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    Clinical Trial Results:
    A Phase 3, Open-label, Multicenter, Randomized Study of Sequential Zevalin (ibritumomab tiuxetan) versus Observation in Patients at least 60 Years of Age with Newly Diagnosed Diffuse Large B-cell Lymphoma in PET-negative Complete Remission after R-CHOP or R-CHOP-like Therapy

    Summary
    EudraCT number
    2011-004916-51
    Trial protocol
    GB   IE   IT   ES   BE   PT   NL   AT   DE   FR  
    Global end of trial date
    23 Oct 2014

    Results information
    Results version number
    v1(current)
    This version publication date
    15 Aug 2020
    First version publication date
    15 Aug 2020
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    SPI-ZEV-11-301
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01510184
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Spectrum Pharmaceuticals, Inc.
    Sponsor organisation address
    157 Technology Drive, Irvine, United States,
    Public contact
    Phil Stevens, Acrotech Biopharma LLC., pstevens@acrotechbiopharma.com
    Scientific contact
    Phil Stevens, Acrotech Biopharma LLC., pstevens@acrotechbiopharma.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    24 Sep 2015
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    23 Oct 2014
    Was the trial ended prematurely?
    Yes
    General information about the trial
    Main objective of the trial
    Determine the efficacy and safety of the Zevalin study regimen compared to the 'Observation' arm in elderly patients in PET-negative complete response as defined by the Revised Response Criteria for Malignant Lymphoma, after first line R-CHOP or R-CHOP-like regimen.
    Protection of trial subjects
    This protocol was conducted in accordance with the applicable Good Clinical Practices (GCP) regulations and guidelines, and in compliance with the principles of the “Declaration of Helsinki” (as amended in Tokyo, Venice,Hong Kong, and South Africa), ICH guidelines, or with the laws and regulations of the country in which the research was conducted. An independent data monitoring committee (IDMC) was established for the purpose of reviewing patient safety and efficacy data. The IDMC was responsible for recommending whether the study should continue or stop early due to futility or safety concerns.
    Background therapy
    Standard of care R-CHOP chemotherapy administered to patients prior to enrolment in the protocol.
    Evidence for comparator
    Approximately 50-60% of patients presenting with DLBCL can be cured with a doxorubicin-based combination chemotherapy. Since the 1970s, CHOP has been the standard first-line therapy for patients with stage II-IV DLBCL. The CHOP regimen (cyclophosphamide 750 mg/m2, doxorubicin 50 mg/m2, vincristine 1.4 mg/m2 up to a maximum of 2 mg on day 1, and prednisone 40 mg/m2/day on days 1 to 5 every three weeks) is usually given for 6 or 8 cycles. Numerous studies have been performed during the last decades in an attempt to find chemotherapy regimens that are superior to CHOP alone. No alternative chemotherapeutic regimen has consistently shown improved results. The addition of rituximab, an anti-CD20 monoclonal antibody improved outcomes in DLBCL. Superior results have been shown in elderly patients with a standard CHOP regimen to which rituximab was added (R-CHOP) This multicenter, randomized, clinical trial showed for all patients (including non-responders) a median 2-year OS rate of 70% in the R-CHOP patients, compared with 57% in the CHOP arm. This study was the basis for the EU approval of rituximab (375 mg/m2) to be given in combination with standard CHOP in patients with DLBCL over 60 years of age. An update after a median follow-up of 5 years, demonstrated a relapse rate of 20% and a 5-year OS rate of 58% for the R-CHOP arm, which supports the concept that unrealized minimal residual disease exists in patients despite achieving a CR/CRu. In this study patients in the observation arm must have received 6 cycles of R-CHOP or R-CHOP-like treatment to be eligible.
    Actual start date of recruitment
    01 Jun 2012
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Portugal: 1
    Country: Number of subjects enrolled
    United Kingdom: 9
    Country: Number of subjects enrolled
    Belgium: 1
    Country: Number of subjects enrolled
    France: 4
    Country: Number of subjects enrolled
    Ireland: 5
    Country: Number of subjects enrolled
    Italy: 7
    Country: Number of subjects enrolled
    Australia: 2
    Country: Number of subjects enrolled
    United States: 43
    Country: Number of subjects enrolled
    Canada: 1
    Country: Number of subjects enrolled
    Israel: 6
    Worldwide total number of subjects
    79
    EEA total number of subjects
    27
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    0
    From 65 to 84 years
    77
    85 years and over
    2

    Subject disposition

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    Recruitment
    Recruitment details
    A total of 79 patients were recruited across 10 countries.

