Test af CC-486 (oral azacitidin) plus standard lægemiddelterapi hos patienter 75 år eller ældre med nyligt diagnosticeret diffust stort B-cellet lymfom
En fase II/III randomiseret undersøgelse af R-MiniCHOP med eller uden CC-486 (oral azacitidin) hos deltagere i alderen 75 år eller ældre med nyligt diagnosticeret diffust storcellet B-celle lymfom, grad IIIB follikulært lymfom, transformeret lymfom og højgradigt B -Cellymfomer med MYC- OG BCL2- og/eller BCL6-omlejringer
This phase II/III trial compares the side effects and activity of oral azacitidine in combination with the standard drug therapy (reduced dose rituximab-cyclophosphamide, doxorubicin, vincristine, and prednisone [R-miniCHOP]) versus R-miniCHOP alone in treating patients 75 years or older with newly diagnosed diffuse large B cell lymphoma. R-miniCHOP includes a monoclonal antibody (a type of protein), called rituximab, which attaches to the lymphoma cells and may help the immune system kill these cells. R-miniCHOP also includes prednisone which is an anti-inflammatory medication and a combination of 3 chemotherapy drugs, cyclophosphamide, doxorubicin, and vincristine. These 3 chemotherapy drugs, as well as oral azacitidine, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Combining oral azacitidine with R-miniCHOP may shrink the cancer or extend the time without disease symptoms coming back or extend patient's survival when compared to R-miniCHOP alone.
Studieoversigt
Status
Status
Betingelser
Betingelser
- Lymfoplasmacytisk lymfom
- Ann Arbor Stage III diffust stort B-cellet lymfom
- Ann Arbor Stage IV diffust stort B-cellet lymfom
- Højgradig B-celle lymfom med MYC og BCL2 eller BCL6 omlejringer
- Højgradig B-cellelymfom med MYC-, BCL2- og BCL6-omlejringer
- Grad 3b follikulært lymfom
- Diffust storcellet B-celle lymfom, ikke andet specificeret
- EBV-positivt diffust stort B-cellet lymfom, ikke andet specificeret
- Højgradig B-celle lymfom, ikke andet specificeret
- Diffust storcellet B-celle lymfom forbundet med kronisk inflammation
- Primært kutant diffust stort B-cellet lymfom, bentype
- Transformeret follikulært lymfom til diffust stort B-cellet lymfom
- Intravaskulært stort B-cellet lymfom
- T-celle/histiocyt-rig stort B-celle lymfom
- Højgradig B-celle lymfom med MYC og BCL2 og/eller BCL6 omlejringer
- Diffus stort B-celle lymfom aktiveret B-celle type
- Diffust stor B-celle lymfom germinal center B-celle type
- HHV8-positivt diffust stort B-cellet lymfom, ikke andet specificeret
- Transformeret marginal zone lymfom til diffust stort B-cellet lymfom
- Ann Arbor Stage IIX (fyldig) diffust stort B-cellet lymfom
- Nodulært lymfocytdominerende B-celle lymfom
Intervention / Behandling
Intervention / Behandling
- Medicin: Cyclophosphamide
- Medicin: Doxorubicin Hydrochloride
- Medicin: Prednisone
- Procedure: Biospecimen Collection
- Biologisk: Rituximab
- Medicin: Vincristine Sulfate
- Andet: Questionnaire Administration
- Procedure: Echocardiography Test
- Procedure: Multigated Acquisition Scan
- Procedure: Positron Emission Tomography
- Biologisk: Rituximab and Hyaluronidase Human
- Procedure: Computed Tomography
- Medicin: Oral Azacitidine
Detaljeret beskrivelse
PRIMARY OBJECTIVES:
I. To determine if the addition of CC-486 (oral azacitidine) to R-miniCHOP results in excess toxicity compared to R-miniCHOP alone that would preclude the combination from being studied further. (Safety run-in) II. To determine if the CC-486 + R-miniCHOP regimen should be tested further (Phase III) against the control R-miniCHOP alone based on progression-free survival (PFS). (Phase II component) III. To compare the overall survival (OS) between CC-486 + R-miniCHOP and R-miniCHOP alone. (Phase III component)
SECONDARY OBJECTIVES:
I. To assess the feasibility of delivering at least 4 cycles of CC-486 with R-miniCHOP in this population.
II. To assess toxicity for CC-486 + R-miniCHOP and for R-miniCHOP. III. To compare complete response rates, as defined by Lugano 2014 classification, between CC-486 + R-miniCHOP and R-miniCHOP alone.
INTEGRATED CORRELATIVE GERIATRIC ASSESSMENTS:
I. To compare functioning as assessed by the S1918 Comprehensive Geriatric Assessment (S1918 CGA) between participants treated with CC-486 + R-miniCHOP versus R-miniCHOP alone.
II. To evaluate if frailty status (fit/unfit versus [vs] frail/superfrail) as assessed by the FIL tool is associated with OS.
III. To evaluate if frailty as measured by the FIL tool correlates with the summary frailty index as measured using components of the S1918 CGA.
BANKING OBJECTIVE:
I. To bank specimens for future correlative studies.
OUTLINE:
Beginning 7 days prior to starting [protocol treatment, all patients receive vincristine sulfate intravenously (IV) on day 1, and prednisone orally (PO) daily on days 1-7.
Patients are then randomized to 1 of 2 arms.
