A Phase II Study of Intensive Consolidation and Stem Cell Mobilization Therapy With Ofatumumab, Etoposide, and High-dose Ara-C (OVA), Followed by Autologous Stem Cell Transplantation in High-risk Patients With Relapsed/Refractory Diffuse Large B-Cell Lymphoma
Patients with relapsed Diffuse Large B-cell Lymphoma (DLBCL) who are refractory to or
relapse within 12 months of first-line rituximab-based therapy, have poor outcomes with
conventional approaches to autologous stem cell transplantation as detailed above. The
investigators hypothesize that the intensive mobilization strategy developed can overcome
some of the obstacles to successful autologous stem cell transplantation (ASCT) by both
eliminating residual disease following salvage therapy and by facilitating stem cell
collection. Even though there is clinical experience in the cooperative group setting with
intensive pre-ASCT mobilization, it has never been prospectively validated in DLBCL and
concerns exist as to its ability to improve outcomes with ASCT in this high-risk, and
heavily pretreated group of patients. Furthermore, most patients in the study site's
registry treated with intensive mobilization were rituximab-naïve and the findings may not
translate in the rituximab-refractory population. The investigators also believe that
ofatumumab, a novel monoclonal antibody against a distinct CD20 epitope may in fact overcome
rituximab resistance in DLBCL patients and through more effective CDC may eliminate minimal
residual disease in the patient and contaminating tumor cells in the stem cell graft.
General Design
This is a single-institution, single-arm, prospective phase II study. Patients with
high-risk DLBCL (defined as either achieving less than complete remission (CR) to initial
rituximab-containing therapy or relapsing within 12 months of initial therapy) will be
enrolled on this study and will undergo staging prior to receiving intensive mobilization
with ofatumumab, etoposide, and high-dose ara-C (OVA). Following successful stem cell
collection, patients will proceed to standard autologous transplantation with
cyclophosphamide, BCNU, and etoposide (CBV) preparative regimen. Response evaluation will
occur after salvage therapy, following intensive mobilization therapy (d42), at day +90
after ASCT, and at 6, 12 and 24 months thereafter. Event-free, progression-free, and
overall survival will also be assessed until 48 months. The primary study endpoint is
mobilization-adjusted complete metabolic response rate (maCR) following OVA. Subjects who
are not chemosensitive to salvage therapy (i.e. do not achieve a PR or CR) will be
re-evaluated after an additional salvage regimen. If they are still not chemosensitive at
this point, they will be withdrawn from the study and replaced.
Interventional
Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Number of patients achieving complete response to the treatment upon successful stem cell mobilization
Response evaluation will occur after salvage therapy, following intensive mobilization therapy (day 42)
No
Charalambos Andreadis, MD, MSCE
Principal Investigator
University of California, San Francisco
United States: Food and Drug Administration
112525
NCT01555541
June 2012
June 2019
Name | Location |
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UCSF Helen Diller Family Comprehensive Cancer Center | San Francisco, California 94115 |