Saarland University HO153 NHL
- HO153 NIVEAU
- Saarland University
- Working group party:
- > 65
- 2de lijn
- Level D
- Included patients:
- Active sites:
Improvement of Outcome in Elderly Patients or Patients not eligible for high-dose chemotherapy with Aggressive Non-Hodgkin Lymphoma in first Relapse or Progression by adding Nivolumab to Gemcitabine, Oxaliplatin plus Rituximab in case of B-cell lymphoma.
- Prospective randomized Phase I/II study
- Monitoring Type:
- Study Specific
Primary end point:
- 1 year progression free survival
Secondary end points:
- complete response rate after eight cycles of (R)-GemOx
- partial response rate after eight cycles of (R)-GemOx
- overall response rate after eight cycles of (R)-GemOx
- duration of response
- progression rate
- rate of treatment-related deaths
- relapse rate
- Event-free survival
- Overall survival
- Protocol adherence
- quality of life as assessed by the EQ-5D-5L.
- outcome according to PD-L1 and PD-1 expression, cell of origin, 9p24.1 alterations
- Inclusion Criteria:
- All patient >65 years of age or older than 18 years if HCT-CI score > 2
- Ineligibility for neither autologous nor allogeneic stem cell transplantation
- All risk groups (IPI 0 to 5)
- Diagnosis of aggressive Non-Hodgkin’s lymphoma, based on an excisional biopsy of a lymph node or on an appropriate sample of a lymph node or of an extranodal involvement at initial diagnosis or relapse or progression. It will be possible to treat the following entities in this study as defined by the 2016 revision of WHO classification of lymphoid neoplasms:
- Follicular lymphoma grade IIIb
- DLBCL, not otherwise specified (NOS)
- T-cell/histiocyte-rich large B-cell lymphoma
- primary cutaneous DLBCL, leg type
- EBV-positive DLBCL, NOS
- DLBCL associated with chronic inflammation
- primary mediastinal (thymic) large B-cell lymphoma
- intravascular large B-cell lymphoma
- ALK-positive large B-cell lymphoma
- plasmablastic lymphoma
- primary effusion lymphoma
- high-grade B-cell lymphoma, with MYC and BCL2 and/or BCL6 rearrangements
- B high-grade B-cell lymphoma, NOS
- B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and classical Hodgkin lymphoma
- Aggressive NK cell leukemia
- Enteropathy-associated T-cell lymphoma
- Hepatosplenic T-cell lymphoma
- Primary cutaneous gamma-delta T-cell lymphoma
- Peripheral T-cell lymphoma, NOS
- Angioimmunoblastic T-cell lymphoma
- Anaplastic large cell lymphoma, ALK-positive
- Anaplastic large cell lymphoma, ALK-negative
- Performance status ECOG 0 – 2. Also patients with performance status 0 – 2 are eligible when assessed after prephase treatment. The performance status of each patient should be assessed before the initiation and after the end of prephase treatment which, as experience has shown, can result in its significant improvement.
- Patients must have only one prior chemotherapy regimen !including! an anthracycline. The last cytotoxic drug must be given at least four weeks before entering the study. Rituximab must be part of the first-line regimen in case of B-cell lymphoma. Patients may have received prior radiation therapy as part of their first-line therapy.
- Men who are sexually active with women of childbearing potential (WOCBP) must use any contraceptive method with a failure rate of less than 1% per year.
- Written informed consent of the patient.
- Patient must be covered by social security system.
- Exclusion Criteria:
- Already initiated lymphoma therapy after first relapse or progression (except for the prephase treatment, cf. 8.6.1).
- Serious accompanying disorder or impaired organ function (except when due to lymphoma involvement), in particular:
- heart: angina pectoris CCS >2, cardiac failure e.g. NYHA >2
- liver: total bilirubin >1.5 times the upper reference limit (except subjects with Gilbert Syndrome, who can have total bilirubin < 51 μmol/l), aspartate transaminase (AST) or alanine transaminase (ALT) >3 x institutional upper reference limit
- kidney: creatinine clearance < 30 ml/min
- WBC < 2.5 G/l, Neutrophils < 2 G/l, Platelets < 100 G/l (does not apply if cytopenia is caused by lymphoma)
- Prolongation of QTc interval > 450 ms, demonstrated in at least two electrocardiograms.
- Family history for Long QT-syndrome
- Patients with an active, known or suspected autoimmune disease. Subjects are permitted to enroll if they have vitiligo, type I diabetes mellitus, residual hypothyroidism due to autoimmune condition only requiring hormone replacement, psoriasis not requiring systemic treatment, or conditions not expected to recur in the absence of an external trigger
- There must also be no requirement for immunosuppressive doses of systemic corticosteroids (> 10 mg/day prednisone equivalents) for at least 2 weeks prior to study drug administration (except for treatment of lymphoma).
- Chronic active hepatitis B or C as defined either HBs Ag positive or HBc Ac positive with detectable viral DNA or hepatitis C virus ribonucleic acid positive.
- Poor patient compliance
- Prior chemo- or radiotherapy, long-term use of corticosteroids or anti-neoplastic drugs for previous disorder (except for first-line therapy of lymphoma).
- Previous therapy with Gemcitabine or Oxaliplatin.
- Patients with a “currently active” second malignancy other than non-melanoma skin cancer. Patients are not considered to have a “currently active” malignancy if they have completed therapy since 6 months and are considered by their physician to be less than 30% risk of relapse within one year.
- CNS involvement of lymphoma (intracerebral, meningeal, intraspinal intradural) or primary CNS lymphoma.
- Persistent neuropathy grade >2 (NCI CTC-AE v4.03) (unless due to lymphoma involvement)
- Pregnancy or breast-feeding women.
- Women of childbearing potential (WOCBP). A WOCBP is defined as any female who has experienced menarche and who has not undergone surgical sterilization (hysterectomy or bilateral oophorectomy) or who is not postmenopausal. Menopause is defined clinically as 12 months of amenorrhea in a woman over 45 in the absence of other biological or physiological causes. In addition, women under the age of 62 must have a documented serum follicle stimulating hormone (FSH) level higher than 40 mIU/mL.
- Active serious infections not controlled by oral and/or intravenous antibiotics or anti-fungal medication.
- Any medical condition which in the opinion of the investigator places the subject at an unacceptably high risk for toxicities.
- Lymphomas other than those listed in the inclusion criteria notably indolent lymphoma, Mantle cell lymphoma, Burkitt lymphoma.
- Persons not able to understand the impact, nature, risks and consequences of the trial (including language barrier)
- Persons not agreeing to the transmission of their pseudonymous data.
- Persons depending on sponsor or investigator.
- Persons from highly protected groups.
- Allergies and Adverse Drug Reaction History of allergy to study drug components.
- Participation in another clinical trial with drug intervention within 4 weeks prior to start of the first cycle and during the study. However, participation in a clinical trial of firstline therapy of lymphoma is allowed.
Online registration and randomization via sponsor website.
The following is requested at registration
- name of investigator
- name of pathologist, who has done the report at relapse / progression if applicable
- name of pathologist, who has done the report at initial diagnosis, if already known
- name of reference pathologist, if already known
- name of nuclear medicine specialist
- name of radiologist
- histopathologic subtype (WHO classification)
- confirmation that patient conforms to eligibility criteria
- confirmation that no exclusion criteria apply
- IPI criteria:
- LDH, if possible prior to any therapy (including prephase treatment or surgery) and upper normal limit of LDH in the respective laboratory
- performance status ECOG score prior to any therapy (including prophase treatment or surgery)
- Ann Arbor stage
- presence of extralymphatic involvement (number, site)
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