ARM I: Patients receive CC-486 PO for 7 days prior to cycle 1. Patients then receive CC-486 PO on days 8-21. Treatment repeats every 21 days for cycles 1-5 in the absence of disease progression or unacceptable toxicity. Patients also receive rituximab IV (or rituximab and hyaluronidase human subcutaneously [SC] for cycles 2-6), cyclophosphamide IV, doxorubicin hydrochloride IV, and vincristine sulfate IV on day 1, and prednisone PO on days 1-5. Treatment repeats every 21 days for cycles 1-6 (6 cycles total) in the absence of disease progression or unacceptable toxicity. Patients undergo echocardiography (ECHO) or multigated acquisition scan (MUGA) at screening and undergo positron emission tomography (PET)-computed tomography (CT) and blood sample collection throughout the study.
ARM II: Patients receive rituximab IV (or rituximab and hyaluronidase human SC for cycles 2-6), cyclophosphamide IV, doxorubicin hydrochloride IV, and vincristine sulfate IV on day 1, and prednisone PO on days 1-5. Treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo ECHO or MUGA at screening and undergo PET-CT and blood sample collection throughout the study.
After completion of study treatment, patients are followed up periodically until 5 years from the date of registration.
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Fase
Fase
- Fase 2
- Fase 3
Kontakter og lokationer
Studiesteder
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Arizona
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Tucson, Arizona, Forenede Stater, 85719
- Banner University Medical Center - Tucson
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Tucson, Arizona, Forenede Stater, 85719
- University of Arizona Cancer Center-North Campus
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Arkansas
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Little Rock, Arkansas, Forenede Stater, 72205
- University of Arkansas for Medical Sciences
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California
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Anaheim, California, Forenede Stater, 92806
- Kaiser Permanente-Anaheim
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Baldwin Park, California, Forenede Stater, 91706
- Kaiser Permanente-Baldwin Park
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Bellflower, California, Forenede Stater, 90706
- Kaiser Permanente-Bellflower
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Beverly Hills, California, Forenede Stater, 90211
- Tower Cancer Research Foundation
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Costa Mesa, California, Forenede Stater, 92627
- UC Irvine Health Cancer Center-Newport
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Duarte, California, Forenede Stater, 91010
- City of Hope Comprehensive Cancer Center
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Fontana, California, Forenede Stater, 92335
- Kaiser Permanente-Fontana
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Harbor City, California, Forenede Stater, 90710
- Kaiser Permanente South Bay
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Huntington Beach, California, Forenede Stater, 92648
- City of Hope Seacliff
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Irvine, California, Forenede Stater, 92618
- Kaiser Permanente-Irvine
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Irvine, California, Forenede Stater, 92618
- City of Hope at Irvine Lennar
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Lancaster, California, Forenede Stater, 93534
- City of Hope Antelope Valley
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Long Beach, California, Forenede Stater, 90822
- Tibor Rubin VA Medical Center
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Long Beach, California, Forenede Stater, 90813
- City of Hope at Long Beach Elm
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Los Angeles, California, Forenede Stater, 90048
- Cedars-Sinai Medical Center
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Los Angeles, California, Forenede Stater, 90027
- Kaiser Permanente Los Angeles Medical Center
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Los Angeles, California, Forenede Stater, 90034
- Kaiser Permanente West Los Angeles
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Newport Beach, California, Forenede Stater, 92660
- City of Hope Newport Beach
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Ontario, California, Forenede Stater, 91761
- Kaiser Permanente-Ontario
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Orange, California, Forenede Stater, 92868
- UC Irvine Health/Chao Family Comprehensive Cancer Center
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Palo Alto, California, Forenede Stater, 94304
- Stanford Cancer Institute Palo Alto
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Panorama City, California, Forenede Stater, 91402
- Kaiser Permanente - Panorama City
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Riverside, California, Forenede Stater, 92505
- Kaiser Permanente-Riverside
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San Diego, California, Forenede Stater, 92120
- Kaiser Permanente-San Diego Zion
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San Marcos, California, Forenede Stater, 92078
- Kaiser Permanente-San Marcos
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San Mateo, California, Forenede Stater, 94402
- UCSF Cancer Center - San Mateo
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South Pasadena, California, Forenede Stater, 91030
- City of Hope South Pasadena
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Torrance, California, Forenede Stater, 90503
- City of Hope South Bay
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Upland, California, Forenede Stater, 91786
- City of Hope Upland
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Woodland Hills, California, Forenede Stater, 91367
- Kaiser Permanente-Woodland Hills
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Colorado
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Golden, Colorado, Forenede Stater, 80401
- Lutheran Hospital - Cancer Centers of Colorado
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Delaware
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Newark, Delaware, Forenede Stater, 19713
- Helen F Graham Cancer Center
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Newark, Delaware, Forenede Stater, 19713
- Delaware Clinical and Laboratory Physicians PA
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Newark, Delaware, Forenede Stater, 19713
- Medical Oncology Hematology Consultants PA
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Florida
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Miami, Florida, Forenede Stater, 33136
- University of Miami Miller School of Medicine-Sylvester Cancer Center
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Georgia
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Atlanta, Georgia, Forenede Stater, 30308
- Emory University Hospital Midtown
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Atlanta, Georgia, Forenede Stater, 30322
- Emory University Hospital/Winship Cancer Institute
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Atlanta, Georgia, Forenede Stater, 30342
- Emory Saint Joseph's Hospital