    Pre-assignment
    Screening details
    Patient eligibility during the trial was assessed according to the eligibility criteria within the current version of the protocol at the time the patient was enrolled.

    Pre-assignment period milestones
    Number of subjects started
    79
    Number of subjects completed
    79

    Period 1
    Period 1 title
    Overall study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Not blinded
    Blinding implementation details
    Not applicable

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Zevalin treated
    Arm description
    Patients receive rituximab on day 1 followed by rituximab on Days 7-9, and Y-90-Zevalin 4 hours later.
    Arm type
    Experimental

    Investigational medicinal product name
    Zevalin
    Investigational medicinal product code
    PRD17186
    Other name
    Pharmaceutical forms
    Kit for radiopharmaceutical preparation
    Routes of administration
    Intravenous use
    Dosage and administration details
    One administration of Zevalin on Day 7-9. Days 7-9: Rituximab 250 mg/m2 intravenous infusion, followed 4 hours later by Y-90-Zevalin 0.4 mCi/kg 10-minute intravenous push (0.3 mCi/kg in patients with a platelet count in 100,000/μL to 149,000/μL).

    Investigational medicinal product name
    Rituximab
    Investigational medicinal product code
    PRD00304MIG
    Other name
    Pharmaceutical forms
    Concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Single treatment on Day 1 and Day 7-9. Day 1: Rituximab 250 mg/m2 intravenous infusion. Days 7-9: Rituximab 250 mg/m2 intravenous infusion, followed 4 hours later by Y-90-Zevalin.

    Arm title
    Observation
    Arm description
    Patients receive standard of care treatment i.e. R-CHOP or R-CHOP like therapy.
    Arm type
    No intervention

    Investigational medicinal product name
    No investigational medicinal product assigned in this arm
    Number of subjects in period 1
    Zevalin treated Observation
    Started
    36
    43
    Completed
    0
    0
    Not completed
    36
    43
         Trial closure
    28
    28
         Disease progression
    1
    2
         Patient withdrawal
    1
    4
         Lost to follow-up
    -
    8
         Bone marrow positive for DLBCL after randomization
    -
    1
         Lost to follow-up
    6
    -

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Overall study (overall period)
    Reporting group description
    -

    Reporting group values
    Overall study (overall period) Total
    Number of subjects
    79 79
    Age categorical
    Units: Subjects
        In utero
    0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0
        Newborns (0-27 days)
    0 0
        Infants and toddlers (28 days-23 months)
    0 0
        Children (2-11 years)
    0 0
        Adolescents (12-17 years)
    0 0
        Adults (18-64 years)
    0 0
        From 65-84 years
    0 0
        85 years and over
    0 0
        Adults (59-85 years)
    79 79
    Age continuous
    Units: years
        median (full range (min-max))
    70 (59 to 85) -
    Gender categorical
    Units: Subjects
        Female
    42 42
        Male
    37 37
    Race
    Units: Subjects
        White
    73 73
        Asian
    1 1
        Black
    1 1
        Other
    2 2
        Unknown
    2 2
    Ethnicity
    Units: Subjects
        Not Hispanic or Latino
    73 73
        Hispanic or Latino
    4 4
        Not reported
    2 2
    ECOG
    Units: Subjects
        0-Fully active
    46 46
        1-Restricted
    31 31
        2-Ambulatory
    2 2

    End points

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    End points reporting groups
    Reporting group title
    Zevalin treated
    Reporting group description
    Patients receive rituximab on day 1 followed by rituximab on Days 7-9, and Y-90-Zevalin 4 hours later.

    Reporting group title
    Observation
    Reporting group description
    Patients receive standard of care treatment i.e. R-CHOP or R-CHOP like therapy.

