ASCT After a Rituximab/Ibrutinib/Ara-c Containing iNduction in Generalized Mantle Cell Lymphoma

Last updated: December 17, 2017
Sponsor: Prof. Dr. M. Dreyling (co-chairman)
Overall Status: Active - Recruiting

Phase

3

Condition

Mantle Cell Lymphoma

Lymphoproliferative Disorders

Lymphoma

Treatment

N/A

Clinical Study ID

NCT02858258
TRIANGLE
  • Ages 18-65
  • All Genders

Study Summary

The primary objective of the the trial is to establish one of three study arms, as future standard based on the comparison of the investigator-assessed failure-free survival.

Eligibility Criteria

Inclusion

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 marrowaspiration 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 highlyeffective contraceptives (eg, condoms, implants, injectables, combined oralcontraceptives, intrauterine devices, sexual abstinence, or sterilized partner) whileon study; this should be maintained for 90 days after the last dose of study drug.

Exclusion

Exclusion Criteria: Any potential subject who meets any of the following criteria will be excluded fromparticipating in the study.

  • Major surgery within 4 weeks prior to randomization.

  • Requires anticoagulation with warfarin or equivalent vitamin K antagonists (egphenprocoumon).

  • 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, inthe investigator's opinion, could compromise the subject's safety, interfere with theabsorption or metabolism of ibrutinib capsules, or put the study outcomes at unduerisk.

  • Vaccinated with live, attenuated vaccines within 4 weeks prior to randomization.

  • Known CNS involvement of MCL

  • Clinically significant hypersensitivity (eg, anaphylactic or anaphylactoid reactionsto the compound of ibrutinib itself or to the excipients in its formulation)

  • Known anti-murine antibody (HAMA) reactivity or known hypersensitivity to murineantibodies

  • Previous lymphoma therapy with radiation, cytostatic drugs, anti-CD20 antibody orinterferon except prephase therapy according to trial protocol

  • Serious concomitant disease interfering with a regular therapy according to the studyprotocol:

  • Cardiac (Clinically significant cardiovascular disease such as uncontrolled orsymptomatic arrhythmias, congestive heart failure, or myocardial infarctionwithin 6 months of Screening, or any Class 3 (moderate) or Class 4 (severe)cardiac disease as defined by the New York Heart Association FunctionalClassification 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 valueand/or creatinin clearance < 50 ml/min)

  • Impairment of liver function (unless caused by the lymphoma): transaminases > 3xnormal 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 cellskin cancer or in situ uterine cervix cancer

  • Pregnancy or lactation

  • Any psychological, familiar, sociological, or geographical condition potentiallyhampering 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 thisstudy.

Study Design

Total Participants: 870
Study Start date:
July 01, 2016
Estimated Completion Date:
May 31, 2026

Study Description

Objectives and Endpoints

Primary Objective:

To establish one of three study arms, R-CHOP/R-DHAP followed by ASCT (control arm A), R-CHOP+ibrutinib /R-DHAP followed by ASCT and ibrutinib maintenance experimental arm A+I), and R-CHOP+ibrutinib /R-DHAP followed by ibrutinib maintenance experimental arm I) as future standard based on the comparison of the investigator-assessed failure-free survival (FFS).

Secondary Objectives:

  • To compare the efficacy of the three treatment arms in terms of secondary efficacy endpoints

  • To determine the safety and tolerability of ibrutinib during induction immuno-chemotherapy and during maintenance and to compare the safety profile of the three treatment arms in terms of secondary toxicity endpoints

Primary Endpoint:

FFS defined as time from start of treatment to stable disease at end of immuno-chemotherapy, progressive disease, or death from any cause.

Secondary Efficacy Endpoints:

  • Overall survival (OS)

  • Progression-free survival (PFS) from randomization, from end of induction immuno-chemotherapy in patients with CR or PR at end of induction immuno-chemotherapy, and from the staging 6 weeks after end of induction assessment (at month 6)

  • Overall response and complete remission rates at midterm, at end of induction, 3 months after end of induction immunochemotherapy (at month 6)

  • PR to CR conversion rate during follow-up after end of induction immuno-chemotherapy

Secondary Toxicity Endpoints:

  • Rates of AEs, SAEs, and SUSARs by CTC grade (Version 4.03) during induction immuno-chemotherapy and during periods of follow-up after response to immune-chemotherapy

  • Cumulative incidence rates of SPMs

Exploratory Objectives:

  • To compare feasibility of ASCT in arm A+I vs. arm A

  • To compare minimal residual disease status between the three treatment groups

  • To determine the impact of ibrutinib during induction immuno-chemotherapy and during maintenance therapy on the minimal residual disease status

