Teste CC-486 (Azacitidina oral) mais a terapia medicamentosa padrão em pacientes com 75 anos ou mais com linfoma difuso de grandes células B recém-diagnosticado
Um estudo randomizado de fase II/III de R-MiniCHOP com ou sem CC-486 (azacitidina oral) em participantes com 75 anos ou mais com linfoma difuso de grandes células B recentemente diagnosticado, linfoma folicular de grau IIIB, linfoma transformado e B de alto grau -Linfomas de células com rearranjos MYC E BCL2 e/ou BCL6
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.
Visão geral do estudo
Status
Status
Condições
Condições
- Linfoma Linfoplasmocítico
- Linfoma Ann Arbor Estágio III Difuso de Grandes Células B
- Linfoma Ann Arbor Estágio IV Difuso de Grandes Células B
- Linfoma de células B de alto grau com rearranjos MYC e BCL2 ou BCL6
- Linfoma de células B de alto grau com rearranjos MYC, BCL2 e BCL6
- Linfoma folicular grau 3b
- Linfoma Difuso de Grandes Células B, Sem Outra Especificação
- Linfoma Difuso de Grandes Células B EBV-Positivo, Sem Outra Especificação
- Linfoma de Células B de Alto Grau, Sem Outra Especificação
- Linfoma Difuso de Grandes Células B Associado à Inflamação Crônica
- Linfoma Difuso Primário de Células B Grandes, Tipo Perna
- Linfoma Folicular Transformado em Linfoma Difuso de Grandes Células B
- Linfoma Intravascular de Grandes Células B
- Linfoma de Células B Grandes Rico em Histiócitos/Células T
- Linfoma de células B de alto grau com rearranjos MYC e BCL2 e/ou BCL6
- Linfoma Difuso de Grandes Células B Ativado Tipo de Células B
- Linfoma Difuso de Grandes Células B Centro Germinal Tipo de Células B
- Linfoma Difuso de Grandes Células B HHV8-Positivo, Sem Outra Especificação
- Linfoma de Zona Marginal Transformado em Linfoma Difuso de Grandes Células B
- Ann Arbor Estágio IIX (volumoso) Linfoma Difuso de Células B Grandes
- Linfoma de Células B Predominante de Linfócitos Nodulares
Intervenção / Tratamento
Intervenção / Tratamento
- Medicamento: Cyclophosphamide
- Medicamento: Doxorubicin Hydrochloride
- Medicamento: Prednisone
- Procedimento: Biospecimen Collection
- Biológico: Rituximab
- Medicamento: Vincristine Sulfate
- Outro: Questionnaire Administration
- Procedimento: Echocardiography Test
- Procedimento: Multigated Acquisition Scan
- Procedimento: Positron Emission Tomography
- Biológico: Rituximab and Hyaluronidase Human
- Procedimento: Computed Tomography
- Medicamento: Oral Azacitidine
Descrição detalhada
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.
