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    Clinical Trial Results:
    A RANDOMIZED PHASE III STUDY USING A PET-DRIVEN STRATEGY AND COMPARING GA101 OR RITUXIMAB IN COMBINATION WITH A CHEMOTHERAPY DELIVERED EVERY 14 DAYS (ACVBP OR CHOP) IN DLBCL CD20+ LYMPHOMA UNTREATED PATIENTS FROM 18 TO 60 PRESENTING WITH 1 OR MORE ADVERSE PROGNOSTIC FACTORS OF THE AGE-ADJUSTED IPI

    Summary
    EudraCT number
    2011-005851-15
    Trial protocol
    BE  
    Global end of trial date
    31 Dec 2017

    Results information
    Results version number
    v1(current)
    This version publication date
    15 Dec 2022
    First version publication date
    15 Dec 2022
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    GAINED
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01659099
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    LYSARC
    Sponsor organisation address
    CH LYON SUD BATIMENT 2D, PIERRE BENITE, France, 69495
    Public contact
    Project Management, LYSARC, 33 472669333, gained@lysarc.org
    Scientific contact
    Coordinating investigator, Pr Steven Le Gouill, 33 240083271, gained@lysarc.org
    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
    31 Dec 2018
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    31 Dec 2017
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The primary objective is to demonstrate an improvement of the 2-year Event Free Survival (EFS) in DLBCL CD20+ patients aged from 18 to 60 years with 1 to 3 adverse prognostic factors of the aa-IPI treated with GA101 or Rituximab in combination with ACVBP14 or CHOP14 in a PET-driven strategy.
    Protection of trial subjects
    DSMC
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    20 Sep 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
    Belgium: 40
    Country: Number of subjects enrolled
    France: 630
    Worldwide total number of subjects
    670
    EEA total number of subjects
    670
    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)
    670
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    From September 20, 2012, to July 30, 2015, France Belgium

    Pre-assignment
    Screening details
    Patients provided informed consent before any non-routine screening tests or evaluations were conducted. The inclusion and exclusion criteria were assessed during the screening period. Patients must have continued to meet all eligibility criteria on day 1 cycle 1 of induction treatment.

    Period 1
    Period 1 title
    Induction
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Obinutuzumab
    Arm description
    Obinutuzumab + Chemo (CHOP or ACVP)
    Arm type
    Experimental

    Investigational medicinal product name
    CHOP
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Standard use

    Investigational medicinal product name
    ACVBP
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Standard use

    Arm title
    Rituximab
    Arm description
    Rituximab + Chemo (CHOP or ACVP)
    Arm type
    Active comparator

    Investigational medicinal product name
    CHOP
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Standard use

    Investigational medicinal product name
    ACVBP
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Standard use

    Number of subjects in period 1
    Obinutuzumab Rituximab
    Started
    336
    334
    Completed
    312
    312
    Not completed
    24
    22
         Consent withdrawn by subject
    -
    2
         Adverse event, non-fatal
    8
    7
         Death
    2
    1
         concurrent illness
    1
    1
         Progression
    2
    1
         Untreated
    4
    3
         other
    5
    2
         Protocol deviation
    2
    5
    Period 2
    Period 2 title
    Consolidation
    Is this the baseline period?
    No
    Allocation method
    Randomised - controlled
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Obinutuzumab
    Arm description
    Obinutuzumab + MTX/VP/Ifosfamide/Arac/CHOP if PET 2 neg / PET 4 neg MTX+BEAM + ASCT if PET 2 pos / PET 4 neg Salvage therapy if PET 4 pos
    Arm type
    Experimental

    Investigational medicinal product name
    MTX/VP/Ifosfamide/Arac/CHOP/R
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    standard use

    Arm title
    Rituximab
    Arm description
    Rituximab + MTX/VP/Ifosfamide/Arac/CHOP if PET 2 neg / PET 4 neg MTX+BEAM + ASCT if PET 2 pos / PET 4 neg Salvage therapy if PET 4 pos
    Arm type
    Active comparator