  • To determine the prognostic value of minimal residual disease status

  • To determine the prognostic value of positron emission tomography with fluorine 18-fluorodeoxyglucose

  • To determine clinical and biological prognostic and predictive factors

  • To determine the role of total body irradiation (TBI) in ASCT conditioning

Exploratory Endpoints:

  • Rate of successful stem cell mobilisations (success: separation of at least 2x2x10(6) CD34-positive cells, including a back-up)

  • Rate of molecular remissions (MRD-negative patients) at midterm, at end of induction immuno-chemotherapy, and at staging time-points during follow-up in patients with remission after end of induction immuno-chemotherapy

  • Time to molecular remission from start of therapy

  • Time to molecular relapse for patients in clinical and molecular remission after end of induction immunochemotherapy

  • RD in FDG-PET negative or positive patients after induction and ASCT

Exploratory objectives may be evaluated only in a subset of patients according to local standards and resources.

Connect with a study center

  • Aalborg University Hospital, Dept of Hematology

    Aalborg, 9000
    Denmark

    Site Not Available

  • Aarhus University Hospital, Dept of Hematology

    Aarhus C, 8000
    Denmark

    Site Not Available

  • Rigshospitalet, Clinic of Hematology

    Copenhagen, 2100
    Denmark

    Site Not Available

  • Herlev Hospital, Department of Hematology L121

    Herlev, 2730
    Denmark

    Site Not Available

  • Odense University Hospital, Dept of Hematology X

    Odense C, 5000
    Denmark

    Site Not Available

  • Sjaelland University Hospital, Dept of Hematology

    Roskilde, 4000
    Denmark

    Site Not Available

  • Zentralklinik Augsburg, II. Med. Klinik, Hämatologie int. Onkologie

    Augsburg, 86156
    Germany

    Active - Recruiting

  • Onkologische Gemeinschaftspraxis Dr. Janssen/Dr. Reichert in der Ubbo-Emmius-Klinik

    Aurich, 26603
    Germany

    Active - Recruiting

  • Klinikum Bayreuth, Klinik f. Onkologie und Hämatologie

    Bayreuth, 95445
    Germany

    Active - Recruiting

  • Charité Univ.-Medizin Berlin, Med. Klinik - Hämatologie, Onkologie und Tumorimmunologie

    Berlin, 12200
    Germany

    Site Not Available

  • Helios Klinikum Berlin-Buch, Hämatologie, Onkologie und Tumorimmunologie

    Berlin, 13125
    Germany

    Active - Recruiting

  • Vivantes Klinikum Am Urban, Klinik f. Innere Medizin, Hämatologie und Onkologie

    Berlin, 10967
    Germany

    Active - Recruiting

  • Knappschaftskrankenhaus Bochum-Langendreer

    Bochum, 44892
    Germany

    Active - Recruiting

  • Universitätsklinikum Bonn

    Bonn, 53127
    Germany

    Active - Recruiting

  • Diako ev. Diakonie-KH gGmbH, Med. Klinik II, Hämatologie und Onkologie

    Bremen, 28239
    Germany

    Active - Recruiting

  • Klinikum Chemnitz gGmbH, Klinik f. Innere Medizin II

    Chemnitz, 09113
    Germany

    Active - Recruiting

  • DONAUISAR Klinikum Deggendorf, Innere Medizin II

    Deggendorf, 94469
    Germany

    Active - Recruiting

  • St.-Johannes-Hospital

    Dortmund, 44137
    Germany

    Active - Recruiting

  • Gemeinschaftspraxis Dr. Mohm und Prange-Krex - Fachärzte für Innere Medizin und Hämatologie und Onkologie

    Dresden, 01307
    Germany

    Active - Recruiting

  • Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden

    Dresden, 01307
    Germany

    Active - Recruiting

  • Marien Hospital Düsseldorf

    Düsseldorf, 40479
    Germany

    Active - Recruiting

  • Universitätsklinikum Düsseldorf, Klinik f. Hämatologie, Onkologie und klinische Immunologie

    Düsseldorf, 40225
    Germany

    Active - Recruiting

  • Helios Klinikum Erfurt GmbH, Zentrum f. Innere Medizin u. internistische Onkologie, Hämostaseologie

    Erfurt, 99089
    Germany

    Active - Recruiting

  • Universitätsklinikum Erlangen, Med. Klinik 5, Hämatologie und internistische Onkologie