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Augusta, Georgia, Forenede Stater, 30912
- Augusta University Medical Center
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Hawaii
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Honolulu, Hawaii, Forenede Stater, 96813
- Queen's Medical Center
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Honolulu, Hawaii, Forenede Stater, 96813
- Hawaii Cancer Care Inc - Waterfront Plaza
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Honolulu, Hawaii, Forenede Stater, 96813
- Queen's Cancer Cenrer - POB I
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Honolulu, Hawaii, Forenede Stater, 96813
- Straub Clinic and Hospital
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Honolulu, Hawaii, Forenede Stater, 96817
- Queen's Cancer Center - Kuakini
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‘Aiea, Hawaii, Forenede Stater, 96701
- Hawaii Cancer Care - Westridge
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‘Aiea, Hawaii, Forenede Stater, 96701
- Pali Momi Medical Center
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Illinois
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Centralia, Illinois, Forenede Stater, 62801
- Centralia Oncology Clinic
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Chicago, Illinois, Forenede Stater, 60611
- Northwestern University
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Chicago, Illinois, Forenede Stater, 60637
- University of Chicago Comprehensive Cancer Center
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Chicago, Illinois, Forenede Stater, 60612
- University of Illinois
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Danville, Illinois, Forenede Stater, 61832
- Carle at The Riverfront
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DeKalb, Illinois, Forenede Stater, 60115
- Northwestern Medicine Cancer Center Kishwaukee
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Decatur, Illinois, Forenede Stater, 62526
- Decatur Memorial Hospital
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Decatur, Illinois, Forenede Stater, 62526
- Cancer Care Specialists of Illinois - Decatur
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Effingham, Illinois, Forenede Stater, 62401
- Crossroads Cancer Center
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Effingham, Illinois, Forenede Stater, 62401
- Carle Physician Group-Effingham
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Evanston, Illinois, Forenede Stater, 60201
- NorthShore University HealthSystem-Evanston Hospital
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Geneva, Illinois, Forenede Stater, 60134
- Northwestern Medicine Cancer Center Delnor
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Glenview, Illinois, Forenede Stater, 60026
- NorthShore University HealthSystem-Glenbrook Hospital
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Glenview, Illinois, Forenede Stater, 60026
- Northwestern Medicine Glenview Outpatient Center
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Grayslake, Illinois, Forenede Stater, 60030
- Northwestern Medicine Grayslake Outpatient Center
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Highland Park, Illinois, Forenede Stater, 60035
- NorthShore University HealthSystem-Highland Park Hospital
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Lake Forest, Illinois, Forenede Stater, 60045
- Northwestern Medicine Lake Forest Hospital
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Mattoon, Illinois, Forenede Stater, 61938
- Carle Physician Group-Mattoon/Charleston
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New Lenox, Illinois, Forenede Stater, 60451
- UC Comprehensive Cancer Center at Silver Cross
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O'Fallon, Illinois, Forenede Stater, 62269
- Cancer Care Center of O'Fallon
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Orland Park, Illinois, Forenede Stater, 60462
- University of Chicago Medicine-Orland Park
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Orland Park, Illinois, Forenede Stater, 60462
- Northwestern Medicine Orland Park
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Peoria, Illinois, Forenede Stater, 61615
- Illinois CancerCare-Peoria
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Shiloh, Illinois, Forenede Stater, 62269
- Memorial Hospital East
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Urbana, Illinois, Forenede Stater, 61801
- Carle Cancer Center
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Warrenville, Illinois, Forenede Stater, 60555
- Northwestern Medicine Cancer Center Warrenville
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Iowa
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Ames, Iowa, Forenede Stater, 50010
- McFarland Clinic - Ames
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Ankeny, Iowa, Forenede Stater, 50023
- UI Health Care Mission Cancer and Blood - Ankeny Clinic
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Clive, Iowa, Forenede Stater, 50325
- UI Health Care Mission Cancer and Blood - West Des Moines Clinic
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Des Moines, Iowa, Forenede Stater, 50309
- Iowa Methodist Medical Center
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Des Moines, Iowa, Forenede Stater, 50309
- UI Health Care Mission Cancer and Blood - Des Moines Clinic
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Des Moines, Iowa, Forenede Stater, 50314
- UI Health Care Mission Cancer and Blood - Laurel Clinic
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Louisiana
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Monroe, Louisiana, Forenede Stater, 71202
- Ochsner LSU Health Monroe Medical Center
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Shreveport, Louisiana, Forenede Stater, 71103
- LSU Health Sciences Center at Shreveport
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Massachusetts
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Boston, Massachusetts, Forenede Stater, 02111
- Tufts Medical Center
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Michigan
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Ann Arbor, Michigan, Forenede Stater, 48106
- Trinity Health Saint Joseph Mercy Hospital Ann Arbor
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Brighton, Michigan, Forenede Stater, 48114
- Trinity Health IHA Medical Group Hematology Oncology - Brighton
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Brighton, Michigan, Forenede Stater, 48114
- Trinity Health Medical Center - Brighton
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Canton, Michigan, Forenede Stater, 48188
- Trinity Health IHA Medical Group Hematology Oncology - Canton
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Canton, Michigan, Forenede Stater, 48188
- Trinity Health Medical Center - Canton
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Chelsea, Michigan, Forenede Stater, 48118
- Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital
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Chelsea, Michigan, Forenede Stater, 48118
- Chelsea Hospital
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Livonia, Michigan, Forenede Stater, 48154
- Trinity Health Saint Mary Mercy Livonia Hospital
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Livonia, Michigan, Forenede Stater, 48154
