Sequential Chemotherapy and Lenalidomide Followed by Rituximab and Lenalidomide Maintenance for Untreated Mantle Cell Lymphoma: A Phase II Study
Trial Snapshot
- Phase
- Phase 2
- Status
- Completed
- Enrollment
- 49
- Locations
- 7
- Primary Endpoint
- 3-year Progression-free Survival (PFS)
Study Overview
Brief Summary
The purpose of this study is to find out what effects, good and/or bad, the treatment including 1) Lenalidomide-RCHOP, 2) R-HIDAC, and 3) Lenalidomide-Rituximab maintenance has on the participant and their lymphoma.
Detailed Description
Patients will receive lenalidomide 15 mg orally daily on days 1-14 with standard-dose R-CHOP (375 mg/m^2 intravenous rituximab, 750 mg/m2 intravenous cyclophosphamide, 50 mg/m^2 intravenous doxorubicin, and 1.4 mg/m2 intravenous vincristine on day 1, and 100 mg prednisone days 1-5 or days 2-6) every 21 days for four cycles.
All patients will receive pegfilgrastim on day 2 of each cycle and aspirin 81 mg orally daily for venous thromboembolism prophylaxis throughout the four cycles.
After four cycles of Len-RCHOP, the patients will undergo restaging PET/CT scans. Patients with evidence of disease progression will be treated off study.
R-HIDAC After lenalidomide-RCHOP phase, patients without evidence of progressive disease will receive rituximab 375 mg/m^2 day 1 and then patients will be admitted for high-dose cytarabine (HIDAC). Recommended age-adjusted HIDAC doses are as follows: ≤65 years: 3 g/m2 every12 hours X 4 doses; 65-70 years: 2 g/m^2 every12 hours X 4 doses; >70 years: 1 g/m^2 every12 hours X 4 doses. Physician discretion will dictate the choice of HIDAC dose, ranging from 1 g/m^2 - 3 g/m^2 every 12 hours X 4 doses.
Patients will receive two cycles of rituximab-HIDAC every 3 weeks. After two cycles of R-HIDAC, the patients will undergo restaging PET/CT scans. Patients with evidence of disease progression will be treated off study.
Study Design
- Study Type
- Interventional
- Allocation
- Na
- Intervention Model
- Single Group
- Primary Purpose
- Treatment
- Masking
- None
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Previously untreated mantle cell lymphoma patients (at least clinical stage 2)
- •Histologic diagnosis confirmed by MSKCC pathologist as mantle cell lymphoma
- •Presence of evaluable disease
- •Age ≥18 years KPS ≥ 70%
- •Adequate organ function: ANC ≥1500 and platelet count ≥100,000, unless felt to be secondary to underlying mantle cell lymphoma
- •Renal function assessed by calculated creatinine clearance as follows:
- •Cockcroft-Gault estimation of CrCl):
- •Calculated creatinine clearance ≥ 30ml/min by Cockcroft-Gault formula. See section below, "Dosing Regimen", regarding lenalidomide dose adjustment for calculated creatinine clearance ≥30ml/min and < 60ml/min.
- •Adequate hepatic function as determined by
- •Total bilirubin <1.5X upper limit of normal (ULN) (unless known Gilbert syndrome)
- •AST (SGOT) and ALT (SGPT) 3 x ULN
- •All study participants must be registered into the mandatory Revlimid REMS® program, and be willing and able to comply with the requirements of the REMS® program.
- •Females of reproductive potential must adhere to the scheduled pregnancy testing as required in the Revlimid REMS® program.
- •Each subject must sign an informed consent form indicating that he or she understand the purpose of and procedures required for the study and are willing to participate.
- •Short course systemic corticosteroids is permissible for disease control, improvement of performance status or non-cancer indication if ≤ 10 days and must be discontinued prior to study treatment.
Exclusion Criteria
- •Known central nervous system (CNS) lymphoma
- •Uncontrolled or severe cardiovascular disease or left ventricular ejection fraction <50% as determined by echocardiogram or MUGA.
- •Any life-threatening illness, medical condition, or organ system dysfunction which, in the investigator's opinion, could compromise the subject's safety or put the study outcomes at undue risk.
- •Pregnant or breast-feeding. Pre-menopausal patients must have a negative serum HCG within 14 days of enrollment.
- •Patients using ≥20 mg/day of prednisone (or steroid equivalent dose) for any chronic medical condition
- •Known seropositive, requiring anti-viral therapy, and with detectable viral load by PCR for human immunodeficiency virus (HIV), hepatitis B virus (HBV) or hepatitis C virus (HCV).
- •Known hypersensitivity to thalidomide or lenalidomide
- •The development of erythema nodosum if characterized by a desquamating rash while taking thalidomide or similar drugs.
- •Patients planned for upfront consolidation with high-dose therapy and autologous stem cell transplant.
Arms & Interventions
Chemotherapy
Lenalidomide + R-CHOP x 4 cycles R-HiDAC x 2 cycles R-Len maintenance x 6 months. Patients will be followed on active follow up for three years after completion of therapy. After the active followup period, survival, relapse, and new anti-lymphoma therapy information will be collected via telephone calls, patient medical records, and/or clinic visits approximately every 6 months until death, loss to follow up or consent withdrawal, whichever comes first.
Intervention: Lenalidomide (Drug)
Chemotherapy
Lenalidomide + R-CHOP x 4 cycles R-HiDAC x 2 cycles R-Len maintenance x 6 months. Patients will be followed on active follow up for three years after completion of therapy. After the active followup period, survival, relapse, and new anti-lymphoma therapy information will be collected via telephone calls, patient medical records, and/or clinic visits approximately every 6 months until death, loss to follow up or consent withdrawal, whichever comes first.
Intervention: R-CHOP (Drug)
Chemotherapy
Lenalidomide + R-CHOP x 4 cycles R-HiDAC x 2 cycles R-Len maintenance x 6 months. Patients will be followed on active follow up for three years after completion of therapy. After the active followup period, survival, relapse, and new anti-lymphoma therapy information will be collected via telephone calls, patient medical records, and/or clinic visits approximately every 6 months until death, loss to follow up or consent withdrawal, whichever comes first.
Intervention: high-dose cytarabine (HIDAC) (Drug)
Outcomes
Primary Outcomes
3-year Progression-free Survival (PFS)
Time Frame: 3 years
acceptable 3-yr PFS as 75% or higher, and unacceptable rate as 60% or lower.
Secondary Outcomes
No secondary outcomes reported