Assessment of Survival and Autonomy With Rituximab Plus Chemotherapy or Rituximab Plus Lenalidomide for Elderly Patients With Relapsed Diffuse Large B-cell Lymphoma

Summary

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma. Annual incidence increases with age and achieves more than 30 per 100 000 patients 65 years old or over.

Despite high response rates with conventional regimen as R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine and Prednisone), 30% to 40% of patients develop a relapse or a refractory disease, with a poor prognosis. There is no standard chemotherapy in second line for elderly patients, which are not eligible to receive a salvage treatment by high-dose therapy followed by autologous stem cell transplantation. The median progression-free-survival (PFS) is less than one year with the most commonly used regimens including R-Gemcitabine-Oxaliplatin (R-GEMOX) and R-Bendamustine. One the other side, Rituximab plus Lenalidomide, an immunomodulatory agent, is an active new therapeutic approach, with an efficacy proved in a phase II trial with a patients with a prolonged disease-free-survival of 32 months for responders in patients with a median age of 74 years old. This combination is also efficient in the ABC phenotype DLBCL which is more common in elderly patients.

For elderly patients, a management of the geriatric impairment together with lymphoma is required. Indeed, a comprehensive geriatric assessment detects frailty and vulnerability in elderly with a lymphoma and predicts severe treatment related toxicity, treatment settings and progression free survival. Moreover, geriatric intervention improved outcome, autonomy and quality of life. Functional status, assessed by Activities of patients Daily Living (ADL) is an independent predictive factor for feasibility of chemotherapy in elderly patients with cancer. The mini Data Set of DIALOG group is a new simplified geriatric assessment for oncologist.

Conditions

• Chemotherapy
• Diffuse Large B-Cell Lymphoma (DLBCL), Nos
• Elderly

Interventions

DRUG

Rituximab

patients ≥ 75 years old with relapsed Diffuse large B-cell lymphoma will be treated with classical Rituximab-based chemotherapy or Rituximab plus Lenalidomide.

DRUG

Lenalidomide 20 MG

patients ≥ 75 years old with relapsed Diffuse large B-cell lymphoma will be treated with Rituximab plus Lenalidomide. Four 28-days cycles of oral Lenalidomide (20 mg / d for 21 days) and Rituximab 375mg/m2 on day 1 and day 21. After this induction phase, patients achieving at least stable disease were given lenalidomide maintenance therapy (20 mg for 21 days) until progression

OTHER

Comprehensive Geriatric Assessment (CGA)

A comprehensive geriatric assessment (CGA) is recommended by the Société Internationale d'Onco Gériatrie (SIOG) in order to assess all geriatric facets (comorbidity, functional impairment, nutritional status, mental and psychological status, environment,…) on which treatment may impact.

OTHER

Activities of daily living (ADL) scale

Activities of daily living (ADL) comprise the basic actions that involve caring for one's self and body, including personal care, mobility, and eating. The Index ranks adequacy of performance in the six functions of bathing, dressing, toileting, transferring, continence, and feeding. Clients are scored yes/no for independence in each of the six functions. A score of 6 indicates full function, 4 indicates moderate impairment, and 2 or less indicates severe functional impairment.

Sponsors & Collaborators

• cimiez hospital Nice

  collaborator UNKNOWN

• Institut Bergonié

  collaborator OTHER

• groupe hospitalier public sud de l'oise

  collaborator UNKNOWN

• Henri Mondor University Hospital

  collaborator OTHER

• Centre Henri Becquerel

  collaborator OTHER

• Hôpital Charles Foix

  collaborator OTHER

• Saint-Louis Hospital, Paris, France

  collaborator OTHER

• Centre Hospitalier Universitaire, Amiens

  lead OTHER

Principal Investigators

• Frederic Peyrade, MD · Centre Antoine Lacassagne, Nice

• Boulhassass, MD · Hopital Cimiez NICE

• Soubeyran, Pr · Institut Bergonié Bordeaux

• Philippe Caillet, MD · Hôpital Henri Mondor, APHP CRETEIL

• Fabrice Jardin, MD · Centre Henri Becquerel, ROUEN

• Pascal Chaibi, MD · Hôpital Charles Foix, APHP IVRY/SEINE

• Catherine Thieblemont, MD · Hôpital Saint-louis, APHP, PARIS

• Damaj, MD · Centre Hospitalier Universitaire Caen

• Garidi, MD · Centre Hospitalier SAINT-QUENTIN

• Leduc, MD · Centre Hospitalier Abbeville

• Dennetière, MD · Centre Hospitalier COMPIEGNE

• Ivanoff, MD · Hôpital Avicenne, APHP BOBIGNY

• Isabelle Grulois, MD · CH Saint Malo

• Margot Robles, MD · CH Périgueux

• Caroline DELETTE, PhD · CHU Amiens Picardie

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

75 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2021-07-26

Primary Completion

2024-12-31

Completion

2024-12-31

Countries

• France

Study Locations