Tipo de estudo
Tipo de estudo
Inscrição (Estimado)
Inscrição
Estágio
Estágio
- Fase 2
- Fase 3
Contactos e Locais
Locais de estudo
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Arizona
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Tucson, Arizona, Estados Unidos, 85719
- Banner University Medical Center - Tucson
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Tucson, Arizona, Estados Unidos, 85719
- University of Arizona Cancer Center-North Campus
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Arkansas
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Little Rock, Arkansas, Estados Unidos, 72205
- University of Arkansas for Medical Sciences
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California
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Anaheim, California, Estados Unidos, 92806
- Kaiser Permanente-Anaheim
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Baldwin Park, California, Estados Unidos, 91706
- Kaiser Permanente-Baldwin Park
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Bellflower, California, Estados Unidos, 90706
- Kaiser Permanente-Bellflower
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Beverly Hills, California, Estados Unidos, 90211
- Tower Cancer Research Foundation
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Costa Mesa, California, Estados Unidos, 92627
- UC Irvine Health Cancer Center-Newport
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Duarte, California, Estados Unidos, 91010
- City of Hope Comprehensive Cancer Center
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Fontana, California, Estados Unidos, 92335
- Kaiser Permanente-Fontana
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Harbor City, California, Estados Unidos, 90710
- Kaiser Permanente South Bay
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Huntington Beach, California, Estados Unidos, 92648
- City of Hope Seacliff
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Irvine, California, Estados Unidos, 92618
- Kaiser Permanente-Irvine
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Irvine, California, Estados Unidos, 92618
- City of Hope at Irvine Lennar
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Lancaster, California, Estados Unidos, 93534
- City of Hope Antelope Valley
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Long Beach, California, Estados Unidos, 90822
- Tibor Rubin VA Medical Center
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Long Beach, California, Estados Unidos, 90813
- City of Hope at Long Beach Elm
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Los Angeles, California, Estados Unidos, 90048
- Cedars-Sinai Medical Center
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Los Angeles, California, Estados Unidos, 90027
- Kaiser Permanente Los Angeles Medical Center
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Los Angeles, California, Estados Unidos, 90034
- Kaiser Permanente West Los Angeles
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Newport Beach, California, Estados Unidos, 92660
- City of Hope Newport Beach
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Ontario, California, Estados Unidos, 91761
- Kaiser Permanente-Ontario
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Orange, California, Estados Unidos, 92868
- UC Irvine Health/Chao Family Comprehensive Cancer Center
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Palo Alto, California, Estados Unidos, 94304
- Stanford Cancer Institute Palo Alto
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Panorama City, California, Estados Unidos, 91402
- Kaiser Permanente - Panorama City
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Riverside, California, Estados Unidos, 92505
- Kaiser Permanente-Riverside
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San Diego, California, Estados Unidos, 92120
- Kaiser Permanente-San Diego Zion
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San Marcos, California, Estados Unidos, 92078
- Kaiser Permanente-San Marcos
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San Mateo, California, Estados Unidos, 94402
- UCSF Cancer Center - San Mateo
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South Pasadena, California, Estados Unidos, 91030
- City of Hope South Pasadena
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Torrance, California, Estados Unidos, 90503
- City of Hope South Bay
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Upland, California, Estados Unidos, 91786
- City of Hope Upland
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Woodland Hills, California, Estados Unidos, 91367
- Kaiser Permanente-Woodland Hills
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Colorado
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Golden, Colorado, Estados Unidos, 80401
- Lutheran Hospital - Cancer Centers of Colorado
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Delaware
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Newark, Delaware, Estados Unidos, 19713
- Helen F Graham Cancer Center
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Newark, Delaware, Estados Unidos, 19713
- Delaware Clinical and Laboratory Physicians PA
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Newark, Delaware, Estados Unidos, 19713
- Medical Oncology Hematology Consultants PA
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Florida
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Miami, Florida, Estados Unidos, 33136
- University of Miami Miller School of Medicine-Sylvester Cancer Center
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Georgia
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Atlanta, Georgia, Estados Unidos, 30308
