Overview

Efficacy of First Line DRC +/- Bortezomib for Patients With Waldenström's Macroglobulinemia

Status:
Active, not recruiting
Trial end date:
2024-04-01
Target enrollment:
0
Participant gender:
All
Summary
In Waldenström macroglobulinemia (WM) conventional chemotherapy induces only low CR rates and responses of short duration compared to other indolent lymphomas. Thus innovative approaches are needed which combine excellent activity and tolerability in patients with WM, who are mostly of advanced age. The immunochemotherapy DRC (dexamethasone, rituximab, cyclophosphamide) was shown to be highly effective in patients with WM without inducing major hematological toxicities. On the other hand the proteasome inhibitor Bortezomib showed substantial activity as a single agent in WM with only very few side effects when given in a weekly schedule. Based on these observations it is the aim of this study to test whether the efficacy of the well tolerated DRC regime can be further improved by adding Bortezomib.
Phase:
Phase 3
Accepts Healthy Volunteers?
No
Details
Lead Sponsor:
University of Ulm
Collaborator:
Centre Hospitalier de Lens, Unité de Recherche Clinique, Lens (Co-Sponsor)
Treatments:
BB 1101
Bortezomib
Cyclophosphamide
Dexamethasone
Dexamethasone 21-phosphate
Dexamethasone acetate
Rituximab
Criteria
Inclusion Criteria:

Clinicopathological diagnosis of WM as defined by consensus panel one of the Second
International Workshop on WM. Pathological diagnosis has to occur before study inclusion
and randomization. In addition, pathological specimens have to be sent to the national
pathological reference center at study inclusion and randomization. The positivity for CD20
can be assumed from any previous bone marrow immunohistochemistry or flow cytometry
analysis performed up to 6 months prior to enrollment. Inclusion in the study will be based
on morphological and immunological criteria. Immunophenotyping will be performed in each
center and saved locally. Flow cytometry of bone marrow and blood cells will include at
least one double staining and assess the expression of the following antigens: surface
immunoglobulin, CD19, CD20, CD5, CD10 and CD23. Patients are eligible if tumor cells
express the following antigens: CD19, CD20, and if they are negative for CD5, CD10 and CD23
expression. Patients with tumor cells positive for CD5 and/or CD23 and morphologically
similar to WM cells may be included after ruling out other low grade B-cell malignancies.

- Presence of at least one criterion for initiation of therapy, according to the 2nd
Workshop on WM:

- Recurrent fever, night sweats, weight loss, fatigue

- Hyperviscosity

- Lymphadenopathy which is either symptomatic or bulky (≥5 cm in maximum diameter)

- Symptomatic hepatomegaly and/or splenomegaly

- Symptomatic organomegaly and/or organ or tissue infiltration

- Peripheral neuropathy due to WM

- Symptomatic cryoglobulinemia

- Cold agglutinin anemia

- IgM related immune hemolytic anemia and/or thrombocytopenia

- Nephropathy related to WM

- Amyloidosis related to WM

- Hemoglobin ≤10g/dL

- Platelet count <100x10^9/L

- Serum monoclonal protein >5g/dL, even with no overt clinical symptoms Cumulative
illness rating scale (CIRS) score less than 6

- World Health Organization (WHO)/ECOG performance status 0 to 2.

- Other criteria:

- Age ≥ than 18 years

- Life expectancy >3 months.

- Baseline platelet count ≥ 50 ×10^9/L, absolute neutrophil count ≥ 0.75×10^9/L (if
not due to BM infiltration by the lymphoma).

- Meet the following pretreatment laboratory criteria at the Screening visit
conducted within 28 days of study enrollment:

- ASAT (SGOT): ≤3 times the upper limit of institutional laboratory normal
value

- ALAT (SGPT): ≤3 times the upper limit of institutional laboratory normal
value

- Total Bilirubin: ≤20 mg/L or 2 times the upper limit of institutional
laboratory normal value, unless clearly related to the disease (except if
due to Gilbert's syndrome)

- Serum creatinine: ≤ 2mg/dl

- Premenopausal fertile females must agree to use a highly effective method of birth
control for the duration of the therapy up to 6 months after end of therapy. A highly
effective method of birth control is defined as those which result in a low failure
rate (i.e. less than 1% per year) when used consistently and correctly such as
implants, injectables, combined oral contraceptives, some IUDs, sexual abstinence or
vasectomised partner.

- Men must agree not to father a child for the duration of therapy and 6 months after
and must agree to advice a female partner to use a highly effective method of birth
control.

- Voluntary written informed consent before performance of any study-related procedure
not part of normal medical care, with the understanding that consent may be withdrawn
by the subject at any time without prejudice to future medical care.

Exclusion criteria:

- Prior systemic treatment of the WM (plasmapheresis and short- term administration of
corticosteroids < 4 weeks administered at a dose equivalent to < 20 mg/day prednisone
is allowed)

- Patient with hypersensitivity to dexamethasone.

- Serious medical or psychiatric illness likely to interfere with participation in this
clinical study.

- Uncontrolled bacterial, viral or fungal infection

- Active HIV, HBV or HCV infection

- Known interstitial lung disease

- Prior allergic reaction or severe anaphylactic reaction related to humanized or murine
monoclonal antibody.

- Central Nervous System involvement by lymphoma

- Prior history of malignancies unless the subject has been free of the disease for ≥ 5
years. Exceptions include the following:

- Basal cell carcinoma of the skin,

- Squamous cell carcinoma of the skin,

- Carcinoma in situ of the cervix,

- Carcinoma in situ of the breast,

- Incidental histologic finding of prostate cancer (TNM stage of T1a or T1b).

- Uncontrolled illness including, but not limited to:

- Uncontrolled diabetes mellitus mellitus (as indicated by metabolic derangements
and/or severe diabetes mellitus related uncontrolled organ complications)

- Chronic symptomatic congestive heart failure (Class NYHA III or IV).

- Unstable angina pectoris, angioplasty, stenting, or myocardial infarction within
6 months

- Clinically significant cardiac arrhythmia that is symptomatic or requires
treatment, or asymptomatic sustained ventricular tachycardia.

- Known pericardial disease

- Subjects with ≥ Grade 2 neuropathy.

- Women who are pregnant as well as women who are breastfeeding and do not consent to
discontinue breast-feeding.

- Participation in another clinical trial within four weeks before randomization in this
study

- No consent for registration, storage and processing of the individual
disease-characteristics and course as well as information of the family physician
about study participation.