    Investigational medicinal product name
    MTX/VP/Ifosfamide/Arac/CHOP
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    standard use

    Number of subjects in period 2
    Obinutuzumab Rituximab
    Started
    312
    312
    Completed
    227
    197
    Not completed
    85
    115
         Consent withdrawn by subject
    -
    1
         missing PET
    20
    23
         Adverse event, non-fatal
    15
    16
         concurrent illness
    1
    -
         PET4+
    37
    56
         Progression
    -
    2
         other
    6
    11
         Protocol deviation
    4
    6
         Lack of efficacy
    2
    -

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Obinutuzumab
    Reporting group description
    Obinutuzumab + Chemo (CHOP or ACVP)

    Reporting group title
    Rituximab
    Reporting group description
    Rituximab + Chemo (CHOP or ACVP)

    Reporting group values
    Obinutuzumab Rituximab Total
    Number of subjects
    336 334 670
    Age categorical
    Units: Subjects
        In utero
    0
        Preterm newborn infants (gestational age < 37 wks)
    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 65-84 years
    0
        85 years and over
    0
    Age continuous
    Units: years
        median (full range (min-max))
    49 (19 to 60) 48 (18 to 61) -
    Gender categorical
    Units: Subjects
        Female
    133 164 297
        Male
    203 170 373
    Subject analysis sets

    Subject analysis set title
    ITT
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    The ITT set included 670 patients, 336 in the GA101 arm and 334 in the Rituximab arm.

    Subject analysis sets values
    ITT
    Number of subjects
    670
    Age categorical
    Units: Subjects
        In utero
        Preterm newborn infants (gestational age < 37 wks)
        Newborns (0-27 days)
        Infants and toddlers (28 days-23 months)
        Children (2-11 years)
        Adolescents (12-17 years)
        Adults (18-64 years)
        From 65-84 years
        85 years and over
    Age continuous
    Units: years
        median (full range (min-max))
    48 (18 to 61)
    Gender categorical
    Units: Subjects
        Female
    297
        Male
    373

    End points

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    End points reporting groups
    Reporting group title
    Obinutuzumab
    Reporting group description
    Obinutuzumab + Chemo (CHOP or ACVP)

    Reporting group title
    Rituximab
    Reporting group description
    Rituximab + Chemo (CHOP or ACVP)
    Reporting group title
    Obinutuzumab
    Reporting group description
    Obinutuzumab + MTX/VP/Ifosfamide/Arac/CHOP if PET 2 neg / PET 4 neg MTX+BEAM + ASCT if PET 2 pos / PET 4 neg Salvage therapy if PET 4 pos

    Reporting group title
    Rituximab
    Reporting group description
    Rituximab + MTX/VP/Ifosfamide/Arac/CHOP if PET 2 neg / PET 4 neg MTX+BEAM + ASCT if PET 2 pos / PET 4 neg Salvage therapy if PET 4 pos

    Subject analysis set title
    ITT
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    The ITT set included 670 patients, 336 in the GA101 arm and 334 in the Rituximab arm.

    Primary: EFS

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    End point title
    EFS
    End point description
    Progression, Death, PET positivity after central review after 2 and/or 4 cycles were considered as an event
    End point type
    Primary
    End point timeframe
    2y -EFS
    End point values
    Obinutuzumab Rituximab
    Number of subjects analysed
    227
    197
    Units: percent of patient with no event
        number (confidence interval 95%)
    59.8 (54.3 to 64.8)
    56.6 (51.1 to 61.8)
    Statistical analysis title
    Comparison Obinutuzumab vs Rituximab
    Comparison groups
    Obinutuzumab v Rituximab
    Number of subjects included in analysis
    424
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.123 [1]
    Method
    Logrank
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.88
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.7
         upper limit
    1.1
    Variability estimate
    Standard deviation
    Notes
    [1] - Stratified