    Primary: Overall survival

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    End point title
    Overall survival [1]
    End point description
    The analysis description was further differentiated into 'living patients' and 'patients who died' in both the Zevalin and Observation arms. The median Overall Survival for living patients treated with Zevalin (8.9 months) was numerically greater than for patients in the Observation group (6.1 months). This was also true for the one patient who died in the Zevalin group (16.8 months) and the two patients in the Observation group (5.8 months).
    End point type
    Primary
    End point timeframe
    Overall survival as defined by the time between date of randomisation and death of patient due to any cause
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Study terminated early for business reasons and the primary efficacy analysis could not be completed due to incomplete enrolment. All analysis was descriptive.
    End point values
    Zevalin treated Observation
    Number of subjects analysed
    36 [2]
    43 [3]
    Units: months
    median (full range (min-max))
        Living patients
    8.9 (2.7 to 22.6)
    6.6 (0.07 to 21.3)
        Patients who died
    16.8 (16.8 to 16.8)
    5.8 (1.9 to 9.7)
    Notes
    [2] - living patients = 35 + patients who died = 1
    [3] - living patients = 41 + patients who died = 2
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    From consent of the patient to Day 90 all adverse events were collected. From Day 91 only adverse events related to study treatment were collected.
    Adverse event reporting additional description
    Safety population was used in all analyses of safety. Safety data of patients who received any study treatment was compared to safety data of patients who received no study treatment.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    21
    Reporting groups
    Reporting group title
    Zevalin
    Reporting group description
    All randomized patients who received any element of Zevalin treatment including rituximab were classified in to the Zevalin treatment regimen arm.

    Reporting group title
    Observation
    Reporting group description
    Patients randomised to the observation arm who did not receive any further anti-lymphoma therapy unless they had a relapse of their disease

