Diffuse Large B-Cell LymphomaPhase 3FIL_PREVIDNCT04442412
Prephase Treatment With Prednisone +/- Vitamin D Supplementation Followed by Immunochemotherapy
A Phase 3 study testing Vitamin D3 (Cholecalciferol) and RCHOP o R-miniCHOP at standard doses in people with Diffuse Large B-Cell Lymphoma and Elderly Patients, run by Fondazione Italiana Linfomi - ETS at 49 sites in Italy.
Trial summary
This is an open-label, multicenter, randomized phase III trial. The study plans to randomize patients with a 1 to 1 ratio to Arm A (Standard arm) or Arm B (Experimental arm). All patients of both arms will receive a prephase with oral prednisone before 6 cycles Q21 of immunochemotherapy with R-CHOP or R-miniCHOP at… Read more about this study
- Who is it for?
- Ages 65 years and older
- Conditions the study is for
- Diffuse Large B-Cell Lymphoma, Elderly Patients
- What is being tested?
- Vitamin D3 (Cholecalciferol) and RCHOP o R-miniCHOP at standard doses
- Type of treatment
- Pill or oral medicine
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 430 participants
- Where
- 49 sitesItaly
- Study dates
- 23 Mar 2021to 1 Sep 2030
- Phase
- Phase 3
- Are there results?
- Not yet: the study is under way
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 65 years and older
- All sexes
- No healthy volunteers
- Older adult
Who may be able to join
- Histologically documented diagnosis of Diffuse Large B-cell Lymphoma or Follicular grade IIIb lymphoma, as defined in the 2017 edition of the World Health Organization (WHO) classification.
- Age ≥ 65 years
- Comprehensive Geriatric Assessment performed at baseline, before start of any treatment.
- Eastern Cooperative Oncology Group performance status (PS) ≤3
- Eligibility for anthracycline containing regimen (R-CHOP or R-miniCHOP)
- No previous treatment for DLBCL or Follicular grade IIIb lymphoma
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- Ann Arbor stage I-IV
- At least one site of measurable nodal disease at baseline ≥ 1.5 cm in the longest transverse diameter as determined by CT scan ; or one metabolic active site of disease at baseline FDG-PET scan
- Serum basic levels of Vitamin D [25 (OH) VitD] ≤ 40 ng / ml;
- Adequate hematological counts defined as follows:
- Absolute Neutrophil count > 1.5 x 109/L unless due to bone marrow involvement by lymphoma
- Platelet count ≥ 80.000/mm3 unless due to bone marrow involvement by lymphoma
- Adequate renal function defined as follows:
- Creatinine ≤ 2 mg/dL, unless secondary to lymphoma
- Adequate hepatic function defined as follows:
- Bilirubin ≤ 2 mg/dL unless secondary to lymphoma
- LVEF > 50% at bidimensionally echocardiogram
- Life expectancy ≥ 6 months
- Subject understands and voluntarily signs an informed consent form approved by an Independent Ethics Committee , prior to the initiation of any screening or study-specific procedures
- Subject must be able to adhere to the study visit schedule and other protocol requirements
- Men must agree to use one of the below reported acceptable method of contraception for the duration of the study and for 3 months after receiving the last dose of immunochemotherapy, and to not donate sperm while on study.
Who cannot join
- Histological diagnosis different from Diffuse large B-Cell Lymphoma or Follicular grade IIIb lymphoma, including diagnosis of HGBL, with rearrangement of MYC, BCL2 and/or BCL6 (double-hit)
- Use of VitD supplementation as standard of care at dose higher than 10,000 U/week
- Suspect or clinical evidence of CNS involvement by lymphoma
- Contraindication to the use of rituximab
- Contraindication to the use of VitD supplementation (Hypercalcemia/Hyperphosphatemia)
- Subject has received any anti-cancer therapy including chemotherapy, immunotherapy, radiotherapy, investigational therapy, including targeted small molecule agents within 14 days prior to the first dose of study drug
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- Significant history of neurologic, psychiatric, endocrinological, metabolic, immunologic, or hepatic disease that would preclude participation in the study or compromise ability to give informed consent
- Any history of other active malignancies within 2 years prior to study entry, with the exception of adequately treated in situ carcinoma of the cervix uterine, basal cell carcinoma of the skin or localized squamous cell carcinoma of the skin or limited stage surgically removed breast cancer or adequately treated with radiation therapy or limited stage prostate carcinoma surgically removed or adequately treated with radiation therapy or previous malignancy confined and surgically resected with curative intent
- Evidence of other clinically significant uncontrolled condition including, but not limited to:
- Uncontrolled and/or active systemic infection (viral, bacterial or fungal)
- Chronic hepatitis B virus or hepatitis C requiring treatment.