    Secondary: Early metabolic response rate - 2 cycles

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    End point title
    Early metabolic response rate - 2 cycles
    End point description
    Central review
    End point type
    Secondary
    End point timeframe
    2 cycles
    End point values
    Obinutuzumab Rituximab
    Number of subjects analysed
    227
    197
    Units: percent of negative PET-2
        number (not applicable)
    73.5
    68.2
    No statistical analyses for this end point

    Secondary: Overall Response rate Cheson 2007

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    End point title
    Overall Response rate Cheson 2007
    End point description
    End point type
    Secondary
    End point timeframe
    4 cycles and end of treatment
    End point values
    Obinutuzumab Rituximab Obinutuzumab Rituximab
    Number of subjects analysed
    312
    312
    227
    197
    Units: percent of CR+PR
        number (confidence interval 95%)
    90.1 (86.2 to 93.1)
    84.2 (79.7 to 88.1)
    86.2 (81.9 to 89.8)
    85.3 (80.9 to 89.0)
    Statistical analysis title
    Comparison of ORR - 4 cycles
    Comparison groups
    Obinutuzumab v Rituximab
    Number of subjects included in analysis
    624
    Analysis specification
    Pre-specified
    Analysis type
    superiority [2]
    P-value
    = 0.018 [3]
    Method
    Cochran-Mantel-Haenszel
    Confidence interval
    Notes
    [2] - Stratified on AA-IPI and chemotherapy
    [3] - 4 cycles
    Statistical analysis title
    Comparison of ORR - End of treatment
    Comparison groups
    Obinutuzumab v Rituximab
    Number of subjects included in analysis
    424
    Analysis specification
    Pre-specified
    Analysis type
    superiority [4]
    P-value
    = 0.836
    Method
    Cochran-Mantel-Haenszel
    Confidence interval
    Notes
    [4] - Stratified on AA-IPI and chemotherapy

    Secondary: Overall Response rate Cheson 1999

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    End point title
    Overall Response rate Cheson 1999
    End point description
    End point type
    Secondary
    End point timeframe
    4 cycles and end of treatment
    End point values
    Obinutuzumab Rituximab Obinutuzumab Rituximab
    Number of subjects analysed
    312
    312
    227
    197
    Units: Percent of PR+CR
        number (confidence interval 95%)
    73.4 (68.1 to 78.2)
    71.4 (66.0 to 76.3)
    80.6 (75.8 to 84.8)
    77.1 (72.1 to 81.6)
    Statistical analysis title
    Comparison ORR - 4 cycles
    Comparison groups
    Obinutuzumab v Rituximab
    Number of subjects included in analysis
    624
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.551 [5]
    Method
    Cochran-Mantel-Haenszel
    Confidence interval
    Notes
    [5] - Stratified on AA-IPI and chemotherapy
    Statistical analysis title
    Comparison ORR - End of treatment
    Comparison groups
    Obinutuzumab v Rituximab
    Number of subjects included in analysis
    424
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.368 [6]
    Method
    Cochran-Mantel-Haenszel
    Confidence interval
    Notes
    [6] - Stratified on AA-IPI and chemotherapy

    Secondary: Duration of response

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    End point title
    Duration of response
    End point description
    End point type
    Secondary
    End point timeframe
    2 years
    End point values
    Obinutuzumab Rituximab
    Number of subjects analysed
    227
    197
    Units: percent of non event
        number (confidence interval 95%)
    87.4 (83.1 to 90.7)
    86.8 (82.3 to 90.2)
    Statistical analysis title
    Comparison
    Comparison groups
    Rituximab v Obinutuzumab
    Number of subjects included in analysis
    424
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    Method
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.984
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.652
         upper limit
    1.484
    Variability estimate
    Standard deviation