- Hope Cancer Clinic
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Ypsilanti, Michigan, Forenede Stater, 48197
- Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus
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Ypsilanti, Michigan, Forenede Stater, 48106
- Huron Gastroenterology PC
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Minnesota
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Deer River, Minnesota, Forenede Stater, 56636
- Essentia Health - Deer River Clinic
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Duluth, Minnesota, Forenede Stater, 55805
- Essentia Health Cancer Center
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Hibbing, Minnesota, Forenede Stater, 55746
- Essentia Health Hibbing Clinic
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Sandstone, Minnesota, Forenede Stater, 55072
- Essentia Health Sandstone
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Virginia, Minnesota, Forenede Stater, 55792
- Essentia Health Virginia Clinic
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Mississippi
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Oxford, Mississippi, Forenede Stater, 38655
- Baptist Memorial Hospital and Cancer Center-Oxford
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Southhaven, Mississippi, Forenede Stater, 38671
- Baptist Memorial Hospital and Cancer Center-Desoto
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Missouri
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Cape Girardeau, Missouri, Forenede Stater, 63703
- Saint Francis Medical Center
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Chesterfield, Missouri, Forenede Stater, 63017
- Saint Luke's Hospital
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City of Saint Peters, Missouri, Forenede Stater, 63376
- Siteman Cancer Center at Saint Peters Hospital
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Creve Coeur, Missouri, Forenede Stater, 63141
- Siteman Cancer Center at West County Hospital
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Saint Joseph, Missouri, Forenede Stater, 64506
- Heartland Regional Medical Center
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St Louis, Missouri, Forenede Stater, 63110
- Washington University School of Medicine
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St Louis, Missouri, Forenede Stater, 63129
- Siteman Cancer Center-South County
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St Louis, Missouri, Forenede Stater, 63136
- Siteman Cancer Center at Christian Hospital
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Nebraska
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Lincoln, Nebraska, Forenede Stater, 68516
- Cancer Partners of Nebraska
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New Jersey
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Basking Ridge, New Jersey, Forenede Stater, 07920
- Memorial Sloan Kettering Basking Ridge
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Englewood, New Jersey, Forenede Stater, 07631
- Englewood Hospital and Medical Center
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Lakewood, New Jersey, Forenede Stater, 08701
- Monmouth Medical Center Southern Campus
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Long Branch, New Jersey, Forenede Stater, 07740
- Monmouth Medical Center
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Middletown, New Jersey, Forenede Stater, 07748
- Memorial Sloan Kettering Monmouth
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Montvale, New Jersey, Forenede Stater, 07645
- Memorial Sloan Kettering Bergen
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New Brunswick, New Jersey, Forenede Stater, 08903
- Rutgers Cancer Institute of New Jersey
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Newark, New Jersey, Forenede Stater, 07112
- Newark Beth Israel Medical Center
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Toms River, New Jersey, Forenede Stater, 08755
- Community Medical Center
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New York
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Buffalo, New York, Forenede Stater, 14263
- Roswell Park Cancer Institute
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Commack, New York, Forenede Stater, 11725
- Memorial Sloan Kettering Commack
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Glens Falls, New York, Forenede Stater, 12801
- Glens Falls Hospital
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Harrison, New York, Forenede Stater, 10604
- Memorial Sloan Kettering Westchester
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Mineola, New York, Forenede Stater, 11501
- NYU Langone Hospital - Long Island
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New York, New York, Forenede Stater, 10065
- Memorial Sloan Kettering Cancer Center
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New York, New York, Forenede Stater, 10032
- NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
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New York, New York, Forenede Stater, 10065
- NYP/Weill Cornell Medical Center
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New York, New York, Forenede Stater, 10016
- Laura and Isaac Perlmutter Cancer Center at NYU Langone
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Oswego, New York, Forenede Stater, 13126
- Upstate Cancer Center at Oswego
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Syracuse, New York, Forenede Stater, 13210
- State University of New York Upstate Medical University
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Uniondale, New York, Forenede Stater, 11553
- Memorial Sloan Kettering Nassau
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Verona, New York, Forenede Stater, 13478
- Upstate Cancer Center at Verona
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North Carolina
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Chapel Hill, North Carolina, Forenede Stater, 27599
- UNC Lineberger Comprehensive Cancer Center
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Ohio
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Cleveland, Ohio, Forenede Stater, 44195
- Cleveland Clinic Foundation
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Cleveland, Ohio, Forenede Stater, 44111
- Cleveland Clinic Cancer Center/Fairview Hospital
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Columbus, Ohio, Forenede Stater, 43210
- Ohio State University Comprehensive Cancer Center
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Dayton, Ohio, Forenede Stater, 45415
- Dayton Physician LLC - Englewood
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Independence, Ohio, Forenede Stater, 44131
- Cleveland Clinic Cancer Center Independence
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Kettering, Ohio, Forenede Stater, 45409
- Greater Dayton Cancer Center
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Mansfield, Ohio, Forenede Stater, 44906
- Cleveland Clinic Cancer Center Mansfield
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Mayfield Heights, Ohio, Forenede Stater, 44124
- Hillcrest Hospital Cancer Center
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Sandusky, Ohio, Forenede Stater, 44870
- North Coast Cancer Care