Trial locations and contacts
49 sites in 1 country. Contact the study team or a site near you to ask about taking part.
49 sites in 1 country
Italy49 sites, 49 recruiting
- Recruiting
A.O. SS. Antonio e Biagio e Cesare Arrigo - S.C. Ematologia
Alessandria, 15121
Manuela Zanni, MD, manuela.zanni@ospedale.al.it
Maria Vittoria Sacchi, mariavittoria.sacchi@ospedale.al.it
- Recruiting
A.O. Universitaria Ospedali Riuniti - Ospedale Umberto I Di Ancona
Ancona, 60126
Guido Gini, g.gini@ospedaliriuniti.marche.it
Alessandra Barucca, alessandra.barucca@gmail.com
- Not yet recruiting
Ascoli Piceno - Ospedale C.e G. Mazzoni - U.O.C. di Ematologia
Ascoli Piceno, 15121
Piero Galieni, MD, piero.galieni@sanita.marche.it
Pietro Galieni, MD
- Recruiting
Aviano - Centro Riferimento Oncologico - S.O.C. Oncologia Medica A
Aviano
Michele Spina, MD, mspina@cro.it
Michele Spina, MD
- Not yet recruiting
Barletta - Ospedale "Monsignor Raffaele Dimiccoli" - Ematologia
Barletta
Giuseppe Tarantini, MD, giuseppetarantini0@gmail.com
Giuseppe Tarantini, MD
- Not yet recruiting
Bergamo - Cliniche Humanitas Gavazzeni - Oncologia - Cliniche Humanitas Gavazzeni
Bergamo
Serena Camilla Dalto, serena.dalto@gavazzeni.it
Serena Camilla Dalto, MD
- Not yet recruiting
Biella - Ospedale Degli Infermi - S.C. Oncologia
Biella
Annarita Conconi, MD, annarita.conconi@aslbi.piemonte.it
Annarita Conconi, MD
- Recruiting
SC Ematologia Spedali Civili
Brescia, BS
Alessandra Tucci, alessandra.tucci@ospedalicivili.brescia.it
Alessandra Tucci, MD
- Not yet recruiting
Campobasso - Universitа Cattolica del Sacro Cuore - Ematologia
Campobasso
Sergio Storti, MD, sergio.storti@unicatt.it
Sergio Storti, MD
- Not yet recruiting
Castelfranco Veneto - Ospedale di Castelfranco Veneto - Ematologia
Castelfranco Veneto
Roberto Sartori, MD, roberto.sartori@iov.veneto.it
Roberto Sartori, MD
- Recruiting
Unità Funzionale di Ematologia AOU Careggi
Florence
Benedetta Puccini, MD, puccinib@aou-careggi.toscana.it
Benedetta Puccini, MD
- Not yet recruiting
Frosinone - Presidio Ospedaliero F. Spaziani - UOC Ematologia
Frosinone
Gabriella Tomei, MD, gintomei@gmail.com
Gabriella Tomei, MD
- Not yet recruiting
Matera - Ospedale Madonna delle Grazie - Ematologia
Matera
Clara Mannarella, MD, clara.mannarella@virgilio.it
Clara Mannarella, MD
- Recruiting
Meldola - Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.) - Ematologia
Meldola
Fabio Augello, MD, accursio.augello@irst.emr.it
Fabio Augello, MD
- Not yet recruiting
Mestre - Ospedale Dell Angelo - U.O. Ematologia
Mestre
Renato Bassan, MD, renato.bassan@aulss3.veneto.it
Renato Bassan, MD
- Not yet recruiting
SC Ematologia AO Niguarda Cà Granda
Milan, 20162
Emanuele Ravano, MD, emanuele.ravano@ospedaleniguarda.it
Isabella Ghislandi, isabella.ghislandi@ospedaleniguarda.it
- Recruiting
Monza - ASST MONZA Ospedale S. Gerardo - Ematologia
Monza
Ivana Casaroli, MD, ivanacasaroli@yahoo.it
Ivana Casaroli, MD
- Not yet recruiting
Napoli - AOU Universitа degli Studi della Campania Luigi Vanvitelli - Oncologia Medica ed Ematologia
Naples
Antonello Sica, MD, antonello.sica@fastwebnet.it
Antonello Sica, MD
- Not yet recruiting
Università del Piemonte Orientale - Novara
Novara, 28100
Gianluca Gaidano, MD, 0321/660655, gianluca.gaidano@med.uniupo.it
Clara Deambrogi, clara.deambrogi@med.uniupo.it
- Not yet recruiting