    Erlangen, 91054
    Germany

    Active - Recruiting

  • St.-Antonius-Hospital Eschweiler, Klinik für Hämatologie und Onkologie

    Eschweiler, 52249
    Germany

    Active - Recruiting

  • Universitätsklinikum Essen, Klinik f. Hämatologie

    Essen, 45147
    Germany

    Active - Recruiting

  • Universitätsklinikum Freiburg, Klinik f. Innere Medizin, Hämatologie, Onkologie u. Stammzelltransplantation

    Freiburg, 79106
    Germany

    Active - Recruiting

  • Universitätsmedizin Greifswald, Klinik u. Poliklinik f. Innere Medizin C, Hämatologie u. Onkologie-, Transplantationszentrum

    Greifswald, 17475
    Germany

    Active - Recruiting

  • Universitätsmedizin Göttingen, Zentrum f. Innere Medizin, Klinik f. Hämatologie und Medizinische Onkologie

    Göttingen, 37075
    Germany

    Active - Recruiting

  • Katholisches Krankenhaus Hagen gGmbH, St.-Marien-Hospital, Klinik f. Hämatologie und Onkologie

    Hagen, 58095
    Germany

    Active - Recruiting

  • Asklepios Klinik Altona, II. Med.Abt. f. Hämatologie und internistische Onkologie, Stammzelltransplantation

    Hamburg, 22763
    Germany

    Active - Recruiting

  • Universitätsklinikum Hamburg-Eppendorf (UKE), II. Med. Klinik u. Poliklinik, Onkologie, Hämatologie, KMT

    Hamburg, 20246
    Germany

    Active - Recruiting

  • Universitätsklinikum Heidelberg, Med. Klinik - Innere Medizin V - Hämatologie, Onkologie und Rheumatologie

    Heidelberg, 69120
    Germany

    Active - Recruiting

  • Universitätsklinikum des Saarlandes, Klinik f. Innere Medizin I Hämatologie & Onkologie

    Homburg, 66421
    Germany

    Active - Recruiting

  • Universitätsklinikum des Saarlandes, Klinik f. Innere Medizin I Hämatologie & Onkologie

    Homburg / Saar, 66421
    Germany

    Site Not Available

  • Klinikum Idar-Oberstein GmbH, Medizinische Klinik I

    Idar-Oberstein, 55743
    Germany

    Active - Recruiting

  • Universitätsmedizin Jena, Klinik f. Innere Medizin II, Abteilung Hämatologie u. Internistische Onkologie

    Jena, 07747
    Germany

    Active - Recruiting

  • Städtisches Klinikum Karlsruhe, Med. Klinik III, Hämatologie und Onkologie

    Karlsruhe, 76133
    Germany

    Active - Recruiting

  • Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik f. Innere Medizin II - Hämatologie und Onkologie

    Kiel, 24105
    Germany

    Active - Recruiting

  • Gemeinschaftsklinikum Mittelrhein gGmbH, Ev. Stift St. Martin, Klinik f. Innere Medizin

    Koblenz, 56068
    Germany

    Active - Recruiting

  • Praxisklinik f. Hämatologie und Onkologie Koblenz

    Koblenz, 56068
    Germany

    Active - Recruiting

  • Uniklinik Köln, Klinik I für Innere Medizin

    Köln, 50937
    Germany

    Active - Recruiting

  • Klinikum Landshut gGmbH, Med. Klinik III, Hämatologie/Internistische Onkologie

    Landshut, 84034
    Germany

    Active - Recruiting

  • Onkologisch-Hämatologische Praxis Dr. Vehling-Kaiser

    Landshut, 84028
    Germany

    Active - Recruiting

  • Caritas-KHLebach, Gemeinschaftspraxis f. Hämatologie und Onkologie, Onkologisches Zentrum Lebach

    Lebach, 66822
    Germany

    Active - Recruiting

  • Universitätsklinikum Leipzig AöR, selbständige Abteilung f. Hämatologie und Internistische Onkologie, Hämostaseologische Ambulanz

    Leipzig, 04103
    Germany

    Active - Recruiting

  • Klinikum Lippe GmbH, Onkologie und Hämatologie

    Lemgo, 32657
    Germany

    Active - Recruiting

  • Klinikum der Stadt Ludwigshafen am Rhein gGmbH, Med. Klinik A

    Ludwigshafen, 67063
    Germany

    Active - Recruiting

  • Universitätsklinikum Magdeburg AöR, Klinik f. Hämatologie und Onkologie

    Magdeburg, 39120
    Germany

    Active - Recruiting

  • Universitätsmedizin der Univ. Mainz, III. Med. Klinik u. Poliklinik

    Mainz, 55131
    Germany

    Active - Recruiting

  • Johannes Wiesling Klinikum Minden, Klinik f. Hämatologie/Onkologie, Hämostaseologie und Palliativmedizin