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Strongsville, Ohio, Forenede Stater, 44136
- Cleveland Clinic Cancer Center Strongsville
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Warrensville Heights, Ohio, Forenede Stater, 44122
- South Pointe Hospital
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Wooster, Ohio, Forenede Stater, 44691
- Cleveland Clinic Wooster Family Health and Surgery Center
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Oklahoma
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Lawton, Oklahoma, Forenede Stater, 73505
- Cancer Centers of Southwest Oklahoma Research
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Oklahoma City, Oklahoma, Forenede Stater, 73104
- University of Oklahoma Health Sciences Center
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Oregon
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Portland, Oregon, Forenede Stater, 97225
- Providence Saint Vincent Medical Center
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Portland, Oregon, Forenede Stater, 97239
- Portland VA Medical Center
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South Carolina
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Charleston, South Carolina, Forenede Stater, 29425
- Medical University of South Carolina
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Greenville, South Carolina, Forenede Stater, 29607
- Saint Francis Cancer Center
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Greenville, South Carolina, Forenede Stater, 29601
- Saint Francis Hospital
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Tennessee
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Memphis, Tennessee, Forenede Stater, 38120
- Baptist Memorial Hospital and Cancer Center-Memphis
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Utah
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Salt Lake City, Utah, Forenede Stater, 84112
- Huntsman Cancer Institute/University of Utah
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Salt Lake City, Utah, Forenede Stater, 84148
- George E Wahlen Department of Veterans Affairs Medical Center
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Virginia
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Charlottesville, Virginia, Forenede Stater, 22908
- University of Virginia Cancer Center
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Fairfax, Virginia, Forenede Stater, 22031
- Inova Schar Cancer Institute
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Richmond, Virginia, Forenede Stater, 23298
- VCU Massey Comprehensive Cancer Center
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Washington
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Bellevue, Washington, Forenede Stater, 98004
- FHCC Overlake
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Kirkland, Washington, Forenede Stater, 98034
- FHCC at EvergreenHealth
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Seattle, Washington, Forenede Stater, 98133
- FHCC at Northwest Hospital
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West Virginia
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Charleston, West Virginia, Forenede Stater, 25304
- Vandalia Health/CAMC Institute for Academic Medicine
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Wisconsin
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Ashland, Wisconsin, Forenede Stater, 54806
- Duluth Clinic Ashland
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Eau Claire, Wisconsin, Forenede Stater, 54701
- Marshfield Medical Center-EC Cancer Center
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Green Bay, Wisconsin, Forenede Stater, 54301
- Saint Vincent Hospital Cancer Center Green Bay
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Green Bay, Wisconsin, Forenede Stater, 54303
- Saint Vincent Hospital Cancer Center at Saint Mary's
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La Crosse, Wisconsin, Forenede Stater, 54601
- Gundersen Lutheran Medical Center
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Marshfield, Wisconsin, Forenede Stater, 54449
- Marshfield Medical Center-Marshfield
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Minocqua, Wisconsin, Forenede Stater, 54548
- Marshfield Medical Center - Minocqua
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Oconto Falls, Wisconsin, Forenede Stater, 54154
- Saint Vincent Hospital Cancer Center at Oconto Falls
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Rice Lake, Wisconsin, Forenede Stater, 54868
- Marshfield Medical Center-Rice Lake
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Sheboygan, Wisconsin, Forenede Stater, 53081
- Saint Vincent Hospital Cancer Center at Sheboygan
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Stevens Point, Wisconsin, Forenede Stater, 54482
- Marshfield Medical Center-River Region at Stevens Point
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Sturgeon Bay, Wisconsin, Forenede Stater, 54235-1495
- Saint Vincent Hospital Cancer Center at Sturgeon Bay
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Weston, Wisconsin, Forenede Stater, 54476
- Marshfield Medical Center - Weston
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Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria:
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Participants must have histologically or cytologically confirmed diffuse large B-cell lymphoma (DLBCL), Ann Arbor Stage IIX (bulky), III or IV. Participants with DLBCL transformed from follicular lymphoma (FL) or marginal zone lymphoma (MZL, including mucosa-associated lymphoid tissue [MALT] lymphomas), lymphoplasmacytic lymphoma (LPL), or nodular lymphocyte-predominant Hodgkin Lymphoma (NLPHL) are eligible. Participants with Grade IIIB follicular lymphoma (FL) or high-grade B-cell lymphomas with MYC and BCL2 and/or BCL6 rearrangements are also eligible. Participants with DLBCL that arose from prior CLL (Richter's transformation) are not eligible.
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As defined by the World Health Organization (WHO), eligible lymphoma subtypes include the following:
- DLBCL, not otherwise specified (NOS)
- DLBCL, germinal-center B-cell type (GCB)
- DLBCL, activated B-cell type (ABC)
- T-cell histiocyte-rich B-cell lymphomas (THRBCL)
- Primary cutaneous DLBCL, leg type
- Intravascular large B cell lymphoma
- EBV+ DLBCL, NOS
- DLBCL associated with chronic inflammation
- HHV8+ DLBCL, NOS
- High-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements
- High grade B-cell lymphoma, NOS
- Follicular lymphoma grade 3b
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Participants must have staging imaging performed within 28 days prior to registration, as follows. PET-CT baseline scans are strongly preferred; diagnostic quality magnetic resonance imaging (MRI), contrast-enhanced CT, or contrast-enhanced MRI scans are also acceptable if PET-CT is not feasible at baseline. Note: PET-CT will be required at end of treatment (EOT) and progression for response assessment. Participants must have measurable disease (at least one lesion with longest diameter ≥ 1.5 cm). All measurable lesions (longest diameter >= 1.5 cm) must be assessed within 28 days prior to registration. Tests to assess non-measurable disease must be performed within 42 days prior to registration.
