik für Innere Medizin IIIRecruiting
- Klinikum Wolfsburg, Med. Klinik IIRecruiting
- Universitätsklinikum Würzburg, Med. Klinik u. Poliklinik II /ZIM
- Azienda Ospedaliera SS. Antonio e Biagio e C. Arrigo, SC EmatologiaRecruiting
- Policlinico S. Orsola Malpighi, Istituto di Ematologia e Oncologia Medica Seragnoli
- Comprensorio Sanitario di Bolzano, Ematologia e trapianto di midollo osseo
- Spedali Civili, Struttura Complessa di Ematologia
- Ospedale Businco, UO Ematologia - CTMO
- ASO S. Croce e Carle, S.C. di Ematologia e Trapianto di Midollo Osseo
- AOU Policlinico Careggi, Unità Funzionale di Ematologia
- IRCCS AOU S. Martino - IST, Clinica Ematologia
- IRCCS AOU S. Martino - IST, Ematologia
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Ematologia
- Istituto Scientifico San Raffaele, Unità Ricerca Clinica Linfomi
- Ospedale Niguarda, Struttura Complessa di Ematologia
- Università di Modena e Reggio Emilia Policlinico - COM Centro Oncologico Modenese, Dipartimento di Oncologia ed Ematologia
- Ospedale S. Gerardo, Divisione di Ematologia
- "IRCCS Istituto Nazionale dei Tumori di Napoli - Pascale", Ematologia OncologicaRecruiting
- AOU Maggiore della Carità - Università del Piemonte Orientale, S.C.D.U Ematologia
- AO Ospedali Riuniti Villa Sofia-Cervello, Divisione di Ematologia
- IRCCS Fondazione Policlinico San Matteo, Clinica Ematologia
- Azienda Ospedaliera Pisana Ospedale "S.Chiara", Dipartimento di Oncologia Divisione di Ematologia
- Ospedale S. Maria delle Croci, U.O di Ematologia
- Azienda Ospedaliera Bianchi, Melacrino, Morelli, Divisione di Ematologia
- Azienda Ospedaliera Arcispedale Santa Maria Nuova - IRCCS, Ematologia
- Ospedale degli Infermi, U.O. Ematologia
- Policlinico Tor Vergata, UOC Oncoematologia
- Università La Sapienza, Ematologia
- Casa Sollievo della Sofferenza, U.O. Ematologia
- A.O. Città della Salute e della Scienza, SC Ematologia
- A.O. U. Città della Salute e della Scienza, S C Ematologia U
- Ospedale Cà Foncello, U.O.C. Ematologia
- Ospedale Cardinale Panico, Divisione di Ematologia
- ASUI Integrata di Udine, Clinica Ematologia
- Ospedale Policlinico G.B. Rossi, "Centro trapianto midollo osseo Ematologia"Recruiting
- Ospedale S. Bortolo, EmatologiaRecruiting
- Haukeland University Hospital , Dept. of Oncology and Medical Physics
- Oslo University Hospital, Dept of Oncology
- Stavanger University Hospital, Division for Hematology&Oncology
- UNN Tromsø, Oncology Dep
- St. Olavs Hospital, Department of Oncology
- Sahlgrenska University Hospital, Section of Hematology and Coagulation, Dept of internal medicine
- University Hospital, Dept of HematolgyRecruiting
- Sunderbyn Hospital, Dept of Medicine
- Skane University HospitalRecruiting
- Karolinska University Hospital, Center of HematologyRecruiting
- Norrland University Hospital, Dept of Oncology
- Academic Hospital, Dept of OncologyRecruiting
- Örebro University Hospital, Dept of OncologyRecruiting
Arms of the Study
Arm 1
Arm 2
Arm 3
Active Comparator
Experimental
Experimental
Standard Arm A
Experimental Arm A+I
Experimental Arm I
R-CHOP/R-DHAP: Alternating 3 cycles of R-CHOP in cycle 1,3,5 and 3 cyles of R-DHAP in cycle 2,4,6; each 21 day cycle Drug: R-CHOP/R-DHAP ASCT conditioning (ASCT: autologous stemm cell transplantation) Drug: THAM or BEAM
R-CHOP+Ibrutinib/R-DHAP: Alternating 3 cycles of R-CHOP + Ibrutinib at Days 1-19 in cycle 1,3,5 and 3 cyles of R-DHAP in cycle 2,4,6; each 21 day cycle Drug: R-CHOP/R-DHAP Drug: Ibrutinib (Induction) ASCT conditioning (ASCT: autologous stemm cell transplantation) Drug: THAM or BEAM 2 years Ibrutinib Maintenance Drug: Ibrutinib (Maintenace)
R-CHOP+Ibrutinib / R-DHAP: Alternating 3 cycles of R-CHOP + Ibrutinib at Days1-19 in cycle 1,3,5 and 3 cyles of R-DHAP in cycle 2,4,6; each 21 day cycle Drug: R-CHOP/R-DHAP Drug: Ibrutinib (Induction) 2 years Ibrutinib Maintenance Drug: Ibrutinib (Maintenance)