    Minden, 32429
    Germany

    Active - Recruiting

  • Klinikum Rechts der Isar, III. Med. Klinik - Hämatologie und Onkologie

    München, 81675
    Germany

    Active - Recruiting

  • Klinikum der Universität München, Med. Klinik und Poliklinik III

    München, 81377
    Germany

    Active - Recruiting

  • Universitätsklinikum Münster, Med. Klinik A, Translationale Onkologie / Lymphome

    Münster, 48149
    Germany

    Active - Recruiting

  • Klinikum Nürnberg,5. Medizinische Klinik, Onkologie / Hämatologie

    Nürnberg, 90419
    Germany

    Active - Recruiting

  • Klinikum Oldenburg gGmbH, Med. Klinik II

    Oldenburg, 26133
    Germany

    Active - Recruiting

  • Klinikum Ernst von Bergmann Potsdam gGmbH, Zentrum f. Innere Medizin, Klinik f. Hämatologie und Onkologie

    Potsdam, 14467
    Germany

    Active - Recruiting

  • KH Barmherzige Brüder, Klinik f. Onkologie und Hämatologie

    Regensburg, 93049
    Germany

    Active - Recruiting

  • Universitätsmedizin Rostock, Abt. f. Hämatologie und Onkologie, Klinik und Poliklinik für Innere Medizin

    Rostock, 18057
    Germany

    Active - Recruiting

  • Klinikum Stuttgart - Katharinenhospital, Klinik f. Hämatologie und Onkologie

    Stuttgart, 70174
    Germany

    Active - Recruiting

  • Robert-Bosch-Krankenhaus, Abt.f. Hämatologie und Onkologie

    Stuttgart, 70376
    Germany

    Active - Recruiting

  • Klinikum Traunstein, Hämatologie - Onkologie- Palliativmedizin

    Traunstein, 83278
    Germany

    Active - Recruiting

  • Klinikum Mutterhaus der Borromäerinnen gGmbH, Okologisches Zentrum

    Trier, 54290
    Germany

    Active - Recruiting

  • Universitätsklinikum Tübingen, Med Klinik I, Innere Medizin II

    Tübingen, 72026
    Germany

    Active - Recruiting

  • Universitätsklinikum Ulm, Klinik für Innere Medizin III

    Ulm, 89081
    Germany

    Active - Recruiting

  • Klinikum Wolfsburg, Med. Klinik II

    Wolfsburg, 38440
    Germany

    Active - Recruiting

  • Universitätsklinikum Würzburg, Med. Klinik u. Poliklinik II /ZIM

    Würzburg, 97080
    Germany

    Site Not Available

  • Azienda Ospedaliera SS. Antonio e Biagio e C. Arrigo, SC Ematologia

    Alessandria, 15121
    Italy

    Active - Recruiting

  • Policlinico S. Orsola Malpighi, Istituto di Ematologia e Oncologia Medica Seragnoli

    Bologna, 40138
    Italy

    Site Not Available

  • Comprensorio Sanitario di Bolzano, Ematologia e trapianto di midollo osseo

    Bolzano, 39100
    Italy

    Site Not Available

  • Spedali Civili, Struttura Complessa di Ematologia

    Brescia, 25123
    Italy

    Site Not Available

  • Ospedale Businco, UO Ematologia - CTMO

    Cagliari, 09121
    Italy

    Site Not Available

  • ASO S. Croce e Carle, S.C. di Ematologia e Trapianto di Midollo Osseo

    Cuneo, 12100
    Italy

    Site Not Available

  • AOU Policlinico Careggi, Unità Funzionale di Ematologia

    Firenze, 50134
    Italy

    Site Not Available

  • IRCCS AOU S. Martino - IST, Clinica Ematologia

    Genova, 16132
    Italy

    Site Not Available

  • IRCCS AOU S. Martino - IST, Ematologia

    Genova, 16132
    Italy

    Site Not Available

  • Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Ematologia

    Meldola (FC), 47014
    Italy

    Site Not Available

  • Istituto Scientifico San Raffaele, Unità Ricerca Clinica Linfomi

    Milano, 20132
    Italy

    Site Not Available

  • Ospedale Niguarda, Struttura Complessa di Ematologia

    Milano, 20162
    Italy

    Site Not Available

  • Università di Modena e Reggio Emilia Policlinico - COM Centro Oncologico Modenese, Dipartimento di Oncologia ed Ematologia