- Emory University Hospital Midtown
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Atlanta, Georgia, Estados Unidos, 30322
- Emory University Hospital/Winship Cancer Institute
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Atlanta, Georgia, Estados Unidos, 30342
- Emory Saint Joseph's Hospital
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Augusta, Georgia, Estados Unidos, 30912
- Augusta University Medical Center
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Hawaii
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Honolulu, Hawaii, Estados Unidos, 96813
- Queen's Medical Center
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Honolulu, Hawaii, Estados Unidos, 96813
- Hawaii Cancer Care Inc - Waterfront Plaza
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Honolulu, Hawaii, Estados Unidos, 96813
- Queen's Cancer Cenrer - POB I
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Honolulu, Hawaii, Estados Unidos, 96813
- Straub Clinic and Hospital
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Honolulu, Hawaii, Estados Unidos, 96817
- Queen's Cancer Center - Kuakini
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‘Aiea, Hawaii, Estados Unidos, 96701
- Hawaii Cancer Care - Westridge
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‘Aiea, Hawaii, Estados Unidos, 96701
- Pali Momi Medical Center
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Illinois
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Centralia, Illinois, Estados Unidos, 62801
- Centralia Oncology Clinic
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Chicago, Illinois, Estados Unidos, 60611
- Northwestern University
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Chicago, Illinois, Estados Unidos, 60637
- University of Chicago Comprehensive Cancer Center
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Chicago, Illinois, Estados Unidos, 60612
- University of Illinois
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Danville, Illinois, Estados Unidos, 61832
- Carle at The Riverfront
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DeKalb, Illinois, Estados Unidos, 60115
- Northwestern Medicine Cancer Center Kishwaukee
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Decatur, Illinois, Estados Unidos, 62526
- Decatur Memorial Hospital
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Decatur, Illinois, Estados Unidos, 62526
- Cancer Care Specialists of Illinois - Decatur
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Effingham, Illinois, Estados Unidos, 62401
- Crossroads Cancer Center
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Effingham, Illinois, Estados Unidos, 62401
- Carle Physician Group-Effingham
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Evanston, Illinois, Estados Unidos, 60201
- NorthShore University HealthSystem-Evanston Hospital
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Geneva, Illinois, Estados Unidos, 60134
- Northwestern Medicine Cancer Center Delnor
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Glenview, Illinois, Estados Unidos, 60026
- NorthShore University HealthSystem-Glenbrook Hospital
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Glenview, Illinois, Estados Unidos, 60026
- Northwestern Medicine Glenview Outpatient Center
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Grayslake, Illinois, Estados Unidos, 60030
- Northwestern Medicine Grayslake Outpatient Center
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Highland Park, Illinois, Estados Unidos, 60035
- NorthShore University HealthSystem-Highland Park Hospital
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Lake Forest, Illinois, Estados Unidos, 60045
- Northwestern Medicine Lake Forest Hospital
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Mattoon, Illinois, Estados Unidos, 61938
- Carle Physician Group-Mattoon/Charleston
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New Lenox, Illinois, Estados Unidos, 60451
- UC Comprehensive Cancer Center at Silver Cross
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O'Fallon, Illinois, Estados Unidos, 62269
- Cancer Care Center of O'Fallon
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Orland Park, Illinois, Estados Unidos, 60462
- University of Chicago Medicine-Orland Park
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Orland Park, Illinois, Estados Unidos, 60462
- Northwestern Medicine Orland Park
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Peoria, Illinois, Estados Unidos, 61615
- Illinois CancerCare-Peoria
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Shiloh, Illinois, Estados Unidos, 62269
- Memorial Hospital East
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Urbana, Illinois, Estados Unidos, 61801
- Carle Cancer Center
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Warrenville, Illinois, Estados Unidos, 60555
- Northwestern Medicine Cancer Center Warrenville
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Iowa
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Ames, Iowa, Estados Unidos, 50010
- McFarland Clinic - Ames
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Ankeny, Iowa, Estados Unidos, 50023
- UI Health Care Mission Cancer and Blood - Ankeny Clinic
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Clive, Iowa, Estados Unidos, 50325
- UI Health Care Mission Cancer and Blood - West Des Moines Clinic
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Des Moines, Iowa, Estados Unidos, 50309
- Iowa Methodist Medical Center
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Des Moines, Iowa, Estados Unidos, 50309
- UI Health Care Mission Cancer and Blood - Des Moines Clinic
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Des Moines, Iowa, Estados Unidos, 50314