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Participants with known human immunodeficiency virus (HIV)-infection are eligible providing they are on effective anti-retroviral therapy and have undetectable viral load at their most recent viral load test (must be within 26 weeks prior to registration). Participants with known HIV must have a CD4 count checked within 28 days prior to registration, but may proceed with therapy regardless of CD4 count.
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All participants must be screened for chronic hepatitis B virus (HBV) within 28 days prior to registration. Participants with known HBV infection (positive serology) must also have a HBV viral load performed within 28 days prior to registration, and participants must have an undetectable HBV viral load on suppressive therapy within 28 days prior to registration. Participants found to be HBV carriers during screening are eligible and must receive standard of care prophylaxis. Participants with active hepatitis B (HBV viral load > 500 IU/mL) within 28 days prior to registration are not eligible
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Participants with a known history of hepatitis C virus (HCV) infection must have an undetectable HCV viral load within in 28 days prior to registration
-
Participants must not have known lymphomatous involvement of the central nervous system (CNS)
-
Participants must not have active inflammatory bowel disease (such as, Crohn's disease, ulcerative colitis), celiac disease (i.e., sprue), prior gastrectomy or upper bowel removal, or any other gastrointestinal disorder or defect that would interfere with the absorption, distribution, metabolism, or excretion of the study drug and/or predispose the subject to an increased risk of gastrointestinal toxicity
-
Participants must not have a history of acute leukemia having been treated with intensive induction therapy. Participants 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
-
Participants must not have received any prior cytotoxic chemotherapy or rituximab for treatment of the newly diagnosed DLBCL except for the pre-phase treatment (within specified dose range) that may have either started before or may start after registration to S1918. Inhaled, nasal, and topical steroid use is allowed. Prior cytotoxic chemotherapy and/or antibody therapy for an indolent lymphoma prior to transformation is allowed. Up to 4 doses of intrathecal (IT) chemotherapy administered for central nervous system (CNS) prophylaxis is allowed in addition to protocol therapy. High-dose intravenous methotrexate is not allowed.
-
Participants must not have received more than a cumulative of dose 250 mg/m^2 of prior doxorubicin (or equivalent dose of another anthracycline, such as epirubicin) therapy (at any time prior to registration).
-
Participants must not currently be receiving any other investigational agents
-
Participant must not have a history of allergic reactions attributed to azacitidine, mannitol, or other hypomethylating agents
-
Participants must be age ≥ 75
-
Participants must have a Zubrod performance status of 0-2
-
Participants must have adequate renal function, as demonstrated by a creatinine clearance, calculated by the Cockcroft and Gault formula, of >= 30 ml/min that was obtained within 28 days prior to registration
-
Aspartate aminotransferase (AST) =< 2.5 x institutional upper limit of normal (IULN), alanine aminotransferase (ALT) =< 2.5 x IULN (within 28 days prior to registration)
-
Total bilirubin =< 2 x institutional upper limit of normal (IULN), unless due to Gilbert's disease, hemolysis, or lymphomatous involvement of liver (within 28 days prior to registration). Note: If total bilirubin is elevated, and direct bilirubin is subsequently performed (within 28 days prior to registration) and resulted to be =< 2 x IULN, the participant will be considered eligible
-
Absolute neutrophil count (ANC) >= 1000/mcL (within 28 days prior to registration)
-
Platelets >= 75,000/mcL (within 28 days prior to registration)
-
Hemoglobin (Hgb) >= 8 g/ dL (within 28 days prior to registration)
-
If there is a documented lymphomatous involvement of the bone marrow, bone marrow function within 28 days prior to registration, as evidenced by:
- ANC >= 500/mcL
- Platelets >= 50,000/mcL
- Hgb >= 8 g/ dL
-
Participants must have a left ventricular ejection (LVEF) fraction >= 45% as measured by echocardiogram or radionuclide (multigated acquisition scan [MUGA]) ventriculography within 56 days prior to registration
-
For the duration of the study treatment period and for at least 4 months following the last dose of study drug, male participants must agree to use effective contraceptive methods during sexual contact with a female of childbearing potential (FCBP) and must agree to refrain from semen or sperm donation during the same timeframe. Effective contraceptive methods include a history of vasectomy, use of hormonal contraception or an intrauterine device (IUD) by the female partner, or use of condoms
- A FCBP is a sexually mature woman who: 1) has not undergone a hysterectomy or bilateral oophorectomy; or 2) has not been naturally postmenopausal for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months)
-
Participants must not have active infection (systemic fungal, bacterial, or viral infection) that is not controlled (defined as ongoing signs/symptoms related the infection without improvement despite appropriate antibiotics, antiviral therapy, and/or other treatment)