    Modena, 41124
    Italy

    Site Not Available

  • Ospedale S. Gerardo, Divisione di Ematologia

    Monza, 20052
    Italy

    Site Not Available

  • "IRCCS Istituto Nazionale dei Tumori di Napoli - Pascale", Ematologia Oncologica

    Napoli, 80131
    Italy

    Active - Recruiting

  • AOU Maggiore della Carità - Università del Piemonte Orientale, S.C.D.U Ematologia

    Novara, 28100
    Italy

    Site Not Available

  • AO Ospedali Riuniti Villa Sofia-Cervello, Divisione di Ematologia

    Palermo, 90146
    Italy

    Site Not Available

  • IRCCS Fondazione Policlinico San Matteo, Clinica Ematologia

    Pavia, 27100
    Italy

    Site Not Available

  • Azienda Ospedaliera Pisana Ospedale "S.Chiara", Dipartimento di Oncologia Divisione di Ematologia

    Pisa, 56126
    Italy

    Site Not Available

  • Ospedale S. Maria delle Croci, U.O di Ematologia

    Ravenna, 48121
    Italy

    Site Not Available

  • Azienda Ospedaliera Bianchi, Melacrino, Morelli, Divisione di Ematologia

    Reggio Calabria, 89125
    Italy

    Site Not Available

  • Azienda Ospedaliera Arcispedale Santa Maria Nuova - IRCCS, Ematologia

    Reggio Emilia, 42123
    Italy

    Site Not Available

  • Ospedale degli Infermi, U.O. Ematologia

    Rimini, 47923
    Italy

    Site Not Available

  • Policlinico Tor Vergata, UOC Oncoematologia

    Roma, 00133
    Italy

    Site Not Available

  • Università La Sapienza, Ematologia

    Roma, 00161
    Italy

    Site Not Available

  • Casa Sollievo della Sofferenza, U.O. Ematologia

    San Giovanni Rotondo, 71013
    Italy

    Site Not Available

  • A.O. Città della Salute e della Scienza, SC Ematologia

    Torino, 10126
    Italy

    Site Not Available

  • A.O. U. Città della Salute e della Scienza, S C Ematologia U

    Torino, 10126
    Italy

    Site Not Available

  • Ospedale Cà Foncello, U.O.C. Ematologia

    Treviso, 31100
    Italy

    Site Not Available

  • Ospedale Cardinale Panico, Divisione di Ematologia

    Tricase, 73054
    Italy

    Site Not Available

  • ASUI Integrata di Udine, Clinica Ematologia

    Udine, 33100
    Italy

    Site Not Available

  • Ospedale Policlinico G.B. Rossi, "Centro trapianto midollo osseo Ematologia"

    Verona, 37134
    Italy

    Active - Recruiting

  • Ospedale S. Bortolo, Ematologia

    Vicenza, 36100
    Italy

    Active - Recruiting

  • Haukeland University Hospital , Dept. of Oncology and Medical Physics

    Bergen, 5021
    Norway

    Site Not Available

  • Oslo University Hospital, Dept of Oncology

    Oslo, 0310
    Norway

    Site Not Available

  • Stavanger University Hospital, Division for Hematology&Oncology

    Stavanger, 4011
    Norway

    Site Not Available

  • UNN Tromsø, Oncology Dep

    Tromsø, 9038
    Norway

    Site Not Available

  • St. Olavs Hospital, Department of Oncology

    Trondheim, 7006
    Norway

    Site Not Available

  • Sahlgrenska University Hospital, Section of Hematology and Coagulation, Dept of internal medicine

    Göteborg, 413 45
    Sweden

    Site Not Available

  • University Hospital, Dept of Hematolgy

    Linköping, 581 85
    Sweden

    Active - Recruiting

  • Sunderbyn Hospital, Dept of Medicine

    Lulea, 971 80
    Sweden

    Site Not Available

  • Skane University Hospital

    Lund, 221 85
    Sweden

    Active - Recruiting

  • Karolinska University Hospital, Center of Hematology

    Stockholm, 141 86
    Sweden

    Active - Recruiting

  • Norrland University Hospital, Dept of Oncology

    Umea, 901 85
    Sweden

    Site Not Available

  • Academic Hospital, Dept of Oncology

    Uppsala, 751 85
    Sweden

    Active - Recruiting

  • Örebro University Hospital, Dept of Oncology

    Örebro, 701 85
    Sweden

    Active - Recruiting

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