    Secondary: Progression-free survival

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    End point title
    Progression-free survival
    End point description
    End point type
    Secondary
    End point timeframe
    2 years
    End point values
    Obinutuzumab Rituximab
    Number of subjects analysed
    227
    197
    Units: Percent
        number (confidence interval 95%)
    83.2 (78.7 to 86.8)
    83.0 (78.5 to 86.7)
    Statistical analysis title
    Comparison of PFS
    Comparison groups
    Obinutuzumab v Rituximab
    Number of subjects included in analysis
    424
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    Method
    Parameter type
    Hazard ratio (HR)
    Point estimate
    1.028
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.735
         upper limit
    1.436
    Variability estimate
    Standard deviation

    Secondary: Overall survival

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    End point title
    Overall survival
    End point description
    End point type
    Secondary
    End point timeframe
    2 years
    End point values
    Obinutuzumab Rituximab
    Number of subjects analysed
    227
    197
    Units: percent
        number (confidence interval 95%)
    90.7 (87.0 to 93.4)
    91.8 (88.1 to 94.3)
    Statistical analysis title
    Comparison of OS
    Comparison groups
    Rituximab v Obinutuzumab
    Number of subjects included in analysis
    424
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    Method
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.959
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.61
         upper limit
    1.507
    Variability estimate
    Standard deviation

    Secondary: Early metabolic response rate - 4 cycles

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    End point title
    Early metabolic response rate - 4 cycles
    End point description
    Central review
    End point type
    Secondary
    End point timeframe
    4 cycles
    End point values
    Obinutuzumab Rituximab
    Number of subjects analysed
    227
    197
    Units: percent of negative PET-4
        number (not applicable)
    87.5
    80.6
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    28 days after end of treatment
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    15.0
    Reporting groups
    Reporting group title
    Obinutuzumab
    Reporting group description
    -

