Trial Outcomes & Findings for Modified VR-CAP and Acalabrutinib as First Line Therapy for the Treatment of Transplant-Eligible Patients With Mantle Cell Lymphoma (NCT NCT04626791)

NCT ID: NCT04626791

Last Updated: 2026-07-22

Results Overview

Measured according to Lugano criteria. A success is defined as a CMR as the objective status at the end of treatment. The proportion of successes will be estimated by the number of successes divided by the total number of evaluable patients. 95% confidence intervals for the true success proportion will be calculated according to the approach of Duffy and Santner.

Recruitment status

ACTIVE_NOT_RECRUITING

Study phase

PHASE2

Target enrollment

41 participants

Primary outcome timeframe

29 months

Results posted on

2026-07-22

Participant Flow

Participant milestones

Participant milestones
Measure
Treatment (Modified VR-CAP, Acalabrutinib)
CYCLES 1, 3, AND 5: Patients receive acalabrutinib PO BID on days 1-21. Patients also receive bortezomib SC on days 1, 8, and 15, rituximab (or rituximab and hyaluronidase human) IV, cyclophosphamide IV, and doxorubicin hydrochloride IV on day 1, and prednisone PO on days 1-5. \> \> CYCLES 2, 4, AND 6: Patients receive acalabrutinib PO BID on days 1-21. Patients also receive rituximab (or rituximab and hyaluronidase human) IV on day 1 and cytarabine IV on days 1-2. \> \> Treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity.\> \> Acalabrutinib: Given PO\> \> Bortezomib: Given SC\> \> Cyclophosphamide: Given IV\> \> Cytarabine: Given IV\> \> Doxorubicin Hydrochloride: Given IV\> \> Prednisone: Given PO\> \> Rituximab: Given IV\> \> Rituximab and Hyaluronidase Human: Given IV
Overall Study
STARTED
41
Overall Study
COMPLETED
39
Overall Study
NOT COMPLETED
2

Reasons for withdrawal

Reasons for withdrawal
Measure
Treatment (Modified VR-CAP, Acalabrutinib)
CYCLES 1, 3, AND 5: Patients receive acalabrutinib PO BID on days 1-21. Patients also receive bortezomib SC on days 1, 8, and 15, rituximab (or rituximab and hyaluronidase human) IV, cyclophosphamide IV, and doxorubicin hydrochloride IV on day 1, and prednisone PO on days 1-5. \> \> CYCLES 2, 4, AND 6: Patients receive acalabrutinib PO BID on days 1-21. Patients also receive rituximab (or rituximab and hyaluronidase human) IV on day 1 and cytarabine IV on days 1-2. \> \> Treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity.\> \> Acalabrutinib: Given PO\> \> Bortezomib: Given SC\> \> Cyclophosphamide: Given IV\> \> Cytarabine: Given IV\> \> Doxorubicin Hydrochloride: Given IV\> \> Prednisone: Given PO\> \> Rituximab: Given IV\> \> Rituximab and Hyaluronidase Human: Given IV
Overall Study
Adverse Event
2

Baseline Characteristics

Modified VR-CAP and Acalabrutinib as First Line Therapy for the Treatment of Transplant-Eligible Patients With Mantle Cell Lymphoma

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Treatment (Modified VR-CAP, Acalabrutinib)
n=41 Participants
CYCLES 1, 3, AND 5: Patients receive acalabrutinib PO BID on days 1-21. Patients also receive bortezomib SC on days 1, 8, and 15, rituximab (or rituximab and hyaluronidase human) IV, cyclophosphamide IV, and doxorubicin hydrochloride IV on day 1, and prednisone PO on days 1-5. \> \> CYCLES 2, 4, AND 6: Patients receive acalabrutinib PO BID on days 1-21. Patients also receive rituximab (or rituximab and hyaluronidase human) IV on day 1 and cytarabine IV on days 1-2. \> \> Treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity.\> \> Acalabrutinib: Given PO\> \> Bortezomib: Given SC\> \> Cyclophosphamide: Given IV\> \> Cytarabine: Given IV\> \> Doxorubicin Hydrochloride: Given IV\> \> Prednisone: Given PO\> \> Rituximab: Given IV\> \> Rituximab and Hyaluronidase Human: Given IV
Age, Continuous
60.9 years
STANDARD_DEVIATION 7.50 • n=9 Participants
Sex: Female, Male
Female
9 Participants
n=9 Participants
Sex: Female, Male
Male
32 Participants
n=9 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
4 Participants
n=9 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
35 Participants
n=9 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
2 Participants
n=9 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
n=9 Participants
Race (NIH/OMB)
Asian
1 Participants
n=9 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
1 Participants
n=9 Participants
Race (NIH/OMB)
Black or African American
3 Participants
n=9 Participants
Race (NIH/OMB)
White
35 Participants
n=9 Participants
Race (NIH/OMB)
More than one race
0 Participants
n=9 Participants
Race (NIH/OMB)
Unknown or Not Reported
1 Participants
n=9 Participants
Region of Enrollment
United States
41 participants
n=9 Participants
ECOG Performance Status
0
20 Participants
n=9 Participants
ECOG Performance Status
1
20 Participants
n=9 Participants
ECOG Performance Status
2
1 Participants
n=9 Participants