Padova - I.R.C.C.S. Istituto Oncologico Veneto - Oncologia 1
Padova
Dario Marino, MD, dario.marino@iov.veneto.it
Dario Marino, MD
- Not yet recruiting
Pagani - Presidio ospedaliero "A. TORTORA" - U.O. Onco-ematologia
Pagani
Catello Califano, MD, c.califano@aslsalerno.it
Catello Califano, MD
- Not yet recruiting
Palermo - A.O. Ospedali Riuniti Villa Sofia-Cervello - Divisione di Ematologia
Palermo
Caterina Patti, MD, k.patti@villasofia.it
Caterina Patti, MD
- Recruiting
Palermo - AOU Policlinico Giaccone - Ematologia
Palermo
Salvatrice Mancuso, MD, salvatrice.mancuso@unipa.it
Salvatrice Mancuso, MD
- Recruiting
UO Ematologia Università - Policlinico San Matteo
Pavia
Luca Arcaini, MD, luca.arcaini@unipv.it
Luca Arcaini, MD
- Not yet recruiting
Pescara - P.O. Spirito Santo di Pescara - UOS Dipartimentale - Centro di diagnosi e Terapia dei linfomi
Pescara
Elsa Pennese, MD, elsapennese@gmail.com
Stefania Luciani, stefyluciani@gmail.com
- Recruiting
UO Ematologia e CTMO di Piacenza
Piacenza, PC, 29121
Annalisa Arcari, MD, a.arcari@ausl.pc.it
Annalisa Arcari, MD
- Not yet recruiting
Potenza - AOR San Carlo
Potenza
Michele Cimminiello, MD, miki-doc@virgilio.it
Michele Ciminiello, MD
- Recruiting
UO Ematologia Ospedale Santa Maria delle Croci
Ravenna
Monica Tani, MD, monica.tani@auslromagna.it
Monica Tani, MD
- Recruiting
Reggio Emilia - AO Santa Maria Nuova
Reggio Emilia, 42123
Francesco Merli, MD, 0522-296618, merli.francesco@asmn.re.it
Caterina Mammi, mammi.caterina@ausl.re.it
- Not yet recruiting
UO Ematologia - Ospedale degli Infermi
Rimini
Anna Lia Molinari, MD, annalia.molinari@auslromagna.it
Anna Lia Molinari, MD
- Not yet recruiting
Ospedale Oncologico regionale CROB
Rionero in Vulture, Piacenza
Giuseppe Pietrantuono, MD, ematologia45@alice.it
Giuseppe Pietrantuono, MD
- Not yet recruiting
Roma - IRCCS Spallanzani - Servizio di Ematologia in malattie infettive
Roma
Michele Bibas, MD, michele.bibas@inmi.it
Michele Bibas, MD
- Not yet recruiting
Roma - Ospedale S. Camillo - Ematologia
Roma
Luigi Rigacci, MD, lrigacci@scamilloforlanini.rm.it
Luigi Rigacci, MD
- Recruiting
Roma - Policlinico Universitario Campus Bio-Medico - Ematologia - Trapianto cellule staminali - Medicina Trasfusionale e Terapia cellulare
Roma
Ombretta Annibali, MD, o.annibali@unicampus.it
Ombretta Annibali, MD
- Not yet recruiting
Università Cattolica S. Cuore, Ematologia
Roma
Stefan Hohaus, MD, stefan.hohaus@Unicatt.it
Stefan Hohaus, MD
- Not yet recruiting
Università La Sapienza Ematologia
Roma
Alice Di Rocco, MD, dirocco@bce.uniroma1.it
Alice Di Rocco, MD
- Not yet recruiting
UOC Ematologia - A.O. Sant'Andrea
Roma
Agostino Tafuri, MD, 0633775113, agostino.tafuri@ospedalesantandrea.it
Agostino Tafuri, MD
- Recruiting
Salerno - Ematologia e Trapianti A.O. San Giovanni di Dio e Ruggi D Aragona - U.O. Ematologia
Salerno
Carmine Selleri, MD, cselleri@unisa.it
Carmine Selleri, MD
- Not yet recruiting
San Giovanni Rotondo - Casa Sollievo della Sofferenza - U.O. Ematologia
San Giovanni Rotondo
Nicola Cascavilla, MD, n.cascavilla@operapadrepio.it
Nicola Cascavilla, MD
- Not yet recruiting
Sassari - AOU di Sassari - Ematologia
Sassari
Claudio Fozza, MD, cfozza@uniss.it
Claudio Fozza, MD
- Recruiting
UOC Medicina Interna MO DH Oncologico
Sassuolo
Sara Bigliardi, MD, s.bigliardi@ausl.mo.it
Sara Bigliardi, MD
- Recruiting
UOC Ematologia, AOU Senese
Siena