- UI Health Care Mission Cancer and Blood - Laurel Clinic
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Louisiana
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Monroe, Louisiana, Estados Unidos, 71202
- Ochsner LSU Health Monroe Medical Center
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Shreveport, Louisiana, Estados Unidos, 71103
- LSU Health Sciences Center at Shreveport
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Massachusetts
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Boston, Massachusetts, Estados Unidos, 02111
- Tufts Medical Center
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Michigan
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Ann Arbor, Michigan, Estados Unidos, 48106
- Trinity Health Saint Joseph Mercy Hospital Ann Arbor
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Brighton, Michigan, Estados Unidos, 48114
- Trinity Health IHA Medical Group Hematology Oncology - Brighton
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Brighton, Michigan, Estados Unidos, 48114
- Trinity Health Medical Center - Brighton
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Canton, Michigan, Estados Unidos, 48188
- Trinity Health IHA Medical Group Hematology Oncology - Canton
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Canton, Michigan, Estados Unidos, 48188
- Trinity Health Medical Center - Canton
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Chelsea, Michigan, Estados Unidos, 48118
- Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital
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Chelsea, Michigan, Estados Unidos, 48118
- Chelsea Hospital
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Livonia, Michigan, Estados Unidos, 48154
- Trinity Health Saint Mary Mercy Livonia Hospital
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Livonia, Michigan, Estados Unidos, 48154
- Hope Cancer Clinic
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Ypsilanti, Michigan, Estados Unidos, 48197
- Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus
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Ypsilanti, Michigan, Estados Unidos, 48106
- Huron Gastroenterology PC
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Minnesota
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Deer River, Minnesota, Estados Unidos, 56636
- Essentia Health - Deer River Clinic
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Duluth, Minnesota, Estados Unidos, 55805
- Essentia Health Cancer Center
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Hibbing, Minnesota, Estados Unidos, 55746
- Essentia Health Hibbing Clinic
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Sandstone, Minnesota, Estados Unidos, 55072
- Essentia Health Sandstone
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Virginia, Minnesota, Estados Unidos, 55792
- Essentia Health Virginia Clinic
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Mississippi
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Oxford, Mississippi, Estados Unidos, 38655
- Baptist Memorial Hospital and Cancer Center-Oxford
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Southhaven, Mississippi, Estados Unidos, 38671
- Baptist Memorial Hospital and Cancer Center-Desoto
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Missouri
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Cape Girardeau, Missouri, Estados Unidos, 63703
- Saint Francis Medical Center
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Chesterfield, Missouri, Estados Unidos, 63017
- Saint Luke's Hospital
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City of Saint Peters, Missouri, Estados Unidos, 63376
- Siteman Cancer Center at Saint Peters Hospital
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Creve Coeur, Missouri, Estados Unidos, 63141
- Siteman Cancer Center at West County Hospital
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Saint Joseph, Missouri, Estados Unidos, 64506
- Heartland Regional Medical Center
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St Louis, Missouri, Estados Unidos, 63110
- Washington University School of Medicine
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St Louis, Missouri, Estados Unidos, 63129
- Siteman Cancer Center-South County
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St Louis, Missouri, Estados Unidos, 63136
- Siteman Cancer Center at Christian Hospital
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Nebraska
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Lincoln, Nebraska, Estados Unidos, 68516
- Cancer Partners of Nebraska
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New Jersey
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Basking Ridge, New Jersey, Estados Unidos, 07920
- Memorial Sloan Kettering Basking Ridge
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Englewood, New Jersey, Estados Unidos, 07631
- Englewood Hospital and Medical Center
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Lakewood, New Jersey, Estados Unidos, 08701
- Monmouth Medical Center Southern Campus
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Long Branch, New Jersey, Estados Unidos, 07740
- Monmouth Medical Center
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Middletown, New Jersey, Estados Unidos, 07748
- Memorial Sloan Kettering Monmouth
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Montvale, New Jersey, Estados Unidos, 07645
- Memorial Sloan Kettering Bergen
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New Brunswick, New Jersey, Estados Unidos, 08903
- Rutgers Cancer Institute of New Jersey
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Newark, New Jersey, Estados Unidos, 07112