PRIMARY outcome

Timeframe: 29 months

Measured according to Lugano criteria. A success is defined as a CMR as the objective status at the end of treatment. The proportion of successes will be estimated by the number of successes divided by the total number of evaluable patients. 95% confidence intervals for the true success proportion will be calculated according to the approach of Duffy and Santner.

Outcome measures

Outcome measures
Measure
Treatment (Modified VR-CAP, Acalabrutinib)
n=41 Participants
CYCLES 1, 3, AND 5: Patients receive acalabrutinib PO BID on days 1-21. Patients also receive bortezomib SC on days 1, 8, and 15, rituximab (or rituximab and hyaluronidase human) IV, cyclophosphamide IV, and doxorubicin hydrochloride IV on day 1, and prednisone PO on days 1-5. \> \> CYCLES 2, 4, AND 6: Patients receive acalabrutinib PO BID on days 1-21. Patients also receive rituximab (or rituximab and hyaluronidase human) IV on day 1 and cytarabine IV on days 1-2. \> \> Treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity.\> \> Acalabrutinib: Given PO\> \> Bortezomib: Given SC\> \> Cyclophosphamide: Given IV\> \> Cytarabine: Given IV\> \> Doxorubicin Hydrochloride: Given IV\> \> Prednisone: Given PO\> \> Rituximab: Given IV\> \> Rituximab and Hyaluronidase Human: Given IV
Proportion of Complete Responses to Therapy (Complete Metabolic Response [CMR])
90.2 percentage of participants
Interval 83.3 to 99.1

SECONDARY outcome

Timeframe: 29 months

The maximum grade for each type of adverse event will be recorded for each patient, and frequency tables will be reviewed to determine patterns. Additionally, the relationship of the adverse event(s) to the study treatment will be reported.

Outcome measures

Outcome measures
Measure
Treatment (Modified VR-CAP, Acalabrutinib)
n=41 Participants
CYCLES 1, 3, AND 5: Patients receive acalabrutinib PO BID on days 1-21. Patients also receive bortezomib SC on days 1, 8, and 15, rituximab (or rituximab and hyaluronidase human) IV, cyclophosphamide IV, and doxorubicin hydrochloride IV on day 1, and prednisone PO on days 1-5. \> \> CYCLES 2, 4, AND 6: Patients receive acalabrutinib PO BID on days 1-21. Patients also receive rituximab (or rituximab and hyaluronidase human) IV on day 1 and cytarabine IV on days 1-2. \> \> Treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity.\> \> Acalabrutinib: Given PO\> \> Bortezomib: Given SC\> \> Cyclophosphamide: Given IV\> \> Cytarabine: Given IV\> \> Doxorubicin Hydrochloride: Given IV\> \> Prednisone: Given PO\> \> Rituximab: Given IV\> \> Rituximab and Hyaluronidase Human: Given IV
Number of Patients Experiencing at Least One Grade 3 or Greater Adverse Event
33 Participants

SECONDARY outcome

Timeframe: 15 months

The proportion of patients alive and progression free with 95% CI will be estimated using the method of Kaplan-Meier.

Outcome measures

Outcome measures
Measure
Treatment (Modified VR-CAP, Acalabrutinib)
n=41 Participants
CYCLES 1, 3, AND 5: Patients receive acalabrutinib PO BID on days 1-21. Patients also receive bortezomib SC on days 1, 8, and 15, rituximab (or rituximab and hyaluronidase human) IV, cyclophosphamide IV, and doxorubicin hydrochloride IV on day 1, and prednisone PO on days 1-5. \> \> CYCLES 2, 4, AND 6: Patients receive acalabrutinib PO BID on days 1-21. Patients also receive rituximab (or rituximab and hyaluronidase human) IV on day 1 and cytarabine IV on days 1-2. \> \> Treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity.\> \> Acalabrutinib: Given PO\> \> Bortezomib: Given SC\> \> Cyclophosphamide: Given IV\> \> Cytarabine: Given IV\> \> Doxorubicin Hydrochloride: Given IV\> \> Prednisone: Given PO\> \> Rituximab: Given IV\> \> Rituximab and Hyaluronidase Human: Given IV
Progression-free Survival
87.5 percentage of participants
Interval 75.2 to 100.0

SECONDARY outcome

Timeframe: 18 months

The proportion of participants alive and 95% CI will be estimated using the method of Kaplan-Meier.