Alberto Fabbri, MD, a.fabbri@ao-siena.toscana.it
Cristiana Cafarelli, cristianacafarelli21@gmail.com
- Recruiting
Univ. Perugia Sede Terni - Oncoematologia
Terni
Anna Marina Liberati, MD, marina.liberati@unipg.it
Anna Marina Liberati, MD
- Recruiting
AOU Citta della Salute e della Scienza di Torino - Ematologia Universitaria
Torino, 10126
Federica Cavallo, MD, +39 0116334264, f.cavallo@unito.it
Luca Palumbo
- Recruiting
SC. Ematologia A.O. Città della Salute e della Scienza
Torino
Barbara Botto, MD, bbotto@cittadellasalute.to.it
Giorgio Priolo
- Not yet recruiting
Torino - San Giovanni Bosco - ASL Cittа di Torino - SSD di Ematologia e Malattie Trombotiche
Torino
Federica De marco, MD, federica.demarco@aslcittaditorino.it
Federica De marco, MD
- Recruiting
Trieste - Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) - SC Ematologia
Trieste, 34121
Francesco Zaja, MD, francesco.zaja@asuits.sanita.fvg.it
Marta De Piccoli, martadepiccoli1810@gmail.com
- Not yet recruiting
Udine - Azienda Sanitaria Universitaria Friuli Centrale (ASU FC) - SOC Clinica Ematologica
Udine
Jacopo Olivieri, MD, jacopo.olivieri@hotmail.it
Cristina D'Odorico, cristina.dodorico@asuiud.sanita.fvg.it
- Recruiting
ULSS 8 Berica - Ospedale S. Bortolo - Ematologia
Vicenza
Maria Chiara Tisi, MD, mariachiara.tisi@aulss8.veneto.it
Maria Chiara Tisi, MD
About this study
Official title: Prephase Treatment With Prednisone +/- Vitamin D Supplementation Followed by Immunochemotherapy in Elderly Patients With Diffuse Large B-Cell Lymphoma (DLBCL) A Randomized, Open Label, Phase III Study by Fondazione Italiana Linfomi.
This is an open-label, multicenter, randomized phase III trial. The study plans to randomize patients with a 1 to 1 ratio to Arm A (Standard arm) or Arm B (Experimental arm).
All patients of both arms will receive a prephase with oral prednisone before 6 cycles Q21 of immunochemotherapy with R-CHOP or R-miniCHOP at standard doses; patients in the Experimental arm (Arm B) will receive also a prephase therapy with VitD and a supplementation of VitD during the intere period of immunochemotherapy according to a prefixed schedule. Choice of type of immunochemotherapy will not rely on Comprehensive Geriatric Assessment result, but treatment at reduced doses with R-miniCHOP is highly recommended option for UNFIT and FRAIL patients.
Read the detailed description
After the patient signs the written informed consent the patient will enter the screening phase planning baseline assessments and will be randomly allocated with a 1 to 1 ratio to Arm A (Standard arm) or Arm B (Experimental arm).
Patients randomized to Arm A will receive a prephase with oral prednisone (50 mg for 7 days [day -6 to day 0]) followed by 6 courses of R-CHOP or R-miniCHOP every 21 days.
If patients randomized to arm A are already on VitD, they are allowed to continue receiving VitD supplementation at a dose that can be considered part of the standard of care and does not exceed the maximum standard VitD dose recommended for general adult and elderly population , up to 10,000 U/week VitD .
If clinically indicated at treating physician judgement, patients could receive 1 mg of vincristine on the first day of prephase ; in this case vincristine administration in cycle 1 of immunochemotherapy should be skipped, in patients receiving R-miniCHOP; reduced to 1 mg, in patients receiving R-CHOP.
