Rituximab and Bendamustine Hydrochloride, Rituximab and Ibrutinib, or Ibrutinib Alone in Treating Older Patients With Previously Untreated Chronic Lymphocytic Leukemia
This randomized phase III trial studies rituximab with bendamustine hydrochloride or ibrutinib to see how well they work compared to ibrutinib alone in treating older patients with previously untreated chronic lymphocytic leukemia. Rituximab is a monoclonal antibody that may interfere with the ability of cancer cells to grow and spread. A monoclonal antibody is a type of protein that can bind to certain targets in the body, such as molecules that cause the body to make an immune response (antigens). Chemotherapy drugs, such as bendamustine hydrochloride, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Ibrutinib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. It is not yet known whether rituximab with bendamustine hydrochloride may work better than rituximab and ibrutinib or ibrutinib alone in treating chronic lymphocytic leukemia.
Eligibility
Sex
ALL
Min age
65 Years
Max age
—
Healthy volunteers
No
Inclusion Criteria:
* PRE-REGISTRATION (STEP 0)
* All patients are REQUIRED to be pre-registered to A041202 in order to submit peripheral blood to the Alliance Hematologic Malignancy Biorepository (HEME) for central Zap-70 methylation. This specimen submission is mandatory prior to registration as results will be used for stratification
* REGISTRATION (STEP 1)
* Patients must be diagnosed with CLL in accordance with International Workshop on Chronic Lymphocytic Leukemia (IWCLL) 2008 criteria that includes all of the following:
* \>= 5 x 10\^9 B lymphocytes (5000/uL) in the peripheral blood
* On morphologic review, the leukemic cells must be small mature lymphocytes, and prolymphocytes must not exceed 55% of the blood lymphocytes
* CLL cells on immunophenotype (performed locally) must reveal a clonal B-cell population, which express the B cell surface markers of CD19 and CD20, as well as the T-cell antigen CD5; patients with bright surface immunoglobulin expression or lack of CD23 expression in \> 10% of cells must lack t(11;14) translocation by interphase cytogenetics
* Patients must be intermediate or high-risk Rai stage CLL
* Intermediate risk (formerly Rai stage I/II) is defined by lymphocytosis plus enlarged lymph nodes at any site, with or without hepatomegaly or splenomegaly
* High risk (formerly Rai stage III/IV) is defined by lymphocytosis with or without enlarged nodes and spleen plus disease-related anemia (hemoglobin \< 11 g/dL) or thrombocytopenia (platelet count \< 100 x 10\^9/L) that is not attributable to autoimmune hemolytic anemia or thrombocytopenia
* Patients must meet criteria for treatment as defined by IWCLL 2008 guidelines which includes at least one of the following criteria:
* Evidence of marrow failure as manifested by the development or worsening of anemia or thrombocytopenia (not attributable to autoimmune hemolytic anemia or thrombocytopenia)
* Massive (\>= 6 cm below the costal margin), progressive or symptomatic splenomegaly
* Massive nodes (\>= 10 cm) or progressive or symptomatic lymphadenopathy
* Autoimmune anemia and/or thrombocytopenia that is poorly responsive to standard therapy
* Constitutional symptoms, which include any of the following:
* Unintentional weight loss of 10% or more within 6 months
* Significant fatigue
* Fevers \> 100.5 degrees F for 2 weeks or more without evidence of infection
* Night sweats \> 1 month without evidence of infection
* Prior treatment
* Patients must not have had prior therapy for CLL (except palliative steroids or treatment of autoimmune complications of CLL with rituximab or steroids)
* Treatment with rituximab and/or high dose corticosteroids for autoimmune complications of CLL must be complete at least 4 weeks prior to enrollment; palliative steroids must be at a dose not higher than 20 mg/day of prednisone or equivalent corticosteroid at the time of registration
* Age \>= 65 years
* Eastern Cooperative Oncology Group (ECOG) performance status 0-2
* Patients with active hepatitis B defined by hepatitis B surface antigen positivity or core antibody positivity in the presence of hepatitis B DNA are not eligible for this study; patients with a positive hepatitis B core antibody but with negative hepatitis B DNA may participate, but must have hepatitis serologies and hepatitis B DNA monitored periodically by the treating physician
* Intravenous immunoglobulin (IVIG) can cause a false positive hepatitis B serology; if patients receiving routine IVIG have core antibody or surface antigen positivity without evidence of active viremia (negative hepatitis B DNA) they may still participate in the study, but should have hepatitis serologies and hepatitis B DNA monitored periodically by the treating physician
* Patients must not be receiving active systemic anticoagulation with heparin or warfarin; patients must be off warfarin therapy for at least 30 days prior to enrollment
* Patients with class III or class IV heart failure by New York Heart Association, those with unstable angina, and those with uncontrolled arrhythmia are not eligible