    Reporting group title
    Rituximab
    Reporting group description
    -

    Serious adverse events
    Obinutuzumab Rituximab
    Total subjects affected by serious adverse events
         subjects affected / exposed
    142 / 336 (42.26%)
    223 / 331 (67.37%)
         number of deaths (all causes)
    34
    36
         number of deaths resulting from adverse events
    8
    1
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    NEOPLASMS BENIGN, MALIGNANT AND UNSPECIFIED (INCL CYSTS AND POLYPS)
         subjects affected / exposed
    3 / 336 (0.89%)
    6 / 331 (1.81%)
         occurrences causally related to treatment / all
    2 / 3
    2 / 6
         deaths causally related to treatment / all
    1 / 1
    1 / 1
    Vascular disorders
    VASCULAR DISORDERS
         subjects affected / exposed
    2 / 336 (0.60%)
    6 / 331 (1.81%)
         occurrences causally related to treatment / all
    0 / 2
    2 / 7
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Surgical and medical procedures
    SURGICAL AND MEDICAL PROCEDURES
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 331 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General disorders and administration site conditions
    GENERAL DISORDERS AND ADMINISTRATION SITE CONDITIONS
         subjects affected / exposed
    24 / 336 (7.14%)
    25 / 331 (7.55%)
         occurrences causally related to treatment / all
    25 / 33
    25 / 31
         deaths causally related to treatment / all
    2 / 2
    0 / 0
    Immune system disorders
    IMMUNE SYSTEM DISORDERS
         subjects affected / exposed
    1 / 336 (0.30%)
    1 / 331 (0.30%)
         occurrences causally related to treatment / all
    1 / 1
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    RESPIRATORY, THORACIC AND MEDIASTINAL DISORDERS
         subjects affected / exposed
    16 / 336 (4.76%)
    15 / 331 (4.53%)
         occurrences causally related to treatment / all
    10 / 16
    13 / 19
         deaths causally related to treatment / all
    2 / 2
    0 / 1
    Psychiatric disorders
    PSYCHIATRIC DISORDERS
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 331 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Investigations
    INVESTIGATIONS
         subjects affected / exposed
    2 / 336 (0.60%)
    3 / 331 (0.91%)
         occurrences causally related to treatment / all
    2 / 2
    3 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    INJURY, POISONING AND PROCEDURAL COMPLICATIONS
         subjects affected / exposed
    22 / 336 (6.55%)
    9 / 331 (2.72%)
         occurrences causally related to treatment / all
    6 / 22
    0 / 9
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    CARDIAC DISORDERS
         subjects affected / exposed
    5 / 336 (1.49%)
    5 / 331 (1.51%)
         occurrences causally related to treatment / all
    1 / 5
    4 / 6
         deaths causally related to treatment / all
    1 / 1
    0 / 0
    Nervous system disorders
    NERVOUS SYSTEM DISORDERS
         subjects affected / exposed
    4 / 336 (1.19%)
    13 / 331 (3.93%)
         occurrences causally related to treatment / all
    1 / 4
    3 / 14
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Blood and lymphatic system disorders
    BLOOD AND LYMPHATIC SYSTEM DISORDERS
         subjects affected / exposed
    16 / 336 (4.76%)
    9 / 331 (2.72%)
         occurrences causally related to treatment / all
    17 / 18
    12 / 12
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    GASTROINTESTINAL DISORDERS
         subjects affected / exposed
    25 / 336 (7.44%)
    22 / 331 (6.65%)
         occurrences causally related to treatment / all
    20 / 30
    26 / 31
         deaths causally related to treatment / all
    1 / 1
    0 / 0
    Hepatobiliary disorders
    HEPATOBILIARY DISORDERS
         subjects affected / exposed
    2 / 336 (0.60%)
    2 / 331 (0.60%)
         occurrences causally related to treatment / all
    2 / 2
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Skin and subcutaneous tissue disorders
    SKIN AND SUBCUTANEOUS TISSUE DISORDERS
         subjects affected / exposed
    5 / 336 (1.49%)
    2 / 331 (0.60%)
         occurrences causally related to treatment / all
    5 / 5
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Renal and urinary disorders
    RENAL AND URINARY DISORDERS
         subjects affected / exposed
    11 / 336 (3.27%)
    8 / 331 (2.42%)
         occurrences causally related to treatment / all
    3 / 12
    3 / 8
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Endocrine disorders
    ENDOCRINE DISORDERS
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 331 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS
         subjects affected / exposed
    3 / 336 (0.89%)
    2 / 331 (0.60%)
         occurrences causally related to treatment / all
    2 / 3
    1 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    INFECTIONS AND INFESTATIONS
         subjects affected / exposed
    61 / 336 (18.15%)
    36 / 331 (10.88%)
