Randomised phase III study on the effect of early intensification of rituximab in combination with two-weekly cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) chemotherapy followed by rituximab maintenance in elderly patients (66 to 80 years) with diffuse large B-cell lymphoma

ISRCTN ISRCTN82286322
DOI https://doi.org/10.1186/ISRCTN82286322
Secondary identifying numbers HO84
Submission date
23/08/2007
Registration date
23/08/2007
Last edited
07/10/2021
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Cancer
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English summary of protocol

Not provided at time of registration

Study website

Contact information

Dr P.J. Lugtenburg
Scientific

Erasmus Medical Centre
Afd. Hematologie
P.O. Box 2040
Rotterdam
3000 CA
Netherlands

Phone +31 (0)10 463 3123
Email p.lugtenburg@erasmusmc.nl

Study information

Study designMulticentre randomised active-controlled parallel-group trial
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)Hospital
Study typeTreatment
Scientific titleRandomised phase III study on the effect of early intensification of rituximab in combination with two-weekly cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) chemotherapy followed by rituximab maintenance in elderly patients (66 to 80 years) with diffuse large B-cell lymphoma
Study acronymHOVON 84 NHL
Study objectivesFirst randomisation:
The hypothesis to be tested is that the outcome in arm B (early intensification of rituximab combined with two weekly CHOP) is better than in arm A (no intensification of rituximab).

Second randomisation:
The hypothesis to be tested is that the outcome in arm 2 (maintenance treatment with Rituximab) is better than in arm 1 (no further treatment).
Ethics approval(s)Approved 25/05/2007, the METC of the Erasmus Medical Center in Rotterdam (Netherlands), ref: 2007-055
Health condition(s) or problem(s) studiedDiffuse large B-cell lymphoma
InterventionArm A: eight cycles of rituximab and cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP14) plus Granulocyte Colony-Stimulating Factor (G-CSF) pegfilgrastim (Neulasta)
Arm B: eight cycles of R-CHOP14 plus G-CSF pegfilgrastim (Neulasta) with intensification of rituximab (MabThera) during the first four cycles

Arm 1: no further treatment
Arm 2: maintenance treatment with rituximab (MabThera) once every eight weeks until relapse (for a maximum period of 24 months)
Intervention typeDrug
Pharmaceutical study type(s)
PhasePhase III
Drug / device / biological / vaccine name(s)Rituximab and cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP)
Primary outcome measureFirst randomisation:
Response rate (complete remission and 18-fluoro-2-deoxy-glucose-positron emission tomography [FDG-PET] negative partial remission or unconfirmed complete remission)

Second randomisation:
Failure free survival (measured from the date of second randomisation)

The protocol prescribes response evaluation during treatment after 4 and 8 cycles of R-CHOP and every 8 weeks during maintenance/observation. Thereafter follow up will be done every 6 months during the next 3 years and annually thereafter till 10 years after entry of the last patient. The total number of patients is expected to be recruited within 5 years. The analysis will be done approx 1 year after entry of the last patient.
Secondary outcome measuresFirst randomisation:
1. Failure free survival measured from the date of registration. Patients still alive or lost to follow up are censored at the last day they were known to be alive
2. Overall survival measured from the time of registration
3. Time to reach response
4. Toxicity

Second randomisation:
1. Overall survival
2. Toxicity

The protocol prescribes response evaluation during treatment after 4 and 8 cycles of R-CHOP and every 8 weeks during maintenance/observation. Thereafter follow up will be done every 6 months during the next 3 years and annually thereafter till 10 years after entry of the last patient. The total number of patients is expected to be recruited within 5 years. The analysis will be done approx 1 year after entry of the last patient.
Overall study start date01/08/2007
Completion date31/03/2012