* Patients who have had a myocardial infarction, intracranial bleed, or stroke within the past 6 months are not eligible
* Patients with known human immunodeficiency virus (HIV) are eligible if their CD4 count is \>= 350 cells/mm\^3 and if they are not taking prohibited CYP-interacting medications
* Patients must not have any history of Richter's transformation or prolymphocytic leukemia (prolymphocytes in blood \> 55%)
* Patients must not require more than 20 mg prednisone or equivalent corticosteroid daily
* Patients must not have uncontrolled active systemic infection requiring intravenous antibiotics
* Patients must not have continued requirement for therapy with a strong cytochrome P450 3A4/5 (CYP3A4/5) inhibitor or inducer
* Patients must not have a known allergy to mannitol
* Patients must not have prior significant hypersensitivity to rituximab (not including infusion reactions)
* Patients may not have had major surgery within 10 days of enrollment, or minor surgery within 7 days of enrollment; examples of minor surgery include dental surgery, insertion of a venous access device, skin biopsy, or aspiration of a joint; the decision about whether a surgery is major or minor can be made at the discretion of the treating physician
* Absolute neutrophil count (ANC) \>= 1,000/uL unless due to bone marrow involvement
* Aspartate aminotransferase (AST) or alanine aminotransferase (AST) =\< 2.5 x upper limits of normal except if due to disease infiltration of the liver
* Bilirubin =\< 1.5 x upper limits of normal (unless due to liver involvement, hemolysis, or Gilbert's disease)
* Creatinine clearance \>= 40 mL/min
* To be calculated by modified Cockcroft-Gault formula
* Platelet count (untransfused) \>= 30,000/uL
Primary outcome measure(s)
Progression Free Survival (PFS) — Time from study entry to the time of documented disease progression or death. The analysis was event driven, performed at 2.5 years after the last patient enrolled;up to 4 years. The Kaplan-Meier method will be used to estimate the progression free survival distributions for each arm, with median estimates provided. Progression is defined as any one of the following: an increase in number of blood lymphocytes by \>= 50% with \>= 5000 B lymphocytes/mL in patients on Arm A or those on Arms 2 or 3 no longer receiving ibrutinib, \>= 50% increase in the products of at least 2 lymph nodes on 2 consecutive determination 2 weeks apart, \>= 50% increase in the size of the liver/spleen, transformation to a more aggressive histology, progression of any cytopenia (i.e. decrease of Hb levels \> 2g/dL). Progression free survival time will be the time to either progression or death whichever occurs first.
Trial sites (937)
Facility
City
Region
Status
University of Alabama at Birmingham Cancer Center
Birmingham
Alabama
Anchorage Radiation Therapy Center
Anchorage
Alaska
Alaska Breast Care and Surgery LLC
Anchorage
Alaska
Alaska Oncology and Hematology LLC
Anchorage
Alaska
Alaska Regional Hospital
Anchorage
Alaska
Alaska Women's Cancer Care
Anchorage
Alaska
Anchorage Oncology Centre
Anchorage
Alaska
Katmai Oncology Group
Anchorage
Alaska
Providence Alaska Medical Center
Anchorage
Alaska
Mayo Clinic Hospital in Arizona
Phoenix
Arizona
Mayo Clinic in Arizona
Scottsdale
Arizona
Banner University Medical Center - Tucson
Tucson
Arizona
University of Arizona Cancer Center-North Campus
Tucson
Arizona
Onvida Health Yuma Medical Center
Yuma
Arizona
CHI Saint Vincent Cancer Center Hot Springs
Hot Springs
Arkansas
NEA Baptist Memorial Hospital and Fowler Family Cancer Center - Jonesboro
Jonesboro
Arkansas
Kaiser Permanente-Anaheim
Anaheim
California
Kaiser Permanente-Deer Valley Medical Center
Antioch
California
PCR Oncology
Arroyo Grande
California
Sutter Auburn Faith Hospital
Auburn
California
Sutter Cancer Centers Radiation Oncology Services-Auburn
Auburn
California
Kaiser Permanente-Baldwin Park
Baldwin Park
California
Kaiser Permanente-Bellflower
Bellflower
California
Alta Bates Summit Medical Center-Herrick Campus
Berkeley
California
Providence Saint Joseph Medical Center/Disney Family Cancer Center
Burbank
California
Mills-Peninsula Medical Center
Burlingame
California
Sutter Cancer Centers Radiation Oncology Services-Cameron Park
Cameron Park
California
John Muir Medical Center-Concord
Concord
California
Sutter Davis Hospital
Davis
California
City of Hope Comprehensive Cancer Center
Duarte
California
Kaiser Permanente-Fontana
Fontana
California
Kaiser Permanente-Fremont
Fremont
California
Kaiser Permanente-Fresno
Fresno
California
Marin Cancer Care Inc
Greenbrae
California
Marin General Hospital
Greenbrae
California
Kaiser Permanente South Bay
Harbor City
California
Kaiser Permanente-Irvine
Irvine
California
Kaiser Permanente Los Angeles Medical Center
Los Angeles
California
Kaiser Permanente West Los Angeles
Los Angeles
California
Cedars-Sinai Medical Center
Los Angeles
California
+ 897 more sites — see the full list on the official registry below.
This page summarises publicly available registry data for informational purposes — not medical advice. Eligibility is determined by each study team; patients should discuss participation with their clinician.
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