Outcome measures

Outcome measures
Measure
Treatment (Modified VR-CAP, Acalabrutinib)
n=41 Participants
CYCLES 1, 3, AND 5: Patients receive acalabrutinib PO BID on days 1-21. Patients also receive bortezomib SC on days 1, 8, and 15, rituximab (or rituximab and hyaluronidase human) IV, cyclophosphamide IV, and doxorubicin hydrochloride IV on day 1, and prednisone PO on days 1-5. \> \> CYCLES 2, 4, AND 6: Patients receive acalabrutinib PO BID on days 1-21. Patients also receive rituximab (or rituximab and hyaluronidase human) IV on day 1 and cytarabine IV on days 1-2. \> \> Treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity.\> \> Acalabrutinib: Given PO\> \> Bortezomib: Given SC\> \> Cyclophosphamide: Given IV\> \> Cytarabine: Given IV\> \> Doxorubicin Hydrochloride: Given IV\> \> Prednisone: Given PO\> \> Rituximab: Given IV\> \> Rituximab and Hyaluronidase Human: Given IV
Overall Survival
95.8 percentage of participants
Interval 88.1 to 100.0

SECONDARY outcome

Timeframe: 29 months

The proportion of patients successfully collecting at least 2 x 10\^6 CD34 cells/kg pt body weight will be calculated and reported.

Outcome measures

Outcome measures
Measure
Treatment (Modified VR-CAP, Acalabrutinib)
n=41 Participants
CYCLES 1, 3, AND 5: Patients receive acalabrutinib PO BID on days 1-21. Patients also receive bortezomib SC on days 1, 8, and 15, rituximab (or rituximab and hyaluronidase human) IV, cyclophosphamide IV, and doxorubicin hydrochloride IV on day 1, and prednisone PO on days 1-5. \> \> CYCLES 2, 4, AND 6: Patients receive acalabrutinib PO BID on days 1-21. Patients also receive rituximab (or rituximab and hyaluronidase human) IV on day 1 and cytarabine IV on days 1-2. \> \> Treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity.\> \> Acalabrutinib: Given PO\> \> Bortezomib: Given SC\> \> Cyclophosphamide: Given IV\> \> Cytarabine: Given IV\> \> Doxorubicin Hydrochloride: Given IV\> \> Prednisone: Given PO\> \> Rituximab: Given IV\> \> Rituximab and Hyaluronidase Human: Given IV
Feasibility of Stem Cell Collection
9 Participants

SECONDARY outcome

Timeframe: 29 months

Population: Only patients that proceeded to ASCT are included in analysis

The feasibility of stem cell collection will be determined by the proportion of patients successfully collecting at least 2 x 10\^6 CD34 cells/kg pt body weight divided by the total number of evaluable patients proceeding to ASCT.

Outcome measures

Outcome measures
Measure
Treatment (Modified VR-CAP, Acalabrutinib)
n=9 Participants
CYCLES 1, 3, AND 5: Patients receive acalabrutinib PO BID on days 1-21. Patients also receive bortezomib SC on days 1, 8, and 15, rituximab (or rituximab and hyaluronidase human) IV, cyclophosphamide IV, and doxorubicin hydrochloride IV on day 1, and prednisone PO on days 1-5. \> \> CYCLES 2, 4, AND 6: Patients receive acalabrutinib PO BID on days 1-21. Patients also receive rituximab (or rituximab and hyaluronidase human) IV on day 1 and cytarabine IV on days 1-2. \> \> Treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity.\> \> Acalabrutinib: Given PO\> \> Bortezomib: Given SC\> \> Cyclophosphamide: Given IV\> \> Cytarabine: Given IV\> \> Doxorubicin Hydrochloride: Given IV\> \> Prednisone: Given PO\> \> Rituximab: Given IV\> \> Rituximab and Hyaluronidase Human: Given IV
Successful Proceeding to Autologous Stem Cell Transplant (ASCT)
9 Participants

OTHER_PRE_SPECIFIED outcome

Timeframe: Up to completion of study treatment

Measured by sequencing. MRD results will be reported descriptively, and explored for correlation with clinical factors and patient outcomes.