Patients randomized to Arm B will receive a prephase with oral prednisone and a prephase therapy with VitD according to the below reported schedule followed by 6 courses of R-CHOP or R-miniCHOP every 21 days.
Schedule for VitD (Cholecalciferol) supplementation: 25,000 U/day starting on day -6:
daily loading dose for 7 days if 25 VitD baseline level 20-40 ng/ml daily loading dose for 14 days if 25 VitD baseline level < 20 ng/ml followed by weekly maintenance supplementation of 25,000 U for the entire duration of immunochemotherapy (6 courses every 21 days - 18 weeks), regardless of the baseline level of 25 VitD.
If clinically indicated at treating physician judgement, patients could receive 1 mg of vincristine on the first day of prephase (DAY -6); in this case vincristine administration in cycle 1 of immunochemotherapy should be: skipped, in patients receiving R-miniCHOP; reduced to 1 mg, in patients receiving R-CHOP.
Patients with 25(OH)VitD levels <30 ng/ml on d1 cycle 2 will receive and additional loading phase of Cholecalciferol 25,000 U/day for 7 days and then 25,000 U once weekly for the duration of immunochemotherapy.
Patients may continue with VitD supplementation after the end of the immunochemotherapy at a (reduced) standard dose of 25,000 U once a month for up to 2 years from end of immunochemotherapy.
Patients experimenting toxicity leading to a delay in treatment administration > 4 weeks will discontinue study treatment and will be addressed to a salvage treatment: these patients will be followed-up for survival until the end of the study.
Consolidation radiotherapy:
- Conditions
- Diffuse Large B-Cell Lymphoma, Elderly Patients
- Being tested
- Vitamin D3 (Cholecalciferol), RCHOP o R-miniCHOP at standard doses
- Keywords
- Vitamin D, prednisone +/- Vitamin D supplementation, randomized, open label, phase III
- Medical subject headings
- Lymphoma, Large B-Cell, Diffuse
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Vitamin D3 (Cholecalciferol)Drug
patients in the Experimental arm (Arm B) will receive also a prephase therapy with VitD and a supplementation of VitD during the intere period of immunochemotherapy according to a prefixed schedule. Choice of type of immunochemotherapy will not rely on Comprehensive Geriatric Assessment (CGA) result, but treatment at reduced doses with R-miniCHOP is highly recommended option for UNFIT and FRAIL patients.
RCHOP o R-miniCHOP at standard dosesDrug
Patients on both arms receive pre-treatment with prednisone oral before 6 cycles of 21 days each of immunochemotherapy with RCHOP
- R-miniCHOP at standard doses
| Study group | Role | What they receive |
|---|---|---|
| Arm B (Experimental): | Experimental | Patients randomized to Arm B will receive a prephase with oral prednisone and a prephase therapy with VitD according to the below reported schedule followed by 6 courses of R-CHOP or R-miniCHOP every 21 days.
Schedule for VitD supplementation: 25,000 U/day starting on day -6:
daily loading dose for 7 days if 25 VitD baseline level 20-40 ng/ml daily loading dose for 14 days if 25 VitD baseline level < 20 ng/ml followed by weekly maintenance supplementation of 25,000 U for the entire duration of immunochemotherapy (6 courses every 21 days - 18 weeks), regardless of the baseline level of 25 VitD. Receives: Drug: Vitamin D3 (Cholecalciferol); Drug: RCHOP o R-miniCHOP at standard doses |
| Arm A (Standard arm) | Other | Patients randomized to Arm A will receive a prephase with oral prednisone followed by 6 courses of R-CHOP or R-miniCHOP every 21 days.
If patients randomized to arm A are already on VitD, they are allowed to continue receiving VitD supplementation at a dose that can be considered part of the standard of care and does not exceed the maximum standard VitD dose recommended for general adult and elderly population , up to 10,000 U/week VitD Receives: Drug: RCHOP o R-miniCHOP at standard doses |
What is being measured
The primary outcome is the main question the study is designed to answer.
