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A Phase III Multicenter, Randomized Study Comparing RIT Vs ASCT in Patients With Relapsed/Refractory (FL)

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ClinicalTrials.gov Identifier: NCT01827605
Recruitment Status : Active, not recruiting
First Posted : April 9, 2013
Last Update Posted : December 14, 2023
Sponsor:
Information provided by (Responsible Party):
Fondazione Italiana Linfomi - ETS

Study Description
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Brief Summary:
This is a Phase III, multicenter, open-label, randomized and controlled study to compare the efficacy of a consolidation therapy with RIT versus ASCT in patients with FL in CR or PR after second or third line chemotherapy supplemented with rituximab.

Condition or disease Intervention/treatment Phase
Relapsed Follicular Lymphoma Other: ZEVALIN Drug: BEAM Phase 3

Detailed Description:

This is a Phase III, multicenter, open-label, randomized and controlled study to compare the efficacy of a consolidation therapy with RIT vs. ASCT in patients with FL in CR or PR after second or third line chemotherapy supplemented with rituximab. Patients with FL will be eligible for screening at the time of relapsed or refractory disease after two or less chemotherapy lines at least one containing rituximab.

This study will be conducted in six steps as follows. Screening Phase, Enrolment and Induction chemotherapy (STEP I) Randomization (STEP II) Stem cell mobilization and collection (STEP III) Consolidation (RIT vs ASCT) (STEP IV) Maintenance (STEP V) Follow-up Phase (STEP VI)

Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 159 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase III Multicenter,Randomized Study Comparing Consolidation With 90yttrium-Labeled Ibritumomab Tiuxetan (Zevalin®) Radioimmunotherapy Vs Autologous Stem Cell Transplantation (ASCT) in Patients With Relapsed/Refractory Follicular Lymphoma (FL) Aged 18-65 Years
Study Start Date : January 2012
Actual Primary Completion Date : October 2019
Estimated Study Completion Date : January 2024

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Lymphoma

Arms and Interventions
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Arm Intervention/treatment
Experimental: Arm A RIT
Infusion of 90Y Ibritumomab Tiuxetan if the patient has less than 25% BM infiltration at the pre-consolidation restaging (0.4 mCi/kg if platelets ≥150,000/mmc, 0.3 mCi/kg if platelets are between 100.000 and 150,000/mmc). Zevalin® will be delivered as per indications and should thus be provided at expenses following regular supplies procedures.
 Other: ZEVALIN
Infusion of 90Y Ibritumomab Tiuxetan if the patient has less than 25% BM infiltration at the pre-consolidation restaging (0.4 mCi/kg if platelets ≥150,000/mmc, 0.3 mCi/kg if platelets are between 100.000 and 150,000/mmc).
Other Name: RIT
Experimental: ARM B ASCT
BEAM conditioning regimen (or in alternative FEAM regimen with fotemustine to replace BCNU) and reinfusion of CD34+ cells of ≥ 2x106/Kg CD34+ day 0 (optimal dose to reinfuse 4x106/Kg CD34+). G-CSF 5 mcg/Kg from day 2 until ANC>1500/mmc. Patients who failed mobilization will directly proceed to rituximab maintenance
 Drug: BEAM

BEAM REGIMEN day -6 Carmustine* 300 mg/ m2 i.v. in 250ml dextrose 5% solution

from day -5 to day -2 Cytarabine 200 mg/m2 i.v. every 12 hours in 250 ml dextrose 5% solution, 250 ml/hr Etoposide 100 mg/m2 i.v. every 12 hours in 250 ml dextrose 5% solution, 250 ml/hr day -1 Melphalan 140 mg/m2 i.v. in 100ml saline solution in 200 ml/hr

day 0

UReinfusion of autologous stem cells following this rules:

  1. Patient collecting ≥6x106 CD34+ cells/kg use >4x106 CD34+ cells/kg for ASCT and keep >2x106 CD34+ cells/kg for back up;
  2. Patient collecting 4-6x106 CD34+ cells/kg use >2x106 CD34+ cells/kg for ASCT and keep >2x106 CD34+ cells/kg for back up;
  3. Patient collecting 2-4x106 CD34+ cells/kg use all CD34+ cells for ASCT and keep no back up.

day 2 Filgrastim or Lenograstim 5μg/Kg s.c. until ANC > 1500/mmc

Other Name: ASCT


Outcome Measures
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Primary Outcome Measures :
  1. Progression Free Survival from randomization (rPFS) [ Time Frame: 36 months ]
    PFS will be defined as the time between the date of randomization and the date of disease progression, relapse or death from any cause.


Secondary Outcome Measures :
  1. Overall Survival from randomization (rOS) [ Time Frame: 36 months ]
    OS will be defined as the time between the date of randomization and the date of death from any cause.

  2. Event Free Survival (EFS) [ Time Frame: 36 months ]
    EFS will be measured from the date of randomization to the date of any treatment failure including death, disease progression or relapse, discontinuation of treatment for any reason (toxicity, patient preference, initiation of new treatment without documented progression).

  3. Treatment Free Survival from randomization (TFS) [ Time Frame: 36 months ]
    TFS will be defined as the time between the date of the end of primary treatment until the institution of the next unplanned chemotherapy in randomized population.

  4. Progression Free Survival from enrolment (ePFS) [ Time Frame: 42 months ]
    PFS will be defined as the time between the date of enrolment and the date of disease progression, relapse or death from any cause.