Outcome measures

Outcome data not reported

OTHER_PRE_SPECIFIED outcome

Timeframe: Up to completion of study treatment

Measured by flow. MRD results will be reported descriptively, and explored for correlation with clinical factors and patient outcomes.

Outcome measures

Outcome data not reported

Adverse Events

Treatment (Modified VR-CAP, Acalabrutinib)

Serious events: 7 serious events
Other events: 41 other events
Deaths: 2 deaths

Serious adverse events

Serious adverse events
Measure
Treatment (Modified VR-CAP, Acalabrutinib)
n=41 participants at risk
Rituximab and Hyaluronidase Human: Given IV
Blood and lymphatic system disorders
Anemia
2.4%
1/41 • Number of events 1 • 29 months
Blood and lymphatic system disorders
Blood and lymph sys disorders - Oth Spec
2.4%
1/41 • Number of events 1 • 29 months
Blood and lymphatic system disorders
Febrile neutropenia
9.8%
4/41 • Number of events 4 • 29 months
Cardiac disorders
Atrial fibrillation
2.4%
1/41 • Number of events 2 • 29 months
Cardiac disorders
Cardiac arrest
2.4%
1/41 • Number of events 1 • 29 months
Gastrointestinal disorders
Gastric hemorrhage
2.4%
1/41 • Number of events 1 • 29 months
Gastrointestinal disorders
Small intestinal obstruction
2.4%
1/41 • Number of events 1 • 29 months
Infections and infestations
Lung infection
2.4%
1/41 • Number of events 1 • 29 months
Infections and infestations
Sepsis
2.4%
1/41 • Number of events 1 • 29 months
Investigations
Platelet count decreased
2.4%
1/41 • Number of events 1 • 29 months
Metabolism and nutrition disorders
Hyperkalemia
2.4%
1/41 • Number of events 1 • 29 months
Nervous system disorders
Dizziness
2.4%
1/41 • Number of events 2 • 29 months
Respiratory, thoracic and mediastinal disorders
Cough
2.4%
1/41 • Number of events 1 • 29 months
Respiratory, thoracic and mediastinal disorders
Dyspnea
2.4%
1/41 • Number of events 1 • 29 months
Respiratory, thoracic and mediastinal disorders
Pleural effusion
2.4%
1/41 • Number of events 1 • 29 months