Progression-Free Survival
Progression-Free Survival
Measured: at the end of treatment - 54 months
Secondary outcomes (8)
Overall Survival
Overall Survival
Measured: at the end of treatment - 54 months
Event Free Survival
Event Free Survival (EFS)
Measured: at the end of treatment - 54 months
Response rate
Response rate
Measured: at the end of treatment - 54 months
Early death rate
Early death rate
Measured: at the end of treatment - 54 months
Rate of ECOG changes after prephase
Rate of ECOG changes after prephase
Measured: at the end of treatment - 54 months
Rate of patients who maintain 25(OH)VitD levels
Rate of patients who maintain 25(OH)VitD levels
Measured: At the beginning of Cycle 2 (each cycle is 21 days)
Rate of 25(OH)VitD correction (VitD supplementation arm)
Rate of 25(OH)VitD correction (VitD supplementation arm)
Measured: At the beginning of Cycle 2 (each cycle is 21 days)
time-to-deterioration physical functioning and fatigue
time-to-deterioration physical functioning and fatigue
Measured: At the beginning of Cycle 2 (each cycle is 21 days)
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted22 Jun 2020
- Study start23 Mar 2021
- Primary completion1 Sep 2025 (estimated)
- Study completion1 Sep 2030 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Diffuse Large B-Cell LymphomaStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
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
- Model description
- This is an open-label, multicenter, randomized phase III trial. The study plans to randomize patients with a 1 to 1 ratio to Arm A (Standard arm) or Arm B (Experimental arm). All patients of both arms will receive a prephase with oral prednisone before 6 cycles Q21 of immunochemotherapy with R-CHOP or R-miniCHOP at standard doses; patients in the Experimental arm (Arm B) will receive also a prephase therapy with VitD and a supplementation of VitD during the intere period of immunochemotherapy according to a prefixed schedule. Choice of type of immunochemotherapy will not rely on Comprehensive Geriatric Assessment result, but treatment at reduced doses with R-miniCHOP is highly recommended option for UNFIT and FRAIL patients.
- Masking
- None (open label)
- Enrolment
- 430 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Fondazione Italiana Linfomi - ETS
- Sponsor type
- University, hospital or other
- Collaborators
- GRADE Onlus
- Responsible party
- Sponsor
- Investigators
- Francesco Merli, Dott., Principal investigator, Reggio Emilia - Azienda Unitа Sanitaria Locale-IRCCS
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04442412
- Sponsor's protocol ID
- FIL_PREVID
- Acronym
- FIL_PREVID
- Status last verified
- Aug 2022
- First submitted
- 26 May 2020
- Last updated
- 26 Aug 2022
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- Yes
- FDA-regulated device
- No
- Individual data sharing
- No: This is an open-label, multicenter, randomized phase III trial. The study plans to randomize patients with a 1:1 ratio to Arm A (Standard arm) or Arm B (Experimental arm). All patients of both arms will receive a prephase with oral prednisone before 6 cycles Q21 of immunochemotherapy with R-CHOP or R-miniCHOP at standard doses; patients in the Experimental arm (Arm B) will receive also a prephase therapy with VitD and a supplementation of VitD during the intere period of immunochemotherapy according to a prefixed schedule. Choice of type of immunochemotherapy will not rely on Comprehensive Geriatric Assessment (CGA) result, but treatment at reduced doses with R-miniCHOP is highly recommended option for UNFIT and FRAIL patients.
Study at a glance
From the registry record, last updated by the sponsor on 26 Aug 2022. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Prephase Treatment With Prednisone +/- Vitamin D Supplementation Followed by Immunochemotherapy in Elderly Patients With Diffuse Large B-Cell Lymphoma (DLBCL) A Randomized, Open Label, Phase III Study by Fondazione Italiana Linfomi.
- ClinicalTrials.gov ID
- NCT04442412
- Acronym / sponsor ID
- FIL_PREVID / FIL_PREVID
- Conditions
- Diffuse Large B-Cell Lymphoma, Elderly Patients
- Keywords
- Vitamin D, prednisone +/- Vitamin D supplementation, randomized, open label, phase III
- Phase
- Phase 3
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 430 participants (estimated)
- Lead sponsor
- Fondazione Italiana Linfomi - ETSUniversity, hospital or other
- Collaborators
- GRADE Onlus
- Study start
- 23 Mar 2021 (actual)
- Primary completion
- 1 Sep 2025 (estimated)
- Study completion
- 1 Sep 2030 (estimated)
- First posted
- 22 Jun 2020 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This is an open-label, multicenter, randomized phase III trial. The study plans to randomize patients with a 1 to 1 ratio to Arm A (Standard arm) or Arm B (Experimental arm).
All patients of both arms will receive a prephase with oral prednisone before 6 cycles Q21 of immunochemotherapy with R-CHOP or R-miniCHOP at standard doses; patients in the Experimental arm (Arm B) will receive also a prephase therapy with VitD and a supplementation of VitD during the intere period of immunochemotherapy according to a prefixed schedule. Choice of type of immunochemotherapy will not rely on Comprehensive Geriatric Assessment result, but treatment at reduced doses with R-miniCHOP is highly recommended option for UNFIT and FRAIL patients.