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Participants must not have active cardiac disease within 26 weeks prior to registration, including: symptomatic congestive heart failure (New York Heart Association [NYHA] class 4), unstable angina pectoris, hemodynamically unstable cardiac arrhythmia, or myocardial infarction
-
Participants must not have >= grade 2 neuropathy, by Common Terminology Criteria for Adverse Events (CTCAE) version (v.) 5.0, within 28 days prior to registration
-
Participants must not have any other known uncontrolled intercurrent illness including, but not limited to ongoing psychiatric illness/social situations that would limit compliance with study requirements
-
Participants must not have a concurrent primary malignancy undergoing active therapy. Exceptions: participants may have non-melanomatous skin cancers requiring only surgical intervention. Participants may have a history of early stage breast cancer or prostate cancer in remission after surgical and/or radiation therapy on adjuvant hormonal therapy only
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Ingen (Åben etiket)
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
|
Eksperimentel: Arm I (oral azacitidine, R-miniCHOP)
Patients receive CC-486 PO for 7 days prior to cycle 1. Patients then receive CC-486 PO on days 8-21. Treatment repeats every 21 days for cycles 1-5 in the absence of disease progression or unacceptable toxicity. Patients also receive rituximab IV (or rituximab and hyaluronidase human SC for cycles 2-6), cyclophosphamide IV, doxorubicin hydrochloride IV, and vincristine sulfate IV on day 1, and prednisone PO on days 1-5. Treatment repeats every 21 days for cycles 1-6 (6 cycles total) in the absence of disease progression or unacceptable toxicity. Patients undergo ECHO or MUGA at screening and undergo PET-CT and blood sample collection throughout the study. |
Given IV
Andre navne:
Given IV
Andre navne:
Given PO
Andre navne:
Undergo blood sample collection
Andre navne:
Given IV
Andre navne:
Given IV
Andre navne:
Ancillary studies Undergo ECHO
Andre navne:
Undergo MUGA
Andre navne:
Undergo PET-CT
Andre navne:
Given SC
Andre navne:
Undergo PET-CT
Andre navne:
Given PO
Andre navne:
|
|
Aktiv komparator: Arm II (R-miniCHOP)
Patients receive rituximab IV (or rituximab and hyaluronidase human SC for cycles 2-6), cyclophosphamide IV, doxorubicin hydrochloride IV, and vincristine sulfate IV on day 1, and prednisone PO on days 1-5. Treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo ECHO or MUGA at screening and undergo PET-CT and blood sample collection throughout the study. |
Given IV
Andre navne:
Given IV
Andre navne:
Given PO
Andre navne:
Undergo blood sample collection
Andre navne:
Given IV
Andre navne:
Given IV
Andre navne:
Ancillary studies Undergo ECHO
Andre navne:
Undergo MUGA
Andre navne:
Undergo PET-CT
Andre navne:
Given SC
Andre navne:
Undergo PET-CT
Andre navne:
|
Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Excess toxicity as a result of adding oral azacitidine (CC-486) to reduced dose rituximab-cyclophosphamide, doxorubicin, vincristine, and prednisone (R-miniCHOP) (Safety run-in)
Tidsramme: Up to completion of cycle 6
|
Will determine if the addition of CC-486 to R-miniCHOP results in excess toxicity compared to R-miniCHOP alone that would preclude the combination from being studied further. |
Up to completion of cycle 6
|
|
Progression-free survival (PFS) (Phase II)
Tidsramme: From date of registration to date of first observation of progressive disease according to the 2014 Lugano classification, or death due to any cause, assessed up to 1 year
|
Will determine if the CC-486 + R-miniCHOP regimen should be tested further (Phase III) against the control R-miniCHOP alone based on PFS. After accruing 130 patients (65 per arm, 21 months of accrual and potentially pausing accrual for 6 months follow-up to reach a target 63 events across arms), a one-sided stratified .10 log-rank test will inform a go/no-go decision based on sufficient evidence of efficacy to continue to the Phase III portion of the study. |
From date of registration to date of first observation of progressive disease according to the 2014 Lugano classification, or death due to any cause, assessed up to 1 year
|
|
Overall survival (Phase III)
Tidsramme: From date of registration to date of death due to any cause, assessed up to 2 years
|
Will compare overall survival in the control arm of R-miniCHOP to the experimental arm of CC-486 (oral azacitidine) + R-miniCHOP. Will be evaluated using a 1-sided .025 level stratified logrank test. |
From date of registration to date of death due to any cause, assessed up to 2 years
|
Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Metabolic complete response (CR)
Tidsramme: Up to end of cycle 6 or end of treatment
|
Will be defined using 2014 Lugano classification. Fisher's exact test will be used to compare CR rates between the experimental arm of CC-486 + R-miniCHOP and the control arm of R-miniCHOP alone. |
Up to end of cycle 6 or end of treatment
|
|
Incidence of adverse events
Tidsramme: Until disease progression, assessed up to 5 years
|
Will be assessed using Common Terminology Criteria for Adverse Events version 5. The maximum Grade for each toxicity will be recorded for each patient, and frequency tables will be reviewed to determine toxicity patterns. Treatment-related toxicities between arms will be compared using Fisher's exact test. |
Until disease progression, assessed up to 5 years
|
|
Overall survival (Phase III)