Other adverse events

Other adverse events
Measure
Treatment (Modified VR-CAP, Acalabrutinib)
n=41 participants at risk
Rituximab and Hyaluronidase Human: Given IV
Nervous system disorders
Peripheral sensory neuropathy
19.5%
8/41 • Number of events 26 • 29 months
Nervous system disorders
Presyncope
2.4%
1/41 • Number of events 1 • 29 months
Nervous system disorders
Syncope
2.4%
1/41 • Number of events 1 • 29 months
Nervous system disorders
Vasovagal reaction
4.9%
2/41 • Number of events 2 • 29 months
Psychiatric disorders
Anxiety
2.4%
1/41 • Number of events 2 • 29 months
Psychiatric disorders
Insomnia
4.9%
2/41 • Number of events 7 • 29 months
Reproductive system and breast disorders
Vaginal dryness
2.4%
1/41 • Number of events 2 • 29 months
Respiratory, thoracic and mediastinal disorders
Cough
7.3%
3/41 • Number of events 4 • 29 months
Respiratory, thoracic and mediastinal disorders
Dyspnea
7.3%
3/41 • Number of events 3 • 29 months
Respiratory, thoracic and mediastinal disorders
Epistaxis
2.4%
1/41 • Number of events 1 • 29 months
Respiratory, thoracic and mediastinal disorders
Sore throat
4.9%
2/41 • Number of events 3 • 29 months
Skin and subcutaneous tissue disorders
Alopecia
7.3%
3/41 • Number of events 5 • 29 months
Skin and subcutaneous tissue disorders
Pruritus
2.4%
1/41 • Number of events 1 • 29 months
Skin and subcutaneous tissue disorders
Purpura
4.9%
2/41 • Number of events 3 • 29 months
Skin and subcutaneous tissue disorders
Rash maculo-papular
4.9%
2/41 • Number of events 3 • 29 months
Skin and subcutaneous tissue disorders
Skin and subcut tissue disord - Oth spec
2.4%
1/41 • Number of events 2 • 29 months
Skin and subcutaneous tissue disorders
Urticaria
2.4%
1/41 • Number of events 2 • 29 months
Vascular disorders
Flushing
2.4%
1/41 • Number of events 3 • 29 months
Blood and lymphatic system disorders
Anemia
39.0%
16/41 • Number of events 26 • 29 months
Blood and lymphatic system disorders
Febrile neutropenia
2.4%
1/41 • Number of events 1 • 29 months
Blood and lymphatic system disorders
Leukocytosis
2.4%
1/41 • Number of events 1 • 29 months
Cardiac disorders
Atrial fibrillation
2.4%
1/41 • Number of events 1 • 29 months
Cardiac disorders
Palpitations
2.4%
1/41 • Number of events 1 • 29 months
Cardiac disorders
Sinus tachycardia
2.4%
1/41 • Number of events 1 • 29 months
Gastrointestinal disorders
Abdominal pain
2.4%
1/41 • Number of events 1 • 29 months
Gastrointestinal disorders
Bloating
2.4%
1/41 • Number of events 1 • 29 months
Gastrointestinal disorders
Constipation
4.9%
2/41 • Number of events 3 • 29 months
Gastrointestinal disorders
Diarrhea
4.9%
2/41 • Number of events 2 • 29 months
Gastrointestinal disorders
Dry mouth
2.4%
1/41 • Number of events 1 • 29 months
Gastrointestinal disorders
Duodenal ulcer
2.4%
1/41 • Number of events 1 • 29 months
Gastrointestinal disorders
Mucositis oral
4.9%
2/41 • Number of events 2 • 29 months
Gastrointestinal disorders
Nausea
19.5%
8/41 • Number of events 14 • 29 months
Gastrointestinal disorders
Vomiting
9.8%
4/41 • Number of events 4 • 29 months
General disorders and administration site conditions
Fatigue
7.3%
3/41 • Number of events 8 • 29 months
General disorders and administration site conditions
Fever
2.4%
1/41 • Number of events 1 • 29 months
General disorders and administration site conditions
Flu like symptoms
2.4%
1/41 • Number of events 1 • 29 months
General disorders and administration site conditions
Injection site reaction
4.9%
2/41 • Number of events 3 • 29 months
Infections and infestations
Conjunctivitis
2.4%
1/41 • Number of events 1 • 29 months
Infections and infestations
Conjunctivitis infective
2.4%
1/41 • Number of events 3 • 29 months
Infections and infestations
Infections and infestations - Oth spec
12.2%
5/41 • Number of events 8 • 29 months
Infections and infestations
Skin infection
2.4%
1/41 • Number of events 1 • 29 months
Infections and infestations
Thrush
9.8%
4/41 • Number of events 4 • 29 months
Injury, poisoning and procedural complications
Infusion related reaction
53.7%
22/41 • Number of events 32 • 29 months
Injury, poisoning and procedural complications
Inj, pois and proced complic - Oth spec
2.4%
1/41 • Number of events 2 • 29 months
Investigations
Alanine aminotransferase increased
4.9%
2/41 • Number of events 3 • 29 months
Investigations
Creatinine increased
2.4%
1/41 • Number of events 1 • 29 months
Investigations
Neutrophil count decreased
34.1%
14/41 • Number of events 20 • 29 months
Investigations
Platelet count decreased
70.7%
29/41 • Number of events 70 • 29 months
Investigations
Weight loss
7.3%
3/41 • Number of events 8 • 29 months
Investigations
White blood cell decreased
2.4%
1/41 • Number of events 2 • 29 months
Metabolism and nutrition disorders
Anorexia
4.9%
2/41 • Number of events 4 • 29 months
Metabolism and nutrition disorders
Hypokalemia
4.9%
2/41 • Number of events 2 • 29 months
Musculoskeletal and connective tissue disorders
Arthralgia
2.4%
1/41 • Number of events 1 • 29 months
Musculoskeletal and connective tissue disorders
Back pain
2.4%
1/41 • Number of events 6 • 29 months
Musculoskeletal and connective tissue disorders
Generalized muscle weakness
2.4%
1/41 • Number of events 1 • 29 months
Musculoskeletal and connective tissue disorders
Neck pain
2.4%
1/41 • Number of events 1 • 29 months
Musculoskeletal and connective tissue disorders
Osteonecrosis of jaw
2.4%
1/41 • Number of events 1 • 29 months
Nervous system disorders
Akathisia
2.4%
1/41 • Number of events 1 • 29 months
Nervous system disorders
Headache
17.1%
7/41 • Number of events 14 • 29 months

Additional Information

Stephen D. Smith M. D.

University of Washington/Fred Hutchinson Cancer Research Center

Phone: 507/538-7448

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place