    Serious adverse events
    Zevalin Observation
    Total subjects affected by serious adverse events
         subjects affected / exposed
    8 / 36 (22.22%)
    3 / 43 (6.98%)
         number of deaths (all causes)
    0
    2
         number of deaths resulting from adverse events
    0
    2
    Investigations
    Platelet count decreased
         subjects affected / exposed
    2 / 36 (5.56%)
    0 / 43 (0.00%)
         occurrences causally related to treatment / all
    4 / 4
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Lymphocyte count decreased
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences causally related to treatment / all
    2 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vascular disorders
    Hypotension
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Embolism
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 43 (2.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    Syncope
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Depressed Level of Consciousness
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 43 (2.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Blood and lymphatic system disorders
    Neutropenia
         subjects affected / exposed
    4 / 36 (11.11%)
    1 / 43 (2.33%)
         occurrences causally related to treatment / all
    2 / 4
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Thrombocytopenia
         subjects affected / exposed
    2 / 36 (5.56%)
    0 / 43 (0.00%)
         occurrences causally related to treatment / all
    2 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Leukopenia
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Death
         subjects affected / exposed
    0 / 36 (0.00%)
    2 / 43 (4.65%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 2
    Infections and infestations
    Lung infection
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 1%
    Non-serious adverse events
    Zevalin Observation
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    21 / 36 (58.33%)
    14 / 43 (32.56%)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Seborrhoeic keratosis
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 43 (2.33%)
         occurrences all number
    0
    1
    Transitional cell carcinoma
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    1
    0
    Vascular disorders
    Hypotension
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    1
    0
    Flushing
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    1
    0
    Embolism
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 43 (2.33%)
         occurrences all number
    0
    1
    Haematoma
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 43 (2.33%)
         occurrences all number
    0
    1
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    10 / 36 (27.78%)
    2 / 43 (4.65%)
         occurrences all number
    15
    2
    Oedema
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    1
    0
    Oedema peripheral
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    1
    0
    Pain
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    1
    0
    Secretion discharge
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    1
    0
    Asthenia
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 43 (2.33%)
         occurrences all number
    0
    1
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    3 / 36 (8.33%)
    0 / 43 (0.00%)
         occurrences all number
    4
    0
    Dyspnoea
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    1
    0
    Dyspnoea exertional
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    1
    0
    Rhinorrhoea
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    1
    0
    Epistaxis
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 43 (2.33%)
         occurrences all number
    0
    1
    Psychiatric disorders
    Insomnia
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    2
    0
    Investigations
    Platelet count decreased
         subjects affected / exposed
    6 / 36 (16.67%)
    0 / 43 (0.00%)
         occurrences all number
    11
    0
    Neutrophil count decreased
         subjects affected / exposed
    6 / 36 (16.67%)
    0 / 43 (0.00%)
         occurrences all number
    13
    0
    White blood cell count decreased
         subjects affected / exposed
    6 / 36 (16.67%)
    0 / 43 (0.00%)
         occurrences all number
    11
    0
    Lymphocyte count decreased
         subjects affected / exposed
    4 / 36 (11.11%)
    0 / 43 (0.00%)
         occurrences all number
    13
    0
    Blood potassium decreased
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    1
    0
    Haemoglobin decreased
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    1
    0
    Cardiac disorders
    Bradycardia
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    1
    0
    Palpitations
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    1
    0
    Sinus bradycardia
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 43 (2.33%)
         occurrences all number
    0
    1
    Nervous system disorders
    Headache
         subjects affected / exposed
    3 / 36 (8.33%)
    0 / 43 (0.00%)
         occurrences all number
    3
    0
    Dizziness
         subjects affected / exposed
    2 / 36 (5.56%)
    1 / 43 (2.33%)
         occurrences all number
    2
    1
    Dysgeusia
         subjects affected / exposed
    2 / 36 (5.56%)
    0 / 43 (0.00%)
         occurrences all number
    3
    0
    Disturbance in attention
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    1
    0
    Paraesthesia
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    1
    0
    Peripheral sensory neuropathy
         subjects affected / exposed
    1 / 36 (2.78%)
    1 / 43 (2.33%)
         occurrences all number
    2
    1
    Neuropathy peripheral
         subjects affected / exposed
    0 / 36 (0.00%)
    3 / 43 (6.98%)
         occurrences all number
    0
    3
    Blood and lymphatic system disorders
    Thrombocytopenia
         subjects affected / exposed
    6 / 36 (16.67%)
    0 / 43 (0.00%)
         occurrences all number
    15
    0
    Neutropenia
         subjects affected / exposed
    4 / 36 (11.11%)
    1 / 43 (2.33%)
         occurrences all number
    9
    1
    Anaemia
         subjects affected / exposed
    5 / 36 (13.89%)
    0 / 43 (0.00%)
         occurrences all number
    5
    0
    Leukopenia
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    1
    0
    Eye disorders
    Lacrimation increased
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    1
    0
    Vision blurred
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 43 (2.33%)
         occurrences all number
    0
    1
    Gastrointestinal disorders
    Constipation
         subjects affected / exposed
    5 / 36 (13.89%)
    0 / 43 (0.00%)
         occurrences all number
    5
    0
    Nausea
         subjects affected / exposed
    4 / 36 (11.11%)
    1 / 43 (2.33%)
         occurrences all number
    6
    1
    Diarrhoea
         subjects affected / exposed
    3 / 36 (8.33%)
    3 / 43 (6.98%)
         occurrences all number
    5
    4
    Vomiting
         subjects affected / exposed
