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Waldenström's MacroglobulinemiaPhase 3NCT01788020

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

A Phase 3 study testing Dexamethasone, Rituximab, Cyclophosphamide and Dexamethasone, Rituximab, Cyclophosphamide, Bortezomib in people with Waldenström's Macroglobulinemia, run by University of Ulm at 1 site in Germany.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial 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. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Waldenström's Macroglobulinemia
What is being tested?
Dexamethasone, Rituximab, Cyclophosphamide and Dexamethasone, Rituximab, Cyclophosphamide, Bortezomib
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
202 participants
Where
1 siteGermany
Study dates
Nov 2013to Apr 2024
Phase
Phase 3
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • 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
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  • 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.

Who cannot join

  • 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
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  • 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.

Trial locations and contacts

1 site in 1 country.

Germany1 site
  • University Hospital Ulm

    Ulm, 89081

Other trials in Germany

About this study

Official title: Efficacy of First Line Dexamethasone, Rituximab and Cyclophosphamide (DRC) +/- Bortezomib for Patients With Waldenström's Macroglobulinemia

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.

Read the detailed description

Waldenström's macroglobulinemia (WM) is defined by a bone marrow infiltration by lymphoplasmacytic cells and the presence of a monoclonal immunoglobulin (Ig) M gammopathy in the peripheral blood. The clinical understanding of the disease has been greatly improved by the identification of internationally recognized criteria for initiating therapy, the description of an international prognostic index for patients requiring a first-line therapy and the definition of response criteria. These criteria are mainly based on the evolution of serum IgM concentration. However, delayed IgM monoclonal protein responses may cause important difficulties in response assessment. In addition, discrepancies between the kinetics of serum M protein reduction and the clearance of monoclonal B-cells from the bone marrow have been reported. Despite continuing advances in the therapy of WM, the disease remains incurable with a median survival of 5 to 8 years from the time of diagnosis thereby necessitating the development and evaluation of novel treatment approaches.

Being tested
Dexamethasone, Rituximab, Cyclophosphamide, Dexamethasone, Rituximab, Cyclophosphamide, Bortezomib
Keywords
DRC, Bortezomib, Oncology
Medical subject headings
Waldenstrom Macroglobulinemia, Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Dexamethasone, Rituximab, CyclophosphamideDrug

  • Dexamethasone, Rituximab, Cyclophosphamide, BortezomibDrug

Study groups in NCT01788020
Study groupRoleWhat they receive
DRC+BortezomibExperimentalInduction experimental arm (Arm B): Cycle 1: Bortezomib 1.6 mg/m2 s.c. Day 1,8,15; Dexamethasone 20 mg p.o. Day 1; Rituximab 375 mg/m2 i.v. Day 1; Cyclophosphamide 100 mg/m2 x 2 p.o. Day 1-5 Cycle 2-6: Bortezomib 1.6 mg/m2 s.c. Day 1,8,15; Dexamethasone 20 mg p.o. Day 1; Rituximab 1400 mg absolute sc Day 1; Cyclophosphamide 100 mg/m2 x 2 p.o. Day 1-5; Repeat day 29.
Receives: Drug: Dexamethasone, Rituximab, Cyclophosphamide, Bortezomib
DRCActive comparatorInduction standard arm (Arm A) Cycle 1: Dexamethasone 20 mg p.o. Day 1; Rituximab 375 mg/m2 i.v. Day 1; Cyclophosphamide 100 mg/m2 x 2 p.o. Day 1-5; Cycle 2-6: Dexamethasone 20 mg p.o. Day 1; Rituximab 1400 mg absolute sc Day 1; Cyclophosphamide 100 mg/m2 x 2 p.o. Day 1-5; Repeat day 29.
Receives: Drug: Dexamethasone, Rituximab, Cyclophosphamide

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Progression Free Survival

    PFS will be calculated from the date of inclusion/randomisation to the following events: the date of progression and the date of death if it occurred earlier. In the absence of progression and death, PFS duration will be censored at the stopping date or the date of last follow-up.

    Measured: participants will be followed for their participation in the trial, an expected average of 5.5 years

Secondary outcomes (8)
  1. Response rate

    The response rates (CR,VGPR, PR, MR) and overall response rate (CR, VGPR, PR, MR) are evaluated 4 weeks after the end of induction treatment.

    Measured: 24 weeks

  2. Best response

    Best response is determined in the time interval from the start of induction therapy to end of follow-up.

    Measured: 24 weeks

  3. Time to best response

    Time to best response is defined as the time from the start of induction to best response the patient achieves (CR, VGPR, PR, MR).

    Measured: 24 weeks

  4. Time to first response

    Time to first response is defined as the time from the start of induction to first response (MR, PR, VGPR or CR).

    Measured: 24 weeks

  5. Time to treatment failure

    Time to treatment failure (TTF) is defined as the time of randomization to discontinuation of therapy for any reason including death from any cause, progression, toxicity or add-on of new anti-cancer therapy. Patients alive without treatment failure are censored at the latest tumor assessment date.

    Measured: participants will be followed for their participation in the trial, an expected average of 5.5 years

  6. Remission duration

    Remission duration will be calculated in patients with response (CR, VGPR, PR, MR) to induction from end of induction to the date of progression, relapse or death from any cause. Patients alive without progression and relapse will be censored at the latest tumor assessment date or the stopping date.

    Measured: participants will be followed for their participation in the trial (from date of response), an expected average of 5 years

  7. Cause specific survival (CSS)

    Cause specific survival is defined as the period from the induction randomization to death from lymphoma or lymphoma related cause; death unrelated to WM is considered as a competing event.

    Measured: participants will be followed for their participation in the trial, an expected average of 5.5 years

  8. Overall survival (OS)

    Overall survival is defined as the period from the induction randomization to death from any cause. Patients who have not died until the time of the analysis will be censored at their last contact date.

    Measured: participants will be followed for their participation in the trial, an expected average of 5.5 years]

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted11 Feb 2013 (estimated)
  2. Study startNov 2013
  3. Primary completionNov 2018
  4. Study completionApr 2024

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
202 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01788020
Sponsor's protocol ID
ECWM-1
Other IDs
2013-000506-37
Status last verified
May 2024
First submitted
1 Feb 2013
Last updated
13 May 2024
Results posted
No
Data monitoring committee
Yes

Publications

  • Buske C, Dimopoulos MA, Grunenberg A, Kastritis E, Tomowiak C, Mahe B, Troussard X, Hajek R, Viardot A, Tournilhac O, Aurran T, Lepretre S, Zerazhi H, Hivert B, Leblond V, de Guibert S, Brandefors L, Garcia-Sanz R, Gomes da Silva M, Kimby E, Schmelzle B, Kaszynski D, Dreyhaupt J, Muche R, Morel P. Bortezomib-Dexamethasone, Rituximab, and Cyclophosphamide as First-Line Treatment for Waldenstrom's Macroglobulinemia: A Prospectively Randomized Trial of the European Consortium for Waldenstrom's Macroglobulinemia. J Clin Oncol. 2023 May 10;41(14):2607-2616. doi: 10.1200/JCO.22.01805. Epub 2023 Feb 10.

    PubMed 36763945

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Dexamethasone, Rituximab, Cyclophosphamide and Dexamethasone, Rituximab, Cyclophosphamide, Bortezomib in people with Waldenström's Macroglobulinemia, run by University of Ulm at 1 site in Germany.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 29 inclusion and 24 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 13 May 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Germany. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Progression Free Survival (time frame: participants will be followed for their participation in the trial, an expected average of 5.5 years). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01788020, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 13 May 2024.

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