- Newark Beth Israel Medical Center
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Toms River, New Jersey, Estados Unidos, 08755
- Community Medical Center
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New York
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Buffalo, New York, Estados Unidos, 14263
- Roswell Park Cancer Institute
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Commack, New York, Estados Unidos, 11725
- Memorial Sloan Kettering Commack
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Glens Falls, New York, Estados Unidos, 12801
- Glens Falls Hospital
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Harrison, New York, Estados Unidos, 10604
- Memorial Sloan Kettering Westchester
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Mineola, New York, Estados Unidos, 11501
- NYU Langone Hospital - Long Island
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New York, New York, Estados Unidos, 10065
- Memorial Sloan Kettering Cancer Center
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New York, New York, Estados Unidos, 10032
- NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
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New York, New York, Estados Unidos, 10065
- NYP/Weill Cornell Medical Center
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New York, New York, Estados Unidos, 10016
- Laura and Isaac Perlmutter Cancer Center at NYU Langone
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Oswego, New York, Estados Unidos, 13126
- Upstate Cancer Center at Oswego
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Syracuse, New York, Estados Unidos, 13210
- State University of New York Upstate Medical University
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Uniondale, New York, Estados Unidos, 11553
- Memorial Sloan Kettering Nassau
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Verona, New York, Estados Unidos, 13478
- Upstate Cancer Center at Verona
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North Carolina
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Chapel Hill, North Carolina, Estados Unidos, 27599
- UNC Lineberger Comprehensive Cancer Center
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Ohio
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Cleveland, Ohio, Estados Unidos, 44195
- Cleveland Clinic Foundation
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Cleveland, Ohio, Estados Unidos, 44111
- Cleveland Clinic Cancer Center/Fairview Hospital
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Columbus, Ohio, Estados Unidos, 43210
- Ohio State University Comprehensive Cancer Center
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Dayton, Ohio, Estados Unidos, 45415
- Dayton Physician LLC - Englewood
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Independence, Ohio, Estados Unidos, 44131
- Cleveland Clinic Cancer Center Independence
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Kettering, Ohio, Estados Unidos, 45409
- Greater Dayton Cancer Center
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Mansfield, Ohio, Estados Unidos, 44906
- Cleveland Clinic Cancer Center Mansfield
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Mayfield Heights, Ohio, Estados Unidos, 44124
- Hillcrest Hospital Cancer Center
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Sandusky, Ohio, Estados Unidos, 44870
- North Coast Cancer Care
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Strongsville, Ohio, Estados Unidos, 44136
- Cleveland Clinic Cancer Center Strongsville
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Warrensville Heights, Ohio, Estados Unidos, 44122
- South Pointe Hospital
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Wooster, Ohio, Estados Unidos, 44691
- Cleveland Clinic Wooster Family Health and Surgery Center
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Oklahoma
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Lawton, Oklahoma, Estados Unidos, 73505
- Cancer Centers of Southwest Oklahoma Research
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Oklahoma City, Oklahoma, Estados Unidos, 73104
- University of Oklahoma Health Sciences Center
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Oregon
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Portland, Oregon, Estados Unidos, 97225
- Providence Saint Vincent Medical Center
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Portland, Oregon, Estados Unidos, 97239
- Portland VA Medical Center
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South Carolina
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Charleston, South Carolina, Estados Unidos, 29425
- Medical University of South Carolina
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Greenville, South Carolina, Estados Unidos, 29607
- Saint Francis Cancer Center
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Greenville, South Carolina, Estados Unidos, 29601
- Saint Francis Hospital
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Tennessee
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Memphis, Tennessee, Estados Unidos, 38120
- Baptist Memorial Hospital and Cancer Center-Memphis
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Utah
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Salt Lake City, Utah, Estados Unidos, 84112
- Huntsman Cancer Institute/University of Utah
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Salt Lake City, Utah, Estados Unidos, 84148
- George E Wahlen Department of Veterans Affairs Medical Center
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Virginia
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Charlottesville, Virginia, Estados Unidos, 22908
- University of Virginia Cancer Center