Detailed description
After the patient signs the written informed consent the patient will enter the screening phase planning baseline assessments and will be randomly allocated with a 1 to 1 ratio to Arm A (Standard arm) or Arm B (Experimental arm).
Patients randomized to Arm A will receive a prephase with oral prednisone (50 mg for 7 days [day -6 to day 0]) followed by 6 courses of R-CHOP or R-miniCHOP every 21 days.
If patients randomized to arm A are already on VitD, they are allowed to continue receiving VitD supplementation at a dose that can be considered part of the standard of care and does not exceed the maximum standard VitD dose recommended for general adult and elderly population , up to 10,000 U/week VitD .
If clinically indicated at treating physician judgement, patients could receive 1 mg of vincristine on the first day of prephase ; in this case vincristine administration in cycle 1 of immunochemotherapy should be skipped, in patients receiving R-miniCHOP; reduced to 1 mg, in patients receiving R-CHOP.
Patients randomized to Arm B will receive a prephase with oral prednisone and a prephase therapy with VitD according to the below reported schedule followed by 6 courses of R-CHOP or R-miniCHOP every 21 days.
Schedule for VitD (Cholecalciferol) supplementation: 25,000 U/day starting on day -6:
daily loading dose for 7 days if 25 VitD baseline level 20-40 ng/ml daily loading dose for 14 days if 25 VitD baseline level < 20 ng/ml followed by weekly maintenance supplementation of 25,000 U for the entire duration of immunochemotherapy (6 courses every 21 days - 18 weeks), regardless of the baseline level of 25 VitD.
If clinically indicated at treating physician judgement, patients could receive 1 mg of vincristine on the first day of prephase (DAY -6); in this case vincristine administration in cycle 1 of immunochemotherapy should be: skipped, in patients receiving R-miniCHOP; reduced to 1 mg, in patients receiving R-CHOP.
Patients with 25(OH)VitD levels <30 ng/ml on d1 cycle 2 will receive and additional loading phase of Cholecalciferol 25,000 U/day for 7 days and then 25,000 U once weekly for the duration of immunochemotherapy.
Patients may continue with VitD supplementation after the end of the immunochemotherapy at a (reduced) standard dose of 25,000 U once a month for up to 2 years from end of immunochemotherapy.
Patients experimenting toxicity leading to a delay in treatment administration > 4 weeks will discontinue study treatment and will be addressed to a salvage treatment: these patients will be followed-up for survival until the end of the study.
Consolidation radiotherapy:
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
- Model description
- This is an open-label, multicenter, randomized phase III trial. The study plans to randomize patients with a 1 to 1 ratio to Arm A (Standard arm) or Arm B (Experimental arm). All patients of both arms will receive a prephase with oral prednisone before 6 cycles Q21 of immunochemotherapy with R-CHOP or R-miniCHOP at standard doses; patients in the Experimental arm (Arm B) will receive also a prephase therapy with VitD and a supplementation of VitD during the intere period of immunochemotherapy according to a prefixed schedule. Choice of type of immunochemotherapy will not rely on Comprehensive Geriatric Assessment result, but treatment at reduced doses with R-miniCHOP is highly recommended option for UNFIT and FRAIL patients.
| Arm | Type | Receives |
|---|---|---|
| Arm B (Experimental): | Experimental | Drug: Vitamin D3 (Cholecalciferol), Drug: RCHOP o R-miniCHOP at standard dosesPatients randomized to Arm B will receive a prephase with oral prednisone and a prephase therapy with VitD according to the below reported schedule followed by 6 courses of R-CHOP or R-miniCHOP every 21 days. Schedule for VitD supplementation: 25,000 U/day starting on day -6: daily loading dose for 7 days if 25 VitD baseline level 20-40 ng/ml daily loading dose for 14 days if 25 VitD baseline level < 20 ng/ml followed by weekly maintenance supplementation of 25,000 U for the entire duration of immunochemotherapy (6 courses every 21 days - 18 weeks), regardless of the baseline level of 25 VitD. |
| Arm A (Standard arm) | Other | Drug: RCHOP o R-miniCHOP at standard dosesPatients randomized to Arm A will receive a prephase with oral prednisone followed by 6 courses of R-CHOP or R-miniCHOP every 21 days. If patients randomized to arm A are already on VitD, they are allowed to continue receiving VitD supplementation at a dose that can be considered part of the standard of care and does not exceed the maximum standard VitD dose recommended for general adult and elderly population , up to 10,000 U/week VitD |
Who may qualify
- Ages
- 65 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Older adult
Key inclusion criteria (21 listed)
- Histologically documented diagnosis of Diffuse Large B-cell Lymphoma or Follicular grade IIIb lymphoma, as defined in the 2017 edition of the World Health Organization (WHO) classification.
