Lymphoma, Large B-cell, Diffuse
Conditions
Keywords
diffuse large B-cell lymphoma, elderly patients, rituximab augmentation
Brief summary
Rituximab (R) plus CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) combination is considered as the new gold standard for the first-line treatment of elderly patients with diffuse large B-cell lymphoma (DLBCL). The study is aimed to evaluate the overall response rate and the safety of four cycles of R-CHOP chemotherapy and followed by rituximab augmentation (weekly four times infusion) in newly diagnosed DLBCL patients with aged more than 70 years.
Detailed description
1. Four cycles of R-CHOP chemotherapy for the induction treatment \[Dose intensity of CHOP chemotherapy is modulated according to Charlson Comorbidity Index (CCI)\] If patients with CCI \<1 * Rituximab: 375 mg/m2, day 1 every 3 weeks. * Conventional dose of CHOP chemotherapy repeat every 3 weeks. If patients with CCI ≥1 * Rituximab: 375 mg/m2, day 1 every 3 weeks. * 75% of conventional CHOP repeat every 3 weeks. 2. Rituximab augmentation * Rituximab: 375 mg/m2, every week x 4 times. * Trimethoprim-sulfamethoxazole 1 tablet per day during augmentation
Interventions
DRUGrituximab
A dose of 375mg/m2 rituximab will be administered intravenously on day 1 of first to fourth R-CHOP chemotherapy and on day 1, 8, 15, 22 of each augmentation chemotherapy.
Sponsors
Samsung Medical Center
Asan Medical Center
Severance Hospital
Chonnam National University Hospital
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
70 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Histologically confirmed CD20 positive DLBCL 2. Age ≥ 70 3. Ann Arbor stage II, III and IV 4. No prior chemotherapy or radiotherapy for DLBCL 5. Performance status (Eastern Cooperative Oncology Group) ≤ 2 6. At least one or more bidimensionally measurable lesion(s) * ≥ 2 cm by conventional computerized tomography (CT) * ≥ 1 cm by spiral CT * skin lesion (photographs should be taken) ≥ 2 cm * measurable lesion by physical examination ≥ 2 cm 7. Cardiac ejection fraction ≥ 50% as measured by echocardiogram without clinically significant abnormalities 8. Adequate renal function: serum creatinine level \< 2 mg/dL (177 μmol/L) 9. Adequate liver functions: 10. Adequate bone marrow functions: hemoglobin ≥ 9 g/dL absolute neutrophil count ≥ 1,500/μL and platelet count ≥ 75,000/μL, unless abnormalities are due to bone marrow involvement by lymphoma 11. Life expectancy more than 6 months 12. Informed consent
Exclusion criteria
1. Other subtypes of non-Hodgkin's lymphoma 2. Patients who transformed follicular lymphoma or other indolent lymphoma 3. Primary Central Nervous System (CNS) DLBCL 4. CNS involvement by lymphoma or any evidence of spinal cord compression. 5. Patients with a known history of human immunodeficiency virus (HIV) seropositivity or hepatitis C virus (+). 6. Any other malignancies within the past 5 years except curatively treated non-melanoma skin cancer or in situ carcinoma of cervix uteri 7. Pregnant or lactating women, women of childbearing potential not employing adequate contraception 8. Other serious illness or medical conditions
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| the overall response rate | three years after the completion of rituximab augmentation | To evaluate the objective overall response rate of four cycles of R-CHOP and followed by four times weekly rituximab augmentation in exteremely elderly patients with DLBCL. |
| Number of patients with adverse events | three years | All patients will be evaluated for the toxicity during the treatment. Toxicity is graded according to the National Cancer Institute Common Toxicity Criteria (NCI-CTC v3.0). |
Secondary
| Measure | Time frame |
|---|---|
| progression-free survival | Three years after the completion of rituximab augmentation |
Countries
South Korea
Contacts
Primary ContactDeok-Hwan Yang, M.D. and Ph.D.
Backup ContactJe-Jung Lee, M.D. and Ph.D.
Outcome results
None listed