Diffuse Large B-cell Lymphoma
Conditions
Keywords
diffuse large B-cell lymphoma, rituximab, CHOP, abbreviated therapy
Brief summary
This study aims; to assess the efficacy of shortened systemic chemotherapy in patients with completely excised CD20 positive Diffuse Large B-cell Lymphoma (DLBCL) with Ann Arbor Stage I or II.
Detailed description
Unlike the limited stage diffuse Large B-cell Lymphoma (DLBCL) treated with primary chemotherapy followed by radiotherapy, patients with stage I or II DLBCL would be treated with surgical resection followed by chemotherapy in this trial. While chemotherapy is the main treatment modality and radiotherapy becomes adjuvant treatment in the former treatment scheme, surgical resection will remove all the gross lesions and chemotherapy aims to remove all microscopic disease whichever exists in the latter treatment scheme. Currently, six cycles of chemotherapy is usually performed after surgery even without any residual lesion compared with three cycles of chemotherapy in the former treatment scheme which plays primary role in the treatment scheme. The investigators will investigate whether abbreviated 3 cycles of Rituximab Plus Cyclophosphamide, Adriamycin, Vincristine, and Prednisolone (R-CHOP) immunochemotherapy following complete resection is an effective and safe treatment.
Interventions
DRUGRituximab plus CHOP Immunochemotherapy
The R-CHOP treatment will continue up to 3 cycles with interval of 21 days: Each cycle consists of rituximab 375mg/m2 (iv, on day 1), cyclophosphamide 750 mg/m2 (iv, on day 1), doxorubicin 50mg/m2 (iv, on day 1), vincristine 1.4mg/m2 (iv, on day 1), and prednisolone 100mg (po, on day 1-5).
Sponsors
Asan Medical Center
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Patients who underwent curative resection of primary tumor * Pathologically confirmed CD20 positive diffuse large B-cell lymphoma (DLBCL) after surgical resection * Ann Arbor Stage I or II * No history of chemotherapy * Performance status: ECOG 0-2 * Age: 18 to 70 years old * Complete excision with negative resection margin on pathologic report after surgery * Cardiac ejection fraction ≥ 50% as measured by MUGA or 2D echocardiography without clinically significant abnormalities * Adequate renal function: serum creatinine level below 2 mg/dL (177μmol/L) * Adequate liver functions: Transaminase (AST/ALT) \< 3X upper normal value, Bilirubin \< 2X upper normal value * Adequate hematologic function: hemoglobin ≥ 9 g/dL, absolute neutrophil count (ANC) ≥ 1,500/mm3 and platelet count ≥ 75,000/mm3 * Informed consent
Exclusion criteria
* Patients with a known history of HIV (+) or HCV (+). However, HBV(+) patients are eligible if primary prophylaxis is given * Previous or concurrent cancer that is distinct in primary site or histology from DLBCL, EXCEPT cervical carcinoma in situ, treated basal cell carcinoma, superficial bladder tumors (Ta, Tis & T1). Any cancer curatively treated \> 3 years prior to entry is permitted * Pregnant or lactating women, women of childbearing potential not employing adequate contraception * Other serious illness or medical conditions 1. Unstable cardiac disease (i.e. congestive heart failure, arrhythmia symptomatic coronary artery disease) despite treatment, myocardial infarction within 6 months prior to study entry 2. History of significant neurological or psychiatric disorders including dementia or seizures 3. Active uncontrolled infection (viral, bacterial or fungal infection) 4. Other serious medical illnesses * Known hypersensitivity to any of the study drugs or their ingredients * Concomitant administration of any other experimental drug under investigation, or concomitant chemotherapy, hormonal therapy, or immunotherapy * Patient with B symptoms or Bulky disease
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Disease-free survival | 2 years | Proportion of patients surviving 2 years after first R-CHOP chemotherapy with no relapse of DLBCL |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall survival | 2 years | proportion of patients surviving at 2 year after first cycle of R-CHOP chemotherapy regardless of relapse of DLBCL |
| any adverse events as a measure of safety and tolerability | from the first R-CHOP to 1 month after completion of R-CHOP | The number of patients with adverse events will be measured during R-CHOP chemotherapy according to CTCAE version 3.0. |
Countries
South Korea
Outcome results
None listed