Eligibility

Participant type(s)Patient
Age groupSenior
SexBoth
Target number of participants550
Total final enrolment600
Key inclusion criteria1. Patients with a confirmed histological diagnosis of Diffuse Large B-Cell Lymphoma (DLBCL) based upon a representative histology specimen according to the World Health Organisation (WHO) classification
2. DLBCL must be CD20 positive
3. Ann Arbor stages II - IV
4. Greater than or equal to 66 and less than or equal to 80 years
5. Age WHO performance status 0 to 2
6. Written informed consent
Key exclusion criteria1. Intolerance of exogenous protein administration
2. Severe cardiac dysfunction (New York Heart Association [NYHA] classification III - IV or Left Ventricular Ejection Fraction [LVEF] less than 45%). Congestive heart failure or symptomatic coronary artery disease or cardiac arrhythmias not well controlled with medication. Myocardial infarction during the last six months
3. Severe pulmonary dysfunction (vital capacity or diffusion capacity less than 50% of predicted value) unless clearly related to Non-Hodgkin lymphoma (NHL) involvement
4. Patients with uncontrolled asthma or allergy, requiring systemic steroid treatment
5. Significant hepatic dysfunction (total bilirubin greater than or equal to 30mmol/l or transaminases greater than or equal to 2.5 x upper normal limit), unless related to NHL
6. Significant renal dysfunction (serum creatinine greater than or equal to 150 umol/l or clearance less than or equal to 60 ml/min), unless related to NHL
7. Clinical signs of severe cerebral dysfunction
8. Suspected or documented central nervous system involvement by NHL
9. Patients with a history of uncontrolled seizures, central nervous system disorders or psychiatric disability judged by the investigator to be clinically significant and adversely affecting compliance to study drugs
10. Testicular DLBCL
11. Primary mediastinal B cell lymphoma
12. Transformed indolent lymphoma
13. Epstein Barr Virus (EBV) lymphoproliferative disorder
14. Secondary lymphoma after previous chemotherapy or radiotherapy
15. Major surgery, other than diagnostic surgery, within the last four weeks
16. Patients with active uncontrolled infections
17. Patients known to be Human Immunodeficiency Virus (HIV)-positive
18. Active chronic hepatitis B or C infection
19. Serious underlying medical conditions, which could impair the ability of the patient to participate in the trial (e.g. ongoing infection, uncontrolled diabetes mellitus, gastric ulcers, active autoimmune disease)
20. Life expectancy less than six months
21. Prior treatment with chemotherapy, radiotherapy or immunotherapy for this lymphoma, except a short course of prednisone (less than one week) and/or cyclophosphamide (less than one week and not in excess of 900 mg/m^2 cumulative) or local radiotherapy in order to control life threatening tumour related symptoms
22. History of active cancer during the past five years, except basal carcinoma of the skin or stage 0 cervical carcinoma
Date of first enrolment01/08/2007
Date of final enrolment31/03/2012

Locations

Countries of recruitment

  • Netherlands

Study participating centre

Erasmus Medical Centre
Rotterdam
3000 CA
Netherlands

Sponsor information

Dutch Haemato-Oncology Association (Stichting Hemato-Oncologie Volwassenen Nederland) (HOVON) (The Netherlands) - Data Centre
Research organisation

Erasmus Medical Centre
Daniel den Hoed Kliniek
P.O. Box 5201
Rotterdam
3008 AE
Netherlands

Phone +31 (0)10 439 1568
Email hdc@erasmusmc.nl
Website http://www.hovon.nl
ROR logo "ROR" https://ror.org/056kpdx27

Funders

Funder type

Industry

HOVON receives unrestricted grants and/or financial support from Amgen, Johnson & Johnson-Orthobiotech, Roche and Novartis for the execution of investigator sponsored trials. In addition HOVON is supported by the Dutch Cancer Society.

No information available

Results and Publications

Intention to publish date
Individual participant data (IPD) Intention to shareNo
IPD sharing plan summaryNot provided at time of registration
Publication and dissemination planNot provided at time of registration
IPD sharing plan

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Results article 30/07/2020 07/10/2021 Yes No

Editorial Notes

07/10/2021: Publication reference and total final enrolment added.