Tidsramme: From date of registration to date of death due to any cause, assessed up to 5 years
|
An additional secondary analysis of overall survival of the Phase III comparison will adjust for patients with identified double-hit phenotype in addition to the pre-specified stratification factors. Will also prospectively collect the number of days between diagnostic biopsy and cycle 1 day 1 of therapy for a pre-planned secondary analysis. |
From date of registration to date of death due to any cause, assessed up to 5 years
|
Andre resultatmål
Andre resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Changes in function (Integrated Correlative Geriatric Assessments Substudy)
Tidsramme: From time of randomization up to 24 months after date of registration
|
Will be assessed by a Comprehensive Geriatric Assessment (Carolina Frailty Index [CFI] Score) between patients treated with CC-486 + R-miniCHOP and those treated with R-miniCHOP alone. Linear regression will be used for each examination, adjusting for the stratification factors from the clinical study and the baseline score (for the examination of change from 12 to 24 months, the 12-month score will be considered the baseline score). Although the number of timepoints is limited to 3, longitudinal assessments of the CFI Score over time will also be conducted using linear mixed models, adjusting for the stratification factors and the baseline score, with patient considered a random effect. |
From time of randomization up to 24 months after date of registration
|
|
Frailty status (fit/unfit vs frail) (Integrated Correlative Geriatric Assessments Substudy)
Tidsramme: Baseline
|
Will evaluate if frailty status (fit/unfit versus frail) as assessed by the Italian Lymphoma Foundation (FIL) tool is associated with overall survival. Multivariable Cox regression will be conducted, adjusting for the stratification variables and the randomized treatment arm as covariates. Will also examine whether randomization to CC-486 + R-miniCHOP is associated with better overall survival compared to treatment with R-miniCHOP alone in the subset of fit and unfit patients. Multivariable Cox regression will be conducted, adjusting for the stratification variables as covariates. |
Baseline
|
|
Frailty status (Integrated Correlative Geriatric Assessments Substudy)
Tidsramme: Up to 24 months after date of registration
|
Will evaluate if frailty status (fit/unfit versus frail) as assessed by the FIL tool correlates with the summary frailty indexed as measured by the S1918 Comprehensive Geriatric Assessment (CGA). In particular, agreement between the FIL and CGA will measured using an unweighted Kappa statistic; moderate or better agreement is defined as a Kappa coefficient of >= 0.41. |
Up to 24 months after date of registration
|
Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Efterforskere
Efterforskere
- Ledende efterforsker: Elizabeth A Brem, SWOG Cancer Research Network
Publikationer og nyttige links
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Studiestart
Primær færdiggørelse (Anslået)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
- Neoplasmer
- Sygdomme i immunsystemet
- Neoplasmer efter histologisk type
- Lymfesygdomme
- Lymfoproliferative lidelser
- Immunproliferative lidelser
- Lymfom, Non-Hodgkin
- Lymfom, B-celle
- Lymfom
- Hemiske og lymfatiske sygdomme
- Lymfom, stor B-celle, diffus
- Lymfom, B-celle, marginalzone
- Aminosyrer, peptider og proteiner
- Proteiner
- Organiske kemikalier
- Heterocykliske forbindelser, 1-ring
- Heterocykliske forbindelser
- Heterocykliske forbindelser, 2-ring
- Heterocykliske forbindelser, smeltet ring
- Undersøgelsesteknikker
- Kliniske laboratorieteknikker
- Diagnostiske teknikker og procedurer
- Diagnose
- Nukleinsyrer, nukleotider og nukleosider
- Kulbrinter
- Kulbrinter, cyklisk
- Kulhydrater
- Alkaloider
- Polycykliske aromatiske kulbrinter
- Kulbrinter, aromatisk
- Polycykliske forbindelser
- Glycosider
- Glykosidhydrolaser
- Hydrolaser
- Enzymer
- Enzymer og coenzymer
- Polysaccharid-lyaser
- Carbon-ilt lyaser
- Lyases
- Indoler
- Antistoffer, monoklonal
- Antistoffer
- Immunoglobuliner
- Immunoproteiner
- Blodproteiner
- Serum globuliner
- Globuliner
- Cytidin
- Pyrimidin -nukleosider
- Pyrimidiner
- Gravidier
- Graviditet
- Steroider
- SMUSED-RING-forbindelser
- Kemiteknikker, analytisk
- Spektrumanalyse
- Fosforamid -sennep
- Nitrogen sennepsforbindelser
- Sennepsforbindelser
- Kulbrinter, halogeneret
- Phosphoramider
- Organophosphorforbindelser
- AZA -forbindelser
- Nukleosider
- Ribonucleosider
- Gravideretioler
- Vinca alkaloider
- Secologanin tryptamin alkaloider
- Indole alkaloider
- Indolizidiner
- Indolizines
- Anthracycliner
- Naphthacenes
- Aminoglycosider
- Antistoffer, monoklonal, murint afledt
- Daunorubicin
- Rituximab
- Prednison
- Cyclofosfamid
- Azacitidin
- Doxorubicin
- Vincristine
- Hyaluronoglucosaminidase
- Håndtering af eksemplar
- Magnetisk resonansspektroskopi
- CC-486
- CT-P10
- Deltacortene
- Prednyliden
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- NCI-2020-01256
- U10CA180888 (U.S. NIH-bevilling/kontrakt)
- NCI-2020-01256 (Registry Identifier: CTRP (Clinical Trial Reporting Program))
- S1918 (Anden identifikator: CTEP)
- S1918 (Anden identifikator: SWOG)
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
IPD-planbeskrivelse
NCI is committed to sharing data in accordance with NIH policy. For more details on how clinical trial data is shared, access the link to the NIH data sharing policy page.
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