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Fairfax, Virginia, Estados Unidos, 22031
- Inova Schar Cancer Institute
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Richmond, Virginia, Estados Unidos, 23298
- VCU Massey Comprehensive Cancer Center
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Washington
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Bellevue, Washington, Estados Unidos, 98004
- FHCC Overlake
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Kirkland, Washington, Estados Unidos, 98034
- FHCC at EvergreenHealth
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Seattle, Washington, Estados Unidos, 98133
- FHCC at Northwest Hospital
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West Virginia
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Charleston, West Virginia, Estados Unidos, 25304
- Vandalia Health/CAMC Institute for Academic Medicine
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Wisconsin
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Ashland, Wisconsin, Estados Unidos, 54806
- Duluth Clinic Ashland
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Eau Claire, Wisconsin, Estados Unidos, 54701
- Marshfield Medical Center-EC Cancer Center
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Green Bay, Wisconsin, Estados Unidos, 54301
- Saint Vincent Hospital Cancer Center Green Bay
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Green Bay, Wisconsin, Estados Unidos, 54303
- Saint Vincent Hospital Cancer Center at Saint Mary's
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La Crosse, Wisconsin, Estados Unidos, 54601
- Gundersen Lutheran Medical Center
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Marshfield, Wisconsin, Estados Unidos, 54449
- Marshfield Medical Center-Marshfield
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Minocqua, Wisconsin, Estados Unidos, 54548
- Marshfield Medical Center - Minocqua
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Oconto Falls, Wisconsin, Estados Unidos, 54154
- Saint Vincent Hospital Cancer Center at Oconto Falls
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Rice Lake, Wisconsin, Estados Unidos, 54868
- Marshfield Medical Center-Rice Lake
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Sheboygan, Wisconsin, Estados Unidos, 53081
- Saint Vincent Hospital Cancer Center at Sheboygan
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Stevens Point, Wisconsin, Estados Unidos, 54482
- Marshfield Medical Center-River Region at Stevens Point
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Sturgeon Bay, Wisconsin, Estados Unidos, 54235-1495
- Saint Vincent Hospital Cancer Center at Sturgeon Bay
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Weston, Wisconsin, Estados Unidos, 54476
- Marshfield Medical Center - Weston
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Critérios de participação
Critérios de elegibilidade
Critérios de elegibilidade
Idades elegíveis para estudo
Aceita Voluntários Saudáveis
Gêneros Elegíveis para o Estudo
Descrição
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
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Participants must not have known lymphomatous involvement of the central nervous system (CNS)
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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
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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
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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.
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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).
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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
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Participants must have a Zubrod performance status of 0-2
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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
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Absolute neutrophil count (ANC) >= 1000/mcL (within 28 days prior to registration)
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Platelets >= 75,000/mcL (within 28 days prior to registration)
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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)
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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
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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
Plano de estudo
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Tratamento
- Alocação: Randomizado
- Modelo Intervencional: Atribuição Paralela
- Mascaramento: Nenhum (rótulo aberto)
Número de braços
Armas e Intervenções
Grupo de Participantes / BraçoGrupo de Participantes / Braço |
Intervenção / TratamentoIntervenção / Tratamento |
|---|---|
|
Experimental: 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
Outros nomes:
Given IV
Outros nomes:
Given PO
Outros nomes:
Undergo blood sample collection
Outros nomes:
Given IV
Outros nomes:
Given IV
Outros nomes:
Ancillary studies Undergo ECHO
Outros nomes:
Undergo MUGA
Outros nomes:
Undergo PET-CT
Outros nomes:
Given SC
Outros nomes:
Undergo PET-CT
Outros nomes:
Given PO
Outros nomes:
|
|
Comparador Ativo: 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
Outros nomes:
Given IV
Outros nomes:
Given PO
Outros nomes:
Undergo blood sample collection
Outros nomes:
Given IV
Outros nomes:
Given IV
Outros nomes:
Ancillary studies Undergo ECHO
Outros nomes:
Undergo MUGA
Outros nomes:
Undergo PET-CT
Outros nomes:
Given SC
Outros nomes:
Undergo PET-CT
Outros nomes:
|
O que o estudo está medindo?