         occurrences causally related to treatment / all
    77 / 86
    37 / 46
         deaths causally related to treatment / all
    1 / 2
    0 / 0
    Metabolism and nutrition disorders
    METABOLISM AND NUTRITION DISORDERS
         subjects affected / exposed
    6 / 336 (1.79%)
    7 / 331 (2.11%)
         occurrences causally related to treatment / all
    4 / 6
    4 / 7
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Obinutuzumab Rituximab
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    325 / 336 (96.73%)
    307 / 331 (92.75%)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    NEOPLASMS BENIGN, MALIGNANT AND UNSPECIFIED (INCL CYSTS AND POLYPS)
         subjects affected / exposed
    3 / 336 (0.89%)
    7 / 331 (2.11%)
         occurrences all number
    3
    7
    Vascular disorders
    VASCULAR DISORDERS
         subjects affected / exposed
    10 / 336 (2.98%)
    10 / 331 (3.02%)
         occurrences all number
    11
    11
    Surgical and medical procedures
    SURGICAL AND MEDICAL PROCEDURES
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 331 (0.00%)
         occurrences all number
    1
    0
    General disorders and administration site conditions
    GENERAL DISORDERS AND ADMINISTRATION SITE CONDITIONS
         subjects affected / exposed
    9 / 336 (2.68%)
    10 / 331 (3.02%)
         occurrences all number
    10
    10
    Immune system disorders
    IMMUNE SYSTEM DISORDERS
         subjects affected / exposed
    3 / 336 (0.89%)
    2 / 331 (0.60%)
         occurrences all number
    3
    2
    Reproductive system and breast disorders
    REPRODUCTIVE SYSTEM AND BREAST DISORDERS
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 331 (0.00%)
         occurrences all number
    1
    0
    Respiratory, thoracic and mediastinal disorders
    RESPIRATORY, THORACIC AND MEDIASTINAL DISORDERS
         subjects affected / exposed
    22 / 336 (6.55%)
    27 / 331 (8.16%)
         occurrences all number
    23
    39
    Psychiatric disorders
    PSYCHIATRIC DISORDERS
         subjects affected / exposed
    2 / 336 (0.60%)
    3 / 331 (0.91%)
         occurrences all number
    7
    3
    Investigations
    INVESTIGATIONS
         subjects affected / exposed
    118 / 336 (35.12%)
    124 / 331 (37.46%)
         occurrences all number
    1365
    1176
    Injury, poisoning and procedural complications
    INJURY, POISONING AND PROCEDURAL COMPLICATIONS
         subjects affected / exposed
    67 / 336 (19.94%)
    26 / 331 (7.85%)
         occurrences all number
    69
    29
    Cardiac disorders
    CARDIAC DISORDERS
         subjects affected / exposed
    7 / 336 (2.08%)
    8 / 331 (2.42%)
         occurrences all number
    7
    11
    Nervous system disorders
    NERVOUS SYSTEM DISORDERS
         subjects affected / exposed
    21 / 336 (6.25%)
    34 / 331 (10.27%)
         occurrences all number
    25
    48
    Blood and lymphatic system disorders
    BLOOD AND LYMPHATIC SYSTEM DISORDERS
         subjects affected / exposed
    303 / 336 (90.18%)
    291 / 331 (87.92%)
         occurrences all number
    2746
    2445
    Ear and labyrinth disorders
    EAR AND LABYRINTH DISORDERS
         subjects affected / exposed
    1 / 336 (0.30%)
    2 / 331 (0.60%)
         occurrences all number
    1
    3
    Eye disorders
    EYE DISORDERS
         subjects affected / exposed
    2 / 336 (0.60%)
    1 / 331 (0.30%)
         occurrences all number
    2
    1
    Gastrointestinal disorders
    GASTROINTESTINAL DISORDERS
         subjects affected / exposed
    54 / 336 (16.07%)
    48 / 331 (14.50%)
         occurrences all number
    100
    90
    Hepatobiliary disorders
    HEPATOBILIARY DISORDERS
         subjects affected / exposed
    6 / 336 (1.79%)
    5 / 331 (1.51%)
         occurrences all number
    7
    5
    Skin and subcutaneous tissue disorders
    SKIN AND SUBCUTANEOUS TISSUE DISORDERS
         subjects affected / exposed
    13 / 336 (3.87%)
    8 / 331 (2.42%)
         occurrences all number
    13
    11
    Renal and urinary disorders
    RENAL AND URINARY DISORDERS
         subjects affected / exposed
    13 / 336 (3.87%)
    9 / 331 (2.72%)
         occurrences all number
    15
    9
    Endocrine disorders
    ENDOCRINE DISORDERS
         subjects affected / exposed
    1 / 336 (0.30%)
    0 / 331 (0.00%)
         occurrences all number
    1
    0
    Musculoskeletal and connective tissue disorders
    MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS
         subjects affected / exposed
    8 / 336 (2.38%)
    7 / 331 (2.11%)
         occurrences all number
    17
    11
    Infections and infestations
    INFECTIONS AND INFESTATIONS
         subjects affected / exposed
    122 / 336 (36.31%)
    118 / 331 (35.65%)
         occurrences all number
    196
    194
    Metabolism and nutrition disorders
    METABOLISM AND NUTRITION DISORDERS
         subjects affected / exposed
    30 / 336 (8.93%)
    30 / 331 (9.06%)
         occurrences all number
    96
    78