  5. Overall Survival from enrolment (eOS) [ Time Frame: 42 months ]
    OS will be defined as the time between the date of enrolment and the date of death from any cause

  6. Complete Response (CR) Rate [ Time Frame: At the end of the consolidation phase (6 months) ]
    Proportion of CR according to the Cheson 2007 response criteria at the end of consolidation phase.

  7. Overall Response Rate (ORR) [ Time Frame: At the end of the consolidation phase (6 months) ]
    ORR at the end of the consolidation phase is defined as Complete Response (CR) or Partial Response according to the Cheson 2007 response criteria.

  8. Toxicity [ Time Frame: 42 months ]
    Incidence of grade 3 or higher Toxicity measured by CTCAE v.4.03 during therapy.

  9. Molecular Response rate (MR) [ Time Frame: 36 months ]
    Rate of MR will be defined as the proportion of patients achieving PCR negativity after the consolidation phase and during follow up.

  10. Molecular Response rate conversion (cMR) [ Time Frame: 6 months ]
    Rate of conversion will be defined as the proportion of patients with baseline PCR-positivity converting to PCR-negativity during treatment.

  11. Molecular Relapse Rate (MRR) [ Time Frame: 24 months ]
    Rate of molecular relapse will be defined as the proportion of patients with PCR-negativity after treatment converting to PCR-positivity during the first two years of follow-up.


Eligibility Criteria
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Ages Eligible for Study:   18 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Age 18-65
  • Histologically documented diagnosis of grade I-IIIa FL defined according to WHO guidelines 2008 (Re-biopsy required)
  • Availability of BM and PB for Minimal Residual Disease (MRD) analysis (see Appendix I)
  • Relapsed or refractory disease after ≤ two chemotherapy lines at least one containing Rituximab (Rituximab maintenance is UNOTU considered a therapeutic line)
  • Clinical indication of treatment i.e. Stage II-IV who require therapy according to SIE and GELF criteria (see Appendix II)
  • ECOG performance status 0-2 (unless disease-related) (see Appendix III)
  • Availability of histological material for centralized revision

  • Laboratory values:

    • ANC ≥ 1500/mmc unless due to marrow involvement by lymphoma and/or platelets ≥ 100000/mmc unless due to marrow involvement by lymphoma
    • Serum creatinine ≤ 1.5 x ULN, unless it is disease related
    • Bilirubin ≤ 1.5 x ULN (or ≤ 3.0 x ULN, if patient has Gilbert syndrome)
    • AST/SGOT and/or ALT/SGPT ≤ 2.5 x ULN if not lymphoma related or ≤ 5.0 x ULN in case of lymphoma liver involvement
  • Adequate cardiac function: LVEF > 50% by echocardiography or MUGA scan
  • Not pregnant or breast-feeding
  • Willingness to use effective contraception during the study and 3 months after the end of treatment
  • No other prior malignancies except for adequately treated non-melanoma skin cancer, carcinoma in situ of the cervix, or other cancer from which the patient has been disease-free for ≥ 5 years (see Exclusion criteria 14)
  • Signed informed written consent

Exclusion Criteria:

  • Grade IIIb FL, transformed FL or histologies different from FL
  • Previous treatment with > two lines of chemotherapy ± rituximab Maintenance is UNOTU considered a therapeutics line)
  • Previous ASCT or RIT treatment
  • CNS involvement by lymphoma
  • HBV positivity with the exception of patients who are seropositive because of hepatitis B virus vaccination and patients HbcAb positive and HbsAg negative with undetectable serum HBV-DNA. Occult carriers: must receive treatment with Lamivudine 100 mg for the duration of treatment program and at least 12 months after treatment cessation; HBV-DNA levels and HBsAg will be monitored every month
  • HCV positivity with elevated transaminases or INR or APTT or active virus replication
  • HIV positivity
  • Any concurrent medical condition requiring long term use (> one month) of systemic corticosteroids
  • Active bacterial, viral, or fungal infection requiring systemic therapy
  • Any concurrent medical or psychiatric condition which might impair administration of therapy or preclude the ability to give informed consent
  • Treatment with an experimental agent within 30 days prior to study entry
  • Myelosuppressive chemo or biological therapy within three weeks before study entry (use rituximab course delivered as maintenance is not an exclusion therapy)
  • Major surgery other than diagnosis within 4 weeks prior to study entry
  • Previous i.v. or i.m. treatments with murine or animal derived antibodies
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01827605


Locations
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Sponsors and Collaborators
Fondazione Italiana Linfomi - ETS
Investigators
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Principal Investigator: Umberto Vitolo AO Città della salute e della Scienza di Torino - Ospedale S. Giovanni Battista - TORINO
Principal Investigator: Marco Ladetto AO SS. Antonio e Biagio e Cesare Arrigo Alessandria
More Information
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Responsible Party: Fondazione Italiana Linfomi - ETS
ClinicalTrials.gov Identifier: NCT01827605    
Other Study ID Numbers: FIL_FLAZ-12
First Posted: April 9, 2013    Key Record Dates
Last Update Posted: December 14, 2023
Last Verified: December 2023
Keywords provided by Fondazione Italiana Linfomi - ETS:
Relapsed follicular Lymphoma
RIT
Zevalin
Additional relevant MeSH terms:
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Lymphoma
Lymphoma, Follicular
Neoplasms by Histologic Type
Neoplasms
Lymphoproliferative Disorders
 Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Lymphoma, Non-Hodgkin