Medidas de resultados primários
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
|
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)
Prazo: 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)
Prazo: 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)
Prazo: 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
|
Medidas de resultados secundários
Medidas de resultados secundários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
|
Metabolic complete response (CR)
Prazo: 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
Prazo: 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)
Prazo: 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
|
Outras medidas de resultado
Outras medidas de resultado
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
|
Changes in function (Integrated Correlative Geriatric Assessments Substudy)
Prazo: 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)
Prazo: 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)
Prazo: 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
|
Colaboradores e Investigadores
Patrocinador
Patrocinador
Investigadores
Investigadores
- Investigador principal: Elizabeth A Brem, SWOG Cancer Research Network
Publicações e links úteis
Datas de registro do estudo
Datas Principais do Estudo
Início do estudo (Real)
Início do estudo
Conclusão Primária (Estimado)
Conclusão Primária
Conclusão do estudo (Estimado)
Conclusão do estudo
Datas de inscrição no estudo
Enviado pela primeira vez
Enviado pela primeira vez
Enviado pela primeira vez que atendeu aos critérios de CQ
Enviado pela primeira vez que atendeu aos critérios de CQ
Primeira postagem (Real)
Primeira postagem
Atualizações de registro de estudo
Última Atualização Postada (Real)
Última Atualização Postada
Última atualização enviada que atendeu aos critérios de controle de qualidade
Última atualização enviada que atendeu aos critérios de controle de qualidade
Última verificação
Última verificação
Mais Informações
Termos relacionados a este estudo
Termos MeSH relevantes adicionais
- Neoplasias
- Doenças do sistema imunológico
- Neoplasias por Tipo Histológico
- Doenças Linfáticas
- Distúrbios Linfoproliferativos
- Distúrbios imunoproliferativos
- Linfoma Não-Hodgkin
- Linfoma de Células B
- Linfoma
- Doenças hemic e linfáticas
- Linfoma de Células B Grandes Difuso
- Linfoma de Células B, Zona Marginal
- Aminoácidos, peptídeos e proteínas
- Proteínas
- Produtos químicos orgânicos
- Compostos heterocíclicos, 1 anel
- Compostos heterocíclicos
- Compostos heterocíclicos, 2 anel
- Compostos heterocíclicos, anel fundido
- Técnicas de investigação
- Técnicas de laboratório clínico
- Técnicas e procedimentos de diagnóstico
- Diagnóstico
- Ácidos nucleicos, nucleotídeos e nucleosídeos
- Hidrocarbonetos
- Hidrocarbonetos, cíclicos
- Carboidratos
- Alcalóides
- Hidrocarbonetos aromáticos policíclicos
- Hidrocarbonetos, aromáticos
- Compostos policíclicos
- Glicosídeos
- Hidrolases de glicosídeo
- Hidrolases
- Enzimas
- Enzimas e coenzimas
- Polissacarídeos-lyases
- Lyases de carbono-oxigênio
- Lyases
- Indoles
- Anticorpos, monoclonais
- Anticorpos
- Imunoglobulinas
- Imunoproteínas
- Proteínas sanguíneas
- Globulinas de soro
- Globulins
- Citidina
- Nucleosídeos de pirimidina
- Pirimidinas
- Pregada
- Pregnas
- Esteróides
- Compostos de anel fundido
- Técnicas de química, analíticas
- Análise de espectro
- Mustarazas de fosforamida
- Compostos de mostarda de nitrogênio
- Compostos de mostarda
- Hidrocarbonetos, halogenados
- Fosforamidas
- Compostos organofosforos
- Compostos AZA
- Nucleosídeos
- Ribonucleosídeos
- PregadaDiols
- Alcalóides de Vinca
- Alcalóides de triptamina de secologanin
- Alcalóides indol
- Indolizidinas
- Indolizinas
- Antraciclinas
- Nafthacenos
- Aminoglicosídeos
- Anticorpos, monoclonais, derivados de murinos
- Daunorubicina
- Rituximabe
- Prednisona
- Ciclofosfamida
- Azacitidina
- Doxorrubicina
- Vincristina
- Haluronoglucosaminidase
- Manipulação de amostras
- Espectroscopia de ressonância magnética
- CC-486
- CT-P10
- Deltacorteno
- prednilideno
Outros números de identificação do estudo
Outros números de identificação do estudo
- NCI-2020-01256
- U10CA180888 (Concessão/Contrato do NIH dos EUA)
- NCI-2020-01256 (Identificador de registro: CTRP (Clinical Trial Reporting Program))
- S1918 (Outro identificador: CTEP)
- S1918 (Outro identificador: SWOG)
Plano para dados de participantes individuais (IPD)
Planeja compartilhar dados de participantes individuais (IPD)?
Descrição do plano IPD
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Informações sobre medicamentos e dispositivos, documentos de estudo
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Estuda um produto de dispositivo regulamentado pela FDA dos EUA
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