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    11 Jun 2012
    Request for modifications from the ANSM of the initial protocol before the start of the study (the main modification was to precise the principal objective paragraph).
    10 Aug 2012
    • "GELARC" replaced by "LYSARC”; “GELA" replaced by "LYSA" reflecting change to names of these organizations; • Suppression of certain evaluations and extension of the deadline for carrying out certain evaluations: vital signs before day 1 of each cycle and each evaluation, and complete blood cells count at Day 7 and 10 of each cycle • Addition of a new rule for SAE reporting: SAE linked to scheduled hospitalizations before patient randomization into the study should not be reported • Addition of a jugal epithelial cells sample for genomic study
    30 Oct 2012
    • This amendment follows the letter from the ANSM dated October 17, 2012, concerning a case of progressive multifocal leukoencephalopathy (PML) reported in a patient who was treated with GA101 (GA101). • Patients with a history of PML will not be included in the study. The exclusion criterion "Prior history of Progressive Multifocal Leukoencephalopathy (PML)" is added. • A neurological examination must be carried out during each clinical examination, during the treatment phase as well as during the follow-up phase, in order to detect any neurological signs suggestive of potential PML. • Information on what to do in case of suspected PML: symptoms, diagnosis, what to do with the administration of anti CD20. In the event of symptoms suggestive of PML, investigations must be carried out: consultation with a neurologist, brain MRI, search for the JC virus in the cerebrospinal fluid, etc. Treatment with Rituximab or GA101 should be suspended during investigations, and definitively stopped if the diagnosis of PML is confirmed.
    12 Dec 2012
    Change of tubes used for biological studies. Analysis of samples collected for the first patients included revealed that the stability of blood cells in EDTA tubes was not compatible with the achievement of standardized NFP. It was decided to keep the number of tubes taken per patient, i.e. 4 tubes, but to distribute these tubes as follows: - 2 EDTA tubes for genetic study - 2 heparin tubes for standardized NFP.
    17 Jun 2013
    Following the shortage of vindesine, possibility of replacing vindesine by vincristine for patients treated with ACVBP chemotherapy. In this study, the centers use CHOP or ACVBP as chemotherapy, according to their habits. This choice is valid for all patients in the same center and cannot be modified, the randomization being stratified on the choice of chemotherapy. Vindesine, a component of ACVBP, was out of stock worldwide (laboratory release dated June 7, 2013). This substitution should only take place in the event of a complete shortage of the stock of vindesine (dosage: D1 and D5 vincristine 0.7 mg / m2 without exceeding 1 mg total dose by injection, which makes a total dose of 1.4mg / m2 per cycle of ACVBP without exceeding 2 mg total dose).
    28 Jul 2014
    • Recommendations have been put in place to alert investigators on the increased toxicity of GA101 and the potential risks of severe infection: contraception until 18 months after last dose of GA101 instead of 12 months, changes in management of hematological toxicities, GA101 dose adjustments. • Addition and modification of blood and bone marrow samples for further biological analyzes.
    10 Feb 2015
    Following the announcement by the ANSM, on November 24, 2014, of the global shortage of BCNU (Carmustine), a drug forming part of the BEAM multidrug therapy (Carmustine, Etoposide, Cytarabine, Melphalan), proposal for 2 alternative conditioning regimes: - Benda-EAM polychemotherapy (Bendamustine, Etoposide, Cytarabine, Melphalan) - BAM polychemotherapy (Busulfan, Cytarabine, Melphalan
    24 Nov 2015
    Modification of the schedule of intermediate and final analyzes. Intermediate analysis n°3 after treatment phase of all patients and final analysis performed after the onset of 345 events

    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.
    None reported

    Online references

    http://www.ncbi.nlm.nih.gov/pubmed/33211799
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