    2 / 36 (5.56%)
    0 / 43 (0.00%)
         occurrences all number
    4
    0
    Abdominal pain upper
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    1
    0
    Dry mouth
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    1
    0
    Dysphagia
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    1
    0
    Stomatitis
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    2
    0
    Haemorrhoids
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 43 (2.33%)
         occurrences all number
    0
    1
    Skin and subcutaneous tissue disorders
    Pruritus
         subjects affected / exposed
    2 / 36 (5.56%)
    0 / 43 (0.00%)
         occurrences all number
    2
    0
    Blister
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    1
    0
    Dermal cyst
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    1
    0
    Dermatitis bullous
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    1
    0
    Rash
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    1
    0
    Renal and urinary disorders
    Pollakiuria
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 43 (2.33%)
         occurrences all number
    0
    1
    Musculoskeletal and connective tissue disorders
    Back pain
         subjects affected / exposed
    3 / 36 (8.33%)
    0 / 43 (0.00%)
         occurrences all number
    3
    0
    Pain in extremity
         subjects affected / exposed
    2 / 36 (5.56%)
    2 / 43 (4.65%)
         occurrences all number
    3
    3
    Arthralgia
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    1
    0
    Musculoskeletal stiffness
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    1
    0
    Myalgia
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    2
    0
    Jaw disorder
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 43 (2.33%)
         occurrences all number
    0
    1
    Lumbar spinal stenosis
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 43 (2.33%)
         occurrences all number
    0
    1
    Musculoskeletal pain
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 43 (2.33%)
         occurrences all number
    0
    1
    Infections and infestations
    Herpes zoster
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    1
    0
    Lower respiratory tract infection
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    1
    0
    Upper respiratory tract infection
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    1
    0
    Gastroenteritis
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 43 (2.33%)
         occurrences all number
    0
    1
    Localised infection
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 43 (2.33%)
         occurrences all number
    0
    1
    Urinary tract infection
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 43 (2.33%)
         occurrences all number
    0
    1
    Skin bacterial infection
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 43 (2.33%)
         occurrences all number
    0
    1
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    1
    0
    Hyperglycaemia
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    1
    0
    Pseudohyperkalaemia
         subjects affected / exposed
    1 / 36 (2.78%)
    0 / 43 (0.00%)
         occurrences all number
    1
    0
    Hypercalcaemia
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 43 (2.33%)
         occurrences all number
    0
    1
    Hyperkalaemia
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 43 (2.33%)
         occurrences all number
    0
    1
    Hypokalaemia
         subjects affected / exposed
    0 / 36 (0.00%)
    1 / 43 (2.33%)
         occurrences all number
    0
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    14 Mar 2012
    Summary of significant changes as follows: • Study population – utilisation of official name of response criteria in study; bone marrow cellularity of >15% is only required for those patients randomised to Zevalin. Clarification to Methodology including: • Definition of risk groups • patient population • length of follow-up for safety assessment, • steps in the study, • response criteria to be used in study, • eligibility criteria, • inclusion and exclusion criteria, • description of patient number assignments made which include rationale for inclusion of follicular lymphoma grade 3B • randomisation process prior to study treatment • timeframe for collection of concomitant mediations • timing for screening activities • timing of bone marrow biopsy to confirm complete remission • screening procedures relating to pathology reports and secondary pathology review • Age-adjusted International Prognostic Index • Post-randomisation study procedures for both arms • Evaluation and timing of disease status, including use of MRI and applicability of neck imaging • Follow-up activities • Timing of survival follow-up • Secondary pathology confirmation procedures • Extended screening window for physical exams • Handling of abnormal laboratory values as adverse events • Timing of haematology laboratory testing • Electrolytes measures in serum laboratory testing • Timing of serum chemistry laboratory testing • Changes to study procedures • Method of assessing disease status • Occurrence of secondary malignancies regardless of timing and study arm reported as SAE • Collection of AEs • Timing and reporting of SAEs to Sponsor • Stratification
    30 Sep 2012
    Summary of significant changes as follows: • WHO classification 2008, as opposed to Revised European American Lymphoma used for confirmatory pathology review • Results updated for zevalin-randomised patients with the most current safety data • Zevalin Regimen scheduled to begin within 12 weeks of first day of last cycle of R-chemotherapy in line with Cheson 2007 response criteria Changes to inclusion criteria: - Confirmatory review was based on secondary reviews - H&E routine stain used for diagnostic purposes - Diagnostic CT scans performed 8 weeks after the first dose of the last cycle of R-chemotherapy. - PET-CT scans carried out in line with Cheson 2007 response criteria - Changes to blood counts monitored in line with standard practice • Changes to exclusion criteria including addition of pregnant and breastfeeding women and clarification of selection criteria • Changes to randomisation criteria in line with Cheson 2007 response criteria • Preparation and release of IMP to be carried out in line with local guidelines and current standard practice • Concomitant therapy updated with the current safety information • Clarification of study and screening procedures in line with Cheson 2007 response criteria • Clarification of study procedures in line with Zevalin regimen patients and evaluation of remission status • Clarification of secondary pathology confirmation • Clarification of screening activities • Change in duration of follow-up of study activities until relapse • Clarification of safety risks in relation to reproductive risks

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    Study terminated early for business reasons and the primary efficacy analysis could not be completed due to incomplete enrolment.
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