- Age ≥ 65 years
- Comprehensive Geriatric Assessment performed at baseline, before start of any treatment.
- Eastern Cooperative Oncology Group performance status (PS) ≤3
- Eligibility for anthracycline containing regimen (R-CHOP or R-miniCHOP)
Key exclusion criteria (11 listed)
- Histological diagnosis different from Diffuse large B-Cell Lymphoma or Follicular grade IIIb lymphoma, including diagnosis of HGBL, with rearrangement of MYC, BCL2 and/or BCL6 (double-hit)
- Use of VitD supplementation as standard of care at dose higher than 10,000 U/week
- Suspect or clinical evidence of CNS involvement by lymphoma
- Contraindication to the use of rituximab
- Contraindication to the use of VitD supplementation (Hypercalcemia/Hyperphosphatemia)
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Vitamin D3 (Cholecalciferol)patients in the Experimental arm (Arm B) will receive also a prephase therapy with VitD and a supplementation of VitD during the intere period of immunochemotherapy according to a prefixed schedule. Choice of type of immunochemotherapy will not rely on Comprehensive Geriatric Assessment (CGA) result, but treatment at reduced doses with R-miniCHOP is highly recommended option for UNFIT and FRAIL patients. | Drug | Arm B (Experimental): |
| RCHOP o R-miniCHOP at standard dosesPatients on both arms receive pre-treatment with prednisone oral before 6 cycles of 21 days each of immunochemotherapy with RCHOP o R-miniCHOP at standard doses | Drug | Arm A (Standard arm), Arm B (Experimental): |
Primary outcome
Progression-Free Survival
Time frame: at the end of treatment - 54 months
Progression-Free Survival
8 secondary outcomes
Overall Survival
Time frame: at the end of treatment - 54 months
Event Free Survival
Time frame: at the end of treatment - 54 months
Response rate
Time frame: at the end of treatment - 54 months
Early death rate
Time frame: at the end of treatment - 54 months
Rate of ECOG changes after prephase
Time frame: at the end of treatment - 54 months
Rate of patients who maintain 25(OH)VitD levels
Time frame: At the beginning of Cycle 2 (each cycle is 21 days)
Rate of 25(OH)VitD correction (VitD supplementation arm)
Time frame: At the beginning of Cycle 2 (each cycle is 21 days)
time-to-deterioration physical functioning and fatigue
Time frame: At the beginning of Cycle 2 (each cycle is 21 days)
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 26 Aug 2022.
- Individual participant dataSharing planned: No. This is an open-label, multicenter, randomized phase III trial. The study plans to randomize patients with a 1:1 ratio to Arm A (Standard arm) or Arm B (Experimental arm). All patients of both arms will receive a prephase with oral prednisone before 6 cycles Q21 of immunochemotherapy with R-CHOP or R-miniCHOP at standard doses; patients in the Experimental arm (Arm B) will receive also a prephase therapy with VitD and a supplementation of VitD during the intere period of immunochemotherapy according to a prefixed schedule. Choice of type of immunochemotherapy will not rely on Comprehensive Geriatric Assessment (CGA) result, but treatment at reduced doses with R-miniCHOP is highly recommended option for UNFIT and FRAIL patients.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Francesco Merli, Dott. principal investigator
Reggio Emilia - Azienda Unitа Sanitaria Locale-IRCCS
49 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 3 study testing Vitamin D3 (Cholecalciferol) and RCHOP o R-miniCHOP at standard doses in people with Diffuse Large B-Cell Lymphoma and Elderly Patients, run by Fondazione Italiana Linfomi - ETS at 49 sites in Italy.
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 21 inclusion and 11 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: looking for participants now, as of the sponsor's last update on 26 Aug 2022. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 49 sites in Italy. 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?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Lorenza Randi, Dott.ssa (0000000000, lrandi@filinf.it), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Progression-Free Survival (time frame: at the end of treatment - 54 months). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
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 26 Aug 2022.